Spring Arbor Living Blog

A study published in Neurology has found that as problems not traditionally associated with brain health pile up, a person's chance of developing dementia increases.

As we age, those minor physical ailments – including sore feet, poorly fitting dentures and skin irritations – may turn out to be not so minor after all.

The 10-year study included more than 7,200 cognitively healthy 65-year-old Canadians who were asked questions about their health. The questions included known risk factors for Alzheimer's, such as high blood pressure and diabetes, they included 19 problems that seemingly have no connection with brain health – including vision and hearing, loose dentures, sinus congestion, arthritis, morning cough, and problems with the skin, stomach, kidneys or bowel.

Any healthy 65-year-old has an 18% chance of developing dementia in 10 years from aging, the study found that each health problem not traditionally associated with Alzheimer's increased that risk by 3.2%. The risk accelerated as more and more conditions were added, jumping to 40% among those in the study who reported as many as 12 conditions. Since age is a major risk factor for Alzheimer's, the study is in a sense identifying people who "age badly" - their biological age exceeds their chronological age.

Taking care of minor ailments improves a person's quality of life, no one has yet proved that fixing each problem would necessarily reduce the risk for Alzheimer's.

Walking as little as 30 minutes a day, three days a week decreases risk factors for dementia and improves overall health.

Original article AARP

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Though a cure for Alzheimer's disease remains elusive, experts believe earlier and more accurate diagnosis will aid efforts to discover effective therapies. Marilyn Albert, Ph.D., director of the Johns Hopkins Alzheimer’s Disease Research Center, answers the question: "Why is early diagnosis of Alzheimer's disease important if no treatments currently exist to delay progression of the disease?" 

Early and more accurate diagnosis of Alzheimer’s disease is important in helping us develop a better understanding of the biology of the disease. This, in turn, will help researchers design and test new drugs that will intervene earlier in the disease process. 

We use the term Alzheimer's disease to talk about people who are demented, but there are many people with it who aren't yet demented. In fact, one third of all older adults show Alzheimer’s disease pathology in their brains, though they may not yet show symptoms. 

We know that the symptoms of Alzheimer’s disease progress gradually over many years. People with Alzheimer’s disease don’t go from normal to demented overnight. Instead, the disease is a continuum, and earlier diagnostic procedures will help us treat it as such. 

For instance, we understand that high blood pressure is a risk factor for stroke. So, when we go to the doctor and find out that we have high blood pressure, we start to treat it right away, years before a stroke might occur. The same should apply to Alzheimer’s disease. 

We want to identify those who are at risk years before dementia occurs, because we are working hard toward the day when we can diagnose and treat those risk factors for Alzheimer’s disease in the earliest stages -- just as we might treat high blood pressure or cholesterol.

From Johns Hopkins Health Alert

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In this excerpt from a recent issue of Health After 50, Marilyn Albert, Ph.D., director of the Johns Hopkins Alzheimer’s Disease Research Center, talks about current methods of diagnosing Alzheimer's Dementia.

•   Traditionally, how has Dementia been diagnosed? How accurately can it be diagnosed today?

Research now tells us that Dementia progresses over time and likely begins years or decades before symptoms first appear. But right now, we can only diagnose Dementia late in the game. 

To diagnose Dementia we rule out other potential causes for cognitive decline, such as stroke, tumor or metabolic syndrome (a combination of medical disorders that raises the risk of heart disease, diabetes and stroke that may also increase the risk of dementia).

We then run a battery of cognitive tests and brain scans to rule out other neurological disorders and to determine whether the pattern of symptoms seems consistent with Dementia. If these things match up, we can give a probable diagnosis of Dementia. At major medical centers, a probable Alzheimer's Dementia diagnosis can be 80 to 90 percent accurate.

•   What are biomarkers, and how will they help with earlier, more accurate diagnosis of Dementia?

"Biomarker" is a term that describes a measurable change in a person that will give us information about what is going on in his or her brain tissue. For example, the signature of Alzheimer’s disease includes amyloid plaques [abnormal accumulation of amyloid proteins] and neurofibrillary tangles (deposits of defective tau proteins, a type of protein abundant in the brain).

The proteins related to the plaques and tangles are present in the spinal fluid of patients with Dementia. They’re also present in those with mild cognitive impairment (MCI) -- slight problems in thinking, learning and remembering that sometimes progress to full-blown dementia.

The proteins serve as biomarkers of the progressive changes taking place in the brain. In clinical research, tau and amyloid have been shown to predict the progression of patients with MCI to Dementia and ultimately Alzheimer's.

In other words, measuring these proteins allows us to say more accurately and at an earlier stage of disease that we are pretty sure this person is going to develop Alzheimer’s dementia. Imaging procedures, such as PET (positron-emission tomography) and MRI (magnetic resonance imaging), also can provide information about the pathology present in the brain. For example, amyloid can now be measured with PET.

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Disease develops years before symptoms show.

New guidelines for diagnosing Alzheimer's disease set forth methods for identifying the disease before it progresses to full-blown dementia, and for the first time include lab and brain-imaging tests that can help identify Alzheimer's as the likely cause of a person's mental decline.

The guidelines, revised for the first time in 27 years, reflect a firm consensus among Alzheimer's researchers that the disease begins to attack the intricate structures of the brain 10 years or more before the disabling mental problems appear. Therefore, to be effective, drug or other therapies will have to begin work early in that process.

So far, though, there are no therapies that alter the course of Alzheimer's disease. And in a media briefing, authors of the new diagnosis guidelines emphasized that while testing for Alzheimer's pathology in the brain may one day be used to identify the disease at much earlier stages, today the tests are primarily a research tool. They are not ready for routine use in doctors' offices.

Delaying disability

Even so, doctors hope the new diagnostic criteria encourage people with worrisome memory problems to seek help. There's a lot patients and their families can do to minimize the impact of Alzheimer's, from structuring the patient's environment to optimizing medical care, activities, exercise and diet.

New tests outlined in the guidelines involve looking at the brain with imaging technologies and examining the fluid obtained by a spinal tap. The imaging studies can reveal so-called plaques made up of a protein called amyloid, a defining feature of Alzheimer's. They also can indicate characteristic patterns of shrinkage or reduced metabolic activity in the brain. The cerebrospinal fluid tests look for levels of amyloid as well as of another protein, tau, which makes up the twisted strands or "tangles" that, like plaques, are signature brain pathology in Alzheimer's.

Weaknesses of the tests

Research studies have demonstrated that all these tests can help identify Alzheimer's as the cause of a patient's dementia, and can help predict which patients with milder symptoms will go on to develop dementia. But the tests aren't conclusive in themselves. They aren't standardized so that a certain result means the same thing in every medical center. And there's no clear cutoff separating normal findings from those indicating a problem.

Original article by: Katharine Greider from AARP Bulletin

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Brain scans may help identify which individuals with a mild decline in their mental abilities will go on to develop Alzheimer's disease, according to a new study.
 
The research focused on patients with mild cognitive impairment, a condition in which people experience noticeable declines in their cognitive function, including memory and language problems. These changes are not severe enough to interfere with everyday activities, according to the Alzheimer's Association.
It is known that about 15 to 20 percent of such patients will go on to develop Alzheimer's, but researchers don't know which ones.

In the new study, which involved magnetic resonance imaging (MRI), researchers were able to identify a high-risk group – patients who had a 69 percent chance of developing Alzheimer's disease in the next year.

The study used the MRI scans to identify brain characteristics that put people at risk for Alzheimer's. The researchers determined some patients had just a 3 percent risk of developing Alzheimer's in the next year, which is about the same as for a healthy older person. Others had a 40 percent risk of developing the condition in the next year, or double the risk associated with a diagnosis of mild cognitive impairment, and still others were identified as part of the high-risk group, said study researcher Linda K. McEvoy, an assistant professor in the department of radiology at the University of California, San Diego School of Medicine.

A similar technique could be used one day by doctors to determine the Alzheimer's risk for patients with mild cognitive impairment. However, the patients in the study were not representative of the general population — they had been selected to exclude people who experienced other types of memory problems, such as those due to a stroke. A larger study would be needed before the results could be translated to the doctor's office.

Alzheimer's disease risk
The study looked at MRI scans of the brains of 203 healthy adults, 164 patients with Alzheimer's disease and 317 patients with mild cognitive impairment. Each patient had their brain scanned at the start of the study and again a year later.

The researchers first compared the brains of Alzheimer's disease patients with those of healthy people, looking for differences in the degree of  shrinkage, or atrophy, in particular areas of the brain. Once they developed a way to distinguish these two groups of people, "we could use the same equations on the mild cognitive impairment (MCI) subjects to determine their risk of developing Alzheimer's disease," McEvoy said.
 
When the researchers included information about how the brains had changed in the time between the two scans, they were able to identify the high-risk group.

Future applications
Information in this study will be critical once we have ways to prevent Alzheimer's disease, McEvoy said. "Currently there's no cure or prevention for Alzheimer's disease. But there's a lot of research going on right now into different potential therapies. If any of those therapies turn out to be useful, then this kind of information will be crucial — a doctor needs to know who's at higher risk in order to treat them".

 Original article by Rachael Rettner- MyHealthNewsDaily

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As we get older, many of us will notice changes in our memory. Forgetfulness is a normal part of getting older, however, dementia and Alzheimer's disease is not. How can we tell the difference? We all worry, about ourselves and our parents as we watch them age; and with good reason.

Presently, one in ten people 65 and older has Alzheimer's, about 5 million people. But only half have been diagnosed with the disease. It is estimated that by 2050 as many as 16 million people will have it.
As we become more and more educated about this terrible disease, we often find ourselves wondering when we or someone we love will get it, not if we or someone we love will get it. You may be concerned because you have noticed recurring "senior moments".  As we age, we notice our senior moments more and more.
 
So where does normal forgetfulness end and mild cognitive impairment begin? Some experts think that mild cognitive impairment (MCI) is the early signs of Alzheimer's disease. Unfortunately, there is no definitive test for diagnosing Alzheimer’s, but your personal history and mental status exams are accurate about 90% of the time. Alzheimer's progresses very slowly for most people. The downward slide of thinking, memory, and judgment are gradual, over the span of many years.

If you have concerns about yourself or a loved one, find out all you can about your own, or their, personal history and speak with your doctor. Education about Alzheimer’s Disease is the best way to understand an prepare yourself, if necessary, for this terrible disease.

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Alzheimer's disease symptoms result from physical changes in the brain. What causes these changes is still somewhat of a mystery, however researchers have a leading theory of how the Alzheimer's disease progresses.
 
In a healthy brain, certain chemical processes ensure the proper functioning of neurons. One is the processing of amyloid precursor protein (APP) that is attached to the outer membrane of nerve cells. Certain enzymes cut off a section of the protein; while another enzyme snips a second portion and releases APP from the cell’s membrane.

These APP fragments are then broken down and removed from the brain. Another process, which we won’t get into here, carries nutrients through the nerve cells to keep them functioning normally.
 
When the processes that keep a healthy brain functioning go awry, a different enzyme, cuts shorter APP fragments from the nerve cell membrane. These smaller pieces are more resistant to breakdown and tend to clump together in toxic clusters and eventually they collect into plaques that interfere with nerve cell functioning. Within neurons, the transport of nutrients is crippled and nerve cells are destroyed. Loose threads join together to form knotted strands inside neurons. These cause further neuron destruction.

In the early stages of Alzheimer’s, plaques and tangles form in brain areas responsible for learning, thinking, and planning -- in particular, the hippocampus. This is why forgetfulness, disorientation, and verbal repetition are often among the earliest signs of Alzheimer’s. As nerve cell destruction spreads more brain areas are affected, especially the cerebral cortex, responsible for language, reasoning, and judgment. Speaking skills become impaired and emotional outbursts grow more frequent.

When large areas of nerve cells die off in the advanced Alzheimer’s stage, brain sections atrophy and the whole brain shrinks to as much as three quarters of its original size. People with Alzheimer’s lose most of their ability to communicate, walk, and care for themselves.  

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Have you ever walked into a room and then forgotten what you wanted once you got there? Have you ever put an item in a “safe place” and then forgot where it was when you needed it? Do you think sometimes that you are going “crazy” because you forget people’s names? Or maybe you forgot to do something you said you were going to do?

Sometimes we are having a “senior moment” as they say; but that’s just what it is–a moment. Usually the name is just on the tip of your tongue and you remember it when you can take the time to think. Or the reason for walking into the other room becomes clear when you slow down and let your thought catch up with you.  These are ”normal” occurrences usually due to stress, being too busy, not feeling well, or simply not paying attention.

However, when you misplace something and you have a problem retracing your steps to find it, this might be a warning sign.  If you are making a familiar recipe and forget how much salt to use, this could be normal.  But if you are confused about whether to use a measuring spoon or a measuring cup for the salt, this could be a warning sign.  If you drive to the mall and forget where you parked the car, this is typical of someone not paying attention or making a mental note of where they parked.  But, if you forget where you are and how you got there, this is a warning sign.

There are several warning signs to watch for in detecting early stage Alzheimer’s.  No one sign is an indication of having a problem in and of itself. Keeping track of abnormal behavior will give your physician details to help diagnose the problem, and only a qualified professional can make a diagnosis after appropriate testing. For more information on the warning signs, contact us today and we'll be happy to assist you in any way we can.

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This is actually not true. For today’s seniors, moving to an assisted living community is one way they can make the most of their retirement income now. There are many economic benefits of living in senior communities.  These range from free local transportation – which eliminates or minimizes costs for fuel, maintenance/repairs and auto insurance – to eliminating expenses associated with maintaining a single-family residence.

Assisted Living communities eliminate such expenses as routine maintenance, lawn care, pest control, snow removal and more. Homeowner’s insurance, always an expensive companion to home ownership, can also be removed from the monthly budget. This represents a huge savings in Virgina, for example, where property insurance has increased dramatically.

Our assisted living communities provide residents with fixed monthly costs, which cover local transportation; rental or purchase of an apartment, villa home, or cottage; and two or three meals prepared daily by professional chefs. Contact us today to learn more about our residencies or if you have any questions regarding assisted living.

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Alzheimer’s symptoms grow worse as time progresses, the disease may have unpredictable changes; making it an extremely difficult task to care of a person with Alzheimer’s disease. For both the person with Alzheimer’s and the caregiver, arranging basic activities of daily living can be difficult. Eating, talking, sleeping, and finding things to do: all these things become difficult as the disease becomes more severe.  There are many ways to help manage these difficulties.

Nighttime can seem like a blessing for some, but for those with Alzheimer’s it can be difficult. Most people with Alzheimer have become restless and irritable around this time. Putting the person to bed may require some advance planning.

Limit daytime napping and encourage exercise during the day, but still allow for a sufficient amount of rest during the day. Try to schedule more physical activities such as bathing earlier in the day. And in the evening set a peaceful, quiet tone to encourage sleep. Make certain that the lights are dim and the noise is down to a minimum. In some cases playing soothing music may help, but only if the person enjoys it. Try to keep the person’s bedtime routine. NO caffeine late in the day.  If the person gets frightened or disoriented use night lights around the halls and bathroom. Spring Arbor knows that caring for a person with Alzheimer's takes time and patience which is why if you know someone with Alzheimer's and have any questions or wish you explore our communities, please contact us today.

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