Archives for June 2017

Evidence Supporting Three Interventions That Might Slow Cognitive Decline and the Onset of Dementia is Encouraging but Insufficient to Justify Public Health Campaign on Their Adoption

(National Academies of Sciences, Engineering, and Medicine) Cognitive training, blood pressure management for people with hypertension, and increased physical activity all show modest but inconclusive evidence that they can help prevent cognitive decline and dementia, but there is insufficient evidence to support a public health campaign encouraging their adoption, says a new report from the National Academies of Sciences, Engineering, and Medicine.  Additional research is needed to further understand and gain confidence in their effectiveness, said the committee that conducted the study and wrote the report.

“There is good cause for hope that in the next several years much more will be known about how to prevent cognitive decline and dementia, as more clinical trial results become available and more evidence emerges,” said Alan I. Leshner, chair of the committee and CEO emeritus, American Association for the Advancement of Science.

“Even though clinical trials have not conclusively supported the three interventions discussed in our report, the evidence is strong enough to suggest the public should at least have access to these results to help inform their decisions about how they can invest their time and resources to maintain brain health with aging.”

An earlier systematic review published in 2010 by the Agency for Healthcare Research and Quality (AHRQ) and an associated “state of the science” conference at the National Institutes of Health had concluded that there was insufficient evidence to make recommendations about any interventions to prevent cognitive decline and dementia.

Since then, understanding of the pathological processes that result in dementia has advanced significantly, and a number of clinical trials of potential preventive interventions have been completed and published.  In 2015, the National Institute on Aging (NIA) contracted with AHRQ to conduct another systematic review of the current evidence.  NIA also asked the National Academies to convene an expert committee to help inform the design of the AHRQ review and then use the results to make recommendations to inform the development of public health messaging, as well as recommendations for future research.

This report examines the most recent evidence on steps that can be taken to prevent, slow, or delay the onset of mild cognitive impairment and clinical Alzheimer’s-type dementia as well as steps that can delay or slow age-related cognitive decline.

Overall, the committee determined that despite an array of advances in understanding cognitive decline and dementia, the available evidence on interventions derived from randomized controlled trials – considered the gold standard of evidence – remains relatively limited and has significant shortcomings.

Based on the totality of available evidence, however, the committee concluded that three classes of interventions can be described as supported by encouraging but inconclusive evidence.  These interventions are:

  • cognitive training – which includes programs aimed at enhancing reasoning and problem solving, memory, and speed of processing – to delay or slow age-related cognitive decline.  Such structured training exercises may or may not be computer-based.
  • blood pressure management for people with hypertension – to prevent, delay, or slow clinical Alzheimer’s-type dementia.
  • increased physical activity – to delay or slow age-related cognitive decline.

Cognitive training has been the object of considerable interest and debate in both the academic and commercial sectors, particularly within the last 15 years.  Good evidence shows that cognitive training can improve performance on a trained task, at least in the short term.  However, debate has centered on evidence for long-term benefits and whether training in one domain, such as processing speed, yields benefits in others, such as in memory and reasoning, and if this can translate to maintaining independence in instrumental activities of daily living, such as driving and remembering to take medications.

Evidence from one randomized controlled trial suggests that cognitive training delivered over time and in an interactive context can improve long-term cognitive function as well as help maintain independence in instrumental activities of daily living for adults with normal cognition.  However, results from other randomized controlled trials that tested cognitive training were mixed.

Managing blood pressure for people with hypertension, particularly during midlife – generally ages 35 to 65 years – is supported by encouraging but inconclusive evidence for preventing, delaying, and slowing clinical Alzheimer’s-type dementia, the committee said.

The available evidence, together with the strong evidence for blood pressure management in preventing stroke and cardiovascular disease and the relative benefit/risk ratio of antihypertensive medications and lifestyle interventions, is sufficient to justify communication with the public regarding the use of blood pressure management, particularly during midlife, for preventing, delaying, and slowing clinical Alzheimer’s-type dementia, the report says.

It is well-documented that physical activity has many health benefits, and some of these benefits – such as stroke prevention – are causally related to brain health.  The AHRQ systematic review found that the pattern of randomized controlled trials results across different types of physical activity interventions provides an indication of the effectiveness of increased physical activity in delaying or slowing age-related cognitive decline, although these results were not consistently positive.

However, several other considerations led the committee to conclude that the evidence is sufficient to justify communicating to the public that increased physical activity for delaying or slowing age-related cognitive decline is supported by encouraging but inconclusive evidence.

None of the interventions evaluated in the AHRQ systematic review met the criteria for being supported by high-strength evidence, based on the quality of randomized controlled trials and the lack of consistently positive results across independent studies.  This limitation suggests the need for additional research as well as methodological improvements in the future research.

The National Institutes of Health and other interested organizations should support further research to strengthen the evidence base on cognitive training, blood pressure management, and increased physical activity, the committee said.  Examples of research priorities for these three classes of interventions include evaluating the comparative effectiveness of different forms of cognitive training interventions; determining whether there are optimal blood pressure targets and approaches across different age ranges; and comparing the effects of different forms of physical activity.

When funding research on preventing cognitive decline and dementia, the National Institutes of Health and other interested organizations should identify individuals who are at higher risk of cognitive decline and dementia; increase participation of underrepresented populations; begin more interventions at younger ages and have longer follow-up periods; use consistent cognitive outcome measures across trials to enable pooling; integrate robust cognitive outcome measures into trials with other primary purposes; include biomarkers as intermediate outcomes; and conduct large trials designed to test the effectiveness of an intervention in broad, routine clinical practices or community settings.

The study was sponsored by the National Institute on Aging.  The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine.  The National Academies operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.  For more information, visit http://national-academies.org.

Citation

http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=24782

Copyright © 2017 National Academy of Sciences. All rights reserved.

 

Leisure Activities Lower Blood Pressure in Alzheimer’s Caregivers

(Wolters Kluwer Health: Lippincott Williams and Wilkins) Going for a walk outside, reading, listening to music — these and other enjoyable activities can reduce blood pressure for elderly caregivers of spouses with Alzheimer’s disease, suggests a study in Psychosomatic Medicine: Journal of Biobehavioral Medicine, the official journal of the American Psychosomatic Society. The journal is published by Wolters Kluwer.

“Greater engagement in pleasant leisure activities was associated with lowered caregivers’ blood pressure over time,” according to the report by Brent T. Mausbach, PhD, of University of California San Diego and colleagues.

“Participation in pleasant leisure activities may have cardiovascular benefits for Alzheimer’s caregivers.”

The study included 126 caregivers enrolled in the UCSD Alzheimer’s Caregiver Study, a follow-up study evaluating associations between stress, coping, and cardiovascular risk in Alzheimer’s caregivers. The caregivers were 89 women and 37 men, average age 74 years, providing in-home care for a spouse with Alzheimer’s disease.

As part of annual interviews over five years, the caregivers provided information on how often they engaged in various pleasant leisure activities. These ratings were analyzed for association with blood pressure over time, with adjustment for demographic and health factors.

The caregivers reported high levels of enjoyable activities — most said they spent time outdoors, laughing, watching TV, listening to music, and reading or listening to stories. About half of caregivers said they exercised frequently.

Caregivers who more frequently engaged in pleasant leisure activities had lower mean arterial blood pressure (a measure of average blood pressure). In follow-up analyses, these activities were associated with a significant reduction in diastolic pressure (the second, lower blood pressure number), although not in systolic pressure (the first, higher number).

As expected, caregivers who exercised more frequently had lower blood pressure. However, other types of “more sedentary, reflective” activities also led to reduced blood pressure. These included reading, listening to music, shopping, and recalling past events.

Blood pressure also decreased after nursing home placement or death of the person with Alzheimer’s disease. That was consistent with previous studies showing that caregivers’ health improves after their caregiving duties end.

Being a caregiver for a disabled loved one is a highly stressful experience, associated with an increased risk of cardiovascular disease and death. Stress may contribute to high blood pressure, which is the strongest risk factor for cardiovascular disease. The new results suggest that leisure activities are a behavioral factor that can prevent the development of high blood pressure in Alzheimer’s caregivers.

Dr. Mausbach notes that the study assessed both the frequency and enjoyment of activities. The premise is that rather than recommending certain activities to everyone, it’s important for caregivers to enjoy the activities they do to receive benefit. While the study can’t determine how many activities people should do,

“We believe three to four enjoyed activities each week could have a modest impact on an individual’s blood pressure,” Dr. Mausbach commented.

“From there, the more an individual can do, the better the impact.”

The researchers have been conducting a clinical trial to examine the effect of a therapy to increase pleasant leisure activities.

“We recognize caregivers may have a difficult time engaging in pleasant leisure activities because they are busy with their caregiving duties,” said Dr. Mausbach.

“So we work with caregivers to find activities they can more confidently engage in even when their spouse is present. We also help them monitor their use of time so they know the times during the day when they are most capable of doing activities. Further, if caregivers use respite services, they are in a perfect position to use some of their respite time to engage in these activities.”

Citation

https://www.sciencedaily.com/releases/2017/06/170623100708.htm

Journal Reference:

Brent T. Mausbach, Rosa Romero-Moreno, Taylor Bos, Roland von Känel, Michael G Ziegler, Matthew A. Allison, Paul J. Mills, Joel E. Dimsdale, Sonia Ancoli-Israel, Andrés Losada, María Márquez-González, Thomas L. Patterson, Igor Grant. Engagement in pleasant leisure activities and blood pressure. Psychosomatic Medicine, 2017; 1 DOI: 10.1097/PSY.0000000000000497

 

Anti-epilepsy Drug Restores Normal Brain Activity in Mild Alzheimer’s Disease

(Beth Israel Deaconess Medical Center) In the last decade, mounting evidence has linked seizure-like activity in the brain to some of the cognitive decline seen in patients with Alzheimer’s disease. Patients with Alzheimer’s disease have an increased risk of epilepsy and nearly half may experience subclinical epileptic activity — disrupted electrical activity in the brain that doesn’t result in a seizure but which can be measured by electroencephalogram (EEG) or other brain scan technology.

In a recent feasibility study, clinician-scientists at Beth Israel Deaconess Medical Center (BIDMC) tested an anti-epileptic drug for its potential impact on the brain activity of patients with mild Alzheimer’s disease. The team, led by Daniel Z. Press, MD, of the Berenson-Allen Center for Non-invasive Brain Stimulation at BIDMC, documented changes in patients’ EEGs that suggest the drug could have a beneficial effect. The research was published in the Journal of Alzheimer’s Disease.

“In the field of Alzheimer’s disease research, there has been a major search for drugs to slow its progression,” said Press, an Instructor of Neurology in the Cognitive Neurology Unit at BIDMC and an Associate Professor of Neurology at Harvard Medical School.

“If this abnormal electrical activity is leading to more damage, then suppressing it could potentially slow the progression of the disease.”

In this double-blind within-subject study, a small group of patients with mild Alzheimer’s disease visited BIDMC three times. At each visit, patients were given a baseline (EEG) to measure the electrical activity in the brain. Next, patients were given injections containing either inactive placebo or the anti-seizure drug levetiracetam, at either a low dose (2.5 mg/kg) or a higher dose (7.5 mg/kg). Neither patients nor medical professionals knew which injections patients were receiving, but each patient eventually got one of each type, in a random order.

After receiving the injection, patients underwent another EEG, then magnetic resonance imaging (MRI) — which measures blood flow in the brain, another way to quantify brain activity and determine where in the brain it is taking place. Finally, patients took a standardized cognitive test, designed to measure memory, executive functioning, naming, visuospatial ability and semantic function — capabilities all affected by Alzheimer’s disease.

In the seven patients able to complete the study protocol successfully, Press and colleagues analyzed changes in their EEGs. (Blood flow analysis from the MRI data is still underway.) Overall, higher doses of the anti-seizure drug appeared to normalize abnormalities seen in the patients’ EEG profiles. That is, researchers saw overall increases in brain wave frequencies that had been abnormally low in Alzheimer’s disease patients prior to receiving the higher dose of levetiracetam, and, likewise, saw decreases in those that had been abnormally high.

“It’s worth noting, we did not demonstrate any improvement in cognitive function after a single dose of medication in this study,” said Press.

“It’s too early to use the drug widely, but we’re preparing for a larger, longer study.”

The risk of developing Alzheimer’s disease increases sharply with age. Today, it affects more than 5 million Americans, a figure that is projected to reach 16 million by 2050 as the population ages. In recent years, researchers have focused on developing techniques to clear the brain of amyloid and tau protein plaques that build up and wreak havoc in the brains of patients with Alzheimer’s disease.

“These strategies have not led to new therapies to date,” said Press.

“There have been a lot of disappointments. So our findings represent an interesting new avenue.”

Citation

https://www.sciencedaily.com/releases/2017/06/170623131512.htm

Story Source:

Materials provided by Beth Israel Deaconess Medical Center. Note: Content may be edited for style and length.

Copyright 2017 ScienceDaily or by third parties, where indicated.

 

Efficacy of Antidepressants for Depression in Alzheimer’s Disease

2017;58(3):725-733. doi: 10.3233/JAD-161247.

Efficacy of Antidepressants for Depression in Alzheimer’s Disease: Systematic Review and Meta-Analysis.

Orgeta V, Tabet N, Nilforooshan R, Howard R.

Abstract

BACKGROUND:

Depression is common in people with Alzheimer’s disease (AD) affecting overall outcomes and decreasing quality of life. Although depression in AD is primarily treated with antidepressants, there are few randomized controlled trials (RCTs) assessing efficacy and results have been conflicting.

OBJECTIVES:

To systematically review evidence on efficacy of antidepressant treatments for depression in AD.

METHODS:

Systematic review and meta-analysis of double blind RCTs comparing antidepressants versus placebo for depression in AD. We searched MEDLINE, CINAHL, EMBASE, PsycINFO, the Cochrane Controlled Trials Register and on line national and international registers. Primary outcomes were treatment response and depressive symptoms. Secondary outcomes were cognition, acceptability, and tolerability. Risk of bias was also assessed.

RESULTS:

Seven studies met inclusion criteria. Three compared sertraline with placebo; one compared both sertraline and mirtazapine to placebo; imipramine, fluoxetine, and clomipramine were evaluated in one study each. In terms of response to treatment (6 studies, 297 patients treated with antidepressants and 223 with placebo), no statistically significant difference between antidepressants and placebo was found (odds ratio (OR) 1.95, 95% CI 0.97-3.92). We found no significant drug-placebo difference for depressive symptoms (5 studies, 311 patients, SMD -0.13; 95% CI -0.49 to 0.24). Overall quality of the evidence was moderate because of methodological limitations in studies and the small number of trials.

CONCLUSION:

Despite the importance of depression in people with AD, few RCTs are available on efficacy of antidepressants, limiting clear conclusions of their potential role. There is a need for further high quality RCTs.

Citation

https://www.ncbi.nlm.nih.gov/pubmed/28505970

 

Alzheimer’s Disease Study Links Brain Health and Physical Activity

(Journal of Alzheimer’s Disease) People at risk for Alzheimer’s disease who do more moderate-intensity physical activity, but not light-intensity physical activity, are more likely to have healthy patterns of glucose metabolism in their brain, according to a new UW-Madison study.

Results of the research were published today online in Journal of Alzheimer’s Disease. Senior author Dr. Ozioma Okonkwo, assistant professor of medicine, is a researcher at the Wisconsin Alzheimer’s Disease Research Center and the Wisconsin Alzheimer’s Institute at the UW School of Medicine and Public Health.

First author Ryan Dougherty is a graduate student studying under the direction of Dr. Dane B. Cook, professor of kinesiology and a co-author of the study, and Dr. Okonkwo. The research involved 93 members of the Wisconsin Registry for Alzheimer’s Prevention (WRAP), which with more than 1,500 registrants is the largest parental history Alzheimer’s risk study group in the world.

Researchers used accelerometers to measure the daily physical activity of participants, all of whom are in late middle-age and at high genetic risk for Alzheimer’s disease, but presently show no cognitive impairment. Activity levels were measured for one week, quantified, and analyzed. This approach allowed scientists to determine the amount of time each subject spent engaged in light, moderate, and vigorous levels of physical activity.

Light physical activity is equivalent to walking slowly, while moderate is equivalent to a brisk walk and vigorous a strenuous run. Data on the intensities of physical activity were then statistically analyzed to determine how they corresponded with glucose metabolism—a measure of neuronal health and activity—in areas of the brain known to have depressed glucose metabolism in people with Alzheimer’s disease. To measure brain glucose metabolism, researchers used a specialized imaging technique called 18F-fluorodeoxyglucose positron emission tomography (FDG-PET).

Moderate physical activity was associated with healthier (greater levels of) glucose metabolism in all brain regions analyzed. Researchers noted a step-wise benefit: subjects who spent at least 68 minutes per day engaged in moderate physical activity showed better glucose metabolism profiles than those who spent less time.

“This study has implications for guiding exercise ‘prescriptions’ that could help protect the brain from Alzheimer’s disease,” said Dougherty.

“While many people become discouraged about Alzheimer’s disease because they feel there’s little they can do to protect against it, these results suggest that engaging in moderate physical activity may slow down the progression of the disease.”

“Seeing a quantifiable connection between moderate physical activity and brain health is an exciting first step,” said Okonkwo.

He explained that ongoing research is focusing on better elucidating the neuroprotective effect of exercise against Alzheimer’s disease. To investigate this further, the team is recruiting individuals with concerns about their memory for a national clinical trial called EXERT to test whether physical exercise can slow the progression of early memory problems caused by Alzheimer’s disease. For more information or to volunteer, contact exercise physiologist Beth Jeanes at 608-265-5752 or by email at emjeanes@medicine.wisc.edu.

The Wisconsin Alzheimer’s Disease Research Center (ADRC) and The Wisconsin Alzheimer’s Institute (WAI) are two collaborative groups working under the UW Initiative to End Alzheimer’s in leading-edge research, education and outreach programs.

The study was supported by the National Institutes of Health, Veterans Administration, Alzheimer’s Association, Wisconsin Alumni Research Foundation, Helen Bader Foundation, Northwestern Mutual Foundation, and Extendicare Foundation.

Citation

http://www.j-alz.com/content/alzheimers-disease-study-links-brain-health-and-physical-activity

Journal of Alzheimer’s Disease is published by IOS Press

Copyright © 2017

 

More Than Memory: Coping With The Other Ills Of Alzheimer’s

(NPR) Greg O’Brien was diagnosed with early-onset Alzheimer’s disease eight years ago. He has written about his experiences with the disease. 

The first problem with the airplane bathroom was its location.

It was March. Greg O’Brien and his wife, Mary Catherine, were flying back to Boston from Los Angeles, sitting in economy seats in the middle of the plane.

“We’re halfway, probably over Chicago,” Greg remembers, “and Mary Catherine said, ‘Go to the bathroom.’ ”

“It just sounded like my mother,” Greg says. So I said ‘no.’ “

Mary Catherine persisted, urging her husband of 40 years to use the restroom. People started looking at them.

“It was kind of funny,” says Greg.

Mary Catherine was more alarmed than amused. Greg has early-onset Alzheimer’s, which makes it increasingly hard for him to keep track of thoughts and feelings over the course of minutes or even seconds. It’s easy to get into a situation where you feel like you need to use the bathroom, but then forget. And they had already been on the plane for hours.

Finally, Greg started toward the restroom at the back of the plane, only to find the aisle was blocked by an attendant serving drinks. Mary Catherine gestured to him.

“Use the one in first class!”

At that point, on top of the mild anxiety most people feel when they slip into first class to use the restroom, Greg was feeling overwhelmed by the geography of the plane. He pulled back the curtain dividing the seating sections.

“This flight attendant looks at me like she has no use for me. I just said ‘Look, I really have to go the bathroom,’ and she says ‘OK, just go.’ “

Before Greg had Alzheimer’s, he would have discreetly made his way up the aisle, used the bathroom and gone back to his seat. Now, no part of that was possible. He had no idea where the bathroom was. Even after the crew member pointed to the front of the plane, he was still confused.

There were two doors.

He moved down the aisle, buying time, feeling the flight attendant watching him. The middle door was larger. He put his hand on it.

Immediately, he knew it was wrong – he had touched the cockpit door. The flight attendant was at his side. He apologized. She asked him to please step away from the door.

“I’m sorry,” Greg told her. “I have a problem. I got some Alzheimer’s.

“I didn’t get to pee,” he says now. “But I think I was lucky nothing bad happened.”

Greg unwinds a hose while doing some yardwork. Along with his failing memory, Greg has been experiencing secondary symptoms including paranoia, depression and slow healing.

Eight years after he was diagnosed with early-onset Alzheimer’s disease, the 67-year-old’s memory is failing slowly and irreversibly. But, increasingly, it is his other symptoms that interrupt his day-to-day life as a writer, father, husband and now grandfather.

Some symptoms he is struggling with have largely unknown mechanisms. His depressed immune system, for example, is likely related to his Alzheimer’s disease, but researchers are still unsure exactly how. Same with the exact relationship between the Alzheimer’s and the numbness he feels in his hands and feet.

But many of the symptoms he experiences have clear links to the disease — things like rage, paranoia, depression and incontinence.

And he thinks that a lot of people who are open about some Alzheimer’s symptoms are uncomfortable talking about things like incontinence. He makes an extra effort to be open about his symptoms and joke about the parts of his life that are still funny.

“You’ll never see me with tan pants. I always have an extra pair of pants in the car,” he says, laughing a little. “I’m not trying to gross anyone out, but that’s my life today.”

“You don’t die of Alzheimer’s,” Greg says. “You die of everything else. But first, you live with it all. Alzheimer’s is not your grandfather’s disease.”

Prescription Side Effects

“I refuse to take this one because it makes me loopy,” Greg explains, standing at his kitchen sink pointing at one of the pill bottles lined up on the windowsill.

He reaches for another bottle.

“I call these ones my smart pills,” he says, struggling with the childproof top. “These goddamn things,” he grunts, the water running into the sink.

He extracts a pill and tosses it into his mouth, dipping his head to drink from the faucet.

He smiles. “Not always the best manners, I know.”

Although there is no drug to slow or stop the inevitable progression of Alzheimer’s, people like Greg, who was diagnosed with the early-onset form of the disease, often take multiple drugs to treat the symptoms. Greg has prescriptions for four drugs he’s supposed to take every day: two to combat dementia and other cognitive symptoms, and two antidepressants, Celexa and trazodone.

Trazodone is the one Greg refuses to take. Along with the second antidepressant, it’s meant to help him deal with the depression and suicidal thoughts that he has been experiencing on and off since he was diagnosed.

“In Alzheimer’s disease, you’re not just affecting the ability to remember things and learn things, but you’re also affecting parts of the brain that control mood,” says Rudy Tanzi, an Alzheimer’s researcher and assistant professor at Harvard Medical School.

He says Alzheimer’s affects the frontal lobe of the brain, which is involved in the ability to show restraint.

As the frontal lobe degenerates, it becomes easier to give into desires and fear. Many people get depressed, angry and anxious.

Celexa and other so-called mood stabilizers can help reduce that stress, agitation and depression. But research has also shown that such drugs can make it more difficult to think and focus, which in turn makes it difficult to do things like write.

And Greg is a writer. For years, he worked at newspapers and magazines in Boston and on Cape Cod. After his diagnosis, he wrote an autobiography, On Pluto: Inside The Mind Of Alzheimer’s, a second edition of which will be distributed by Viking/Random House in July. He still works as a freelance writer and editor, in part because he says his family needs the income.

And so, for now, he has decided to live with rage and depression, rather than compromise his ability to write.

Not everyone agrees with his choice to forgo some medication. His wife, Mary Catherine, and his son Conor, who works as a full-time assistant for Greg, have their own opinions.

This spring, Mary Catherine talked to one of Greg’s doctors.

“I was asking for some medication so I wouldn’t regret being married for 40 years,” she says, half-joking as she unloads groceries.

She has said that one of the unexpected parts of her husband’s Alzheimer’s is that it has brought them closer to each other, but everyone in the family seems to agree that his rage is still particularly difficult to handle.

“They have to put up with this,” Greg acknowledges, “that’s not fair.”

“I understand,” he continues, his smile fading.

“I’m worried about not being able to control the rage, and it’s getting to the point where it’s upsetting.

My son doesn’t even want to watch a Celtics game with me anymore, because if someone dribbles the wrong way, it’s ticking [me off], particularly if it’s at night.”

“How do I get a handle on it? I’m not quite sure. But I want to write. That’s what keeps me whole. That’s what makes me who I am.”

Sadness replaces defiance in his voice.

“I don’t know. I don’t want to lose any more than is already being taken from me,” he says.

“It means I become less of me.”

“He’s stalking me”

“That guy is watching me. I’ve got no freaking idea who he is,” Greg says, looking over his shoulder at a man sitting a few tables away.

The outdoor patio at a café in Orleans, Mass., is half full. It’s early afternoon on a Thursday.

A few minutes ago, the mystery man walked by and said hello to Greg. Now, as Greg looks over at him, he is smiling.

“He gave me a big hug, put his arm around me. Obviously I’ve known him for 20 years,” says Greg, his voice low.

“He’s sitting there on the steps now waiting for me. He’s waiting for me. He’s stalking me.”

At some level, he knows it’s not a rational fear. Sitting outside, a few minutes from his home on a spring day, Greg O’Brien is not in danger. But he is a man without a map, adrift in a sea of seemingly random information that has no context or way to order itself in his mind.

And so, in place of rational reaction to a man saying hello to him, Greg begins to worry he is being watched by a potential assassin.

In Alzheimer’s, “your brain can no longer regulate how what you hear and what you see at any given moment is integrated into a map of the world,” explains Tanzi.

“The paranoia is coming because you’re really experiencing in a sensory way things that are happening only in your own mind.”

But, in some ways, Greg is still the gregarious writer and father of three who frustrated his family with his endless gabbing when they went out to eat. Now, that part of his personality cuts through the paranoia, and he stands up and walks toward the stranger.

And this, says Tanzi, is absolutely the best way to react to Alzheimer’s disease.

“Greg is absolutely an outlier,” he says (the two met through the Boston-based Cure Alzheimer’s Fund).

“Having the motivation and the incentive and the drive every day to say, ‘Look, I have a disease. It’s progressive and it’s going to keep going. But I have a chance every day to try to fight it.’ Having that sense of purpose literally turns on the frontal cortex,” he explains.

“It provides you with meaning, and purpose and self-awareness. It’s brave.”

Greg approaches the mystery man.

“Hi, I’m Greg O’Brien. Do we know each other?”

Yes, the stranger replies gently. He is an old friend, a colleague from back when Greg worked at the The Cape Codder newspaper. He has known Greg for more than 20 years. He is a frequent confidant these days, though mostly by email, he says.

He thanks Greg for the help and support with his aging mother, who suffered memory loss. And they sit and chat, like the old friends they are.

Citation

http://www.npr.org/sections/health-shots/2017/06/24/525887392/more-than-memory-coping-with-the-other-ills-of-alzheimers

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US Death Rates from Alzheimer’s Disease Increased 55 Percent from 1999 to 2014

(MedicalNewsToday) Death rates from Alzheimer’s disease (AD) increased 55 percent between 1999 and 2014, according to data released today in the CDC’s Morbidity and Mortality Weekly Report. The number of Alzheimer’s deaths at home also increased during the same period, from 14 percent to 25 percent, suggesting an increase in the number of caregivers that would benefit from support, including education and case management services.

Alzheimer’s disease is a fatal form of dementia. It is the sixth leading cause of death in the United States, accounting for 3.6 percent of all deaths in 2014. It is the fifth leading cause of death among people ages 65 years and older in the United States.

“Millions of Americans and their family members are profoundly affected by Alzheimer’s disease,” said CDC Acting Director Anne Schuchat, M.D.

“Our new study reveals an increase in the incidence of Alzheimer’s disease-related deaths. As the number of older Americans with Alzheimer’s disease rises, more family members are taking on the emotionally and physically challenging role of caregiver than ever before. These families need and deserve our support.”

This study is the first to provide county-level rates for deaths caused by AD. CDC researchers analyzed state- and county-level death certificate data from the National Vital Statistics System to identify deaths with AD reported as the underlying cause.

According to the analysis, possible reasons for the increase include the growing population of older adults in the U.S., increases in diagnosis of AD at earlier stages, increased reporting by physicians and others who record the cause of death, and fewer deaths from other causes of deaths for the elderly, such as heart disease and stroke.

Key findings from analysis of AD rates

  • The death rate increased 55 percent – from 16.5 per 100,000 people in 1999 to 25.4 per 100,000 in 2014 after accounting for age.
  • Most Alzheimer’s deaths still occur in a nursing home or long-term care facility, but fewer in 2014 (54 percent) than in 1999 (68 percent).
  • Counties with the highest death rates were primarily in the Southeast; other areas with high rates included the Midwest and West Coast.

Age is the greatest risk factor for AD; most adults with the disease are 65 years or older. As fewer people die from other diseases, more survive into older adulthood and the risk for AD increases.

“As Alzheimer’s disease progresses, caregiving becomes very important. Caregivers and patients can benefit from programs that include education about Alzheimer’s disease, how to take care of themselves and their loved one, and case management to lessen the burden of care,” said Christopher Taylor, Ph.D., lead author and epidemiologist, Division of Population Health, CDC’s National Center for Chronic Disease Prevention and Health Promotion.

“Supportive interventions can lessen the burden for caregivers and improve the quality of care for people with Alzheimer’s disease.”

While there is currently no cure for AD, people should see a doctor if they experience symptoms affecting their daily life such as memory loss, difficulties with problem solving, or misplacing objects. Early diagnosis is important to allow patients and their families to begin planning medical and caregiving needs at all stages of the disease.

Article: Deaths from Alzheimer’s Disease – United States, 1999-2014, Christopher A. Taylor, PhD et al., Morbidity and Mortality Weekly Report, doi: 10.15585/mmwr.mm6620a1, published 26 May 2017.

Citation

http://www.medicalnewstoday.com/releases/317665.php

Healthline Media UK Ltd, Brighton, UK.

© 2004-2017 All rights reserved.

 

Vegetarian Diets Almost Twice as Effective in Reducing Body Weight, Study Finds

(Taylor & Francis) Dieters who go vegetarian not only lose weight more effectively than those on conventional low-calorie diets but also improve their metabolism by reducing muscle fat, a new study published in the Journal of the American College of Nutrition has found.

Losing muscle fat improves glucose and lipid metabolism so this finding is particularly important for people with metabolic syndrome and type 2 diabetes, says lead author, Dr. Hana Kahleová, Director of Clinical Research at the Physicians Committee for Responsible Medicine in Washington DC.

Seventy-four subjects with type 2 diabetes were randomly assigned to follow either a vegetarian diet or a conventional anti-diabetic diet. The vegetarian diet consisted of vegetables, grains, legumes, fruits and nuts, with animal products limited to a maximum of one portion of low-fat yoghurt per day; the conventional diabetic diet followed the official recommendations of the European Association for the Study of Diabetes (EASD). Both diets were restricted by 500 kilocalories per day compared to an isocaloric intake for each individual.

The vegetarian diet was found to be almost twice as effective in reducing body weight, resulting in an average loss of 6.2kg compared to 3.2kg for the conventional diet.

Using magnetic resonance imaging, Dr. Kahleová and colleagues then studied adipose (fat-storage) tissue in the subjects’ thighs to see how the two different diets had affected subcutaneous, subfascial and intramuscular fat (that is, fat under the skin, on the surface of muscles and inside muscles).

They found that both diets caused a similar reduction in subcutaneous fat. However, subfascial fat was only reduced in response to the vegetarian diet, and intramuscular fat was more greatly reduced by the vegetarian diet.

This is important as increased subfascial fat in patients with type 2 diabetes has been associated with insulin resistance, so reducing it could have a beneficial effect on glucose metabolism. In addition, reducing intramuscular fat could help improve muscular strength and mobility, particularly in older people with diabetes.

Dr. Kahleová said: “Vegetarian diets proved to be the most effective diets for weight loss. However, we also showed that a vegetarian diet is much more effective at reducing muscle fat, thus improving metabolism.

This finding is important for people who are trying to lose weight, including those suffering from metabolic syndrome and/or type 2 diabetes. But it is also relevant to anyone who takes their weight management seriously and wants to stay lean and healthy.”

Citation

Taylor & Francis. “Vegetarian diets almost twice as effective in reducing body weight, study finds.” ScienceDaily. ScienceDaily, 12 June 2017. <www.sciencedaily.com/releases/2017/06/170612094458.htm>.

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Journal Reference:

Hana Kahleova, Marta Klementova, Vit Herynek, Antonin Skoch, Stepan Herynek, Martin Hill, Andrea Mari, Terezie Pelikanova. The Effect of a Vegetarian vs Conventional Hypocaloric Diabetic Diet on Thigh Adipose Tissue Distribution in Subjects with Type 2 Diabetes: A Randomized Study. Journal of the American College of Nutrition, 2017; 1 DOI: 10.1080/07315724.2017.1302367

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