When Both Parents Have Alzheimer's

A recent study reports that if both parents have Alzheimer's, the risk of dementia in their offspring doubles. The risk of developing Alzheimer's for the general public is approximately 6-13%; however the risk increases to 22.6%  chance if both parents had the disease.

The bad news is that most of the people in the study were younger than 70.  Since the risk of developing Alzheimer's naturally increases with age, in all likelihood the actual risk of developing the disease if both parents had it may be higher than reported.

Antipsychotics and Alzheimer's

A new study from the UK suggests that neuroleptics commonly given to Alzheimer's patients with behavioral problems provide no benefit and may actually decrease verbal skills.

The term "neuroleptic" refers to medications that are used to affect behavior such as confusion, delusions, hallucinations, aggression, and agitation in patients with psychotic symptoms.  They are also used as sedatives in patients with dementia.

Some of the more common neuroleptics include Haldol, Risperdal, Clozapine, Zyprexa, Seroquel, Geodon, and Abilify.

Many Alzheimer's patients in nursing homes are given neuroleptics to control their behavior.  

In the British study, published in the Public Library of Medical Science, six months of treatment with a neuroleptic resulted in pronounced deficits in verbal skills.  Another study is underway to investigate the hypothesis that neuroleptics may also increase death rates.

Researchers suggest that using neuroleptics to treat behavior problems should be considered a last resort in patients with severe problems who have not responded to other forms of treatment.

Prevent Head Injuries in Older Adults

Falling is the single largest cause of injuries for adults over the age of 65 in the United States.  One way to lower your risk of developing dementia is to lower your risk of falling and injuring your head.

To make your living environment safer, the Centers for Disease Control and Prevention advises the following:

-- Remove anything that might cause you to trip, including throw rugs or excessive clutter in walkways

-- Use non-slip mats in the bathtub or on shower floors

-- Install grab bars next to the toilet and tub or shower

-- Install handrails on both sides of a stairway

-- Improve lighting throughout the home

-- Maintain a regular exercise program to improve lower body strength and balance

Research suggests that a person who has experienced a head injury has a significantly greater likelihood of developing dementia.  

Is it Depression or Dementia

Do you know the difference between depression and dementia?  

Depression is often referred to as "pseudo-dementia" because the symptoms can look like dementia in older adults.  Differentiating between depression and dementia is important because each condition requires different treatment and has a different expected outcome.

Here is a quick guide to distinguishing between depression and dementia:

Memory:

In depression, memory deficits are usually due to reduced attention and concentration. One key indicator is that the person usually complains and worries about their memory difficulties.

In dementia, a person has difficulty remembering things that occurred a short time ago, such as what they ate for breakfast.  Many adults with dementia try to mask their deficits for as long as possible so they do not usually complain about their poor memory.

Memory and Mood:

In a depressed person, mood and memory are often related.  If the person is experiencing impairments in memory, than their mood is often depressed.

In a demented adult, mood and memory are not related.  As a person memory declines, they often become irritable and dull as they withdraw from activities they used to enjoy.

Language:

People who are depressed may complain about having a difficult time expressing themselves, but they are able to speak, write and use language in an appropriate manner.

People with dementia often have trouble finding the right name for an object.  They may point to their watch when they are trying to discuss the time or refer to a toothbrush as "that thing I clean my teeth with."

Adults with dementia also have difficulty remembering the proper use for common everyday objects.  

When a doctor attempts to test a person's cognition, people with depression will make disparaging comments about their poor memory, often describing it as being worse than it actually is.  Adults with dementia try to hide their impairments and will often become irritable or try to change the subject to avoid the test.

If you are concerned about whether or not a loved one's memory loss is due to depression or dementia, a neuropsychological assessment can help to differentiate between the two so that appropriate interventions can be put into place.

Study Shows a Large Belly Increases the Risk of Dementia

A Kaiser Permanente study, published in the March 26, 2008 issue of Neurology, suggests that people in their 40's with larger bellies have a higher risk of developing dementia when they reach their 70's.

Previous studies have also shown that a large abdomen increases the risk of diabetes, stroke, and coronary heart disease.  These illnesses also increase the risk of dementia.

Researchers in Northern California studied 6583 adults aged 40-45.  Approximately 36 years later, 16% of these people had developed dementia.  

Those who were overweight and carried excess fat in their abdomen were 2.3 times more likely to develop dementia than similarly matched adults at a healthier weight.  

Subjects who were obese and had a large belly had a 3.6 times greater likelihood of developing dementia than their healthy counterparts.

Obesity is defined as having a Body Mass Index (BMI) of 30 or above while overweight is considered a BMI of 25.  A BMI of 30 means a person is approximately 30 pounds overweight.  The BMI is calculated using a person's height and weight and correlates strongly with overall fat content.

To calculate your own BMI go to www.halls.md/body-mass-index/av.htm

Additionally, researchers found that those most likely to have abdominal obesity were non-whites, smokers, people with high blood pressure, high cholesterol or diabetes, and those with less than a high school education.

Alzheimer's Patients Being Enrolled in Eli Lilly Study

Eli Lilly has started Phase 3 of a clinical trial investigating the use of a potential new medication for Alzheimer's patients with mild to moderate dementia.  

The medication is a gamma secretase inhibitor, which means it is supposed to inhibit the action of gamma secretase, which is an enzyme that can create amyloid beta, the sticky protein that forms plaque in the brain.  The plaque is believed to be at least partially responsible for killing brain cells, resulting in the cognitive decline that are the hallmark of Alzheimer's dementia.

The clinical trial is called The IDENTITY Trial:  Interrupting Alzheimer's Dementia by EvaluatiNg Treatment of AmyloId PaThologY.

For more information about the IDENTITY Trial, go to Eli Lilly's website:

www.lillytrials.com  or www.clinicaltrials.gov

You can also call 1-877-CTLilly  (1-877-285-4559).

Alzheimer's Facts

A recent report published by the Alzheimer's Association revealed the following facts:

-- As many as 5.2 million people in the US are currently living with Alzheimer's dementia.

-- Someone develops Alzheimer's every 71 seconds.

-- Alzheimer's is the 7th leading cause of death (after heart disease, cancer, stroke, chronic respiratory disease, accidents, and diabetes)

-- The cost of Alzheimer's is estimated to be $148 billion a year

-- The number of adults diagnosed with Alzheimer's is expected to at least triple by the year 2050 in developed countries.

-- The average duration between the onset of symptoms and death is about 8-10 years

-- There is currently no cure for Alzheimer's.  Some medications are thought to slow down the progression of the disease but they do not work for everyone.

For more information visit their website at www.alz.org

Fighting Dementia Should Start in Midlife

New research suggests that the fight to ward off dementia should begin in midlife.

Although most midlife adults are cognitively healthy, 10-15% begin to show some decline in their intellectual abilities.  Many of those have hypertension.  

Contrary to popular belief, cognitive decline is not inevitable as a person ages.  One important factor seems to be that people who believe they have control over their lives tend to be happier and better health than those who feel they are at the mercy of forces beyond their control.   

The reason for this seems to be that those who feel they have some control over their lives will take steps to ward off decline in memory and intellectual functioning more often than those who feel their efforts will come to nothing.  In addition, many people who feel they are declining and can do nothing about it often feel greater levels of stress and anxiety, which in turn can interfere with cognitive functioning.

The steps to ward off cognitive decline and keep your brain healthy are deceptively simple:  eat well, know your numbers (blood pressure, cholesterol, weight, etc), exercise daily, spend time with friends and loved ones, learn something new, and keep your levels of stress down.  

Easier said than done, no?

Alzheimer's and Finances

An article published in USA Today reports, "People who are in the early stages of Alzheimer's disease show rapid decline in their ability to manage their financial affairs."

Alzheimer's patients suffer from confusion and memory loss and lose their ability to manage their day to day affairs. Often this is one of the first signs noticed by family and friends.

Researchers gave early Alzheimer patients everyday financial tasks and found that they had some difficulty filling out checks or preparing a bill for the mail. One year later, these same adults showed even more decline in their ability to manage their finances.

Many Alzheimer's patients become the victim of fraud schemes by phone or by mail. I have seen several patients in recent months who have sent money to complete strangers after being told over the phone that they have won a sweepstakes or some other prize. The money is never recovered and this type of fraud is becoming more and more commonplace.

This research highlights the importance of being diagnosed in the early stages of dementia so you can still make decisions about your future. Early stage patients should make an appointment with a lawyer to outline how they want their affairs handled while they still can. Documents such as a Durable Power of Attorney allow family members to take over the management of a person's affairs when their disease renders them incapable of managing on their own.

Driving and Dementia

A new study from Rhode Island Hospital and Brown University show that adults who have Alzheimer's disease are involved in more traffic accidents and perform more poorly on driving tests than their peers who do not have any cognitive impairment.

Researchers studied 128 older drivers. Eighty-four were in the early stages of Alzheimer's and 44 were age-matched controls with no cognitive impairment.  The goal was to understand driving impairments in adults with very mild to mild dementia.

In addition to an increase in traffic accidents and a decrease in performance on driving tests, adults with Alzheimer's showed significant and steady decrease in their driving abilities over time.  Although some individuals with very mild dementia can continue to drive safely for a period of time, regular driving assessments are necessary to avoid accidents.

So how do you know when you or your loved one should stop driving?  Some people naturally understand the risks involved in driving with a cognitive impairment and stop by themselves.  Others lack the ability to judge their skills and may insist they are able to continue to drive even when it becomes obvious to others they cannot.

Driving is privilege, not a right and adults who have been diagnosed with very mild or mild dementia have an obligation to have their driving skills evaluated.  Individuals with moderate to severe dementia should not drive at all.

Independent driving evaluations are often available through driver rehabilitation programs or your state DMV.  Googling "driver evaluation" and your state should get you several names in your geographic area who offer this service. 

Your physician may be required to report a diagnosis of dementia to the DMV, resulting in the automatic suspension of a driver's license.  However, reporting laws are different in each state.  When a driver is reported to the DMV, they may be required to take a new behind-the-wheel driving test.

If you or other family members are driving with a person with dementia, it is your obligation to monitor their driving skills.  Signs of potential trouble include drivers who stop in traffic for no apparent reason or fail to stop at stop signs or red lights; getting lost in familiar areas or not being able to remember the way home; traffic violations, fender benders or near-misses; or driving too slowly.

High Blood Pressure and Dementia

Health advocates stress the importance of "knowing your numbers."  These important numbers include your weight, body fat, cholesterol, blood sugar, and blood pressure.  Overall physical health is important to maintain a healthy brain.  Uncontrolled high blood pressure leads to more cognitive problems as we age.  Blood pressure naturally increases with age and hypertension, sometimes referred to as "the silent killer," affects approximately 60% of adults over the age of 60.

Multi-infarct dementia, one of the most common causes of dementia in older adults, is caused by a series of strokes that destroy nerve tissue in the brain.  The most common risk factor for this type of dementia is high blood pressure.

If you don't know your numbers, you should see your doctor and have your blood pressure tested.  In the meantime, The Mayo Clinic has an online quiz to check your risk of high blood pressure.  It only takes a few minutes and it just might save your life!

B12 Helps Maintain a Healthy Brain

A new study in the American Journal of Clinical Nutrition (November 2007) suggests that deficiencies of vitamin B12 can cause cognitive impairment in adults.  The study tracked 1648 men and women over the age of 65 over the course of 10 years.  

Vitamin B12, also called cobalamin, helps to keep nerve cells and red blood cells healthy.  It is also used in making DNA.  It is found in many foods that come from animals, including fish, meat, poultry, eggs, milk and milk products.

Symptoms of a B12 deficiency include: anemia, fatigue, weakness, constipation, numbness and tingling in the hands and feet, depression, confusion, disorientation, dementia, and soreness in the mouth.  Many of these symptoms mimic the signs of Alzheimer's but are reversible with the proper treatment.  

According to the National Institutes on Health, " Vitamin B12 is bound to the protein in food. Hydrochloric acid in the stomach releases vitamin B12 from proteins in foods during digestion.  Once release, vitamin B12 combines with a substance called intrinsic factor (IF).  This complex can then be absorbed by the intestinal tract."  Because of this process, adults with GI problems who use some antacids that slow the release of hydrochloric acid into the stomach, may not be able to effectively absorb B12.  Examples of these medications include Prilosec, Prevacid, Tagament, Pepsid, and Zantac.

Metaformin, a drug used to treat diabetes, may interfere with the absorption of calcium which then leads to difficulty in the absorption of B12.  Researchers found that using calcium carbonate supplements helped to minimize the effect of Metaformin on the malabsorption of B12.

If you take any of these medications and are experiencing cognitive difficulties (problems with your memory, concentration, attention, thinking) talk to your doctor.  He or she may order blood tests and/or suggest supplements.  It is important that you do not stop taking anything that has been prescribed by your physician without medical advice.

For more information on Vitamin B12, including a list of foods high in B12 and a list of medications that may interfere with the absorption of B12, see the factsheet from the National Institutes on Health at http://dietary-supplements.info.nih.gov/factsheets/vitaminb12.asp

Normal Aging and Dementia

Do you know the difference between normal aging and dementia?  If not, the Alzheimer's Association publishes the following list:  10 Warning Signs of Dementia.  If you are concerned about your ability to think, to remember, or to concentrate, ask yourself the following questions:

1.  Memory Loss:  Forgetting recently learned information is one of the most common early warning signs of Alzheimer's disease.  Do you forget things more often or find yourself unable to recall information later?  Do your friends or family tell you that you keep repeating the same question over and over again?

2.  Difficulty Performing Familiar Tasks:  Do you have difficulty planning or completing everyday tasks?  Do you lose track of the steps involved in preparing a meal, placing a telephone call, or playing a game?

3.  Problems with Language:  Do you often forget simple familiar words or substitute unusual words?  Do you mimic actions when you can't remember the words to describe them?  People with dementia may be unable to think of the word "toothbrush" for instance and instead ask for "that thing in my mouth" or mimic the action of brushing their teeth.

4.  Disorientation to Time and Place:  Do you ever get lost in your own neighborhood, forgetting where you are or how you got there?  Have you ever been unable to find your way home?

5.  Poor or Decreased Judgment:  Has anyone told you lately that you dress inappropriately, wearing several layers on a warm day or little clothing in the cold?  Do you ever show poor judgment, like giving away large sums of money or engaging with telemarketers who tell you you've won a sweepstakes?

6.  Problems with Abstract Thinking:  Do you ever have unusual difficulty performing complex mental tasks, like forgetting what numbers are for and how they should be used?

7.  Misplacing Things:  Do you ever put things in unusual place, such as your watch in the sugar bowl or your keys in the freezer?

8.  Changes in Mood or Behavior:  Do you experience rapid mood swings, from calm to anger or tears, for no reason?

9.  Changes in Personality:  The personalities of people with dementia can change dramatically.  Have you become extremely confused, suspicious, fearful or dependent on family members?

10.  Loss of Initiative:  Have you become very passive, sitting in front of the TV for hours, sleeping more than usual?  Have you lost interest in your usual activities?

To find out more about the 10 Warning Signs of Dementia, visit the Alzheimer's Association website at www.alz.org

Most Older Adults Have Brain Disease

A study from The Rush Memory and Aging Project at Rush University Medical Center in Chicago suggests that most older adults have significant brain disease when they die even if they don't have any signs or symptoms of dementia.

Researchers in the study evaluated the brains of 141 subjects, both with and without any clinical signs of dementia.  Only 20 were free of any physical signs of brain disease.  And many of the subjects with clinically diagnosed dementia had several different types of pathology causing their cognitive impairment.  The most common combination was Alzheimer's along with signs of stroke damage; the second was Alzheimer's with Lewy Body disease, which has symptoms similar to Parkinson's disease.

The take away message from this research is that, although the prevention of Alzheimer's is important, it is also necessary to prevent other types of pathologies such as stroke by managing high blood pressure, high cholesterol, diabetes, obesity, and smoking.

For more information or to participate in the Memory and Aging Project, go to

www.rush.edu.rumc/page-1099611542239.html