Archives for August 2013

Vascular Risk Factors and Neurodegeneration in Dementias

Curr Alzheimer Res. 2013 Jul;10(6):642-53.

Vascular risk factors and neurodegeneration in ageing related dementias: Alzheimer’s disease and vascular dementia.

Akinyemi ROMukaetova-Ladinska EBAttems JIhara MKalaria RN.

Institute for Ageing and Health, NIHR Biomedical Research Building (Neuropathology), Campus for Ageing & Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom.


Age is the strongest risk factor for brain degeneration whether it results from vascular or neurodegenerative mechanisms or both. To evaluate the current views on the impact of vascular disease on the most common causes of dementia, most relevant articles to the selected subject headings were reviewed until November 2011 from the popularly used databases including Pubmed, Cochrane Database and Biological Abstracts.

Within the past decade, there has been four-fold increased interest in the vascular basis of neurodegeneration and dementia. Vascular ageing involving arterial stiffness, endothelial changes and blood-brain barrier dysfunction affects neuronal survival by impairing several intracellular protective mechanisms leading to chronic hypoperfusion.

Modifiable risk factors such as hypertension, diabetes, dyslipidaemia and adiposity linked to Alzheimer’s disease and vascular dementia promote the degeneration and reduce the regenerative capacity of the vascular system.

These in tandem with accumulation of abnormal proteins such as amyloid β likely disrupt cerebral autoregulation, neurovascular coupling and perfusion of the deeper structures to variable degrees to produce white matter changes and selective brain atrophy. Brain pathological changes may be further modified by genetic factors such as the apoliopoprotein E ε4 allele.

Lifestyle measures that maintain or improve vascular health including consumption of healthy diets, moderate use of alcohol and implementing regular physical exercise in general appear effective for reducing dementia risk.

Interventions that improve vascular function are important to sustain cognitive status even during ageing whereas preventative measures that reduce risk of vascular disease are predicted to lessen the burden of dementia in the long-term.


PMID: 23627757 PubMed – in process

National Center for Biotechnology Information, U.S. National Library of Medicine


A Change in Sleep Pattern May Predict Alzheimer Disease

Am J Geriatr Psychiatry. 2013 Aug 13. pii: S1064-7481(13)00233-9. doi: 10.1016/j.jagp.2013.04.015. [Epub ahead of print]

A Change in Sleep Pattern May Predict Alzheimer Disease.

Hahn EAWang HXAndel RFratiglioni L.

Department of Psychology, Brandeis University, Waltham, MA.



Sleep problems may adversely affect neuronal health. We examined a subjective report of change (reduced duration and/or depth) in sleep pattern in relation to subsequent risk of incident all-cause dementia and Alzheimer disease (AD) over 9 years.


This longitudinal study used data from a population-based sample of 214 Swedish adults aged 75 and over who were dementia-free both at baseline and at first follow-up (3 years later). The sample was 80% female and, on average, 83.4 years of age at baseline. All participants underwent a thorough clinical examination to ascertain all-cause dementia and AD.


Forty percent of participants reported a change in sleep duration at baseline. Between the 6th and 9th year after baseline, 28.5% were diagnosed with all-cause dementia, 22.0% of whom had AD. Reduced sleep was associated with a 75% increased all-cause dementia risk (hazard ratio: 1.75; 95% confidence interval: 1.04-2.93; Wald = 4.55, df = 1, p = 0.035) and double the risk of AD (hazard ratio: 2.01; 95% confidence interval: 1.12-3.61; Wald = 5.47, df = 1, p = 0.019) after adjusting for age, gender, and education. The results remained after adjusting for lifestyle and vascular factors but not after adjusting for depressive symptoms. No evidence supported a moderating effect of the use of sleeping pills, and the sleep-dementia relationship remained after controlling for the presence of the apolipoprotein E ε4 allele.


Self-reported sleep problems may increase the risk for dementia, and depressive symptoms may explain this relationship. Future research should determine whether treatment, in particular, behavioral or nonpharmacologic treatment, may represent one avenue toward reduction of dementia risk in late life.


Copyright © 2013 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.


Confusion, Memory Loss, and Altered Alertness

(WebMD) It is not unusual to occasionally forget where you put your keys or glasses, where you parked your car, or the name of an acquaintance. As you age, it may take you longer to remember things. Not all older adults have memory changes, but they can be a normal part of aging. This type of memory problem is more often annoying than serious.

Memory loss that begins suddenly or that significantly interferes with your ability to function in daily life may mean a more serious problem is present.

  • Dementia is a slow decline in memory, problem-solving ability, learning ability, and judgment that may occur over several weeks to several months. Many health conditions can cause dementia or symptoms similar to dementia. In some cases dementia may be reversible. Alzheimer’s disease is the most common cause of dementia in people older than age 65.
  • Delirium is a sudden change in how well a person’s brain is working (mental status). Delirium can cause confusion, change the sleep-wake cycles, and cause unusual behavior. Delirium can have many causes, such as withdrawal from alcohol or drugs or medicines, or the development or worsening of an infection or other health problem.
  • Amnesia is memory loss that may be caused by a head injury, a stroke, substance abuse, or a severe emotional event, such as from combat or a motor vehicle accident. Depending upon the cause, amnesia may be either temporary or permanent.

Confusion or decreased alertness may be the first symptom of a serious illness, particularly in older adults. Health problems that cause confusion or decreased alertness can include:

Alcohol and many prescription and nonprescription medicines can cause confusion or decreased alertness. These problems may develop from:

  • Taking too much of a medicine (overmedicating). Overuse of medicines may be the single biggest cause of memory loss or confusion in older adults.
  • Alcohol and medicine interactions. This is a problem, especially for older adults, who may take many medicines at the same time.
  • Misusing or abusing a medicine or alcohol.
  • Drug intoxication or the effects of withdrawal.

Other causes of confusion or decreased alertness can include:

Conditions in the environment that can cause changes in the level of consciousness include:

  • Cold temperature exposure, leading to hypothermia.
  • High temperature exposure, leading to heatstroke.
  • Hospitalization. This especially affects older adults when their environment and routines are changed.
  • Decreased oxygen in the blood (hypoxia) from high altitude.
  • Exposure to toxins (poisons), such as carbon monoxide.

Many times other symptoms are present, such as a fever, chest pain, or the inability to walk or stand. It is important to look for and tell your doctor about other symptoms you experience when confusion or decreased alertness occurs. This can help your doctor determine the cause of your symptoms.

A decrease in alertness may progress to loss of consciousness. A person who loses consciousness is not awake and is not aware of his or her surroundings. Fainting (syncope) is a form of brief unconsciousness. Coma is a deep, prolonged state of unconsciousness.


© 1995-2015 Healthwise


When One Loses Empathy: Its Effect on Carers of Patients with Dementia

J Geriatr Psychiatry Neurol September 2013 vol. 26 no. 3 174-184

Published online before print July 14, 2013, doi: 10.1177/0891988713495448

When One Loses Empathy: Its Effect on Carers of Patients With Dementia

Sharpley Hsieh, Muireann Irish, Naomi Daveson, John R. Hodges, Olivier Piguet


The effects of empathy loss in frontotemporal dementia (FTD) and Alzheimer disease (AD) on carer symptomatology were investigated.

Carers of patients with 2 clinical subtypes of FTD (behavioral-variant FTD [bvFTD] = 18; semantic dementia [SD] = 14) and AD (n = 18) completed the Interpersonal Reactivity Index (IRI), a standardized questionnaire of empathy as well as a measure of perceived burden (Zarit Burden Interview) and the quality of the marital relationship (Intimate Bond Measure).

Patient ratings were also obtained on the IRI. Loss of empathy was most striking in the bvFTD group with a marked discrepancy observed between carer and patient ratings for change in emotional warmth and the ability to take the perspective of others.

Empathy loss in bvFTD was associated with a loss of a caring marital relationship. Empathic deficits in SD were milder by comparison to bvFTD and correlated with disease severity and increased perceived carer burden.

The behavioral pattern observed in AD differed from the FTD syndromes; deficits were observed only for measures of personal distress with carers reporting that patients were less able to handle emotionally evocative situations. Results highlight that changes in aspects of empathy differ across dementia syndromes and are associated with differing carer and clinical variables.

These findings might be explained by the progression of atrophy in regions that are known to be critical for empathy and social behavior and has implications for the delivery and planning of services in dementia.


Copyright © 2013 by SAGE Publications


Life Expectancy in Alzheimer’s Disease

Arch Gerontol Geriatr. 2009;49 Suppl 1:237-43. doi: 10.1016/j.archger.2009.09.035.

UO Alzheimer-Memory Clinic, IRCCS Centra S. Giovanni di Dio Fatebenefratelli, Brescia, Italy.

Life expectancy in Alzheimer’s disease (AD).

Zanetti OSolerte SBCantoni F.


Survival following a diagnosis of AD is important information for health planners, caregivers, patients, and their families. AD is associated with variable, but shortened life expectancy. Knowing the expected survival time may empower people with AD and their families, but clinicians currently have limited predictive information. A better knowledge about prognosis in patients affected by AD and related disorders should be of paramount importance in order to improve care plans and assist in medical decisions, above all for patients in the moderate-severe stages of the disease.

Life expectancy for patients with AD can vary between 3 to 10 years. Many studies have tried to identify predictive factors that can be of help for clinicians. The main predictor of life expectancy is the age. Therefore caregivers, patients, and their families could plan on a median life span as long as 7 to 10 years for patients whose conditions are diagnosed when they are in their 60s and early 70s, to only about 3 years or less for patients whose conditions are diagnosed when they are in their 90s.

Dementias with prominent psychiatric-behavioral manifestations and gait impairment have a faster progression compared to AD. However the many variables that influence life expectancy make difficult to define prognosis at the bedside and more studies are needed to assist clinicians in they daily routine with patients and caregivers.


PMID: 19836639 PubMed – indexed for MEDLINE

National Center for Biotechnology Information, U.S. National Library of Medicine


Alzheimer’s Disease: Tips for Maintaining a Normal Life

(WebMD) Living with Alzheimer’s disease is a challenge for anyone. It’s difficult to remember things, make decisions, and find your way around the way you used to. It can be frustrating a good deal of the time, but there are good days and bad days. Here are some helpful tips and things you can do to make things easier for yourself — to make things feel a bit more normal again.

How Do I Cope With My Memory Problems?

To help cope with memory problems:

  • Always keep a book with you to record important information, phone numbers, names, ideas you have, appointments, your address, and directions to your home.
  • Place sticky notes around the house when you need to remember things.
  • Label cupboards and drawers with words or pictures that describe their contents.
  • Place important phone numbers in large print next to the phone.
  • Ask a friend or family member to call and remind you of important things that you need to do in the day, like meal times, medication times, and appointments.
  • Use a calendar to keep track of time and to remember important dates.
  • Use photos of people you see often labeled with their names.
  • Keep track of phone messages by using an answering machine.

 What’s the Best Way to Plan the Day?

In planning your day:

  • Find things to do that you enjoy and are able to do safely on your own.
  • It will be easier to accomplish tasks during the times of the day when you feel best.
  • Allow yourself the time to do the things you need to do, and don’t feel rushed or let other people rush you.
  • If something gets too difficult, take a break.
  • Ask for help if you need it.

How Do I Avoid Getting Lost?

To keep from getting lost:

  • Ask someone to go with you when you go out.
  • Ask for help if you need it and explain that you have a memory problem.
  • Always take directions for where you’re going with you.

What Will Make Communicating Easier?

Communicating with others will be easier if you:

  • Always take your time, and don’t feel rushed.
  • If you need to, ask the person you’re speaking with to repeat what he/she is saying or to speak slowly if you do not understand.
  • Avoid distracting noises, and find a quiet place to talk.

What About Driving?

Driving can be of particular concern for Alzheimer’s patients. Here are some things to consider:

  • Have someone else drive you where you need to go.
  • If you tend to get lost or confused easily, consider alternative modes of transportation.
  • Drive only in areas that are familiar to you.
  • Contact organizations like the Alzheimer’s Association to learn what local transportation services are available.
  • The Department of Motor Vehicles will assess your driving skills if you’re not sure whether you should drive.
  • At some point, it may no longer be safe for you to drive.

How Do I Take Care of Myself at Home?

To make sure you are well taken care of at home, put some of these measures into place early so they become routine:

  • Local Alzheimer organizations or your doctor will be able to tell you how to get help with things like shopping, housekeeping, meals (including home-delivered meals), and transportation.
  • Ask a neighbor you trust to keep a set of house keys.
  • Ask a friend or family member to help you to organize your closets and drawers to make it easier for you to find things.
  • Ask a family member to check things out around the house, such as electrical appliances, mail, and perishable food items.
  • Keep a list of important and emergency numbers by the phone.
  • Have family, friends, or a community service program call or visit daily to ensure that everything is all right.
  • Ask someone to check your smoke alarm regularly.

How Do I Maintain My Responsibilities?

  • Arrange for direct deposit of checks, such as your retirement pension or Social Security benefits.
  • Inform your bank if you have difficulty keeping track of your accounts and record keeping. They may provide special services for people who have Alzheimer’s.

It is important to realize that at some point, it will become too difficult or dangerous for you to live by yourself. But, in the earliest stages of the disease, many people do manage on their own — with support and help from friends, family, and community programs and with simple adjustments and safety practices in place.


© 2011 WebMD, LLC. All rights reserved.


Give Your Memory a Hand: Everyday Tips to Improve Your Memory

(Copper Ridge Institute) We all accept that the average person in his 60’s or 70’s can’t run as fast or jump as high as he could at age 20 or 30. For some reason, however, we find it harder to accept that our ability to store and recall information is not as sharp in older adulthood as in our youth. However, most of us experience some decline in memory efficiency as we age, especially after age 70 or so. But all is not lost!

There are a number of simple things you can do every day to compensate for mild memory loss. Not all of these strategies will be useful to every person, and you may be doing many of them already, but give some of the others a try!

You have nothing to lose and everything to gain!

Here are Some Tips for a Better Memory

  1. Write all appointments on a large calendar in a prominent place in your home (the kitchen is usually the preferred place) and/or in a pocket-size date book. Get in the habit of checking your calendar several times a day.
  2. Carry a memo pad and pen at all times to write down things you’ll need to recall later. Don’t be embarassed to do this!
  3. Keep a pad of paper and pen next to every telephone in your house.  Also keep them on your nightstand to write down things you want to remember that come to mind before you fall asleep at night.
  4. To remember the name of someone to whom you’ve just been introduced, try to form an association of some  type between the name and the face. Does she remind you of some- one you know, or somebody famous, with the same or a similar name? Can you make any sort of connection between the name and the face? Remember, these are your own, personal memory strategies; so go ahead and form silly or bizarre associations if you want! In fact, some research has shown that weird mental images are remembered better than ordinary ones!
  5. Change part of your personal make-up so that it acts as a prompt to do something you intend to do. For example, you might move your wrist watch from your left wrist to your right to cue you to make an important phone call. (I will often transfer my car keys from my left pants pocket to my right to remember to stop at the gas station and fill the tank on the way home.)
  6. Leave important items in a prominent place where they can’t be overlooked. For example, you might want to place outgoing mail in a basket near the front door of your home so that you’ll remember to take it to the mailbox when you leave.
  7. If you use a home computer, use scheduling or calendar programs to remind you about both recurring and one-time events. Some have alarms to alert you to important dates and times.
  8. Use a programmable electronic alarm-watch to “beep” you when it’s time to do something.
  9. Post-It Notes® are the forgetful person’s best friend! I have reminders to myself on these little, yellow, sticky-notes all over my office.
  10. Do you ever forget whether you’ve taken a dose of your medicationGet a pillbox marked with the days of the week and times of the day (morning/noon/night) or meals (breakfast/lunch/dinner). Fill a week’s worth of medication at a time. Then, just check the appropriate compartment to see if there are any pills remaining!
  11. Here’s another tip for remembering whether youve taken your medication: After you take your morning dose, turn the pill bottle on its cap. After you take your evening dose, turn it right-side up. So, if it’s lunchtime and you’re wondering whether you took your morning medicine, all you have to do is check whether the bottle is upside-down (you took it) or right-side up (you didn’t).
  12. Most newer telephones allow you to program 10 or 20 (or more) frequently-used numbers. You might want to use these memory slots for those phone numbers you use less often and have trouble remembering, not for your most frequently-used numbers (which you probably have well memorized).
  13. Keep your brain healthy!  Eat a balanced diet. Consider taking a Vitamin E supplement. Drink alcohol only in moderation. Watch your blood pressure. Take your medications only as prescribed. With a little regular maintenance, your “memory machine” can last a long time!
  14. Finally, ask your friends and relatives to remind you about things! One of two things will happen: Either they’ll be helpful in prompting you to remember, or you’ll find that everyone forgets from time to time!


Jason Brandt, Ph.D., The Copper Ridge Institute

© 2011 The Copper Ridge Institute.


How Cocoa Can Help the Brain’s of Older People

Neurology 10.1212/WNL.0b013e3182a351aa

Published online before print August 7, 2013, doi: 10.1212/WNL.0b013e3182a351aa

Neurovascular coupling, cerebral white matter integrity, and response to cocoa in older people

Farzaneh A. Sorond, MD, PhD, Shelley Hurwitz, PhD, David H. Salat, PhD, Douglas N. Greve, PhD and Naomi D.L. Fisher, MD



To investigate the relationship between neurovascular coupling and cognitive function in elderly individuals with vascular risk factors and to determine whether neurovascular coupling could be modified by cocoa consumption.


Sixty older people (aged 72.9 ± 5.4 years) were studied in a parallel-arm, double-blind clinical trial of neurovascular coupling and cognition in response to 24 hours and 30 days of cocoa consumption. Cognitive measures included Mini-Mental State Examination and Trail Making Test A and B. Neurovascular coupling was measured from the beat-to-beat blood flow velocity responses in the middle cerebral arteries to the N-Back Task. In a subset of MRI-eligible participants, cerebral white matter structural integrity was also measured.


Neurovascular coupling was associated with Trails B scores (p = 0.002) and performance on the 2-Back Task. Higher neurovascular coupling was also associated with significantly higher fractional anisotropy in cerebral white matter hyperintensities (p = 0.02). Finally, 30 days of cocoa consumption was associated with increased neurovascular coupling (5.6% ± 7.2% vs −2.4% ± 4.8%; p = 0.001) and improved Trails B times (116 ± 78 seconds vs 167 ± 110 seconds; p = 0.007) in those with impaired neurovascular coupling at baseline.


There is a strong correlation between neurovascular coupling and cognitive function, and both can be improved by regular cocoa consumption in individuals with baseline impairments. Better neurovascular coupling is also associated with greater white matter structural integrity.