Archives for February 2017

New Approach to Treating Alzheimer’s Disease

(Ulsan National Institute of Science and Technology) Alzheimer’s disease (AD) is one of the most common form of dementia. In search for new drugs for AD, the research team, led by Professor Mi Hee Lim of Natural Science at UNIST has developed a metal-based substance that works like a pair of genetic scissors to cut out amyloid-β (Aβ), the hallmark protein of AD.

The study has been featured on the cover of the January 2017 issue of the Journal of the American Chemical Society (JACS) and has been also selected as a JACS Spotlight article.

Alzheimer’s disease is the sixth leading cause of death among in older adults. The exact causes of Alzheimer’s disease are still unknown, but several factors are presumed to be causative agents. Among these, the aggregation of amyloid-β peptide (Aβ) has been implicated as a contributor to the formation of neuritic plaques, which are pathological hallmarks of Alzheimer’s disease (AD).

As therapeutics for AD, Professor Lim suggested a strategy that uses matal-based complexes for reducing the toxicity of the amyloid beta (Aβ). Althought various metal complexs have been suggested as therapeutics for AD, none of them work effectively in vivo.

The research team has found that they can hydrolyze amyloid-beta proteins using a crystal structure, called tetra-N methylated cyclam (TMC). Hydrolysis is the process that uses water molecules to split other molecules apart. The metal-mediated TMC structure uses the external water and cut off the binding of amyloid-beta protein effectively.

In this study, the following four metals (cobalt, nickel, copper and zinc) were placed at the center of the TMC structure. When the double-layered cobalt was added to the center, the hydrolysis activity was at the highest.

The research team reported that the cobalt-based metal complex (Co(II)(TMC)) had the potential to penetrate the blood brain barrier and the hydrolysis activity for nonamyloid protein was low. Moreover, the effects of this substance on the toxicity of amyloid-beta protein were also observed in living cell experiments.

“This material has a high therapeutic potential in the treatment of Alzheimer’s disease as it can penetrate the brain-vascular barrier and directly interact with the amyloid-beta protein in the brain,” says Professor Lim.

This study has also attracted attention by the editor of the Journal of the American Chemical Society. “Not only do they develop new materials, but they have been able to propose details of the working principles and experiments that support them,” according to the editor.

“As a scientist, this is such a great honor to know that our recent publication in JACS was highlighted in JACS Spotlights,” says Professor Lim. “This means that our research has not only been recognized as an important research, but also has caused a stir in academia.”

This study has been conducted in collaboration with Professor Jaeheung Cho of Daegu Gyeongbuk Institute of Science and Technology (DGIST), Professor Kiyoung Park of Korea Advanced Institute of Science and Technology (KAIST), and Dr. Sun Hee Kim of Korea Basic Science Institute (KBSI). It has been also supporte by the National Research Foundation of Korea (NRF) and the Ministry of Science, ICT and Future Planning (MSIP).

Citation

http://news.unist.ac.kr/ new-approach-to-treating-alzheimers-disease/

By Joo Hyeon Heo

Journal Reference:

Jeffrey S. Derrick, Jiwan Lee, Shin Jung C. Lee, Yujeong Kim, Eunju Nam, Hyeonwoo Tak, Juhye Kang, Misun Lee, Sun Hee Kim, Kiyoung Park, Jaeheung Cho, Mi Hee Lim. Mechanistic Insights into Tunable Metal-Mediated Hydrolysis of Amyloid-β Peptides. Journal of the American Chemical Society, 2017; 139 (6): 2234 DOI: 10.1021/jacs.6b09681

Copyright Ulsan National Institute of Science and Technology

 

Alzheimer’s Disease and Alternative Treatments

(Alzheimer’s Association) A growing number of herbal remedies, dietary supplements and “medical foods” are promoted as memory enhancers or treatments to delay or prevent Alzheimer’s disease and related dementias. Claims about the safety and effectiveness of these products, however, are based largely on testimonials, tradition and a rather small body of scientific research. The rigorous scientific research required by the U.S. Food and Drug Administration (FDA) for the approval of a prescription drug is not required by law for the marketing of dietary supplements or “medical foods.”

Concerns About Alternative Therapies

Although some of these remedies may be valid candidates for treatments, there are legitimate concerns about using these drugs as an alternative or in addition to physician-prescribed therapy:

  • Effectiveness and safety are unknown. The rigorous scientific research required by the U.S. Food and Drug Administration (FDA) for the approval of a prescription drug is not required by law for the marketing of dietary supplements. The maker of a dietary supplement is not required to provide the FDA with the evidence on which it bases its claims for safety and effectiveness.
  • Purity is unknown. The FDA has no authority over supplement production. It is a manufacturer’s responsibility to develop and enforce its own guidelines for ensuring that its products are safe and contain the ingredients listed on the label in the specified amounts.
  • Dietary supplements can have serious interactions with prescribed medications. No one should take a supplement without first consulting a physician

Caprylic Acid (clinically tested as Ketasyn [AC-1202], marketed as a “medical food” called Axona®) and Coconut Oil

Caprylic acid is the active ingredient of Axona, which is marketed as a “medical food.” Caprylic acid is a medium-chain triglyceride (fat) produced by processing coconut oil or palm kernel oil. The body breaks down caprylic acid into substances called “ketone bodies.” The theory behind Axona is that the ketone bodies derived from caprylic acid may provide an alternative energy source for brain cells that have lost their ability to use glucose (sugar) as a result of Alzheimer’s. Glucose is the brain’s chief energy source. Imaging studies show reduced glucose use in brain regions affected by Alzheimer’s.

Axona’s development was preceded by development of the chemically similar Ketasyn (AC-1202). Ketasyn was tested in a Phase II clinical study enrolling 152 volunteers with mild to moderate Alzheimer’s. Most participants were also taking FDA-approved Alzheimer’s drugs. The manufacturer of Axona reports that study participants who took Ketasyn performed better on tests of memory and overall function than those who received a placebo (a look-alike, inactive treatment).

The chief goal of Phase II clinical studies is to provide information about the safety and best dose of an experimental treatment. Phase II trials are generally too small to confirm that a treatment works. To demonstrate effectiveness under the prescription drug approval framework, the FDA requires drug developers to follow Phase II studies with larger Phase III trials enrolling several hundred to thousands of volunteers.

The manufacturer of Ketasyn decided not to conduct Phase III studies to confirm its effectiveness. The company chose instead to use Ketasyn as the basis of Axona and promote Axona as a “medical food.” Medical foods do not require Phase III studies or any other clinical testing. The Alzheimer’s Association Medical and Scientific Advisory Council has expressed concern that there is not enough evidence to assess the potential benefit of medical foods for Alzheimer’s disease. For more information, please see the Medical and Scientific Advisory Council statement about medical foods.

Some people with Alzheimer’s and their caregivers have turned to coconut oil as a less expensive, over-the-counter source of caprylic acid. A few people have reported that coconut oil helped the person with Alzheimer’s, but there’s never been any clinical testing of coconut oil for Alzheimer’s, and there’s no scientific evidence that it helps.

Coenzyme Q10

Coenzyme Q10, or ubiquinone, is an antioxidant that occurs naturally in the body and is needed for normal cell reactions. This compound has not been studied for its effectiveness in treating Alzheimer’s.

A synthetic version of this compound, called idebenone, was tested for Alzheimer’s disease but did not show any benefit. Little is known about what dosage of coenzyme Q10 is considered safe, and there could be harmful effects if too much is taken.

Coral Calcium

“Coral” calcium supplements have been heavily marketed as a cure for Alzheimer’s disease, cancer and other serious illnesses. Coral calcium is a form of calcium carbonate claimed to be derived from the shells of formerly living organisms that once made up coral reefs.

Coral calcium differs from ordinary calcium supplements only in that it contains traces of some additional minerals incorporated into the shells by the metabolic processes of the animals that formed them. It offers no extraordinary health benefits. Most experts recommend that individuals who need to take a calcium supplement for bone health take a purified preparation marketed by a reputable manufacturer.

The Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) have filed formal complaints against the promoters and distributors of coral calcium. The agencies state that they are aware of no competent and reliable scientific evidence supporting the exaggerated health claims and that such unsupported claims are unlawful.

Ginkgo Biloba

Ginkgo biloba is a plant extract containing several compounds that may have positive effects on cells within the brain and the body. Ginkgo biloba is thought to have both antioxidant and anti-inflammatory properties, to protect cell membranes and to regulate neurotransmitter function. Ginkgo has been used for centuries in traditional Chinese medicine and currently is being used in Europe to alleviate cognitive symptoms associated with a number of neurological conditions.

However, results of a large, multicenter Phase 3 clinical trial conducted by several branches of the National Institutes of Health showed that ginkgo was no better than a placebo in preventing or delaying Alzheimer’s disease.

The Ginkgo Evaluation and Memory (GEM) Study enrolled 3,000 individuals age 75 or older who had no signs of dementia or had mild cognitive impairment (MCI). Participants were randomly assigned to receive twice daily doses of either a placebo or 120 milligrams of ginkgo biloba extract. They were followed up every six months for six years.

Researchers found no statistical difference in rates of dementia or Alzheimer’s disease between the ginkgo and placebo groups. For more information about the GEM study results, click here

Huperzine A

Huperzine A (pronounced HOOP-ur-zeen) is a moss extract that has been used in traditional Chinese medicine for centuries. It has properties similar to those of cholinesterase inhibitors, one class of FDA-approved Alzheimer’s medications. As a result, it is promoted as a treatment for Alzheimer’s disease.

The Alzheimer’s Disease Cooperative Study (ADCS) conducted the first large-scale U.S. clinical trial of huperzine A as a treatment for mild to moderate Alzheimer’s disease. Participants taking huperzine A experienced no greater benefit than those taking a placebo.

Because currently available formulations of huperzine A are dietary supplements, they are unregulated and manufactured with no uniform standards. Taking these unregulated preparations could increase the risks of serious side effects, especially if used in combination with FDA-approved Alzheimer’s drugs.

Omega-3 Fatty Acids

Omega-3s are a type of polyunsaturated fatty acid (PUFA). Research has linked certain types of omega-3s to a reduced risk of heart disease and stroke.

The U.S. Food and Drug Administration (FDA) permits supplements and foods to display labels with “a qualified health claim” for two omega-3s called docosahexaneoic acid (DHA) and eicosapentaenoic acid (EPA). The labels may state, “Supportive but not conclusive research shows that consumption of EPA and DHA omega-3 fatty acids may reduce the risk of coronary heart disease,” and then list the amount of DHA or EPA in the product. The FDA recommends taking no more than a combined total of 3 grams of DHA or EPA a day, with no more than 2 grams from supplements.

Research has also linked high intake of omega-3s to a possible reduction in risk of dementia or cognitive decline. The chief omega-3 in the brain is DHA, which is found in the fatty membranes that surround nerve cells, especially at the microscopic junctions where cells connect to one another.

Theories about why omega-3s might influence dementia risk include their benefit for the heart and blood vessels; anti-inflammatory effects; and support and protection of nerve cell membranes.

Two studies reported at the 2009 Alzheimer’s Association International Conference on Alzheimer’s Disease (AAICAD) found mixed results for the possible benefits of DHA:

  • The first study was a large federally funded clinical trial conducted by the Alzheimer’s Disease Cooperative Study (ADCS). In the ADCS study, participants with mild to moderate Alzheimer’s disease taking 2 grams of DHA daily fared no better overall than those who took a placebo (inactive, lookalike treatment). The data indicated a “signal” (preliminary but not conclusive evidence) that participants without the APOE-e4 Alzheimer’s risk gene might have experienced a slight benefit. More research is needed to confirm whether that preliminary signal is valid. Results of this study also appeared in the Nov. 3, 2010, issue of the Journal of the American Medical Association.
  • The second study—Memory Improvement with DHA (MIDAS)—enrolled older adults with normal age-related cognitive decline. Those who took 900 milligrams of DHA daily scored slightly better on a computerized memory test than those receiving the placebo. MIDAS was conducted by Martek Biosciences, the manufacturer of the DHA used in both studies.

Experts agree that more research is needed, and there is not yet sufficient evidence to recommend DHA or any other omega-3 fatty acids to treat or prevent Alzheimer’s disease

Phosphatidylserine

Phosphatidylserine (pronounced FOS-fuh-TIE-dil-sair-een) is a kind of lipid, or fat, that is the primary component of the membranes that surround nerve cells. In Alzheimer’s disease and similar disorders, nerve cells degenerate for reasons that are not yet understood. The theory behind treatment with phosphatidylserine is its use may shore up the cell membrane and possibly protect cells from degenerating.

The first clinical trials with phosphatidylserine were conducted with a form derived from the brain cells of cows. Some of these trials had promising results. However, most trials were with small samples of participants.

This line of investigation came to an end in the 1990s over concerns about mad cow disease (bovine spongiform encephalopathy), a fatal brain disorder believed to be caused by consuming foods or other products from affected cattle. Supplements containing phosphatidylserine are now derived from soy extracts. The FDA permits supplements containing very high-quality soy-derived phosphatidylserine to display a “qualified health claim” stating that “Very limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk of dementia in the elderly. FDA concludes that there is little scientific evidence supporting this claim.” For more information about FDA qualified health claims, please click here. Experts agree that more research is needed, and do not currently recommend use of phosphatidylserine.

Tramiprosate (clinically tested as Alzhemed, marketed as a “medical food” called ViviMind™)

Tramiprosate is a modified form of taurine, an amino acid found naturally in seaweed. Amino acids are the chemical building blocks of proteins. Tramiprosate was tested in a large Phase 3 clinical study as a possible Alzheimer’s treatment. Analysis of the Phase 3 trial data was initially inconclusive for a variety of reasons. Investigators tried to work with the FDA to obtain clearer results, but the manufacturer decided to abandon development of tramisprosate as a prescription drug and market it over the Internet a “medical food.” Tramiprosate currently has no proven benefits, and “medical foods” are not subject to the same level of FDA regulation as prescription drugs. For more information, please see the statement of the Alzheimer’s Association Medical and Scientific Advisory Council on medical foods.

Citation

http://www.alz.org/alzheimers_disease_alternative_treatments.asp

Copyright © 2017  Alzheimer’s Association®. All rights reserved.

 

Alzheimer’s Disease: Tax Deductions and Credits

(Alz.org) As a caregiver, you likely pay for some care costs out-of-pocket. Because of this, you may qualify for tax benefits from the Internal Revenue Service (IRS). Tax rules are complex and can change. Be sure to get advice from your tax adviser or accountant before filing your returns.

  • Medical expenses
  • Child and Dependent Care Credit
  • Flexible spending account
  • State tax credits

Medical Expenses

The person with dementia may be considered your dependent for tax purposes. If so, you may be allowed to itemize his or her medical costs. Currently, you may deduct only the amount by which your total medical expenses exceed 7.5 percent of your adjusted gross income. Beginning in 2013, you may deduct only the amount by which your total medical expenses exceed 10 percent of your adjusted gross income. Only expenses that have not been reimbursed by insurance can be counted toward the medical expense deduction.

See IRS Publication 502: Medical and Dental Expenses, for a complete list of allowable expenses. Here’s a brief list:

  • Medical fees from doctors, laboratories, assisted living residences, home health care and hospitals
  • Cost of prescription drugs
  • Cost of transportation to receive medical care
  • Home modifications costs such as grab bars and handrails
  • Personal care items, such as disposable briefs and food

See IRS Publication 501: Exemptions, Standard Deductions and Filing Information to learn more about claiming the person with dementia as a dependent.

Child and Dependent Care Credit

If you paid someone to care for the person with dementia so you could work or look for work, you may be able to claim the “Child and Dependent Care Credit” on your federal income tax return. If eligible, you would be allowed a credit of up to 35 percent of your qualifying expenses, depending upon your adjusted gross income.

To qualify:

  • You must have earned income
  • The person with dementia must be unable to physically or mentally care for him or herself
  • The person with dementia must be claimed as a dependent on your tax return

See IRS Publication 503: Child and Dependent Care Expenses for more information.

TIP: If you pay someone to come to your home and care for the person with dementia, you may be a household employer and may have to withhold and pay Social Security and Medicare tax and pay federal unemployment tax. See IRS Publication 926: Household Employer’s Tax Guide.

Flexible Spending Account

If the person with dementia is a dependent under the tax rules, you might be able to use your own workplace flexible spending account (FSA). A flexible spending account allows payment for out-of-pocket medical expenses and dependent care expenses with pretax dollars, for a potential savings of about 20 to 30 percent.

State Tax Credits

Many states have additional tax deductions or tax credits to provide financial relief to caregivers. These tax programs build on the federal tax credit, which reduces the amount of income taxes a family owes. Each state program differs by name and eligibility requirements.

Help Is Available

The Internal Revenue Service (IRS) offers free tax forms and publications explaining various tax deductions and credits.

AARP’s Tax-Aide program provides free tax preparation and counseling information to all low and middle-income taxpayers, even if you are not an AARP member.

Other Resources

Note: This information is not intended as tax advice. The determination of how tax laws affect a taxpayer depends on the taxpayer’s situation. A taxpayer may be affected by exceptions to the general rules and by other laws not discussed here. Therefore, taxpayers are encouraged to seek advice from a competent tax professional.

Citation

http://www.alz.org/care/alzheimers-dementia-tax-deductions-credits.asp?WT.mc_id=enews2017_01_17&utm_source=enews-aff-&utm_medium=email&utm_campaign=enews-2017-01-17

Copyright © 2017 Alzheimer’s Association. All rights reserved.

 

Alzheimer’s Caregiving: Bathing, Dressing, Grooming

(NIH Senior Health) At some point, people with Alzheimer’s disease will need help with bathing, dressing, and grooming. Because these are private activities, people may not want help. They may feel embarrassed about being naked in front of caregivers. They also may feel angry about not being able to care for themselves.

Bathing

The person with Alzheimer’s may be afraid. To reduce these fears, follow the person’s lifelong bathing habits, such as doing the bath or shower in the morning or before going to bed. Here are other tips for bathing.

Bathing Safety Tips

  • Never leave a confused or frail person alone in the tub or shower.
  • Always check the water temperature before he or she gets in the tub or shower.
  • Use plastic containers for shampoo or soap to prevent them from breaking.
  • Use a hand-held showerhead.
  • Use a rubber bath mat and put safety bars in the tub.
  • Use a sturdy shower chair in the tub or shower. This will support a person who is unsteady, and it could prevent falls. You can get shower chairs at drug stores and medical supply stores.
  • Don’t use bath oil. It can make the tub slippery and may cause urinary tract infections.

Preparing for a Bath or Shower

  • Get the soap, washcloth, towels, and shampoo ready.
  • Make sure the bathroom is warm and well lighted. Play soft music if it helps to relax the person.
  • Be matter-of-fact about bathing. Say, “It’s time for a bath now.” Don’t argue about the need for a bath or shower.
  • Be gentle and respectful. Tell the person what you are going to do, step-by-step.
  • Make sure the water temperature in the bath or shower is comfortable.

During the Bath or Shower

  • Allow the person with Alzheimer’s to do as much as possible. This protects his or her dignity and helps the person feel more in control.
  • Put a towel over the person’s shoulders or lap. This helps him or her feel less exposed. Then use a sponge or washcloth to clean under the towel.
  • Distract the person by talking about something else if he or she becomes upset.
  • Give him or her a washcloth to hold. This makes it less likely that the person will try to hit you.

After a Bath or Shower

  • Prevent rashes or infections by patting the person’s skin with a towel. Make sure the person is completely dry. Be sure to dry between folds of skin.
  • If the person has trouble with incontinence, use a protective ointment, such as Vaseline, around the rectum, vagina, or penis.
  • If the person with Alzheimer’s has trouble getting in and out of the bathtub, do a sponge bath instead.

Dressing

People with Alzheimer’s often need more time to dress. It can be hard for them to choose their clothes. They might wear the wrong clothing for the season. They also might wear colors that don’t go together or forget to put on a piece of clothing. Allow the person to dress on his or her own for as long as possible.

Dressing Tips

  • Lay out clothes in the order the person should put them on, such as underwear first, then pants, then a shirt, and then a sweater.
  • Hand the person one thing at a time or give step-by-step dressing instructions.
  • Put away some clothes in another room to reduce the number of choices. Keep only one or two outfits in the closet or dresser.
  • Keep the closet locked if needed. This prevents some of the problems people may have while getting dressed.
  • Buy three or four sets of the same clothes, if the person wants to wear the same clothing every day.
  • Buy loose-fitting, comfortable clothing. Avoid girdles, control-top pantyhose, knee-high nylons, garters, high heels, tight socks, and bras for women. Sports bras are comfortable and provide good support. Short cotton socks and loose cotton underwear are best. Sweat pants and shorts with elastic waistbands are helpful.
  • Use Velcro® tape or large zipper pulls for clothing, instead of shoelaces, buttons, or buckles. Try slip-on shoes that won’t slide off or shoes with Velcro® straps.

Grooming

For the most part, when people feel good about how they look, they feel better. Helping people with Alzheimer’s brush their teeth, shave, or put on makeup often means they can feel more like themselves. Here are some grooming tips.

Mouth Care

Good mouth care helps prevent dental problems such as cavities and gum disease.

  • Show the person how to brush his or her teeth. Go step-by-step. For example, pick up the toothpaste, take the top off, put the toothpaste on the toothbrush, and then brush. Remember to let the person do as much as possible.
  • Brush your teeth at the same time.
  • Help the person clean his or her dentures. Make sure he or she uses the denture cleaning material the right way.
  • Ask the person to rinse his or her mouth with water after each meal and use mouthwash once a day.
  • Try a long-handled, angled, or electric toothbrush, if you need to brush the person’s teeth.
  • Take the person to see a dentist. Some dentists specialize in treating people with Alzheimer’s. Be sure to follow the dentist’s advice about how often to make an appointment.

Other Grooming Tips

  • Encourage a woman to wear makeup if she has always used it. If needed, help her put on powder and lipstick. Don’t use eye makeup.
  • Encourage a man to shave, and help him as needed. Use an electric razor for safety.
  • Take the person to the barber or beauty shop. Some barbers or hairstylists may come to your home.
  • Keep the person’s nails clean and trimmed.

For more caregiving tips, see NIA’s guide, Caring for a Person with Alzheimer’s Disease.

Citation
https://nihseniorhealth.gov/alzheimerscare/personalcare/01.html

 

The American Heart Association’s Diet and Lifestyle Recommendations

(American Heart Association) A healthy diet and lifestyle are your best weapons to fight cardiovascular disease. It’s not as hard as you may think!  Remember, it’s the overall pattern of your choices that counts. Make the simple steps below part of your life for long-term benefits to your health and your heart.

Use up at least as many calories as you take in.

  • Start by knowing how many calories you should be eating and drinking to maintain your weight. Nutrition and calorie information on food labels is typically based on a 2,000 calorie diet. You may need fewer or more calories depending on several factors including age, gender, and level of physical activity.
  • If you are trying not to gain weight, don’t eat more calories than you know you can burn up every day.
  • Increase the amount and intensity of your physical activity to match the number of calories you take in.
  • Aim for at least 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity – or an equal combination of both – each week.

Regular physical activity can help you maintain your weight, keep off weight that you lose and help you reach physical and cardiovascular fitness. If it’s hard to schedule regular exercise sessions, try aiming for sessions of at last 10 minutes spread throughout the week.

If you would benefit from lowering your blood pressure or cholesterol, the American Heart Association recommends 40 minutes of aerobic exercise of moderate to vigorous intensity three to four times a week.

Eat a variety of nutritious foods from all the food groups.

You may be eating plenty of food, but your body may not be getting the nutrients it needs to be healthy. Nutrient-rich foods have minerals, protein, whole grains and other nutrients but are lower in calories. They may help you control your weight, cholesterol and blood pressure.

Eat an overall healthy dietary pattern that emphasizes:

Limit saturated fat, trans fat, sodium, red meat, sweets and sugar-sweetened beverages. If you choose to eat red meat, compare labels and select the leanest cuts available.

One of the diets that fits this pattern is the DASH (Dietary Approaches to Stop Hypertension) eating plan. Most healthy eating patterns can be adapted based on calorie requirements and personal and cultural food preferences.

Eat less of the nutrient-poor foods.

The right number of calories to eat each day is based on your age and physical activity level and whether you’re trying to gain, lose or maintain your weight. You could use your daily allotment of calories on a few high-calorie foods and beverages, but you probably wouldn’t get the nutrients your body needs to be healthy. Limit foods and beverages high in calories but low in nutrients. Also limit the amount of saturated fat, trans fat and sodium you eat. Read Nutrition Facts labels carefully — the Nutrition Facts panel tells you the amount of healthy and unhealthy nutrients in a food or beverage.

As you make daily food choices, base your eating pattern on these recommendations:

  • Eat a variety of fresh, frozen and canned vegetables and fruits without high-calorie sauces or added salt and sugars. Replace high-calorie foods with fruits and vegetables.
  • Choose fiber-rich whole grains for most grain servings.
  • Choose poultry and fish without skin and prepare them in healthy ways without added saturated and trans fat. If you choose to eat meat, look for the leanest cuts available and prepare them in healthy and delicious ways.
  • Eat a variety of fish at least twice a week, especially fish containing omega-3 fatty acids (for example, salmon, trout and herring).
  • Select fat-free (skim) and low-fat (1%) dairy products.
  • Avoid foods containing partially hydrogenated vegetable oils to reduce trans fat in your diet.
  • Limit saturated fat and trans fat and replace them with the better fats, monounsaturated and polyunsaturated. If you need to lower your blood cholesterol, reduce saturated fat to no more than 5 to 6 percent of total calories. For someone eating 2,000 calories a day, that’s about 13 grams of saturated fat.
  • Cut back on beverages and foods with added sugars.
  • Choose foods with less sodium and prepare foods with little or no salt. To lower blood pressure, aim to eat no more than 2,400 milligrams of sodium per day. Reducing daily intake to 1,500 mg is desirable because it can lower blood pressure even further. If you can’t meet these goals right now, even reducing sodium intake by 1,000 mg per day can benefit blood pressure.
  • If you drink alcohol, drink in moderation. That means no more than one drink per day if you’re a woman and no more than two drinks per day if you’re a man.
  • Follow the American Heart Association recommendations when you eat out, and keep an eye on your portion sizes.

Also, don’t smoke tobacco — and avoid secondhand smoke.

Learn more about quitting smoking.

For more information on the American Heart Association Diet and Lifestyle Recommendations:

Citation

http://www.heart.org/HEARTORG/HealthyLiving/HealthyEating/Nutrition/The-American-Heart-Associations-Diet-and-Lifestyle-Recommendations_UCM_305855_Article.jsp#.WLIubPLMbv0

©2017 American Heart Association, Inc.

 

Alzheimer’s Drug Donezpezil Prescribed Off-Label Could Pose Risk for Some

(University of California – Los Angeles Health Sciences) Donepezil, a medication that is approved to treat people with Alzheimer’s disease, should not be prescribed for people with mild cognitive impairment without a genetic test. UCLA School of Nursing researchers discovered that for people who carry a specific genetic variation — the K-variant of butyrylcholinesterase, or BChE-K — donezpezil could accelerate cognitive decline.

Mild cognitive impairment is a transitional state between normal age-related changes in cognition and dementia. Because many people with the condition display symptoms similar to those caused by Alzheimer’s disease, some physicians prescribe donepezil, which is marketed under the brand name

Aricept and is the most-prescribed medication for Alzheimer’s.

Donepezil was tested as a possible treatment for mild cognitive impairment in a large, federally funded study published in 2005, but it was not approved by the FDA. Still, doctors have often prescribed the drug “off-label” — meaning that it is not approved for that specific disorder — for their patients with mild cognitive impairment.

From data collected during the 2005 trial, the researchers looked at the association between BChE-K and changes in cognitive function. Using two tests that measure cognitive impairment, the Mini-Mental State Examination and the Clinical Dementia Rating Sum of Boxes, they found that people with the genetic variation who were treated with donepezil had greater changes in their scores than those who took placebos. They also found that those who took donepezil had a faster cognitive decline than those who took the placebo.

Physicians are increasingly using personalized medicine, including pharmacogenetics — the study of how genetics affect a person’s response to a drug — to tailor their patients’ care. The findings reinforce the importance of physicians discussing the possible benefits and risks of this treatment with their patients.

The study was published in the Journal of Alzheimer’s Disease.

Citation

https://www.uclahealth.org/alzheimers-drug-prescribed-offlabel-for-mild-cognitive-impairment-could-pose-risk-for-some

Journal Reference:

Louis De Beaumont, Sandra Pelleieux, Louise Lamarre-Théroux, Doris Dea, Judes Poirier. Butyrylcholinesterase K and Apolipoprotein E-ɛ4 Reduce the Age of Onset of Alzheimer’s Disease, Accelerate Cognitive Decline, and Modulate Donepezil Response in Mild Cognitively Impaired Subjects. Journal of Alzheimer’s Disease, 2016; 54 (3): 913 DOI: 10.3233/JAD-160373

Copyright 2017 UCLA

 

Be­ne­fits of Cog­nit­ive Train­ing in De­men­tia Pa­tients Un­clear

(University of Helsinki) Positive effects of cognitive training in healthy elderly people have been reported, but data regarding its effects in patients with dementia is unclear.

“The effects of cognitive training in dementia patients have been studied actively during recent decades but the quality and reliability of the studies varies,” says licenced neuropsychologist Eeva-Liisa Kallio. She reviewed 31 randomized controlled trials on cognitive training in dementia patients.

Kallio’s reserch paper “Cognitive Training Interventions for Patients with Alzheimer’s Disease: A Systematic Review” was published in Journal of Alzheimer’s Disease.

Some of the studies in the review focused primarily on cognitive training and in others cognitive training was part of broader cognitive or multi-component intervention.

“Many of the studies reported effects on cognitive functions immediately after the intervention but only few studies included follow-up of the patients or showed improvement in cognitive functions that were not directly linked to the skills trained in the intervention,” Kallio says.

In the studies, cognitive functioning was measured before and after the intervention. Also questionnaires on psychological wellbeing, quality of life and activities of daily living were used.

According to Kallio’s review, the data from the previous studies is not adequate to give any recommendations on the use of cognitive training in the treatment of dementia patients. Even though the scientific evidence remains scarce, the studies do suggest that the training should be intensive or focus primarily on a particular aspect of cognitive functions.

“Healthy adults can get limited benefits from cognitive training but we need more high quality trials to confirm cognitive training as an effective treatment option in dementia,” Kallio says.

She belongs to the University of Helsinki’s FINCOG research group, led by professor Kaisu Pitkälä. The next step in the project is to study the effects of intensive, 3-month cognitive training on the community-dwelling older persons with dementia participating in adult day care activities organised by the City of Helsinki.

In this randomized controlled trial, part of the participants attend systematic cognitive training while their control group participates in the normal day care activities.

In addition to cognitive functions, also indicators of quality of life and activities of daily living are used and the measurements are repeated six months after the intervention. The research also includes a 24-month health register follow-up.

“Cognitive training is quite easy to implement. If our research suggests that the participants benefit from it, cognitive training can be easily included in the adult day care activities,” Kallio says.

Citation
https://www.helsinki.fi/en/news/benefits-of-cognitive-training-in-dementia-patients-unclear

Journal Reference:

Eeva-Liisa Kallio, Hanna Öhman, Hannu Kautiainen, Marja Hietanen, Kaisu Pitkälä. Cognitive Training Interventions for Patients with Alzheimer’s Disease: A Systematic Review. Journal of Alzheimer’s Disease, 2017; 56 (4): 1349 DOI: 10.3233/JAD-160810

Copyright University of Helsinki 2017

 

Heart Disease Factors in Middle Age Increase Risk of Dementia Later in Life

(American Heart Association) People who have heart disease risks in middle age — such as diabetes, high blood pressure or smoking — are at higher risk for dementia later in life, according to research presented at the American Stroke Association’s International Stroke Conference 2017.

“The health of your vascular system in midlife is really important to the health of your brain when you are older,” said Rebecca F. Gottesman, M.D., Ph.D., lead researcher and associate professor of neurology and epidemiology at the Johns Hopkins University in Baltimore.

In an ongoing study that began in 1987 and enrolled 15,744 people in four U.S. communities, the risk of dementia increased as people got older. That was no surprise, but heart disease risks detected at the start of the study, when participants were between 45-64 years of age, also had a significant impact on later dementia, researchers noted. Dementia developed in 1,516 people during the study, and the researchers found that the risk of dementia later in life was:

  • 41 percent higher in midlife smokers than in non-smokers or former smokers;
  • 39 percent higher in people with high blood pressure (?140/90 mmHg) in middle age, and 31 percent higher in those with pre-hypertension (between 120/80 mmHg and 139/89 mmHg) compared to those with normal blood pressure; and
  • 77 percent higher in people with diabetes in middle age than in non-diabetics.

“Diabetes raises the risk almost as much as the most important known genetic risk factor for Alzheimer’s disease,” Gottesman said.

Overall, the risk of dementia was 11 percent lower in women. The risk was highest in individuals who were black, had less than a high school education, were older, carried the gene known to increase Alzheimer’s risk, or had high blood pressure, diabetes or were current smokers at the time of initial evaluation.

Smoking and carrying the gene known to increase the chance of Alzheimer’s were stronger risk factors in whites than in blacks, the researchers noted.

“If you knew you carried the gene increasing Alzheimer’s risk, you would know you were predisposed to dementia, but people don’t necessarily think of heart disease risks in the same way. If you want to protect your brain as you get older, stop smoking, watch your weight, and go to the doctor so diabetes and high blood pressure can be detected and treated,” said Gottesman.

Because Atherosclerosis Risk in Communities is an observational study, the current study could not test whether treating heart risk factors will result in a lessened dementia risk later in life.

“The benefit is that this is a long-term study and we know a lot about these people. Data like these may supplement data from clinical trials that look at the impact of treatment for heart disease risks,” Gottesman said.

Citation

http://news.heart.org/heart-disease-factors-in-middle-age-increase-risk-of-dementia-later-in-life/

©2017 American Heart Association, Inc.