dementia » Alzheimer's Association

Lee’s Story: My Diagnosis of Younger-Onset Alzheimer’s

Diagnosing Alzheimer's, Featured Posts, Voices of Alzheimer's 14 Responses »

Jun 012012

In 2008, at the age of 62, I was diagnosed with younger-onset Alzheimer’s disease (also known as early-onset Alzheimer’s). Not long after, I retired after serving 23 years as the President/CEO of the Private Industry Council (PIC) of San Luis Obispo County. While I thought I was functioning well, there were ample signs a few years before, indicating not all was necessarily right with my health.

Part of me recognized this, while another part of me chalked it up to work overload. In fact, I knew I was having a problem with my own self-confidence — and my 15 employees saw it more clearly, and earlier, than I did; if we are not careful, we tend to forget how intuitive employees truly are. Fortunately, we all came to a point of understanding that I needed help, and the Board of Directors and staff were ready to seek ways to retain me and keep me functioning, while also making sure we were all honest with one another, henceforth.

I was recognizing changes in my own behavior: I was losing my ability to juggle multiple projects. It took more effort to decide which projects had highest priority — and, worst of all, I realized that my self-confidence as an executive was rapidly eroding. I could not find any solutions to turn that around; I didn’t know how to fix it. This was brought home directly, on a couple of business trips (by auto), when I found myself overlooking familiar freeway exits and driving well down the road before realizing I was way off course.

Read Val’s experience as Lee’s care partner.

All of this led my wife and I to visit the Mayo Clinic twice in Scottsdale, Arizona, in 2006 and 2007; we also participated in a battery of testing at U.C. San Francisco. I was finally diagnosed with Early-Onset Alzheimer’s on that visit (also known as Younger-Onset Alzheimer’s), with evidence of “Executive Dysfunction.” Several medical doctors, staff and students participated in that discussion, and they video-taped the discussion. It was an eye-opening experience.

Back home in San Luis Obispo, we also took the time, on two occasions for me to be tested for sleep apnea, in a local lab located in our community. Outcome: “Positive.” Thanks to the technology of this remarkable invention, I now sleep better than I ever have in my life. While I am no expert in this technology, I am convinced there is a direct (negative) relationship between sleep apnea and potential damage to the brain, over time.

Several months later, when this all sunk in, I resigned myself to accept this fate — over which I would have zero control. But, I also have been able to put a face on Alzheimer’s in our local community, by being an advocate and local voice. I have written several “Viewpoints” and “Commentaries” in our local Tribune newspaper. I have formed a close relationship with our local Alzheimer’s Association Chapter Office and its staff, secured a seat on the three-county Chapter Board of Directors, and also accepted an appointment to the Alzheimer’s Association Early-Stage Advisory Group (ESAG) for the 2011-2012 year. This participation, in turn, has opened more new doors with the National Office of the Alzheimer’s Association in very positive ways.

I am well aware there is no known cure for Alzheimer’s. It’s a given, for now, and I refuse to spend much time worrying about it. I prefer to be matter of fact with regard to my diagnosis and I spend more time out in the community and working with the Alzheimer’s office to support them in their work. If there is anything I worry about, it is my family. Family and friends are the best medicine that any of us will have, in a journey such as this one.

Read about Val’s experience as Lee’s care partner.

Blog author Lee Ferrero is a member of the national Alzheimer’s Association 2011 Early-Stage Advisory Group. He is eager to put a face to Alzheimer’s and alert individuals, communities, the media and local organizations about the critical need to act on this disease and help find a cure. Lee lives in Los Osos, California, with his wife, Valerie. Lee and Valerie have two children, Jennifer and Eric. They take great delight in spoiling their grandson, John Ferrero Stout.

Why Berries May Delay Memory Decline

Current Studies, Featured Posts, Risk Factors/ Prevention, Women & Minorities 5 Responses »

May 312012

Berries, they’re not just for breakfast anymore.

In a study published last month in the Annals of Neurology, researchers reported that consumption of berries and flavonoids showed a slower rate of cognitive decline in women aged 70 and older.* Using data from the long-running Nurses’ Health Study of 122,000 registered nurses, the researchers conducted assessments on 16,010 women.

The Nurses Health Study began in 1976. Every four years they were questioned on their eating habits. Between 1995 and 2001, more than 16,000 women aged 70 and older underwent memory testing. The researchers at Brigham Women’s Hospital/Harvard Medical School in Boston and the German Center for Neurodegenerative Diseases in Bonn, Germany found that greater ingestion of blueberries and strawberries correlated with slower rates of cognitive decline for up to 2.5 years. The women who showed the most improvement consumed two or more servings of the berries each week.

Berries contain a particularly high amount of flavonoids called anthocyanidins that are capable of crossing the blood brain barrier and localizing themselves in the hippocampus, an area of the brain known for memory and learning. Investigational drugs and other alternative therapies often fail because they cannot cross the blood brain barrier or reach the hippocampus.

Flavonoids are known to have antioxidant and anti-inflammatory characteristics which can benefit the brain. The study’s authors acknowledge that previous small trials of berry supplementation have shown positive results as well. In some earlier non-related studies inflammation and stress have been shown to contribute to a reduction in brain functioning. Increasing flavonoid consumption might slow these harmful effects, but more study is needed to test this hypothesis.

The authors acknowledge that this was an observational study that relied on accurate dietary reporting from the nurses. In addition they do not know if the results would apply equally to men since all of the people they studied were female. For the future the authors recommend that men be part of the cohort. Finally, they encourage older adults to consume berries as they offer an easy dietary modification that may delay memory decline and will not cause harm.

*Devore, E. E., Kang, J. H., Breteler, M. M. B. and Grodstein, F. (2012), Dietary intakes of berries and flavonoids in relation to cognitive decline. Ann Neurol.. doi: 10.1002/ana.23594

Jeffree Itrich, M.S.W., M.J.
Sr. Clinical Trials Communications & Recruitment Specialist
Alzheimer’s Disease Cooperative Study
University of California San Diego

This post originally appeared in Alzheimer’s Insights, an ADCS Blog.

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Glen Campbell Sings to Congress, Keeps Alzheimer’s in the Public Eye

Advocacy, Featured Posts 52 Responses »

May 232012

Glen Campbell

On Wednesday, May 16, the Alzheimer’s Association hosted “An Evening with Glen Campbell,” an event to raise awareness of Alzheimer’s disease among members of Congress. Held at the Library of Congress, the evening honored country music legend Campbell, who is living with Alzheimer’s disease, and his family.

Actress and philanthropist Jane Seymour welcomed a crowd including members of Congress, staff and their families. Seymour’s husband, James Keach, and his filmmaking partner, Trevor Albert, are making a documentary on Campbell and his family, following their battle with Alzheimer’s disease as Campbell conducts his farewell tour.

The attendees watched a brief film highlighting the state of Alzheimer’s today, revealing statistics from the recently released Alzheimer’s Association 2012 Alzheimer’s Disease Facts and Figures report. The film focuses on the cost of Alzheimer’s to the country, which will total a shocking $200 billion in 2012.

Harry Johns, president and CEO, Alzheimer’s Association, started the program by congratulating the assembled crowd on the release of the National Alzheimer’s Plan the day before.

“The release of the National Alzheimer’s Plan is a huge historic moment for our cause. I want thank of all the members of Congress for their support of the National Alzheimer’s Project Act,” Johns said. “Your leadership has made it possible to have a plan that creates a platform to address Alzheimer’s in America, and we truly appreciate that.”

Johns also talked about the challenge ahead, applauding Campbell and his family for their bravery as they publically face this disease.

“There are 5.4 million people today that have this disease, and because of baby boomers like me, that number is going to grow to 16 million in the next 38 years,” Johns said. “What I want to commend Glen and his family for is announcing his diagnosis and staying in the public eye. It sets a precedent and helps to advance conversation about the cause.”

Congressmen Ed Markey (D-Mass.) and Chris Smith (R-N.J.), longtime co-chairs of the Congressional Task Force on Alzheimer’s Disease, also spoke to the attendees, addressing recent successes in the fight against the disease and looking to the future.

“No coach goes into a big game without a strategy, and now we have a fully integrated plan with public and private stakeholders,” Smith said. “We have worked on this for a long time.”

“These families at home, they are heroes. But heroes need help,” Markey added. “You’ve heard the numbers. We have to give them hope.”

Dr. Ron Petersen, director of the Mayo Alzheimer’s Disease Research Center and a member of the National Advisory Council on Alzheimer’s Disease, gave an update on scientific progress in the field and the ways in which the National Alzheimer’s Plan will help to advance that research.

“Now we have a blueprint, a roadmap, for how we are actually going to get to a cure for this disease,” said Petersen. “The charge is back to us, the charge is back to Congress. I think we’ve done part of the work, but in another sense the work has just begun.”

After Petersen’s remarks, Campbell’s daughter Ashley took to the stage to introduce a sneak preview of the documentary focusing on her father’s farewell tour. She and her brothers, Shannon and Cal, are members of Campbell’s band and travel with him; Campbell’s wife, Kim, is his primary caregiver.

“We decided to go on a farewell tour with him to keep his struggle public,” she said. “We didn’t want people to think they were going through this alone. This isn’t a disease that just affects the person living with it — it affects their entire family.”

After a sneak preview of the documentary, Campbell took to the stage and received a standing ovation. Moving around with the microphone in hand, he was at ease, joking with the crowd and teasing his children. He drew repeated thunderous applause as he displayed his skill with the guitar, performing favorites such as “Galveston,” “Wichita Lineman,” “Rhinestone Cowboy” and “Southern Nights.”

Ashley and her family feel that performing is helping Campbell to face his disease and its symptoms.

“We’ve seen music as a form of therapy on this tour. He seems to be happier, to do better with his memory,” she said. “Happiness is the non-medical medicine.”

Throughout the evening, Campbell reinforced this observation, frequently telling the crowd, “I’m a happy, happy man. Do you want to hear some more?”

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Can Coconut Oil Treat Alzheimer’s?

Current Studies, Featured Posts 50 Responses »

May 102012

We’ve received quite a few questions recently about whether or not coconut oil can be used to treat Alzheimer’s disease. This is a topic that comes up often, so I thought it would be helpful to provide some background:

The claim

This theory has to do with substances called ketones. The damage caused by Alzheimer’s disrupts the brain’s ability to use its primary energy source, known as glucose. The brain naturally gets a portion of its energy from ketone bodies when glucose is less available (e.g., during fasting, strenuous exercise and in newborns). Ketones may provide an alternative energy source to the brain’s cells to moderate the damage caused by Alzheimer’s disease. The body produces ketones when it metabolizes coconut oil and similar substances (fatty acids).

Beyond the headline

Unfortunately, there just isn’t any creditable science to support this idea. It is impossible for us to know how well coconut oil does or does not work in Alzheimer’s disease because there have not been rigorous, large-scale research studies done.

The bottom line

Because there haven’t been any large studies to test the effectiveness of coconut oil, we just can’t say whether it really helps people with Alzheimer’s disease. Maybe it does, maybe it doesn’t. I personally suspect that it has little effect on Alzheimer’s symptoms but, to be fair, I haven’t had any family members, friends or clients who’ve tried it.

My rule of thumb is that if the risks and costs are low, you might consider trying it. If the risks or costs are high, don’t chance it. Think about how you would feel if you gave your loved one something and they lost ground and independence as a result.

Some alternative therapies have substantial risk associated with them; be careful and don’t assume that something that is “natural” is safe. If you are considering trying coconut oil, please consult your doctor first to make sure it will do no harm to the person with dementia

About the author: Elizabeth Edgerly, Ph.D., is the chief program officer for the Alzheimer’s Association, Northern California and Northern Nevada Chapter. To read more blog posts by Dr. Edgerly, click here.

This post originally appeared on www.alzheimersblog.org.

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Scott Kirschenbaum on Making a Film in an Alzheimer’s Unit

Caregiving 10 Responses »

Mar 292012

In the fall of 2008, I wrote a screenplay I intended to film entirely in an Alzheimer’s Unit. After many weeks of rehearsals, I arrived at a troubling realization: I was not just making a challenging film—I was making the wrong film.

Writing a fictional Alzheimer’s narrative—creating a neat and orderly plot whose course I could control, from a disease by nature chaotic and nonlinear—was impossible. In the way that a son or daughter doesn’t know exactly what to expect during a visit with a parent who has Alzheimer’s, it’s inconceivable (some might even say ridiculous) for a screenwriter to map out the trajectory of a scene in an Alzheimer’s Unit, and expect it to play itself out in a manner remotely resembling what was written.

Other than the loose structure provided by a schedule of daily activities—a parachute toss, the hair salon, an oldies sing-a-long—life in an Alzheimer’s Unit does not follow the logic of the real world. It is founded upon the incidental and accidental; a string of interactions and experiences that digress unpredictably, omnidirectionally, and constantly turn back on themselves. The Alzheimer’s Unit almost never adheres to the continuity of the linear narratives that we enjoy on a daily basis—or that screenplays require.

The first time I visited the Traditions Alzheimer’s Unit in Danville, Calif., I was greeted at the door by Lee Gorewitz, a spry septuagenarian in a baby blue jogging suit. With the exuberance of a cruise director, Lee presented herself as a staff member, took my hand and gave me a tour, during which she delivered a soliloquy unlike anything I had ever heard before: for well over a minute she prattled on about purses, windows and gardens, before she eventually locked eyes with me and said: “I hear the song in my ears, and I think they don’t love me anymore.”

From this spontaneous word-salad came two things that forever altered my film project; I realized Lee was not staff, but a resident. And, I decided, her presence in the Unit was reason enough to throw away that screenplay I’d just written.

For the next six months I visited Lee with the hope of making a documentary that would capture her inner universe: the discord and frustration, the communication breakdown and uninhibited behavior everyone speaks of when they speak of Alzheimer’s—and, the unusually poetic candor it can distill. Reflecting on her birthplace, Lee would say, “Brooklyn, it’s right behind you.” Considering love: “That’s a damn good thing to work with.” Regarding her deceased husband: “How do I even say it? The air — was very good.”

Like many in an Alzheimer’s Unit, for Lee every day is an odyssey: wandering to and fro with no destination in particular, on a quest for something that she can neither articulate nor comprehend. Having advanced Alzheimer’s was once described to me by a neuroscientist as akin to waking up in the middle of hinterland Russia, alone, not knowing a lick of the local language, not knowing how you got there, and being expected to act like it was home.

Due to that constant sense of disorientation, in the span of minutes Lee could morph from pensive thinker, to gregarious helper; from bubbly mover-and-shaker, to morose and sometimes cruel instigator. When in good spirits, she consoled heartbroken women, kissed caregivers and shook a tail feather even after the music had stopped. And with no realistic option for leaving, Lee also gave in to frustration: she argued with her tablemate at lunch, kicked a bouncy ball at a frail man’s legs, and unapologetically told a sickly woman that she is going to die.

My time with Lee, and her struggle, left me utterly confounded. Who should say Lee’s fragmented reality is any less valid than my own?

Composer John Cage once wrote, “The first question I ask myself when something doesn’t seem to be beautiful is why do I think it’s not beautiful. And very shortly you discover that there is no reason.” A shift happened for me when I started to embrace the sublime chaos of Lee’s world. Spending time with her became not about remorsing on what will never be; her past (most of which she cannot remember)—nor was it about analyzing the tragedy of her plight. It became about letting Lee tell her own story, one unfolding in the context of a cruel, debilitating disease. And it became about learning that there was no reason not to let that story seem beautiful.

In ways that are often painful and intense to the rest of us, Lee and others with Alzheimer’s stumble along a road we’re all traveling, trying—often desperately—to communicate something, anything, grasping for unanswerable riddles.

And until there’s a cure for Alzheimer’s, there’s one way, outside of medicine, to counter this disease, which we all have within our reach, whatever the road, whatever our relative agility at traversing it.

Empathy.

Scott Kirschenbaum is a filmmaker based in San Francisco, Calif. His documentary “You’re Looking At Me Like I Live Here And I Don’t” will premiere nationally on PBS’ Independent Lens on Thursday, March 29, 2012.

Joey McIntyre’s Story: My Mom May Not Know Who I Am…

Caregiving, Featured Posts, Women & Minorities 21 Responses »

Mar 272012

But she does a pretty good job of making me feel like she does. I believe she knows there is a connection. She keeps it very simple when she talks to me. Partly I think because she knows that she can’t quite remember but is still witty enough to know that she doesn’t want to make it any more confusing than it already is for her.

I think she is past the most scary part— realizing she is “losing her mind.” She knew something was happening. And at first I thought it was just my mom being dramatic. But looking back a few years, her behavior was strange. And soon it was clear that she was slipping away. That mostly showed up in her feeling scared and not wanting to be alone.

I remember in the fall of 2008, she said something very profound and sadly poetic. She said, “me and the night don’t get along.” I thought that was quite a lyric. My mother was as witty as they come. She wrote tons of poems and parodies of songs. Mostly for co-workers leaving for another job or for cast-mates at the end of a show she was in. Or for my sisters’ bosses or workmates. She would whip something up in an evening. She could do it all. Of course she had and raised nine kids — that says it all.

I don’t want to keep saying WAS because she still IS. She still has her one-liners. She is still sweet and very interested in what you are saying.

When I saw her last December at my sister Carol’s Christmas show at the fabled Footlight Club, she was so into the show. I enjoyed watching her as much as the show. If you didn’t know she had Alzheimer’s, you wouldn’t think it. She was very in the moment — happy to see my father introduce my sister, but also zinging him saying to herself, “he’s awful.” She watched each song— liking some and loving others. But then a few minutes after, I asked if she liked the show, and she answered, “what show, dear?” That kind of sums up where she is right now.

I am no expert and I am 3,000 miles away, but she is doing ok for someone at her stage of this disease. My mother was a force and could do so many things. Now, she is very slow. But through all this there is a bitter sweetness. I hear stories from my siblings about how sweet she is and the simple loving words she says to them. There is still a person in there. And she is alive and still working it out.

I think she still knows that she has some kind of disease, but she has moments of peace. Hopefully, with more funding and the hard work of all involved, we can find a cure so that Alzheimer’s will not affect generations to come. This disease affects the whole family. My mother is so fortunate to have the care she has, but so many are not as lucky.

I will be running the Hollywood Half Marathon on April 7, 2012, in her honor — and in honor of all those affected by Alzheimer’s — and to raise awareness and funds for the Alzheimer’s Association. If you can, please donate to my page at http://www.crowdrise.com/JoeyMcIntyre

Thank you for always supporting me in anyway you can— in your thoughts and prayers and deeds.

Joey McIntyre is a singer/songwriter who rose to fame as a member of New Kids on the Block selling over 80 million albums and countless sold-out shows worldwide. He continues to push boundaries with his music as a solo artist and has vast theatre and screen experience including appearing in Wicked on Broadway and as a season regular on Boston Public. Recently, Joey declared himself an Alzheimer’s Association Champion and is fighting to end Alzheimer’s on behalf of his mother who is living with the disease.

Caregiver Facts and Figures: A Bittersweet Reality

Caregiving, Women & Minorities 19 Responses »

Mar 092012

This post originally appeared on the ChicagoNow blog, “Ask Dr. Chill: Practical Answers to the Toughest Caregiving Questions.” It is being reposted here with the author’s permission.

Almost eight years at the Alzheimer’s Association — five at the Utah Chapter and close to three at the National Office right here in Chicago — left equally enduring imprints on my mind and heart. The mental imprint is analytical, bridging science and people in the shape of a fervent belief that a cure is inevitable.

The imprint on my heart is much different. It’s in the form of my own grandmother, who died of complications from Alzheimer’s disease and vascular dementia at the age of 89. It’s a delicate imprint, and it still hurts sometimes, even though she died more than 20 years ago. I see her face in almost every person I meet who has the disease.

It is because of these imprints that I took great interest in the Alzheimer’s Association’s recent release of its 2012 Alzheimer’s Disease Facts and Figures Report. This compendium of facts is impressive and startling. For a very cool visual summary of the toll that Alzheimer’s disease takes on individuals, caregivers, families, and the health care system, check out this 2-minute video marking the report’s release:

It gave Dr. Chill the chills…and some tears. According to the report, there are more than 15 million caregivers in the United States caring for someone with Alzheimer’s or a related dementia. In 2011, they provided over 17 billion hours of care valued at more than $210 billion.

But here’s the thing that really disturbs me. Caregivers don’t only care for people with Alzheimer’s disease and other dementias. There are caregivers for people with cancer, diabetes, heart disease, lung disease and those who had a stroke among other health complications. Some of you reading this blog may be caring for someone with a developmental or physical disability. Others might be taking care of someone who is simply having trouble maintaining independence due to the normal course of aging.

The numbers in the Alzheimer’s Association’s report are stunning, but they paint just one swath of the caregiver landscape. I started to wonder how much of the landscape remained. Some digging turned up a 2009 report—the most recent I could find that provides general numbers — compiled by the National Alliance for Caregiving and AARP. Caregiving in the US states there are 65.7 million caregivers in the United States caring for someone who is aged, disabled, and/or ill. Now that’s really stunning.

Remember that mental imprint I described? The analytical, more objective one. When I hear these kinds of numbers, my mind turns toward concepts of magnitude, awareness, research, the badly mired health care system, graphs, charts, grant proposals, and yes, cool videos that send shivers down my spine. In other words, I see the big picture.

But if you recall that other, more subjective imprint inside me — the one on my heart — I see a different vision. Try to imagine these massive numbers melting together into an indecipherable glob of hurt. What I see is one caregiver, one that represents the hundreds I’ve known over the years. She is tired, distraught, scared and doesn’t know where to turn for help. She feels incredibly alone. Yet she is not alone. As we’ve learned, she is literally in the company of millions.

It’s a bittersweet reality.

About Guest Blog Author Carrie Steckl, Ph.D.

Carrie Steckl, Ph.D. is a freelance writer specializing in caregiving, psychology, and aging. Her blog, “Ask Dr. Chill,” provides practical answers to the toughest caregiving questions.

Vascular Risk Factors and Dementia in Korean Adults

Women & Minorities 1 Response »

Mar 112011

I recently attended an event hosted by the American Heart Association and Go Red Chicago, where a panel of physicians and healthcare providers discussed the effect of diet, hormones and cardiovascular risk factors on the heart and brain. The physicians also touched on emerging data that suggest there may be racial/ethnic differences in the prevalence and effects of cardiovascular risk factors to the development of heart disease and brain functioning in these diverse populations. Thus, I was very interested in reading the following article from Korea that examined the effects of vascular risk factors in mid and late life to dementia risk.

The initial study population included over one million persons aged 30-95 years who participated in at least one biennial National Health Insurance Corporation (NHIC) medical evaluation between 1992 and 1995. The NHIC provides health insurance to government employees, teachers and their dependents and it was estimated that at the time of this study, approximately 11 percent of the Korean population was insured by this organization. Persons were excluded from the study if they reported having cardiovascular disease, cancer, liver disease prior to their initial visit, or if they had missing data on any study variables. Thus the final sample size for this study was 848,505 participants, aged 40 years or older, followed for up to 14 years.

As is typical with many studies focusing on cardiovascular disease, questions regarding history of cigarette use and alcohol consumption were obtained along with height, weight (for body mass index calculations) and blood pressure. Fasting blood samples were obtained for both serum glucose and serum cholesterol. The specific criteria for hypertension were a systolic blood pressure of at least 140 mmHg or a diastolic blood pressure of at least 90 mmHg. Cholesterol was characterized as “desirable” if the serum cholesterol was 200 mg/dl, “borderline high” if it was between 200-239 mm/dl, and “high” if it was greater or equal to 240 mg/dl. Diabetes was defined as a fasting serum glucose level of 126 mg/dl or higher.

As this was a large sample of persons evaluated in clinical hospitals, the main variable of interest was a dementia diagnosis. For these analyses, the dementia categories included Alzheimer’s dementia (AD), Vascular dementia (VaD), and “unspecified” dementia.

Of the 848,505 persons who were evaluated at the baseline examination, there were 358,060 women (age at baseline 53.6 yrs) and 490,445 men (age at baseline 51.9 yrs). The entire population had a low level of body mass index. Both cigarette smoking and alcohol consumption were more common in men compared to women. During the 14 years of follow up, 3,252 persons were hospitalized for issues related to dementia; the majority of those dementias were listed as Alzheimer’s. Increasing dementia incidence of Alzheimer’s was noted as age increased, peaking at the ages of 75-80 years, then decreasing at older ages.

In both women and men, diabetes was associated with all types of dementia, and appeared to be higher for VaD than Alzheimer’s in women. Hypertension (HTN) was also associated with all dementias; strongly associated with VaD in men, but did not appear to be associated with Alzheimer’s in women. In both groups total cholesterol was not associated with dementia.

Further analyses were conducted measuring the impact of vascular risk factors measured in midlife (<65 years old) compared to later (>65 years old). Diabetes appeared to be associated with Alzheimer’s in both the younger and older age groups for men, whereas smoking was associated with Alzheimer’s in midaged men (< 65 years) compared to older men (> 65 years). HTN had a strong association with VaD in both men and women before and after 65 years old. There were no notable interaction effects between HTN and diabetes on the risk of dementia for either gender.

This study in the Korean population supports data from Western population studies, suggesting that diabetes and HTN are important risk factors for the development of both Alzheimer’s and VaD. Further, this large study also suggests that vascular risk factors in midlife appear to have a higher risk for dementia development as compared to later risk factors. One limitation of the study, as noted by the authors, was the relatively high rate of “unspecified dementia cases” (36 percent for men, 39 percent for women) which could affect the strength of these associations. Nevertheless, this study provides support that there is an increased risk of dementia associated with these factors in this Asian population, and highlights the need for aggressive vascular risk reduction treatment as a dementia prevention method.

Thanks for reading.

Neelum T. Aggarwal, M.D.
Steering Committee Member, ADCS
This post originally appeared in Alzheimer’s Insights, an ADCS Blog.

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Risk factors for Alzheimer’s

Dietary Vitamin D and Cognition in Older Women

Women & Minorities No Responses »

Jan 162011

Dear Readers,

I was recently on a conference call with women physicians discussing the latest in Women’s Health and was asked about vitamin D and its effect on cognition. Indeed vitamin D has received a lot of media attention lately; attention focused on its potential effect on cardiovascular and bone health, in addition to its anti-inflammatory and anti-oxidative effects. Thus, it was not a surprise to me when the discussion turned to “cognitive health” and whether or not (1) vitamin D levels were associated with cognitive function and (2) whether its supplementation would provide an “added cognitive benefit” to female patients.

At the time the question was posed, I immediately thought about an article I read in Neurology that examined whether weekly dietary intake of vitamin D was associated with cognitive function in older women. Participants in this study came from the EPIDOS, a French community dwelling cohort study that was designed to evaluate the risk factors for hip fracture among women aged 75 years and older. Over a course of two years (1992- 1994) over 7000 women – free of a previous history of hip fracture or hip replacement – were recruited from five French cities to participate in this study. At baseline evaluation all participants received a full medical examination, which consisted of structured questionnaires, information about everyday dietary habits, chronic diseases, disability, sun exposure and a clinical examination. Medications and vitamin supplements were reported by interviewer questions and also by direct inspection of medications brought to the visit. Women were excluded from the study if over the last 18 months they had taken vitamin D drug supplements. A total of 5,596 women met the inclusion criteria and analyses were based on this sample size.

Dietary habits were assessed at baseline examination using a 21 question food frequency questionnaire that included questions on intake of fish (two items), dairy intake (six items) and the consumption of eggs, fruits, vegetables, starchy foods, chocolate and drinking history. The dietary intake of vitamin D per week was calculated by multiplying the content of individual food items (across all areas) by the frequency of consumption and adding this together. The vitamin D content for all food items was based on a dietary content database – continually updated by the French food and safety agency. For the French adult population, the dietary intake of vitamin D was 400 IU /day (or 35 micrograms/week). The assessment of cognitive function used– the Pfeiffer Short Portable Mental State Questionnaire (SPMSQ). This is a 10 item measure that has been in use in large scale studies as a screening tool to assess moderate to severe cognitive deficits. A score of 8 or below indicates cognitive impairment.

Although the mean weekly dietary intake of vitamin D for the entire group was well above the suggestive value of > 35 micrograms/week (mean 62.3 micrograms/week), approximately 14% of the women had inadequate dietary intakes of vitamin D. Based on the cognitive testing results, a total of 11% of the women were deemed to have cognitive impairment. Further, women who had lower levels of weekly vitamin D intakes had lower mean SPMSQ scores. These women were also older and reported more disability on a disability scale. To further examine the association between weekly vitamin D intake and cognitive function, other factors such as body mass index, sun exposure, number of chronic diseases, history of hypertension, depression, disability or use of antidepressants or other medications, were controlled for in their analyses. The association between dietary vitamin D and cognitive function remained significant even after adjusting for all of these factors.

This study nicely demonstrates that in women free of vitamin D drug supplementation, weekly dietary intake of vitamin D was significantly associated with the cognitive performance. Few studies have examined the association of dietary vitamin D to cognition in a large population sample. Such studies are needed to clarify whether the associations reported in this study exist in other populations (i.e. U.S. based and those that involve substantial numbers of minority participants) and will guide future research as to whether or not to persue large scale clinical trials that examine the benefits of vitamin D supplementation to treat or prevent cognitive impairment.

Here are 3 articles you can refer to, to learn about this particular study or the latest research on vitamin D and cognitive function:

HDL Cholesterol and Alzheimer’s Disease

Current Studies, Risk Factors/ Prevention 4 Responses »

Dec 152010

According to researchers at Columbia University, people with high levels of HDL cholesterol (the “good” form) are 60 percent less likely to develop AD. The researchers followed 1,130 seniors with no history of memory loss or dementia and measured their cholesterol levels every 18 months for four years. When the researchers compared the cholesterol levels of study participants with and without Alzheimer’s, they found that those with the highest HDL counts, greater than 55 mg/dL, had about a 60 percent reduced risk of developing the disease compared to those whose levels were less than 39 mg/dL.

Their findings support the theory that high levels of HDL cholesterol are correlated with lower incidence of AD. The study was published earlier this week in the Archives of Neurology and sheds more light on the interactions between cholesterol and AD.

Apolipoprotein E (apoE), as readers of this blog will recall, participates in the mobilization and distribution of cholesterol among various tissues of the body, including the brain. In humans, there are three common isoforms of apoE: apoE2, apoE3 and apoE4. ApoE4 differs from apoE3, the most common isoform of apoE. A single e4 allele is sufficient to increase the risk of developing atherosclerosis, and also Alzheimer’s disease. The e4 allele results in slightly elevated plasma LDL cholesterol levels and a small but significant decrease in plasma HDL levels. HDL is one of the major carriers of protein in and out of the brain, and also binds to beta-amyloid.

This finding further advances the idea that the interplay between cholesterol, cholesterol-carrying proteins such as apoE and HDL, and beta-amyloid may be critical in the development of Alzheimer’s disease. This study has important strengths. It is a prospective cohort study designed for the diagnosis of cognitive decline that has complete clinical and neuropsychological evaluation at each interval.

Guidelines recommend that men raise HDL levels that are less than 40 mg/dL and that women increase HDL numbers less 50 mg/dL. An HDL of 60 mg/dL or higher is optimal.

Michael S. Rafii, M.D., Ph.D.
Associate Medical Director, ADCS Medical Core
This post originally appeared in Alzheimer’s Insights, an ADCS Blog.

* Association of Higher Levels of High-Density Lipoprotein Cholesterol in Elderly Individuals and Lower Risk of Late-Onset Alzheimer Disease. Christiane Reitz et al., Arch Neurol. 2010;67(12):1491-1497.

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