Se­nior Care

Novem­ber be­ing Alzheimer’s Dis­ease Aware­ness Month, we bring you some re­cent re­search, strate­gies and treat­ments to help you pre­serve your mem­ory and brain health as you age.

Health & Nutrition - - CONTENTS -

Strengthen your mind, this Alzheimer’s Dis­ease Aware­ness Month

Alzheimer’s Dis­ease (AD) af­fects mil­lions across the world, and there is cur­rently no cure. How­ever, neu­rol­o­gist Sam Gandy, MD, PhD, director of Mount Si­nai’s Cen­tre for Cog­ni­tive health and NFL Cog­ni­tive Care, says that there are some hope­ful de­vel­op­ments in AD re­search – along with po­ten­tially promis­ing data you may have seen re­ported in the news that needs fur­ther in­ves­ti­ga­tion be­fore its clin­i­cal sig­nif­i­cance can be clar­i­fied. Here, Dr Gandy of­fers his verdict on some re­cent stud­ies.

Down­ward Trend in De­men­tia

A large study pub­lished in ‘JAMA In­ter­nal Medicine’, sug­gests that be­tween 2000 and 2012, the preva­lence of de­men­tia de­creased by about 25% in peo­ple aged 65 and older, even though the pop­u­la­tion has con­tin­ued to age. Those with the most years of ed­u­ca­tion had the low­est chances of de­vel­op­ing de­men­tia.

Doc­tor’s verdict Car­dio­vas­cu­lar risk fac­tors such as high blood pres­sure, choles­terol, and blood su­gar may play a role in AD. Dur­ing the last decade, progress has been made in ad­dress­ing these risk fac­tors, and more peo­ple are tak­ing med­i­ca­tions to treat them. These data re­flect that progress.

Choles­terol Fluc­tu­a­tions a Fac­tor?

The con­nec­tion be­tween heart and brain health is un­der­lined by a study as­so­ci­at­ing greater fluc­tu­a­tions in LDL (‘bad’ choles­terol) lev­els with worse cog­ni­tive func­tion in se­niors. The study in ‘Cir­cu­la­tion’ in­cluded 4,428 older adults who un­der­went stan­dard mem­ory tests. Com­pared to peo­ple with the low­est vari­abil­ity in LDL, those with the high­est LDL vari­abil­ity took 2.7 sec­onds longer, on av­er­age, to name the real colours of colour names writ­ten in dif­fer­ent ink (for ex­am­ple, the world blue writ­ten in red ink). Greater LDL fluc­tu­a­tions also were as­so­ci­ated with lower brain blood flow, and a greater num­ber of white mat­ter hy­per­in­ten­si­ties (tiny le­sions that have been as­so­ci­ated with a greater risk for AD).

Doc­tor’s verdict High choles­terol is as­so­ci­ated with a

build-up of an ab­nor­mal pro­tein called beta-amy­loid in the brain. It is be­lieved that beta-amy­loid de­posits con­trib­ute to AD by de­stroy­ing the brain cells’ abil­ity to com­mu­ni­cate with each other. In mouse stud­ies, low­er­ing choles­terol works like magic: Beta-amy­loid melts away – but no hu­man trial has come close to achiev­ing the same re­sult. Fur­ther stud­ies are needed to ex­am­ine whether these data could be use­ful in clin­i­cal prac­tice, but right now they sup­port ex­pert ad­vice to fol­low healthy lifestyle mea­sures that can help main­tain nor­mal choles­terol lev­els.

The Role of Tau

Of the two ab­nor­mal pro­teins that char­ac­ter­ize AD, beta amy­loid has been more thor­oughly stud­ied than tau, which builds up and forms tan­gles in the brains of peo­ple with AD. This is largely due to the de­vel­op­ment of new brain scan­ning tech­niques that al­low re­searchers to vi­su­al­ize beta-amy­loid – and sim­i­lar tech­niques can now vi­su­al­ize tau. A re­cent small study (‘Science Trans­la­tional Medicine’) in­cluded 10 peo­ple with mild AD and 36 healthy older adults. Par­tic­i­pants un­der­went imag­ing scans for beta-amy­loid and tau, and com­pleted stan­dard tests of mem­ory and cog­ni­tion. Peo­ple with AD had an ac­cu­mu­la­tion of beta-amy­loid and tau tan­gles. The lo­ca­tion in the brain of the tau tan­gles cor­re­lated to the spe­cific prob­lems with mem­ory and think­ing ex­pe­ri­enced by the par­tic­i­pants with AD, but this was less true for beta-amy­loid. Doc­tor’s verdict These find­ings sug­gest that tau tan­gles more closely track the symp­toms of AD. The fail­ure of drugs that are de­signed to tar­get be­taamy­loid means sci­en­tists are now in­ves­ti­gat­ing tau-low­er­ing ther­a­pies. The first tau drugs are in tri­als. How­ever, the key will still be early in­ter­ven­tion, be­fore the dam­age caused by AD has been set in mo­tion.

Vi­ta­min D Con­nec­tion

In ad­di­tion to its es­sen­tial role in build­ing healthy bones, vi­ta­min D has ef­fects on other or­gans in the body, in­clud­ing the brain. Stud­ies sug­gest that peo­ple with AD have low vi­ta­min D lev­els. For a 15-year study pub­lished in the ‘Jour­nal of Alzheimer’s Dis­ease’, re­searchers mea­sured vi­ta­min D lev­els in more than 3,400 peo­ple aged 60 and older. Those with a vi­ta­min D de­fi­ciency per­formed worse on tests of cog­ni­tive func­tion, and also tended to have a smaller hip­pocam­pus. This brain struc­ture, which is in­volved in short term mem­ory, is one of the first af­fected by AD.

Doc­tor’s verdict There is lots of new re­search into vi­ta­min D, which ap­pears to ac­ti­vate the im­mune sys­tem’s ‘garbage dis­posal’ cells in the brain. These cells may help clear be­taamy­loid. Vi­ta­min D should be checked rou­tinely and treated if low, but it is im­por­tant to keep in mind that there cur­rently is no ev­i­dence that

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