Dementia Prevention Information Is Confusing

Part of the responsibility of being a physician is keeping up with the medical literature. I subscribe to numerous print and on line journals and read volumes each day. My professional email is littered with summaries of journals. As the baby boomers age and 10,000 of them are enrolled in Medicare per day the emphasis on preventing and treating cognitive impairment leads to volumes of studies and reports daily. To say it is confusing is an understatement.

A recent report from the National Academies of Sciences, Engineering and Medicine has painted a more optimistic picture of potential interventions in its current report as compared to its 2010 report. In the 2010 report they had nothing to be positive about. In the current report that negativism has changed to “inconclusive but encouraging “evidence of staving off cognitive decline. Within the geriatric care community this group’s opinion is still contested by the National Institute of Aging and the Agency for Healthcare Research and Quality but the National Academy of Sciences felt it was appropriate to share its findings with the rest of us. They believe there is moderate evidence to support being active as something that we can do to stave off cognitive dysfunction. They are not asking us to become marathon runners or tri-athletes but just get up and keep moving for ninety minutes a day. There is additionally fairly good evidence that controlling our blood pressure especially during mid-life will help your chances of avoiding dementia. The most controversial area was whether cognitive training with brain teasers, puzzles, learning a new language is of value. I will advise my patients that if they can find a cognitive training activity they enjoy then they should pursue it because it certainly will not hurt. The paper did not address issues which we know are important to control such as avoiding smoking or excessive alcohol of narcotic intake.

At the same time that the National Academy of Sciences was offering a small ray of hope we see articles on artificially sweetened drinks being associated with increased risk of dementia. Add common medications like proton pump inhibitors (Nexium, Protonix, and Pepcid) and overactive bladder medicines to the list of drugs that can increase your risk of dementia. We also can add the cholesterol lowering medications called statins to the list of drugs that can increase your risk of dementia but primarily in inactive individuals.

The information is non-stop and it is never ending. A few years ago I attended a lecture by the head of one of the Harvard Medical School’s Geriatric Programs. The speaker was a family practitioner in her fifties or sixties who stressed the importance of getting plenty of exercise, eating in moderation, cultivating and maintaining relationships with friends, avoiding smoking, controlling your blood pressure and blood sugar and playing “ brain games” if you enjoyed them . It seems that with the latest publication of the National Academies of Sciences, Engineering and Medicine, not much has changed since then.

Advertisements

Fish Oils Fail To Stave Off Mental Decline

Dietary supplementation with Omega-3 fatty acids did not prevent cognitive decline in older individuals according to a study which reviewed the subject in the online magazine MedPage, a publication of the University of Pennsylvania School of Medicine.  By the year 2040, more than 80 million people will be affected with dementia. There has been increasing interest in identifying dietary factors that could help diminish these numbers.

The study was performed by Emma Sydenham, MSc of the London School of Hygiene and Tropical Medicine in response to some previous observational studies that suggested that consuming high levels of polyunsaturated fatty acids may reduce the likelihood of cognitive decline with aging. Some evidence does exist that fatty acids play an important role in brain health through the maintenance of neuronal functioning while acting as mediators of inflammation and oxidative stress.

Sydenham and associates looked back at three major studies designed primarily to assess the efficacy of Omega-3 fatty acids in preventing cardiovascular disease.  Cognitive function was assessed by various methods in all three well-designed studies.  All three studies indicated that Omega-3 fatty acids played no role in preventing cognitive decline.

Sydenham’s team suggested that more research is needed in this area. I believe this study emphasizes the wisdom of eating a balanced diet prepared in a way to retain the nutrients – inclusive of several portions of cold water fleshy fish per week.

In general, if you provide your body with the nutrients it needs by consuming appropriately prepared healthy portions, your body will extract what it needs.

What’s New in Dementia, Alzheimer’s

Alzheimer’s Disease is a form of dementia and considered to be a progressive, fatal neurologic disease. Medications to slow it down are successful in about 50 % of patients for a very limited amount of time (6 -12 months).  As Baby Boomers age and move into the retirement sector, we are always looking for positive data regarding the disease to offset the expected epidemic of dementia.  We have a limited amount of good news to report.

Japanese researchers report that they have developed several types of contrast material for imaging studies which will allow doctors to see accumulating plaque in the brain and possibly the tangles of neurons associated with the disease at a much earlier stage.  At the same time researchers now claim to be able to do a spinal tap and, by examining the spinal fluid, make an earlier and more accurate diagnosis. At this point there might not yet be an advantage to early detection of the disease but as research proceeds it may become an important advantage.

The British Medical Journal is reporting that cognitive decline actually starts in midlife. They studied a mix of 7,300 men and women at five years intervals beginning in 1997 and found a decrease in intellectual functions beginning at 45 years old. They concluded that “what is good for our hearts is also good for our heads.”  They stressed the importance of controlling hypertension, obesity and abnormal cholesterol as a way to prevent dementia.

You might ask why I consider the fact that dementia begins in midlife a positive?  It’s a positive because we have the ability to control our weight, blood pressure, cholesterol and exercise level. Anytime a disease is modifiable by how we live our life we are given the chance to prevent it or limits its impact. This fact is supported by a recent study published in the Archives of Neurology looking at individuals with a genetic variant which predisposes them to develop Alzheimer’s Disease.  They found that older adults with the genetic predisposition for Alzheimer’s Disease who exercised regularly, at or above the American Heart Association recommended levels, developed “amyloid deposits” on scans of their brain less than expected and in line with the general public who did not have a genetic predisposition to develop the disease.

These are small but positive steps in facing dementia. We can find it earlier and slow down or turn off genetic predisposition by living a healthy life.

Moderate Drinking Can Reduce Dementia, Alzheimer’s Risk

In an article in the International Business Times 08/19/2011 edition, Loyala University Medical Center researchers admit that moderate consumption of alcohol reduces the risk of developing cognitive dysfunction and Alzheimer’s type dementia.

They reviewed 143 studies, which included about 365,000 members from 19 different countries. The health benefits were seen in 14 of the 19 countries including the USA.  Moderate drinking was defined as one drink daily for women and two for men. Further clarification defines moderate intake as 1.5 ounces of spirits, 5 ounces of wine or 12 ounces of beer.

It was not clear why moderate alcohol intake reduced the risk of Alzheimer’s disease but it is believed to be due to its anti-inflammatory effects.  Neuroinflammation which occurs in both Alzheimer’s disease and other dementias can be altered by moderate alcohol consumption. They did caution however, that heavy drinking defined as 3-5 drinks per day actually causes neuroinflammation and memory problems.  The study, published in the Neuropsychiatric Disease and Treatment Journal, showed that wine consumption was a better choice to reduce the risk of dementia.

The study review showed that moderate drinking didn’t impair the cognitive functions in younger subjects aged 18 -50 and actually reduced the risk of dementia and Alzheimer’s in participants over the age of 50.

Alzheimer’s Disease – Recent Data

Researcher’s gathered in Paris, France this month to present their data on new developments with Alzheimer’s disease.  In reviewing the meeting’s material, it is clear that much of what is “new” is old.

In the past we were taught that patients placed on medications for Alzheimer’s Disease would derive a benefit about 50% of the time. This benefit would last for six to twelve months.

One of the world’s authorities on this topic is Susan Rountree, M.D. of Baylor College of Medicine in Houston.  She has followed 641 patients since the late 1980’s.  In 2008 she reported that patients treated with medicines such as donepezil (Aricept) and rivastigmine (Exelon) survived about three years longer than patients who did not take these medications.  She re-analyzed that data, updated it and came to the conclusion that “using anti-dementia drugs doesn’t seem to prolong survival.”   She did however recommend continuing their use because her data showed that patients taking them had improved cognition and ability to function.

At the Paris event there was material presented that was not surprising but needs the legitimacy of a well planned study to turn theory into scientific evidence and fact.

The study showing that military personnel who suffered traumatic brain injuries during the Vietnam War were more likely to develop dementia has great implications for today’s veterans fighting in Iraq and Afghanistan where brain injuries are on the rise.  It will clearly help us as well in terms of long-term planning for the development of dementia in private citizens suffering from traumatic brain injuries.  It was not surprising either when certain medications were cited as being more likely to contribute to the development of Alzheimer’s Disease. This year’s culprits seem to be anticholinergic drugs which make a patient’s mouth dry and cause constipation.

What was not surprising were the studies that showed that elderly individuals who engaged in regular and vigorous physical exercise were less likely to develop cognitive impairment.  Those patients who get regular and vigorous exercise who show signs of cognitive problems declined at a slower rate than those who don’t.

While much of the material discussed confirmed the fact that healthy lifestyle is the best defense against this disease; there was also much hopeful discussion of research which is untangling the relationship between brain chemicals, development of plaques in the brain and its relationship to Alzheimer’s. On an encouraging note, we are much closer to early detection and therapeutic intervention than we were a decade ago.