Flu Vaccination May Guard Against Alzheimer’s Dementia

While it is early summer here in North America, most primary care practices have already ordered their influenza vaccine for the fall of 2022. Our practice will be using the “senior” high dose quadrivalent vaccine for patients 65 years of age and older as recommended by the ACIP (American College of Immunization Practices), a division of the CDC.

While experts debate when to administer the vaccine, we prefer to do it between Halloween and Thanksgiving based on when influenza arrives in South Florida and the limited length of protection seniors get from the vaccine. Flu shots can protect against serious infection and hospitalization in most cases.

Avram Bukhbinder, MD, of the University of Texas Medical Center in Houston believes the vaccine also protects seniors against Alzheimer’s disease. His work was published in the Journal of Alzheimer’s Disease recently.

His group looked at almost one million influenza vaccinated adults and compared them over time with a similar sized unvaccinated group of senior citizens 65 years of age or older. The median age was 73.7 years and 57% were women. All were free of dementia over the six year “look back period”.

They followed these groups for 46 months and found the risk of developing Alzheimer’s Disease was 40% lower in the vaccinated group. The paper did not determine why the flu vaccine lowered the risk of developing Alzheimer’s dementia. Dr. Bukhbinder hypothesized that the vaccine may have prevented severe inflammation seen with infection reducing the development of amyloid plaques and neurofibrillary tangles. An official with the Alzheimer’s Association was quick to point out that possibly those who took flu shots were more health conscious leading to less development of Alzheimer’s Disease.

Further research is warranted but this study provides an additional incentive to obtain your flu shot this fall.

Antioxidants & Dementia Risk – A New Study in Neurology

May A. Beydoun, PhD, MPH of the National Institute on Aging of the NIH in Bethesda, Maryland and associates published a study on blood antioxidant levels, food consumed and the risk of developing dementia as you aged. The study hoped to determine which foods were best to eat to limit your chances of developing cognitive impairment in later years. The researchers discovered that those individuals with the highest serum levels of lutein+ zeaxanthin and beta-cryptoxanthin at baseline were less likely to develop dementia decades later than their peers with lower levels of these protective antioxidants.

Lutein and zeaxanthin are found in green leafy vegetables such as kale, spinach, broccoli, and peas. Beta -cryptoxanthin is found in fruits such as oranges, papaya, tangerines, and persimmons. “Antioxidants may help protect the brain form oxidative stress, which can cause cell damage,” said lead author Dr. Beydoun.

The study, published in the journal Neurology analyzed 7,283 participants in the 3rd National Health and Nutrition Examination Survey who were at least 45 years old at the start of the study and were then followed for 16-17 years. The data showed the higher the serum levels of beta-cryptoxanthin at baseline the lower the risk of developing dementia. No such protection was found for lycopene, alpha-carotene, beta carotene or Vitamins A, C, or E.

This was an observational study looking at data already collected. In critiquing the study, Dr B. Hooshmand, MD, PhD and Milia Kiviipelto, MD, PhD of the Karolinska Institute, Stockholm, Sweden commented on the research noting that this was an observational study and previous studies supplementing individuals with antioxidants were disappointing and did not prevent development of cognitive dysfunction. They believe there is a more complex relationship between the foods we eat, antioxidants, socioeconomic status and lifestyle which all contribute to the development of dementia.

While there is work to be done in this field, this study certainly supported my love for a fresh orange or tangerine to start off the day. The accompanying editorial made it clear that consuming my antioxidants and vitamins in fresh fruit and produce seems to be healthier than depending on store purchased supplements.

Vaccine for Prevention of Alzheimer’s Disease in Development

Vaxxinity has been testing an immunotherapeutic vaccine candidate that targets aggregated amyloid beta in the brain considered to be toxic and contribute to the progression of Alzheimer’s Disease. The topic was discussed in the online journal MPR early in May. The vaccine , known as UB-311 has been in human clinical trials for three years now. Volunteers have received repeated doses of the vaccine with adverse effects no worse than in the placebo group in the trial. The manufacturer in the main study ClinicalTrials.gov Identifier: NCT025518009 showed that a “ robust and durable anti-amyloid beta antibody response was elicited in their patients while no amyloid related imaging abnormalities or edema were reported in the mild to moderate Alzheimer’s patients observed. In view of the early success shown the FDA has granted this drug Fast Track designation to speed its development and production .

The development of a medication that slows down and or prevents the development of this fatal progressive neurological disorder would be a major step forward in the battle against this relentless illness.

Dementia – Telltale Indicators

In the United States, 11% of adults 65 years of age and 33% over 80 years old are diagnosed with dementia. My generation of Baby Boomers likes to pretend that todays “80” is like yesterday’s 55 years old but it simply is not true.

To combat dementia researchers are looking at numerous causes to try and reduce the number of future patients. An interesting article looked at the resting heart rate of senior citizens. Those who had a resting heart rate over 80 beats per minute were statistically more likely to develop dementia.

At the same time, the same research group was looking at resting heart rate another research group was looking at inflammatory markers that can be detected with a blood draw and be prognostic. They found an association between having a low HDL level and elevated Triglyceride level and an increased risk of developing cognitive impairment. This was especially true in individuals with Type II Diabetes Mellitus.

Researchers are looking for genetic markers that would hint at an increased risk of dementia. Others are trying to develop medications that will stop or interrupt the process and prevent or limit the disease.

In the meantime, we are left with trying to live a healthy lifestyle starting at an early age. Being active, avoiding smoking, avoiding excessive alcohol and keeping our weight and blood pressure under control will still be our best defense. Starting at any age helps but developing healthy living habits as a young adult seems to be the best choice.

An Extra Tablespoon of Olive Oil Per Day May Keep Death Away

Dr. Marta Guash-Ferre’ and team at Harvard T. H. Chan School of Public Health evaluated whether substituting a teaspoon of olive oil daily to replace margarine, butter, mayonnaise and dairy fat led to a drop in the likelihood of death from cardiovascular disease, cancer, dementia and respiratory diseases.

Her team looked at 92,00 participants who were free of cancer and cardiovascular disease in 1990. Every four years, for the next 28 years of follow-up, the researchers assessed each person’s diet through a detailed questionnaire. Olive oil consumption was determined from olive oil used on salads, cooking, or used on breads and foods.

Their long-term calculations showed that olive oil consumption increased in the study participants during the test period while consumption of margarine decreased, and other fats stayed the same. Participants with higher olive oil consumption were more likely to be physically active, less likely to smoke, consumed more fruits and vegetables than lower olive oil consumers. When the researchers compared those with little olive oil consumption to those with the highest consumption, the high consumers had a 19% lower risk of death from cardiovascular disease, a 17%lower risk of cancer death, a 29% lower risk of death from dementia and an 18% lower risk of respiratory disease death. The study also concluded that substituting ten grams of olive oil per day (a bit less than one tablespoon) for other fats such as butter, margarine, mayonnaise, and dairy fat their death risk dropped by 8-34% from all causes.

In reviewing the data, its seems that their study group represented an extremely well-educated health-conscious group of individuals. Substituting olive oil for other fats is certainly a worthy goal based on these numbers and I will certainly aim to try it.

Dementia – Multiple Trials & Interventions to Delay Cognitive Decline

There have been multiple studies presented at scientific meetings recently that look at what influences the development of dementia and what may delay it. We have known for years that anything that interferes with sensory input to the brain can lead to increased risk of dementia. Improving hearing with hearing aids was found long ago to improve your chances to avoid dementia as you age.

A recent study published by Cecelia Lee, MD MS in JAMA Internal Medicine revealed that individuals undergoing improvement of vision with cataract surgery reduced their risk of dementia significantly. The study looked at over three thousand patients undergoing cataract surgery and or glaucoma treatment between the years 1994 and September 2018. Patients were evaluated every two years during the study with Cognitive Abilities Screening Instrument (CASI) and those with scores indicating a cognitive decline were referred for more detailed testing. Although having cataract surgery reduced your risk of dementia treating glaucoma, it did not provide the same risk reduction for dementia. There were numerous theories on why cataract repair helped based on the type and quality of light reaching the retina and brain, but it was an improvement to normal in another of our senses.

Another study looked at the effect of taking a daily multivitamin on the risk of developing dementia. This study funded in part by Centrum Silver and called the COSMOS trial looked at 2262 men and women all older than sixty-five with a mean age of seventy-three. They were evaluated before entry into the study with cognitive tests and again every year for three years. Those taking a multivitamin exhibited a “slowing of cognitive aging by 60%”. Taking a multivitamin seems like an easy inexpensive intervention to preserve cognitive function and hopefully these results will be confirmed and reproduced in future studies.

Recent studies looked at the benefits in maintaining brain volume and cognitive function when drinking coffee and tea containing caffeine. The studies showed that coffee drinkers benefitted more than tea drinkers but they both benefitted in reducing the risk of cognitive decline. A recent publication took the research a step further by having test subjects drink several cups of coffee and several cups of tea per day. The benefits of drinking both beverages on the same day were far greater than drinking individually.

    Last but not least , a study executed by the Cleveland Clinic Genomic Medicine Institute under the direction of F. Cheng, PhD, looked at insurance data to determine if taking Viagra (Sildenafil) modified your risk of developing Alzheimer’s disease (one form of dementia)  The study over a 6-year period suggested that Viagra users were 69% less likely to develop Alzheimer’s disease than non-Sildenafil users. This study, which was announced and covered extensively on television news and the print media, resulted in more phone calls to my office than the other studies. This was an observational type of study and further research is needed before prescribing this medication for this preventive reason.

Of interest to me was the fact that most of the men who called asking for Viagra after reading this article were on other medications for other medical illnesses that prevented them from safely using Sildenafil products.

FDA Approves New Non-Verbal Computerized Test for Cognitive Impairment

Many of you are used to the Mini Mental Status Test or Montreal Cognitive Assessment Test during which an examiner asks you verbal questions and there are some pictures to interpret. This week the FDA approved a new test taken on an iPad or tablet using images of animals. The test asks you to classify the pictures as either an animal or nonanimal. The advantage of using the nonverbal picture test is it eliminates bias based on level of education and culture. In addition, it eliminates a successful score on subsequent tests due to a “learning the test” effect.

The test results can be incorporated into a patient’s electronic health medical record and become a part of the patient’s permanent chart. The test was given to 230 volunteers. There were eighty individuals with mild cognitive impairment, 55 with mild Alzheimer’s Disease and 95 healthy individuals. The results revealed the test was as sensitive as current verbal tests currently used to detect early dementia.

CognICA is the name of this new test and will be available for purchase in the next few months

Blood Test Biomarkers for Alzheimer’s Disease

Adam Boxer, MD, PhD of the University of California San Francisco and associates published in Lancet Neurology a study which discussed their identifying two chemical biomarkers that distinguish normal patients from those with Alzheimer’s disease or other types of dementia. The two blood markers, phosphorylated tau 217 (p-tau217) and phosphorylated tau 181(p-tau181) showed “exquisite sensitivity and specificity” for discriminating Alzheimer disease from normal and other entities.

These biomarkers are currently only being used for research purposes and are not available to be used by doctors and patients through commercial labs yet. The researchers believe a commercially available lab test will be developed within the next few years

Alzheimer’s Disease – More Insight

The August 1, 2019 issue of the journal Neurology carried a report of a team of researchers who have developed a blood test that can detect the presence of amyloid in the brain with 94% accuracy.  Amyloid is one of the chemical constituents found to be tangling up the neuron nerve communication pathways in humans with Alzheimer’s disease.

The article emphasizes this is currently a strict research tool. It is not a laboratory test that your physician or clinic can order or use to detect this form of dementia early. The results of the blood test correlate well with imaging studies currently in use. It is one small step in the investigation of the causes of this progressive, and fatal, heartbreaking disease and hopefully will allow us to evaluate Alzheimer’s at its earliest stages.

In a journal specifically dedicated to this disease entitled Alzheimer’s and Dementia, researchers at the University of California, San Francisco discussed the increased tendency of patients with Alzheimer’s disease to nap and sleep inappropriately and ineffectively. Previously it was felt that this inappropriate sleep pattern when observed was in fact a risk factor and marker for the development of the disease.

Lea Grinberg, MD and her co-authors feel it is a symptom of the disease instead. They believe that the disease process has already destroyed or inhibited those neurons (brain nerve cells) responsible for wakefulness and alertness. In the absence of this stimulation, patients nap and sleep ineffectively and inappropriately.

Imaging of these areas is difficult to obtain because of their location in the skull and brain but, on detailed studies, more tau protein deposition in these wakefulness areas is visualized.   This concept now allows researchers to zero in on other brain chemicals associated with wakefulness, alertness and sleep as a potential form of treatment of Alzheimer’s disease in addition to those chemicals in the cholinergic system that most medications attack.

Fitness Lowers Your Risk of Dementia

Over the years I have read and passed on to my patients the benefits of exercise on quality of life and healthy aging. This hypothesis was supported by a recent publication in the journal “Primary Care” by Peter Lin, MD, CCFP. Dr Lin and colleagues followed a group of woman aged 38 to 60 years for 44 years to determine the relationship between fitness and development of dementia. They chose to follow 191 women from a group of 1462 patients and selected a balanced number of patients in each age group up to age 60. They performed a physical fitness test on the women in 1968 and then grouped them into high fitness category, intermediate fitness category and low fitness category based on their performance in the physical fitness test. The women then received neuropsychiatric evaluations in 1974, 1980, 1992, 2000, 2005 and 2009.

The patients within the high fitness group showed an 88% reduction in dementia rate compared to those with medium fitness. Those in the lowest fitness group had a 41% increase d risk of dementia compared to the medium fitness group. Those patients in the high fitness group who developed dementia showed symptoms 9.5 years later on average than the patients in the medium fitness group.

The message for young adults is simple. Stay fit at a high level doing something you enjoy and you may reduce your risk of developing dementia by up to 90%.