Changes in be­hav­ior could sig­nal de­men­tia

Research: Shifts in at­ti­tude aren’t ‘just part of ag­ing’

Houston Chronicle - - HEALTH - By Lauran Neergaard

WASH­ING­TON — Mem­ory loss may not al­ways be the first warn­ing sign that de­men­tia is brew­ing — changes in be­hav­ior or per­son­al­ity might be an early clue.

Re­searchers on Sun­day out­lined a syn­drome called “mild be­hav­ioral im­pair­ment” that may be a har­bin­ger of Alzheimer’s or other de­men­tias, and pro­posed a check­list of symp­toms to alert doc­tors and fam­i­lies.

Los­ing in­ter­est in fa­vorite ac­tiv­i­ties? Get­ting un­usu­ally anx­ious, ag­gres­sive or sus­pi­cious? Sud­denly mak­ing crude com­ments in pub­lic?

“His­tor­i­cally, those symp­toms have been writ­ten off as a psy­chi­atric is­sue, or as just part of ag­ing,” said Dr. Zahi­noor Ismail of the Uni­ver­sity of Cal­gary, who pre­sented the check­list at the Alzheimer’s As­so­ci­a­tion In­ter­na­tional Con­fer­ence in Toronto.

Now, “when it comes to early de­tec­tion, mem­ory symp­toms don’t have the cor­ner on the mar­ket any­more,” he said.

Alzheimer’s, the most com­mon form of de­men­tia, af­fects more than 5 mil­lion peo­ple in the U.S., a num­ber grow­ing as the pop­u­la­tion ages. It grad­u­ally strips peo­ple of their mem­ory and the abil­ity to think and rea­son.

But it creeps up, qui­etly rav­aging the brain a decade or two be­fore the first symp­toms be­come no­tice­able. Early mem­ory prob­lems called “mild cog­ni­tive im­pair­ment,” or MCI, can raise the risk of later de­vel­op­ing de­men­tia, and wors­en­ing mem­ory of­ten is the trig­ger for po­ten­tial pa­tients or their loved ones to seek med­i­cal help.

It’s not un­com­mon for peo­ple with de­men­tia to ex­pe­ri­ence neu­ropsy­chi­atric symp­toms, too — prob­lems such as de­pres­sion or “sun­down­ing,” ag­i­ta­tion that oc­curs at the end of the day — as the de­gen­er­a­tion spreads into brain re­gions re­spon­si­ble for more than mem­ory. And pre­vi­ous stud­ies have found that peo­ple with mild cog­ni­tive im­pair­ment are at greater risk of de­cline if they also suf­fer more sub­tle be­hav­ioral symp­toms.

What’s new: The con­cept of pre-de­men­tia “mild be­hav­ioral im­pair­ment,” or MBI, a term that de­scribes spe­cific changes in some­one’s prior be­hav­ior that might sig­nal de­gen­er­a­tion is start­ing in brain re­gions not as cru­cial for mem­ory, he said.

Also at Sun­day’s meet­ing:

• Com­plex jobs that re­quire work­ing with peo­ple may help the brain build re­silience against de­men­tia, what’s called “cog­ni­tive re­serve,” Uni­ver­sity of Wis­con­sin re­searchers re­ported.

The team tested 284 adults in late mid­dle-age whose brain scans showed changes that have been linked to an in­creased risk of Alzheimer’s. Com­par­ing their cog­ni­tive abil­ity and their ca­reers, the re­searchers found those who worked pri­mar­ily with peo­ple, rather than ob­jects or data, func­tioned bet­ter even if brain scans showed more of that quiet dam­age.

• Preliminary re­sults from a study of “brain train­ing” sug­gested one type might help de­lay cog­ni­tive im­pair­ment.

Re­searchers ex­am­ined records from 2,785 older adults who’d par­tic­i­pated in a pre­vi­ous trial that com­pared three cog­ni­tive train­ing strate­gies — to im­prove mem­ory, rea­son­ing or re­ac­tion times —with no in­ter­ven­tion. A decade later, that re­ac­tion-time train­ing sug­gested ben­e­fit: 12 per­cent of peo­ple who’d com­pleted up to 10 hours had ev­i­dence of cog­ni­tive de­cline or de­men­tia com­pared with 14 per­cent in the con­trol group, said Dr. Jerri Ed­wards of the Uni­ver­sity of South Florida. The fig­ure was lower — 8 per­cent — for peo­ple who got some extra booster train­ing.

“It’s the first hint for a cog­ni­tive train­ing in­ter­ven­tion like this,” but more research is needed, said Dr. Jonathan King of the Na­tional In­sti­tute on Ag­ing, who wasn’t in­volved in the new study.

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