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Scientists Propose New Mechanism Driving Alzheimer’s Disease

Amyloid-beta plaques have long been linked to Alzheimer’s disease, with some scientists theorizing that the plaques actually cause the degenerative brain disease.

But a new study suggests that the plaques are actually a symptom of what’s going on in the brain, rather than the cause of Alzheimer’s.

Instead, decreasing levels of the “normal,” water-soluble form of amyloid-beta is the real culprit behind Alzheimer’s, a research team argues in the Journal of Alzheimer’s Disease.

“The paradox is that so many of us accrue plaques in our brains as we age, and yet so few of us with plaques go on to develop dementia,” said lead researcher Dr. Alberto Espay. He’s director and endowed chair of the Center for Parkinson’s Disease and Movement Disorders at the University of Cincinnati Neuroscience Institute.

“Yet the plaques remain the center of our attention as it relates to biomarker development and therapeutic strategies,” Espay said in a university news release.

The team’s previous research had found that regardless of plaque buildup in the brain, people with high levels of soluble amyloid-beta kept their brain health. On the other hand, those with low levels of the protein were more likely to have cognitive impairment.

The researchers think soluble amyloid-beta levels decrease because the normal protein, exposed to stressors, starts transforming into abnormal amyloid plaques.

For this study, Espay and his team focused on amyloid-beta levels in a specific group of patients who carry mutations that predict they’d have more amyloid plaques in their brains — and therefore should be more likely to develop Alzheimer’s disease.

However, this group wound up having the same Alzheimer’s risk as the general population.

“What we found was that individuals already accumulating plaques in their brains who are able to generate high levels of soluble amyloid-beta have a lower risk of evolving into dementia over a three-year span,” Espay said.

Folks carrying a baseline level of soluble amyloid-beta can remain cognitively normal, regardless of the amount of amyloid plaques in their brains, researchers found.

These results jibe with previous clinical trials that showed that drugs effective in reducing amyloid plaques in the brain failed to slow the progression of Alzheimer’s, researchers said. Earlier studies also have shown that reducing levels of soluble amyloid-beta can cause worse outcomes for Alzheimer’s patients.

Next, the researchers plan to test whether increasing levels of soluble amyloid-beta in the brain could be a beneficial therapy for Alzheimer’s.


Source: HealthDay

Music: Bridging Memories for People With Alzheimer’s

Dennis Thompson wrote . . . . . . . . .

Wes Mika started out on drums, but in his heart he was a tambourine man.

“He got fascinated by the little silver discs on the tambourine,” said his wife, Susan Mika. “Sometimes he would hit the tambourine with the little mallets of the drum. He just he loved that tambourine.”

Wes, 77, has dementia and lives in a memory care facility in Arlington Heights, Ill., a northwest suburb of Chicago. He and Susan, 76, participated in a music program designed to help dementia patients connect with their loved ones.

The program, Musical Bridges to Memory, has been shown to enhance patients’ ability to non-verbally interact with their caregivers, according to a study published recently in the journal Alzheimer Disease and Associated Disorders.

The music therapy also reduces troubling dementia symptoms like agitation, anxiety and depression.

“He’s in a wheelchair, and it was just a nice, close connection for both of us,” Susan said. “We both enjoyed it. I would sing the lyrics I knew, and at times I would see him moving his lips. He doesn’t speak loudly but he would move his lips, so I think he knew the words and was connected with the music.”

The music program was developed by the non-profit Institute for Therapy through the Arts, and is designed to help dementia patients who are losing their ability to communicate verbally with loved ones.

In the program, a live ensemble plays music from a patient’s youth. The patient and their caregiver are encouraged to interact with the music together by singing, dancing or playing simple instruments like shakers, drums or tambourines.

It’s well-established that even as dementia wreaks havoc on the mind and memories, the degenerative brain disorder doesn’t appear to affect a person’s ability to enjoy music until much later in the disease course, said senior researcher Dr. Borna Bonakdarpour. He is an associate professor of neurology at Northwestern University Feinberg School of Medicine, in Chicago.

Because of this, patients can retain their ability to dance and sing long after their ability to talk has diminished.

“They can process music, they can get it, they receive it, they respond to it, they can dance with it, they can play with it, they can sing along with it,” Bonakdarpour said. “These are components that are pretty much intact, which is amazing.”

The Alzheimer’s Association recognizes music therapy as an important non-drug therapy for dementia, said Sam Fazio, senior director for psychosocial research and quality care.

“You’re accessing different parts of the brain that may not be affected by the disease’s symptoms,” Fazio said. “Sometimes when people can no longer express themselves in words, they can still express themselves with lyrics of a song or feel the melody.”

Helping patients and caregivers

For this study, Bonakdarpour’s team asked 21 patients and their caregivers to take part in the Musical Bridges to Memory program once a week. The study was unusual because earlier music therapy efforts have tended to focus solely on the patient, while this involved both patients and caregivers.

The program included 45 minutes of music, as well as a 15-minute talk beforehand so the music therapist could discuss specific communication skills to be addressed during the time together. Overall, patients took part in 12 sessions over three months.

The patient/caregiver pairs also were videotaped for 10 minutes before and 10 minutes after each session, so research assistants could analyze the effect music therapy had on their interactions, Bonakdarpour said.

While the program is designed to help access the musical part of a patient’s brain, these sessions also counsel caregivers on ways to patiently engage with their loved one, Bonakdarpour said.

“Things can get escalated between the patient and caregiver because the care partner doesn’t know what to do with abnormal behaviors,” he said. “A patient with a memory problem may ask the same question 10 times, and the partner can get exasperated.”

Wes and Susan took part in the program virtually because of the COVID-19 pandemic.

The music included old standards like “You Are My Sunshine,” “Take Me Out to the Ballgame,” and “You’re a Grand Old Flag,” but the musicians took requests, Susan said. She and Wes love Josh Groban, so the ensemble added some of his tunes to their repertoire.

“She would play videos and she’d do an opening and an ending song,” Susan recalled. “She asked what we wanted to hear, and she would play it for us, and then we would sing along. I was right next to him, so I would often look into his face, and we’d connect that way.”

The researchers found that non-verbal social interactions significantly increased between the patients and caregivers who took part in the program, while communication declined among eight patient/caregiver pairs who did not participate and served as a control group.

In group conversations after the music, patients were more socially engaged, the researchers said. They maintained eye contact more often, were less distracted and agitated, and were in an upbeat mood.

Bonakdarpour remembered one particular patient “who was very hyperactive and during the sessions would get up and wanted to dance with everybody. The wife was kind of embarrassed, and she would get mad at him.”

“But then as the sessions moved forward, and by the middle to end, this guy was sitting down during all the sessions with his wife,” Bonakdarpour said. “They’re communicating. They’re using percussion instruments to participate. They dance together. So it really changed their relationship.”

‘It just makes him happy’

Based on these results, Bonakdarpour’s team has received a three-year grant from the National Endowment for the Arts to expand the program and perform another clinical trial involving more patients.

Fazio praised the study because it was done with professional music therapists and with the right protocols so it could have the best possible outcomes.

“Sometimes people think they’re doing music therapy by just playing a record in the background, when that’s not really true,” Fazio said. “To have the outcomes we want, like increased engagement and less anxiety or agitation, the correct protocols need to be in place by trained music therapy professionals who understand how to use music to accomplish non-musical goals.”

Bonakdarpour is convinced that music therapy should be an important part of helping manage the symptoms of dementia patients whose capabilities are declining.

“For some of these psychiatric issues of people with dementia, we don’t have great drugs,” he said. “When we’re really desperate, we have to use some drugs that have side effects. Some of them can really affect the heart. It can even shorten people’s lives. And if you can avoid using these toxic medications, wouldn’t that be great?”

Wes enjoyed the program so much that Susan now incorporates music into their regular visits, she said. She asks an Amazon device to play a list of songs.

“Alexa plays those songs and then we just play along with the instruments. I try to find songs that he’ll remember. It just makes him happy,” Susan said.


Source: HealthDay

Lots of Napping Could Raise a Senior’s Odds for Alzheimer’s

Denise Mann wrote . . . . . . . . .

Taking longer or more frequent naps during the day may sound enticing, but it may be a harbinger of Alzheimer’s disease.

Older adults who nap throughout the day may be more likely to develop Alzheimer’s, while napping may also be a consequence of advancing Alzheimer’s, a new study suggests.

“Daytime napping and Alzheimer’s disease seem to be driving each other’s changes in a bi-directional way,” said study author Dr. Yue Leng. She is an assistant professor of psychiatry at the University of California, San Francisco.

The bottom line? “Older adults, and especially those with Alzheimer’s disease, should pay more attention to their daytime napping behaviors,” Leng said.

There are several potential ways that daytime napping and Alzheimer’s may be linked.

“It could be a reflection of underlying Alzheimer’s pathology at the preclinical stage that affects the wake-promoting network and contributes to increased daytime sleepiness,” she said. “Excessive daytime napping might also impact and interact with nighttime sleep, resulting in altered 24-hour circadian rhythms, which has also been linked to an increased risk of Alzheimer’s.”

For the study, more than 1,400 older Americans, average age 81, wore a watch-like activity monitor for two weeks every year. Any prolonged period of no activity from 9 a.m. to 7 p.m. was considered a nap. Participants also underwent a battery of neurological tests each year.

When the study started, more than three-quarters of participants showed no signs of any cognitive impairment, 19.5% had mild cognitive impairment, and slightly more than 4% had Alzheimer’s disease.

Daily napping increased by about 11 minutes per year among folks who didn’t develop cognitive impairment during roughly 14 years of follow-up. The greater the increase in naps, the more quickly memory and thinking skills declined, the findings showed.

The rate of increase in naps doubled after a diagnosis of mild cognitive impairment and nearly tripled after a diagnosis of Alzheimer’s disease, according to the report published in the journal Alzheimer’s & Dementia.

Another part of the study sought to determine if napping is a risk for developing Alzheimer’s disease. To answer this question, the researchers compared participants who had normal memories and thinking skills at the start of the study but developed Alzheimer’s disease to their counterparts whose thinking remained stable during the study. They found that older people who napped more than an hour a day had a 40% higher risk of developing Alzheimer’s.

Alzheimer’s disease affects more than just memory and thinking skills, said study author Dr. Aron Buchman. He’s a professor of neurology at Rush University Medical Center and a neurologist at Rush Alzheimer’s Disease Center, in Chicago.

In some, this disease may steal memories, but in others, it may result in sleep issues. In others, it could affect motor function, Buchman said.

“More studies are needed to better understand the relationship between napping and Alzheimer’s disease. But it’s possible that improving sleep may be a way of modifying the course of Alzheimer’s disease and its manifold manifestations,” he added.

Experts who were not involved with the study caution that it is way too early to say napping increases the risk for Alzheimer’s disease.

Study patients could have already had pre-clinical signs of Alzheimer’s disease in their brains, said Ricardo Osorio, director of the Center for Sleep and Brain Health at NYU Langone in New York City. “At age 80, even with no symptoms, it is quite common to have Alzheimer’s pathology in the brain,” he explained.

In the future, research should look at napping patterns in younger people and follow them to see who develops Alzheimer’s disease and who doesn’t, Osorio suggested.

People can nap for reasons that have nothing to do with Alzheimer’s disease, he said. Daytime naps may be a result of sleep apnea, overexertion during the day, or even depression and loneliness. “We need to tease out the other things that may cause people to nap more before drawing conclusions,” Osorio added.

There are other caveats as well, said Dr. Derek Chong, vice chair of neurology at Lenox Hill Hospital in New York City.

“This study was performed in Chicago, where the society tends to have only one sleep period at night,” Chong said. “Many other cultures and societies have a siesta or midday nap that is often longer than one hour long, and some of these cultures are known to have slow aging, so these results may not be applicable worldwide.”

Still, this study does call attention to the health consequences of poor sleep, he noted.

“Even though the study does not tell us the cause for why people need to nap more, it should remind us the importance of daytime stimulation, seeking help with depression, and high-quality sleep, and checking with your doctor for things like sleep apnea, especially when we are sleepy during the day,” Chong said.


Source: HealthDay

Having a Poor Score on a Simple Memory Test May be Linked to Alzheimer’s Biomarkers

Among people with no memory or thinking problems, having a poor score on a simple memory test may be linked to biomarkers in the brain associated with Alzheimer’s disease as well as very early signs of memory impairment that precede dementia by several years, according to a study published in the online issue of Neurology®, the medical journal of the American Academy of Neurology.

“These findings suggest that this test can be used to improve our ability to detect cognitive decline in the stage before people are diagnosed with Alzheimer’s disease,” said study author Ellen Grober, PhD, of Albert Einstein College of Medicine in the Bronx, New York. “This could be helpful in determining who to enroll in clinical trials for prevention of cognitive decline. It could also help by narrowing down those who already have signs of Alzheimer’s in the brain with a simple test rather than expensive or invasive scans or lumbar punctures.”

For the test, people are shown pictures of items and given cues about the item’s category, such as a picture of grapes with the cue of “fruit.” Then participants are asked to remember the items, first on their own, then with the category cues for any items they did not remember. This type of controlled learning helps with the mild memory retrieval problems that occur in many healthy elderly people but does not have much impact on memory for people with dementia, Grober said.

The study involved 4,484 people with no cognitive problems and an average age of 71. The participants were divided into five groups based on their scores on the test, or stages zero through four. Stages zero through two reflect increasing difficulty with retrieving memories or items learned and precede dementia by five to eight years. In these stages, people have increasing trouble remembering the items on their own, but they continue to be able to remember items when given cues. In the third and fourth stages, people cannot remember all of the items even after they are given cues. These stages precede dementia by one to three years.

The study participants also had brain scans to look for the beta-amyloid plaques in the brain that are markers of Alzheimer’s disease, as well as to measure the volume of areas of the brain associated with Alzheimer’s pathology.

Half of the participants had no memory issues. Half had retrieval issues, issues for storage of memories or both.

The researchers found that people who tested in the third and fourth stages were likely to have higher amounts of beta-amyloid in their brains than people in the lower stages. They were also more likely to have a lower volume in the hippocampus and other areas of the brain associated with Alzheimer’s pathology.

At stage zero, 30% of people had beta-amyloid plaques, compared to 31% at stage one, 35% at stage two, 40% at stage three and 44% at stage four.

Grober said, “This system allows us to distinguish between the following: the difficulty people have retrieving memories when they are still able to create and store memories in their brains, which occurs in the very early stages before dementia can be diagnosed; and the memory storage problems that occur later in this predementia phase when people can no longer store the memories in their brains.”

A limitation of the study was that the participants had a high level of education, so the results may not be applicable to the general population.


Source: American Academy of Neurology

Treasure House

Dr. Avitzur wrote . . . . . . . . .

When I was an intern, I treated a patient in the emergency department who’d had a stroke and was unable to speak. The patient’s family had shared with us his love of baseball, so one of my colleagues, also a fan, started singing “Take Me Out to the Ball Game” to him. My patient joined right in and sang every word with so much gusto that I remember the incident to this day.

Such quirks of the brain have inspired many neurologists. Best-selling author and neurologist Oliver Sacks, who wrote Musicophilia: Tales of Music and the Brain in 2007, described the phenomenon in an interview for this publication the following year: “With music, there’s something very special because of its intense coherence. Every bar of a piece naturally follows a previous bar and leads to the next, and the music is held together by a sense of expectancy. So even if one doesn’t know a piece, one feels where it is going.

“I like to imagine a sort of storage box, a treasure house deep in the brain,” Sacks told us, “in the basal ganglia, the cerebellum—parts of the brain which are not usually affected by stroke or brain damage.”

Music can reengage people with a variety of brain disorders, including dementia, as depicted in the story about Tony Bennett, the legendary singer whose career has spanned more than 70 years. As you will read below, the performer transforms onstage; he understands what he is singing and totally connects with his audience. Bennett demonstrates that music is therapeutic and can be used strategically, according to our experts, who describe how music affects memory and how to take advantage of its power to calm and soothe.

Like many people dealing with neurologic conditions, the Bennett family initially kept Tony’s diagnosis private, deciding to share it publicly later to show people that Alzheimer’s disease does not mean life is over.


Source: Brain and Life


Read more:

Tony Bennett Demonstrates the Power of Music Against Alzheimer’s Disease . . . . .

MIND Diet May Guard Against Alzheimer’s


Enlarge image . . . . .

The MIND diet may help older people ward off Alzheimer’s disease, a new study finds.

Developed by the late Martha Clare Morris, who was a Rush University nutritional epidemiologist, and her colleagues, the MIND diet is a hybrid of the Mediterranean and DASH diets.

People in the study who followed the MIND diet even later in life did not develop thinking problems, researchers say.

“Some people have enough plaques and tangles in their brains to have a postmortem diagnosis of Alzheimer’s disease, but they do not develop clinical dementia in their lifetime,” said researcher Dr. Klodian Dhana, an assistant professor in the division of geriatrics and palliative medicine at Rush Medical College in Chicago. “Some have the ability to maintain cognitive function despite the accumulation of these pathologies in the brain, and our study suggests that the MIND diet is associated with better cognitive functions independently of brain pathologies related to Alzheimer’s disease.”

For the study, researchers followed nearly 600 people who completed annual evaluations and tests to see if they had memory and thinking problems. Starting in 2004, participants were given an annual food frequency questionnaire about how often they ate 144 food items in the past year.

The MIND diet has 15 components, including 10 brain-healthy food groups and five unhealthy groups that include, red meat, butter and stick margarine, cheese, pastries and sweets and fried or fast food.

The MIND diet is rich in whole grains, green leafy and other vegetables every day. People are also encouraged to have a glass of wine and snack on nuts, and eat beans every other day or so, eat poultry and berries at least twice a week and fish at least once a week.

But people must watch their consumption of unhealthy foods, including limiting butter to less than 1 1/2 teaspoons a day and eating less than one serving a week of sweets and pastries, whole fat cheese, and fried or fast food.

“We found that a higher MIND diet score was associated with better memory and thinking skills independently of Alzheimer’s disease pathology and other common age-related brain pathologies. The diet seemed to have a protective capacity and may contribute to cognitive resilience in the elderly,” Dhana said in a university news release.

“Diet changes can impact cognitive functioning and risk of dementia, for better or worse,” he continued. “There are fairly simple diet and lifestyle changes a person could make that may help to slow cognitive decline with aging, and contribute to brain health.”

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


Source: HealthDay

Time Until Dementia Symptoms Appear Can be Estimated Via Brain Scan

Tamara Bhandari wrote . . . . . . . . .

Researchers at Washington University School of Medicine in St. Louis have developed an approach to estimating when a person with no cognitive symptoms will start showing signs of Alzheimer’s dementia based on data from brain scans and the person’s age.

Researchers at Washington University School of Medicine in St. Louis have developed an approach to estimating when a person who is likely to develop Alzheimer’s disease, but has no cognitive symptoms, will start showing signs of Alzheimer’s dementia.

The algorithm, available online in the journal Neurology, uses data from a kind of brain scan known as amyloid positron emission tomography (PET) to gauge brain levels of the key Alzheimer’s protein amyloid beta.

In those who eventually develop Alzheimer’s dementia, amyloid silently builds up in the brain for up to two decades before the first signs of confusion and forgetfulness appear. Amyloid PET scans already are used widely in Alzheimer’s research, and this algorithm represents a new way of analyzing such scans to approximate when symptoms will arise. Using a person’s age and data from a single amyloid PET scan, the algorithm yields an estimate of how far a person has progressed toward dementia — and how much time is left before cognitive impairment sets in.

“I perform amyloid PET scans for research studies, and when I tell cognitively normal individuals about positive results, the first question is always, ‘How long do I have until I get dementia?’,” said senior author Suzanne Schindler, MD, PhD, an assistant professor of neurology. “Until now, the answer I’d have to give was something like, ‘You have an increased risk of developing dementia in the next five years.’ But what does that mean? Individuals want to know when they are likely to develop symptoms, not just whether they are at higher risk.”

Schindler and colleagues analyzed amyloid PET scans from 236 people participating in Alzheimer’s research studies through Washington University’s Charles F. and Joanne Knight Alzheimer Disease Research Center. The participants were an average of 67 years old at the beginning of the study. All participants underwent at least two brain scans an average of 4½ years apart. The researchers applied a widely used metric known as the standard uptake value ratio (SUVR) to the scans to estimate the amount of amyloid in each participant’s brain at each time point.

The researchers also accessed over 1,300 clinical assessments on 180 of the participants. The assessments typically were performed every one to three years. Most participants were cognitively normal at the start of data collection, so the repeated assessments allowed the researchers to pinpoint when each participant’s cognitive skills began to slip.

Schindler spent years trying to figure out how to use the data in amyloid PET scans to estimate the age at which symptoms would appear. The breakthrough came when she realized that amyloid accumulation has a tipping point and that each individual hits that tipping point at a different age. After this tipping point, amyloid accumulation follows a reliable trajectory.

“You may hit the tipping point when you’re 50; it may happen when you’re 80; it may never happen,” Schindler said. “But once you pass the tipping point, you’re going to accumulate high levels of amyloid that are likely to cause dementia. If we know how much amyloid someone has right now, we can calculate how long ago they hit the tipping point and estimate how much longer it will be until they are likely to develop symptoms.”

People in the study who reached the tipping point at younger ages took longer to develop cognitive symptoms than those who reached it later in life. Participants who hit the tipping point at age 50 typically took nearly 20 years to develop symptoms; those who hit it at age 80 took less than 10 years.

“When we look at the brains of relatively young people who have died with Alzheimer’s, they typically look pretty healthy, other than Alzheimer’s,” Schindler said. “But older people more frequently have damage to the brain from other causes, so their cognitive reserves are lower, and it takes less amyloid to cause impairment.”

The power of this new technique is that it requires just one brain scan, plus the person’s age. With that data, the model can estimate the time to symptom onset, plus or minus several years. In this study, the correlation between the expected age of symptom onset and the true age at diagnosis was better than 0.9 on a scale of 0 (no correlation) to 1 (perfect correlation).

After age, the genetic variant APOE4 is the strongest risk factor for Alzheimer’s dementia. People who carry one copy of the variant are two to three times more likely to develop Alzheimer’s dementia than the general population, and people who carry two copies are 10 times more likely. In this study, people with the high-risk variant hit the tipping point younger, but once that point was passed, they followed the same trajectory as everyone else.

“APOE4 seems to have a seeding effect,” Schindler said. “At very low levels, below the tipping point, you see amyloid rising in people with APOE4 while it’s not changing in people without APOE4. That means APOE4 carriers are going to hit the tipping point sooner. People with two copies of APOE4 hit the tipping point about 10 years earlier than people with no copies. But after that point, we see no difference between the APOE4 carriers and noncarriers.”

With an out-of-pocket cost of around $6,000, amyloid PET brain scans may be financially out of reach for many people. However, this algorithm could help accelerate the pace of drug development by streamlining clinical trials.

“Most participants in clinical trials designed to prevent or slow Alzheimer’s symptoms do not develop symptoms during the trials,” Schindler said. “That’s a lot of time and effort — for the participants as well as the researchers — that doesn’t yield useful data. If we could do trials only on people who are likely to develop symptoms in the next few years, that would make the process of finding therapies much more efficient.”


Source: Washington University School of Medicine

Some Diabetes Meds Might Also Lower Alzheimer’s Risk

Amy Norton wrote . . . . . . . . .

Older adults who take certain diabetes drugs may see a slower decline in their memory and thinking skills, a new study suggests.

Researchers in South Korea found that among older people who’d been having memory issues, those using diabetes drugs called DDP-4 inhibitors typically showed a slower progression in those symptoms over the next few years. That was compared with both diabetes-free older adults and those taking other diabetes medications.

People on DDP-4 inhibitors also showed smaller amounts of the “plaques” that build up in the brains of people with Alzheimer’s disease.

Experts cautioned that the findings do not prove the drugs can prevent or delay dementia.

To do that, researchers would need to conduct clinical trials that directly test the medications, said Dr. Howard Fillit, chief science officer for the nonprofit Alzheimer’s Drug Discovery Foundation in New York City.

But, he said, the study adds to evidence that certain existing medications — including some for diabetes or high blood pressure — could be “repurposed” for protecting the aging brain.

In fact, other diabetes medications, such as metformin and GLP-1 agonists, are already being studied for slowing down declines in memory and thinking skills.

There has been less research, Fillit said, into DDP-4 inhibitors — which include oral medications like sitagliptin (Januvia), linagliptin (Tradjenta), saxagliptin (Onglyza) and alogliptin (Nesina). They share a similarity with GLP-1 agonists, in that they act on the same “pathway” in the body.

Fillit explained that DDP-4 inhibitors work by boosting blood levels of GLP-1, a gut hormone that stimulates insulin release. Insulin is a hormone that regulates blood sugar.

People with diabetes are resistant to insulin, which results in chronically high blood sugar levels. Some studies have found that people with Alzheimer’s also have problems with insulin resistance — and researchers have speculated that may contribute to the brain degeneration seen in the disease.

But Fillit said that diabetes medications might have effects beyond improving insulin resistance.

Animal research has suggested DDP-4 inhibitors can reduce brain inflammation and protect brain cells from Alzheimer’s-like injury.

For the current study, researchers led by Dr. Phil Hyu Lee of Yonsei University College of Medicine in Seoul reviewed the cases of 282 patients who had come to their clinic with complaints about their memory and thinking abilities. Brain scans had shown all had evidence of amyloid — the protein that makes up Alzheimer’s-related plaques.

Of those patients, half had diabetes: 70 were taking a DDP-4 inhibitor, and 71 were using other diabetes drugs, most often metformin and sulfonylureas.

On average, the researchers found, patients on DDP-4 inhibitors had less amyloid buildup than either the diabetes-free patients or those on other diabetes medications. And over the next few years, they also showed a slower decline on tests of memory and thinking.

The findings were published online in the journal Neurology.

Maria Carrillo, chief science officer for the Alzheimer’s Association, stressed that the study cannot prove DDP-4 inhibitors slow down the dementia process.

One of the study’s limitations, she noted, is that patients’ amyloid levels were only measured at the start. So it’s not clear whether those on DDP-4 inhibitors had a slower accumulation of brain plaques over time.

It’s well known, Carrillo said, that people with diabetes have a higher risk of developing Alzheimer’s than those without diabetes — though the reasons are not fully clear, she added.

Insulin resistance, as well as high blood sugar, may partly explain it, according to the Alzheimer’s Association. Carrillo noted that this study did not look at patients’ long-term blood sugar control — and whether that had any role in their rates of decline over time.

“There is some rationale for looking at these diabetes drugs in people with Alzheimer’s,” Carrillo said.

But like Fillit, she said only randomized clinical trials — where patients are randomly assigned to take a DDP-4 inhibitor or not — can prove whether there are benefits.

One question for future studies, Fillit said, is whether DDP-4 inhibitors can slow mental decline in people without diabetes, or only those with the disease.

Because Alzheimer’s is so complex, Fillit said it is likely that medication combinations — aimed at different mechanisms behind the disease — will prove most effective at treating or preventing the disease.

Both of the nonprofits encourage people to eat a healthy diet, exercise, avoid smoking and engage in mentally stimulating activities to help keep their bodies and minds in good shape as they age.


Source: HealthDay

Cleaning Up the Air Could Help Prevent Alzheimer’s

Dennis Thompson wrote . . . . . . . . .

Air pollution causes you to gasp and wheeze. Smog puts strain on your hearts and inflames your lungs.

Could dirty air also be costing you your brain health?

A trio of new studies finds that air quality appears linked to a risk of thinking declines and dementia, and bad air might even promote toxic brain proteins that are a hallmark of Alzheimer’s disease.

“This is extremely exciting, because it indicates the potential that improving air quality levels could have on mortality levels, other areas of health, and also perhaps risk of dementia,” said Claire Sexton, director of scientific programs and outreach for the Alzheimer’s Association.

In the first study, researchers found that reduction of fine particulate pollution and smog over a decade was tied to reductions in dementia risk among women.

The study followed more than 2,200 women between the ages of 74 and 92 without dementia who’d enrolled in a long-term study of brain health. Researchers tracked their thinking, reasoning and memory skills as they aged, and compared the results to the air quality of their various communities.

The women’s risk of dementia decreased by up to 26% for every 10% improvement in air quality in their neighborhoods, the researchers concluded. Women in areas with cleaner air had dementia risk similar to that seen in women two to three years younger.

Cleaner air also seems to slow overall decline in cognitive function and memory, similar to women one to two years younger, results showed.

These benefits occurred regardless of age, education or neighborhood, said lead researcher Xinhui Wang, an assistant professor of research neurology at the University of Southern California.

“Air pollution is a modifiable risk factor,” Wang said. “The impact will be great because everybody is exposed to some level of air pollution. If we reduce air pollution, everybody will benefit.”

A second study from researchers led by Noemie Letellier, a postdoctoral scholar at University of California, San Diego, found that reductions in fine particle pollution between 1990 and 2000 caused dementia and Alzheimer’s risk to fall among a group of more than 7,000 people in France.

Dementia risk fell by 15% and Alzheimer’s risk by 17% for every microgram reduction in air pollution per cubic meter of air, researchers found. Again, the changes benefited everyone, regardless of their income or where they lived in a community.

The third study, led by Christina Park, a doctoral student in the University of Washington’s Department of Epidemiology, provided a potential explanation for why air pollution might affect brain health.

Researchers found that people with longer exposure to particle pollution and smog had higher levels of beta amyloid, a sticky protein that can clump in the brain. Amyloid plaques are one of the hallmarks of Alzheimer’s disease.

Air pollution also might increase dementia risk by causing inflammation in the body and by damaging heart and lung health, Wang and Sexton said.

So battling air pollution might not be just a way to stop climate change and protect heart health, but a way to actually reduce dementia among aging folks, experts concluded.

“There’s been improvements in air quality over a number of years and decades, but there’s still so much further to go,” Sexton said. “Globally, more than 90% of people breathe air that fails to meet World Health Organization standards.”

All three studies will be presented Monday at the Alzheimer’s Association annual meeting, held both in Denver and online. Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.


Source: HealthDay

Study: Reading, Puzzles May Delay Alzheimer’s by 5 Years

An active mind in old age may delay Alzheimer’s disease by up to five years, a new study suggests.

Activities like reading, writing letters, playing cards or doing puzzles may prolong brain health even for those in their 80s, researchers say.

“The key element is that you’re processing information,” said lead researcher Robert Wilson, a professor in the neurological sciences department at Rush University Medical Center, in Chicago.

“Reading is certainly important, but anything that stimulates the mind and is challenging to you intellectually can be helpful,” he said.

Wilson cautioned that this study can’t prove that being mentally active delays dementia, but it “suggests that reading and various cognitive activities may be helpful.”

Although other studies have shown that an active mind delays dementia, this study put a real-world timeframe on the delay.

“There are already estimates that a five-year delay in the onset of this disease could reduce its impact by 40% in the population,” he said.

For the study, Wilson’s team collected data on nearly 2,000 people with an average age of 80 who did not have dementia at the start of the study.

Over seven years, participants were given several mental acuity, or cognitive, tests.

At the start, participants were asked how often they read books and how often they played games like checkers, board games, cards or puzzles in the past year. Participants were also asked about cognitive activity in childhood, adulthood and middle age.

Over the follow-up period, 457 people with an average age of 89 developed Alzheimer’s dementia. Those who had the highest levels of mental activity developed dementia at 94. Those with the lowest levels developed dementia at 89, the researchers found.

Wilson’s group also studied the brains of 695 people who died during the study. They looked for markers of Alzheimer’s like amyloid and tau deposits and tangles, but no association between mental activity and markers of Alzheimer’s disease or other disorders in the brain was found.

Wilson noted that “keeping mentally active is not a pill to stop the underlying plaques and tangles” linked with Alzheimer’s disease. The buildup of amyloid protein plaques in the brain, as well as “tangles” of another protein, tau, are hallmarks of the illness.

Although there are no effective treatments or cures for Alzheimer’s, Wilson and another expert, Dr. Sam Gandy of New York City, said the study adds to evidence that lifestyle changes are one way to help ward off dementia.

“This fits beautifully with decades of basic science and provides the first detailed ‘prescription’ for cognitive activity that doctors can offer to their patients and to the public at large,” said Gandy. He is associate director of the Mount Sinai Alzheimer’s Disease Research Center and a professor of neurology and psychiatry at the Icahn School of Medicine at Mount Sinai.

“We have had three sessions of 30 minutes each per week of brisk walking or weight training for a while. Now we can add this cognitive activity prescription to our repertoire,” Gandy said.

Wilson added, “Changing lifestyles to be more conducive to having a healthy brain can have an enormous impact on your risk for this disease.”

The report was funded by the U.S. National Institute on Aging, and published online in the journal Neurology.


Source: HealthDay