tag:theconversation.com,2011:/es/topics/alzheimers-disease-30935/articlesAlzheimer's disease – The Conversation2024-03-21T12:23:49Ztag:theconversation.com,2011:article/2168922024-03-21T12:23:49Z2024-03-21T12:23:49ZNew studies suggest millions with mild cognitive impairment go undiagnosed, often until it’s too late<figure><img src="https://images.theconversation.com/files/579473/original/file-20240304-18-x3o3fj.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7360%2C4912&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Mild cognitive impairment can be an early sign of Alzheimer's disease or other dementias.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-women-lost-in-thoughts-in-wheel-chair-royalty-free-image/677895828?phrase=mild+cognitive+impairment+&adppopup=true">ivanastar/iStock via Getty Images Plus</a></span></figcaption></figure><p>Mild cognitive impairment – an early stage of dementia – is widely underdiagnosed in people 65 and older. That is the key takeaway of two recent studies from our team. </p>
<p>In the first study, we used Medicare data for about 40 million beneficiaries age 65 and older from 2015 to 2019 to estimate the prevalence of mild cognitive impairment in that population and to identify what proportion of them had actually been diagnosed. </p>
<p>Our <a href="https://doi.org/10.1186/s13195-023-01272-z">finding was sobering</a>: A mere 8% of the number of cases with mild cognitive impairment that we expected based on a statistical model had actually been diagnosed. Scaled up to the general population 65 and older, this means that approximately 7.4 million cases across the country remain undiagnosed. </p>
<p>In the second study, we analyzed data for 226,756 primary care clinicians and found that <a href="https://doi.org/10.14283/jpad.2023.131">over 99% of them underdiagnosed mild cognitive impairment</a> in this population. </p>
<h2>Why it matters</h2>
<p>Mild cognitive impairment is an early symptom of Alzheimer’s disease in <a href="https://doi.org/10.1001/jama.2019.2000">about half of cases</a> and progresses to dementia <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment">at a rate of 10% to 15% per year</a>. It includes symptoms such as losing the ability to remember recent events and appointments, make sound decisions and master complex tasks. Failure to detect it might deprive patients of an opportunity to get treated and to slow down disease progression. </p>
<p>Mild cognitive impairment can sometimes be caused by easily addressable factors, such as medication side effects, thyroid dysfunction or <a href="https://theconversation.com/vitamin-b12-deficiency-is-a-common-health-problem-that-can-have-serious-consequences-but-doctors-often-overlook-it-192714">vitamin B12 deficiency</a>. Since mild cognitive impairment has <a href="https://doi.org/10.1016/j.amjopharm.2008.06.004">the same risk factors as cardiovascular disease</a>, such as high blood pressure and cholesterol, medication management of these risks combined with diet and exercise <a href="https://doi.org/10.1016/S0140-6736(15)60461-5">can reduce the risk of progression</a>.</p>
<p>In 2023, the Food and Drug Administration <a href="https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval">approved the drug lecanemab</a> as the <a href="https://theconversation.com/what-the-fdas-accelerated-approval-of-a-new-alzheimers-drug-could-mean-for-those-with-the-disease-5-questions-answered-about-lecanemab-197460">first disease-modifying treatment</a> <a href="https://www.nia.nih.gov/health/alzheimers-causes-and-risk-factors/what-happens-brain-alzheimers-disease">for Alzheimer’s disease</a>, the most common cause of mild cognitive impairment. In contrast to previous drugs, which can temporarily improve symptoms of the disease, such as memory loss and agitation, this new treatment addresses the underlying cause of the disease. </p>
<p>Lecanemab, a monoclonal antibody, <a href="https://www.news-medical.net/health/What-are-Amyloid-Plaques.aspx#">reduces amyloid plaques</a> in the brain, which are toxic protein clumps that are believed to contribute to the progression of the disease. In a large clinical trial, lecanemab was able to <a href="https://doi.org/10.1056/NEJMoa2212948">reduce the progression</a> of early-stage Alzheimer’s disease. A similar drug, donanemab, also <a href="https://doi.org/10.1001/jama.2023.13239">succeeded in a clinical trial</a> and is expected to be <a href="https://www.medicalnewstoday.com/articles/fda-delays-approval-of-alzheimers-drug-donanemab-what-experts-think">approved sometime in 2024</a>. </p>
<p>However, these drugs must be used in the early stages of Alzheimer’s disease, ideally when a patient has only mild cognitive impairment, as there is <a href="https://www.alz.org/alzheimers-dementia/treatments/lecanemab-leqembi#">no evidence that they are effective in advanced stages</a>.</p>
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<figcaption><span class="caption">An earlier diagnosis leads to early treatment and better outcomes.</span></figcaption>
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<h2>What still isn’t known</h2>
<p>Many factors contribute to the <a href="https://doi.org/10.1002/alz.13051">lack of timely detection</a>. But researchers don’t have a good understanding of the relative importance of those individual factors or how to reduce the high rate of underdiagnosis.</p>
<p>While distinct, symptoms are subtle and their slow progression means that they can be overlooked or misinterpreted as normal aging. A neurologist in China told our research team that diagnosis rates spike in China after the New Year’s holiday, when children who haven’t seen their parents for a year notice changes that are harder to pick up when interacting with someone daily. </p>
<p>Doctors also commonly discount memory concerns as normal aging and doubt that much can be done about it. While cognitive tests to distinguish mild cognitive impairment from pathologic decline do exist, they take about 15 minutes, which can be hard to come by during the limited time of a doctor’s visit and may require a follow-up appointment. </p>
<h2>What’s next</h2>
<p>People, particularly those in their 60s and beyond, as well as their families and friends need to be vigilant about cognitive decline, bring it up during doctor’s appointments and insist on a formal assessment. </p>
<p>The <a href="https://www.medicare.gov/coverage/yearly-wellness-visits">Medicare yearly “wellness” visit</a> is an opportunity to explore such concerns, but only about half of beneficiaries <a href="https://doi.org/10.1377/hlthaff.2019.01795">take advantage of it</a>. </p>
<p>Just as physicians ask patients about unexplained weight loss and take those concerns seriously, we believe questions that explore a patient’s cognitive state need to become the norm. </p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/216892/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Soeren Mattke receives funding from Alzheon, Biogen, C2N, Eisai, Lilly and Roche/Genentech through the University of Southern California. He consults to Biogen, C2N, Eisai, Novartis, Novo Nordisk and Roche/Genentech. </span></em></p><p class="fine-print"><em><span>Ying Liu receives funding from Genentech, a member of the Roche Group, through the University of Southern California. </span></em></p>Medicare covers an annual well-check visit that could potentially identify cognitive issues, but only about half of beneficiaries take advantage of them.Soeren Mattke, Director of the USC Dornsife Brain Health Observatory, University of Southern CaliforniaYing Liu, Research Scientist, Center for Economic and Social Research, USC Dornsife College of Letters, Arts and SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2248122024-03-13T12:28:30Z2024-03-13T12:28:30ZSlowed speech may indicate cognitive decline more accurately than forgetting words<figure><img src="https://images.theconversation.com/files/580833/original/file-20240310-30-y6u8ju.jpg?ixlib=rb-1.1.0&rect=21%2C0%2C4723%2C3165&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/image-senior-man-thinking-set-question-271407230">tomertu/Shutterstock</a></span></figcaption></figure><p>Can you pass me the whatchamacallit? It’s right over there next to the thingamajig. </p>
<p>Many of us will experience “lethologica”, or difficulty finding words, in everyday life. And it usually becomes more prominent with age. </p>
<p>Frequent difficulty finding the right word can signal changes in the brain <a href="https://www.geriatric.theclinics.com/article/S0749-0690(22)00058-1/abstract">consistent</a> with the early (“preclinical”) stages of Alzheimer’s disease – before more obvious symptoms emerge. However, a <a href="https://doi.org/10.1080/13825585.2024.2315774">recent study</a> from the University of Toronto suggests that it’s the speed of speech, rather than the difficulty in finding words that is a more accurate indicator of brain health in older adults.</p>
<p>The researchers asked 125 healthy adults, aged 18 to 90, to describe a scene in detail. Recordings of these descriptions were subsequently analysed by artificial intelligence (AI) software to extract features such as speed of talking, duration of pauses between words, and the variety of words used. </p>
<p>Participants also completed a standard set of tests that measure concentration, thinking speed, and the ability to plan and carry out tasks. Age-related decline in these “executive” abilities was closely linked to the pace of a person’s everyday speech, suggesting a broader decline than just difficulty in finding the right word. </p>
<p>A novel aspect of this study was the use of a “picture-word interference task”, a clever task designed to separate the two steps of naming an object: finding the right word and instructing the mouth on how to say it out loud. </p>
<p>During this task, participants were shown pictures of everyday objects (such as a broom) while being played an audio clip of a word that is either related in meaning (such as “mop” – which makes it harder to think of the picture’s name) or which sounds similar (such as “groom” – which can make it easier). </p>
<p>Interestingly, the study found that the natural speech speed of older adults was related to their quickness in naming pictures. This highlights that a general slowdown in processing might underlie broader cognitive and linguistic changes with age, rather than a specific challenge in memory retrieval for words.</p>
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<figcaption><span class="caption">Alzheimer’s explained.</span></figcaption>
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<h2>How to make the findings more powerful</h2>
<p>While the findings from this study are interesting, finding words in response to picture-based cues may not reflect the complexity of vocabulary in unconstrained everyday conversation. </p>
<p>Verbal fluency tasks, which require participants to generate as many words as possible from a given category (for example, animals or fruits) or starting with a specific letter within a time limit, may be used with picture-naming to better capture the “tip-of-the-tongue” phenomenon. </p>
<p>The tip-of-the-tongue phenomenon refers to the temporary inability to retrieve a word from memory, despite partial recall and the feeling that the word is known. These tasks are considered a better test of everyday conversations than the picture-word interference task because they involve the active retrieval and production of words from one’s vocabulary, similar to the processes involved in natural speech.</p>
<p>While verbal fluency performance does not significantly decline with normal ageing (as shown in a <a href="https://doi.org/10.1186/s13643-022-02018-y">2022 study</a>), poor performance on these tasks can indicate neurodegenerative diseases such as Alzheimer’s. </p>
<p>The tests are useful because they account for the typical changes in word retrieval ability as people get older, allowing doctors to identify impairments beyond what is expected from normal ageing and potentially detect neurodegenerative conditions.</p>
<p>The verbal fluency test engages various brain regions involved in language, memory, and executive functioning, and hence can offer insights into which regions of the brain are affected by cognitive decline.</p>
<p>The authors of the University of Toronto study could have investigated participants’ subjective experiences of word-finding difficulties alongside objective measures like speech pauses. This would provide a more comprehensive understanding of the cognitive processes involved. </p>
<p>Personal reports of the “feeling” of struggling to retrieve words could offer valuable insights complementing the behavioural data, potentially leading to more powerful tools for quantifying and detecting early cognitive decline.</p>
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<h2>Opening doors</h2>
<p>Nevertheless, this study has opened exciting doors for future research, showing that it’s not just what we say but how fast we say it that can reveal cognitive changes. </p>
<p>By harnessing natural language processing technologies (a type of AI), which use computational techniques to analyse and understand human language data, this work advances previous studies that noticed subtle changes in the spoken and written language of public figures like <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6922000/">Ronald Reagan</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/15574466/">Iris Murdoch</a> in the years before their dementia diagnoses. </p>
<p>While those opportunistic reports were based on looking back after a dementia diagnosis, this study provides a more systematic, data-driven and forward-looking approach.</p>
<p>Using rapid advancements in natural language processing will allow for automatic, detection of language changes, such as slowed speech rate. </p>
<p>This study underscores the potential of speech rate changes as a significant yet subtle marker of cognitive health that could aid in identifying people at risk before more severe symptoms become apparent.</p>
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Read more:
<a href="https://theconversation.com/could-many-dementia-cases-actually-be-liver-disease-222779">Could many dementia cases actually be liver disease?</a>
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<img src="https://counter.theconversation.com/content/224812/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Lancaster receives funding from the Economic and Social Research Council and Sussex Partnership NHS Foundation Trust to investigate speech-based markers of neurodegenerative disease. </span></em></p><p class="fine-print"><em><span>Alice Stanton receives funding from the Economic and Social Research Council and Sussex Partnership NHS Foundation Trust to investigate speech-based markers of neurodegenerative disease.</span></em></p>A new study suggests that talking speed is a more important indicator of brain health than difficulty finding words.Claire Lancaster, Lecturer, Dementia, University of SussexAlice Stanton, PhD Candidate, Dementia, University of SussexLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2231812024-03-12T06:26:19Z2024-03-12T06:26:19ZDoes intermittent fasting have benefits for our brain?<figure><img src="https://images.theconversation.com/files/579767/original/file-20240305-20-q62h9n.jpg?ixlib=rb-1.1.0&rect=17%2C8%2C5850%2C3598&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/group-elderly-women-have-breakfast-cafeteria-2237394693">Shutterstock</a></span></figcaption></figure><p>Intermittent fasting has become a popular dietary approach to help people lose or manage their <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8683964/">weight</a>. It has also been promoted as a way to reset metabolism, control chronic disease, slow ageing and <a href="https://pubmed.ncbi.nlm.nih.gov/27810402">improve overall health</a>.</p>
<p>Meanwhile, some research suggests intermittent fasting may offer a different way for the brain to access energy and provide protection against neurodegenerative diseases like <a href="https://link.springer.com/article/10.1007/s11011-023-01288-2">Alzheimer’s disease</a>. </p>
<p>This is not a new idea – the ancient Greeks believed fasting <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839325/">enhanced thinking</a>. But what does the modern-day evidence say?</p>
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Read more:
<a href="https://theconversation.com/i-want-to-eat-healthily-so-why-do-i-crave-sugar-salt-and-carbs-212114">I want to eat healthily. So why do I crave sugar, salt and carbs?</a>
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<h2>First, what is intermittent fasting?</h2>
<p>Our <a href="https://pubmed.ncbi.nlm.nih.gov/35487190/">diets</a> – including calories consumed, macronutrient composition (the ratios of fats, protein and carbohydrates we eat) and when meals are consumed – are factors in our lifestyle we can change. People do this for cultural reasons, desired weight loss or potential health gains.</p>
<p>Intermittent fasting consists of short periods of calorie (energy) restriction where food intake is limited for 12 to 48 hours (usually 12 to 16 hours per day), followed by periods of normal food intake. The intermittent component means a re-occurrence of the pattern rather than a “one off” fast. </p>
<p>Food deprivation beyond 24 hours typically constitutes starvation. This is distinct from fasting due to its specific and potentially harmful biochemical alterations and nutrient deficiencies if continued for long periods.</p>
<h2>4 ways fasting works and how it might affect the brain</h2>
<p>The brain accounts for about <a href="https://theconversation.com/how-much-energy-do-we-expend-thinking-and-using-our-brain-197990">20% of the body’s energy consumption</a>.</p>
<p>Here are four ways intermittent fasting can act on the body which could help explain its potential effects on the brain.</p>
<p><strong>1. Ketosis</strong></p>
<p>The goal of many intermittent fasting routines is to flip a “<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">metabolic switch</a>” to go from burning predominately carbohydrates to burning fat. This is called ketosis and typically occurs after 12–16 hours of fasting, when liver and glycogen stores are depleted. <a href="https://www.ncbi.nlm.nih.gov/books/NBK493179/">Ketones</a> – chemicals produced by this metabolic process – become the preferred energy source for the brain. </p>
<p>Due to this being a slower metabolic process to produce energy and potential for lowering blood sugar levels, ketosis can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10844723/">cause symptoms</a> of hunger, fatigue, nausea, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8754590/">low mood</a>, irritability, constipation, headaches, and brain “fog”. </p>
<p>At the same time, as glucose metabolism in the brain declines with ageing, studies have shown ketones could provide an alternative energy source to <a href="https://www.science.org/doi/10.1126/science.aau2095">preserve brain function</a> and prevent <a href="https://pubmed.ncbi.nlm.nih.gov/32709961/">age-related neurodegeneration disorders and cognitive decline</a>.</p>
<p>Consistent with this, increasing ketones through <a href="https://pubmed.ncbi.nlm.nih.gov/31027873/">supplementation</a> or <a href="https://pubmed.ncbi.nlm.nih.gov/31757576/">diet</a> has been shown to improve cognition in adults with mild cognitive decline and those at risk of Alzheimer’s disease respectively. </p>
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Read more:
<a href="https://theconversation.com/does-it-matter-what-time-of-day-i-eat-and-can-intermittent-fasting-improve-my-health-heres-what-the-science-says-203762">Does it matter what time of day I eat? And can intermittent fasting improve my health? Here's what the science says</a>
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<p><strong>2. Circadian syncing</strong></p>
<p>Eating at times that <a href="https://pubmed.ncbi.nlm.nih.gov/32480126/">don’t match our body’s natural daily rhythms</a> can disrupt how our organs work. Studies in shift workers have suggested this might also make us more prone to <a href="https://pubmed.ncbi.nlm.nih.gov/22010477/">chronic disease</a>. </p>
<p>Time-restricted eating is when you eat your meals within a six to ten-hour window during the day when you’re most active. Time-restricted eating causes changes in <a href="https://pubmed.ncbi.nlm.nih.gov/36599299/">expression of genes in tissue</a> and helps the body during rest and activity. </p>
<p>A 2021 <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827225/">study of 883 adults</a> in Italy indicated those who restricted their food intake to ten hours a day were less likely to have cognitive impairment compared to those eating without time restrictions. </p>
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<a href="https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="older man playing chess" src="https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579766/original/file-20240305-30-b9gwh4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Matching your eating to the active parts of your day may have brain benefits.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/move-that-wins-senior-men-plying-1703587585">Shutterstock</a></span>
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<p><strong>3. Mitochondria</strong></p>
<p>Intermittent fasting may provide <a href="https://pubmed.ncbi.nlm.nih.gov/35218914/">brain protection</a> through improving mitochondrial function, metabolism and reducing oxidants.</p>
<p>Mitochondria’s <a href="https://www.genome.gov/genetics-glossary/Mitochondria">main role is to produce energy</a> and they are crucial to brain health. Many age-related diseases are closely related to an energy supply and demand imbalance, likely attributed to <a href="https://www.nature.com/articles/s41574-021-00626-7">mitochondrial dysfunction during ageing</a>. </p>
<p>Rodent studies suggest alternate day fasting or reducing calories <a href="https://journals.sagepub.com/doi/10.1038/jcbfm.2014.114">by up to 40%</a> might protect or improve <a href="http://www.ncbi.nlm.nih.gov/pubmed/21861096">brain mitochondrial function</a>. But not all studies support this theory. </p>
<p><strong>4. The gut-brain axis</strong></p>
<p>The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6469458/">gut and the brain communicate with each other</a> via the body’s nervous systems. The brain can influence how the gut feels (think about how you get “butterflies” in your tummy when nervous) and the gut can affect mood, cognition and mental health.</p>
<p>In mice, intermittent fasting has shown promise for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913738/">improving brain health</a> by increasing survival and <a href="https://pubmed.ncbi.nlm.nih.gov/12354284/">formation of neurons</a> (nerve cells) in the hippocampus brain region, which is involved in memory, learning and emotion. </p>
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<a href="https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="medical clinician shows woman a sheet of brain scans" src="https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579770/original/file-20240305-18-cqzgoc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">What we eat can affect our brain, and vice versa.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/brain-disease-diagnosis-medical-doctor-diagnosing-1525567082">Shutterstock</a></span>
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<p>There’s <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8470960/">no clear evidence</a> on the effects of intermittent fasting on cognition in healthy adults. However one 2022 study interviewed 411 older adults and found <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9646955/">lower meal frequency</a> (less than three meals a day) was associated with reduced evidence of Alzheimer’s disease on brain imaging.</p>
<p>Some research has suggested calorie restriction may have a protective effect against <a href="https://academic.oup.com/nutritionreviews/article/81/9/1225/7116310">Alzheimer’s disease</a> by reducing oxidative stress and inflammation and promoting vascular health. </p>
<p>When we look at the effects of overall energy restriction (rather than intermittent fasting specifically) the evidence is mixed. Among people with mild cognitive impairment, one study showed <a href="https://pubmed.ncbi.nlm.nih.gov/26713821/">cognitive improvement</a> when participants followed a calorie restricted diet for 12 months. </p>
<p>Another study found a 25% calorie restriction was associated with <a href="https://pubmed.ncbi.nlm.nih.gov/30968820">slightly improved working memory</a> in healthy adults. But a <a href="https://www.sciencedirect.com/science/article/pii/S0022316623025221?via%3Dihub">recent study</a>, which looked at the impact of calorie restriction on spatial working memory, found no significant effect.</p>
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Read more:
<a href="https://theconversation.com/yes-intermittent-fasting-can-boost-your-health-but-how-and-when-to-restrict-food-consumption-is-crucial-197170">Yes, intermittent fasting can boost your health, but how and when to restrict food consumption is crucial</a>
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<h2>Bottom line</h2>
<p>Studies in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9740746/">mice</a> support a role for intermittent fasting in improving brain health and ageing, but few studies in humans exist, and the evidence we have is mixed.</p>
<p>Rapid weight loss associated with calorie restriction and intermittent fasting can lead to nutrient deficiencies, muscle loss, and decreased immune function, particularly in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8749464/">older adults</a> whose nutritional needs may be higher. </p>
<p>Further, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6314618/">prolonged fasting</a> or <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9042193/">severe calorie restriction</a> may pose risks such as fatigue, dizziness, and electrolyte imbalances, which could exacerbate existing health conditions. </p>
<p>If you’re considering <a href="https://www.nejm.org/doi/10.1056/NEJMra1905136?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed">intermittent fasting</a>, it’s best to seek advice from a health professional such as a dietitian who can provide guidance on structuring fasting periods, meal timing, and nutrient intake. This ensures intermittent fasting is approached in a safe, sustainable way, tailored to individual needs and goals.</p><img src="https://counter.theconversation.com/content/223181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alongside her academic role, Hayley O'Neill works as a wellness consultant.</span></em></p>Many dieters vouch for the effect of intermittent fasting on their body – but what about their brain?Hayley O'Neill, Assistant Professor, Faculty of Health Sciences and Medicine, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2227792024-03-07T18:17:28Z2024-03-07T18:17:28ZCould many dementia cases actually be liver disease?<p>A <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814346">recent study</a> of US veterans found that 10% of those diagnosed with dementia actually had a liver condition called hepatic encephalopathy (HE) – a treatable condition.</p>
<p>The liver can be damaged by several things, including alcohol, fatty deposits and hepatitis viruses. When the damage continues over several years, the liver becomes scarred (known as cirrhosis) and, at a certain point, can no longer perform one of its critical tasks: detoxifying the blood. Toxins (mainly ammonia) can build up and get into the brain, interfering with brain function. This is HE. </p>
<p>HE can be very mild and difficult to diagnose. <a href="https://britishlivertrust.org.uk/information-and-support/liver-conditions/hepatic-encephalopathy/">Symptoms</a> can be as subtle as changes in sleep pattern or irritability. As the condition worsens, symptoms such as forgetfulness, disorientation or confusion emerge. In its most severe form, it can cause coma and death. </p>
<p>Once diagnosed, it can be treated, initially with laxatives that help to remove ammonia and other toxins that accumulate in the gut. This is followed by treatment with an antibiotic (rifaximin) that kills some of the harmful ammonia-producing bacteria in the gut. If it is very severe, HE can even be a reason to have a liver transplant.</p>
<h2>Silent condition</h2>
<p>HE is easier to spot and treat if we know the person has cirrhosis. The trouble is that cirrhosis is a silent condition until it reaches very late stages when the liver starts to fail. HE is much harder to diagnose in the general population. The symptoms of change of mood, behaviour, confusion and forgetfulness are also all seen in people with dementia.</p>
<p><a href="https://www.nhs.uk/conditions/dementia/about-dementia/what-is-dementia/">Dementia</a> is a condition caused by long-term damage to brain function. This is most commonly caused by reduced blood supply to the brain because of damage to small blood vessels through diabetes or high blood pressure (<a href="https://www.nhs.uk/conditions/vascular-dementia/">vascular dementia</a>). Other forms of dementia include <a href="https://www.nia.nih.gov/health/alzheimers-and-dementia/alzheimers-disease-fact-sheet">Alzheimer’s disease</a>, where deposits damage the brain causing typical symptoms of forgetfulness and confusion.</p>
<p>The new US study examined medical records of former soldiers treated by the Veterans Health Administration over ten years with a diagnosis of dementia made on at least two separate occasions. </p>
<p>The team looked at clinical data including blood results from this group and used them to calculate an <a href="https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/hep.21178">FIB-4 score</a> (a score based on liver blood results and age), which can be used to predict liver damage. Over 175,000 people were included in the analysis. Of these, 10% (18,390 people) had a FIB-4 score of more than 3.25 (an accepted cut-off for the diagnosis of liver scarring).</p>
<p>The researchers found that a high FIB-4 score was more common in those with viral hepatitis and heavy alcohol users – risk factors for liver disease. </p>
<p>A high score was less likely in people who had diabetes, high blood pressure or kidney disease – all risk factors for dementia. This suggests that people with a high FIB-4 score may actually have liver disease with HE causing their symptoms rather than dementia. </p>
<p>The researchers went on to confirm these findings by looking at a separate group of people that were assessed for dementia at their hospital and found similar results, with 9% having a high FIB-4 score and potential cirrhosis.</p>
<p>This study suggests that around 10% of people diagnosed with dementia may instead have underlying silent liver disease with HE causing or contributing to the symptoms – an important diagnosis to make as HE is treatable. </p>
<h2>Important new avenue</h2>
<p>It is the first study of its kind to analyse routinely collected health data in this way. However, we should treat these results with some caution.</p>
<p>First, the data is from military veterans – 97% male and 80% white ethnicity – and hence not representative of the wider population. Second, FIB-4 was used as a marker of cirrhosis. It is a useful score that is easily calculated, but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418560/">accuracy</a> depends on the cause of liver disease and is lower in older people. Finally, having a high FIB-4 score does not necessarily mean that the person has HE.</p>
<p>This study opens an important new avenue of research. It raises the awareness of checking for liver disease in people with general symptoms of dementia. This is likely to be a growing problem as the rates of both dementia and cirrhosis are increasing. But we still need better data to fully understand the number of people with HE incorrectly given a diagnosis of dementia and how best to identify and treat them.</p><img src="https://counter.theconversation.com/content/222779/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ashwin Dhanda does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A study of US veterans found that one in ten had been wrongly diagnosed with dementia, when they actually had a treatable liver condition.Ashwin Dhanda, Associate Professor of Hepatology, University of PlymouthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2228542024-02-29T21:48:23Z2024-02-29T21:48:23ZBetter sleep is a protective factor against dementia<figure><img src="https://images.theconversation.com/files/573581/original/file-20240117-23-vqzz7m.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lack of sleep, or poor quality sleep, is one of the risk factors for developing Alzheimer's disease. Fortunately, there are ways to improve sleep.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Dementia is a progressive loss of cognitive abilities, such as memory, that is significant enough to have an impact on a person’s daily activities. </p>
<p>It can be caused by a number of different diseases, including <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s</a>, which is the most common form. Dementia is caused by a loss of neurons over a long period of time. Since, by the time symptoms appear, many changes in the brain have already occurred, many scientists are focusing on studying the risk and protective factors for dementia. </p>
<p>A risk factor, or conversely, a protective factor, is a condition or behaviour that increases or reduces the risk of developing a disease, but does not guarantee either outcome. Some risk factors for Alzheimer’s disease and dementia, such as age or genetics, are not modifiable, but there are several other factors we can influence, <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">specifically lifestyle habits and their impact on our overall health</a>.</p>
<p>These risk factors include depression, lack of physical activity, social isolation, high blood pressure, obesity, diabetes, excessive alcohol consumption and smoking, as well as poor sleep.</p>
<p>We have been focusing our research on the question of sleep for over 10 years, particularly in the context of the <a href="https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs">Framingham Heart Study</a>. In this large community-based cohort study, ongoing since the 1940s, the health of surviving participants has been monitored to the present day. As researchers in sleep medicine and epidemiology, we have expertise in researching the role of sleep and sleep disorders in cognitive and psychiatric brain aging. </p>
<p>As part of our research, we monitored and analyzed the sleep of people aged 60 and over to see who did — or did not — develop dementia. </p>
<h2>Sleep as a risk or protective factor against dementia</h2>
<p>Sleep appears to play an essential role in a number of brain functions, such as memory. Good quality sleep <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2793873">could therefore play a vital role in preventing dementia</a>.</p>
<p>Sleep is important for maintaining <a href="https://www.science.org/doi/10.1126/science.1241224">good connections in the brain</a>. Recently, research has revealed that sleep seems to have a function similar to that of a garbage truck for the brain: <a href="https://doi.org/10.1016/j.mad.2023.111899">deep sleep could be crucial for eliminating metabolic waste from the brain</a>, including clearing certain proteins, such as those known to accumulate in the brains of people with Alzheimer’s disease. </p>
<p>However, the links between deep sleep and dementia still have to be clarified.</p>
<h2>What is deep sleep?</h2>
<p>During a night’s sleep, we go through several <a href="http://ceams-carsm.ca/en/a-propos-du-sommeil/">sleep stages</a> that succeed one another and are repeated. </p>
<p>NREM sleep (non-rapid eye movement sleep) is divided into light NREM sleep (NREM1 stage), NREM sleep (NREM2 stage) and deep NREM sleep, also called slow-wave sleep (NREM3 stage). The latter is associated with several restorative functions. Next, REM sleep (rapid eye movement sleep) is the stage generally associated with the most vivid dreams. An adult generally spends around 15 to 20 per cent of each night in deep sleep, if we add up all the periods of NREM3 sleep. </p>
<p>Several sleep changes are common in adults, such as going to bed and waking up earlier, sleeping for shorter periods of time and less deeply, and waking up more frequently during the night.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Sleep stages, and the role of deep sleep for brain health.</span>
<span class="attribution"><span class="source">(Andrée-Ann Baril)</span></span>
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<h2>Loss of deep sleep linked to dementia</h2>
<p>Participants in the <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2810957">Framingham Heart Study</a> were assessed using a sleep recording — known as polysomnography — on two occasions, approximately five years apart, in 1995-1998 and again in 2001-2003. </p>
<p>Many people showed a reduction in their deep slow-wave sleep over the years, as is to be expected with aging. Conversely, the amount of deep sleep in some people remained stable or even increased. </p>
<p>Our team of researchers from the Framingham Heart Study followed 346 participants aged 60 and over for a further 17 years to observe who developed dementia and who did not. </p>
<p>Progressive loss of deep sleep over time was associated with an increased risk of dementia, whatever the cause, and particularly Alzheimer’s type dementia. These results were independent of many other risk factors for dementia.</p>
<p>Although our results do not prove that loss of deep sleep causes dementia, they do suggest that it could be a risk factor in the elderly. Other aspects of sleep may also be important, such as its duration and quality. </p>
<h2>Strategies to improve deep sleep</h2>
<p>Knowing the impact of a lack of deep sleep on cognitive health, what strategies can be used to improve it? </p>
<p>First and foremost, if you’re experiencing sleep problems, it’s worth talking to your doctor. Many sleep disorders are underdiagnosed and treatable, particularly through behavioural (i.e. non-medicinal) approaches. </p>
<p>Adopting good sleep habits can help, such as going to bed and getting up at consistent times or avoiding bright or blue light in bed, like that of screens. </p>
<p>You can also avoid caffeine, limit your alcohol intake, maintain a healthy weight, be physically active during the day, and sleep in a comfortable, dark and quiet environment.</p>
<p>The role of deep sleep in preventing dementia remains to be explored and studied. Encouraging sleep with good lifestyle habits could have the potential to help us age in a healthier way.</p><img src="https://counter.theconversation.com/content/222854/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrée-Ann Baril received funding from the Sleep Research Society Foundation, the Alzheimer Society of Canada, the Canadian Institutes of Health Research, Banting Postdoctoral Fellowships, the Fondation de l'Hôpital du Sacré-Coeur de Montréal, the Université de Montréal and speaking fees from Eisai.</span></em></p><p class="fine-print"><em><span>Matthew Pase received funding from the National Health and Medical Research Council of Australia, National Institute on Aging, Dementia Australia, Alzheimer's Association, National Heart Foundation of Australia, Australian Research Council, Stroke Foundation, Brain Foundation, Alzheimer's Drug Discovery Foundation, Rebecca L Cooper Medical Research Foundation, and Bethlehem Griffiths Research Foundation.</span></em></p>Sleep appears to play an essential role in a number of brain functions, such as memory. So good quality sleep could play a vital role in preventing dementia.Andrée-Ann Baril, Professeure-chercheure adjointe au Département de médecine, Université de MontréalMatthew Pase, Associate Professor of Neurology and Epidemiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2232492024-02-21T13:04:42Z2024-02-21T13:04:42ZAlzheimer’s disease: Viagra is seen as a potential treatment, but the research shows contradictory findings<figure><img src="https://images.theconversation.com/files/576285/original/file-20240217-16-zhh1ow.jpg?ixlib=rb-1.1.0&rect=15%2C7%2C5160%2C3437&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bandung-indonesia-04092020-viagra-blue-pills-1828131392">Ek Ing/Shutterstock</a></span></figcaption></figure><p>A <a href="https://www.bbc.co.uk/news/health-68232649">recent study reported</a> that sildenafil, sold under the brand name Viagra, and other medicines from the same group called <a href="https://www.phauk.org/treatment-for-pulmonary-hypertension/oral-therapies/phosphodiesterase-5-inhibitors/#:%7E:text=What%20are%20phosphodiesterase%205%20inhibitors,to%20the%20heart%20and%20lungs">phosphodiesterase type-5 inhibitors</a> may reduce the risk of Alzheimer’s disease. But <a href="https://www.nih.gov/news-events/news-releases/nih-dream-study-finds-viagra-cialis-do-not-reduce-risk-alzheimer-s-related-dementias">other research</a> has found no effect. </p>
<p>Why isn’t the picture clear? And what can be concluded about whether drugs such as sildenafil reduce the risk of Alzheimer’s if the available research has contradictory findings?</p>
<p>Dementia has been <a href="https://www.forbes.com/sites/sophieokolo/2022/05/26/dementia-is-on-the-rise-worldwide-heres-how-to-stop-it/">described as a global pandemic</a>. In 2022, it was the <a href="https://www.alzheimersresearchuk.org/news/dementia-is-the-uks-biggest-killer-we-need-political-action-to-save-lives/#:%7E:text=Our%20new%20analysis%20shows%20that,claimed%20more%20than%2074%2C000%20lives.">biggest cause of death</a> in England and Wales. </p>
<p>Alzheimer’s disease is the most common form of dementia, and current treatment is with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648782/#:%7E:text=AChE%20inhibitors%20or%20anti%2Dcholinesterases,two%20groups%3A%20irreversible%20and%20reversible">Acetylcholinesterase inhibitors</a> such as donepezil (sold as aricept) and memantine. These medications may relieve symptoms of Alzheimer’s but <a href="https://www.nhs.uk/conditions/alzheimers-disease/treatment/">have no effect</a> on the underlying disease process. </p>
<p>Twenty-eight potentially disease-modifying treatments are currently being developed and one, lecanemab, has <a href="https://www.alz.org/alzheimers-dementia/treatments/lecanemab-leqembi">recently been licensed in the US</a>, China and Japan. However, lecanemab – and the related medication <a href="https://www.alzheimers.org.uk/blog/what-is-donanemab-alzheimers-drug">donanemab</a>, which is <a href="https://www.alz.org/alzheimers-dementia/treatments/donanemab">likely to be available soon</a> – have a limited effect and simply slow any decline in symptoms. </p>
<p>There are also <a href="https://www.nature.com/articles/d41586-023-00030-3">key safety concerns</a> about these medications relating to brain bleeds and swelling. There is thus an urgent need for new treatments that are both effective and safe. </p>
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<h2>Drug repurposing: cheaper and quicker?</h2>
<p>An alternative to the long and expensive process of discovering new medicines is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9945820/">drug repurposing</a>. This is when existing drugs or medications are used for alternative medical conditions. </p>
<p><a href="https://www.ucl.ac.uk/news/2024/feb/erectile-dysfunction-drugs-linked-reduced-alzheimers-risk">The most recent UK study</a> on the link between phosphodiesterase type-5 inhibitors (avanafil, sildenafil, tadalafil and vardenafil) and Alzheimer’s found they are associated with an 18% reduction in the risk of being diagnosed with Alzheimer’s. But two earlier observational US studies found different results.</p>
<p><a href="https://academic.oup.com/braincomms/article/4/5/fcac247/6731685">One of these studies</a> found no link between the use of phosphodiesterase type-5 inhibitors and developing Alzheimer’s. <a href="https://www.nature.com/articles/s43587-021-00138-z">The other</a> found sildenafil use was linked with a 69% reduced risk of the disease, significantly higher than the latest 18% finding.</p>
<p>So why the variability in results? The answer could be in the way the different studies were designed. </p>
<p>They were all <a href="https://www.cancer.gov/research/participate/what-are-observational-studies">observational studies</a> that involved tracking large numbers of patients over time to see if they developed Alzheimer’s disease and whether they were taking the medication. However, the three studies used different databases: USA insurance, USA Medicare Fee-For-Service claims, and UK primary care records. </p>
<h2>Confounding variables</h2>
<p><a href="https://www.mrcctu.ucl.ac.uk/patients-public/about-clinical-trials/what-is-an-observational-study/">Observational studies</a> are usually designed to account for other factors that might influence the results. For example, the reason someone was prescribed a medication might influence the likelihood of the event you are monitoring actually happening.</p>
<p>Therefore, studies need to <a href="https://www.cambridge.org/core/books/abs/matched-sampling-for-causal-effects/controlling-bias-in-observational-studies-a-review/FDCA2A699B3398E89A560F2F339AAF63">control for biases</a> and <a href="https://www.understandinghealthresearch.org/useful-information/confounders-17">confounding variables</a>. These are factors that are separately related to both the medication and the outcome. They might explain why there appears to be an association between the medication and the outcome when there is, in fact, no link.</p>
<p>For example, children’s IQ is associated with height. But the confounding variable is age: as children grow up, they become both taller and brighter.</p>
<p>All the studies exploring the link between phosphodiesterase type-5 inhibitors and Alzheimer’s used advanced techniques to try to control for the potential impact of confounding variables. But they could only use what was recorded in the dataset. </p>
<p>For example, with the Medicare study, it was possible to control for potential signs of frailty and behavioural symptoms, whereas with the UK study, socioeconomic status, alcohol use, blood pressure and body mass index could all be controlled for. </p>
<p>A problem with observational studies is they assume that participants took the medication as prescribed, which may not be correct. The US studies could at least confirm the medication was collected from the pharmacy, whereas this step was not known in the UK study. </p>
<p>Another issue is that medication may not always be recorded on these databases; for example, private prescriptions for sildenafil in the UK may not have been included in the data. Also, the <a href="https://www.neurology.org/doi/10.1212/WNL.0000000000209180">diagnosis of dementia may not be accurately recorded</a> on the electronic databases. </p>
<h2>Multiple reasons for differing results</h2>
<p>There are other reasons for the different results of the studies. Researchers selected certain populations and comparison medications to help them understand if any effect on Alzheimer’s disease risk was related to the medicine, or a confounding variable. </p>
<p>The dose of phosphodiesterase type-5 inhibitors varies depending upon what is being treated. The 2022 US study included men and women with pulmonary hypertension only. The UK study only had men with erectile dysfunction, whereas the 2021 US included both genders and both conditions. Because the dose is different for the different conditions, we cannot compare dose across the studies.</p>
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<p>There are further factors that could also help explain the difference in findings between the studies. </p>
<p>First, the medication investigated wasn’t the same in all three. In the 2021 US study, all participants received sildenafil, whereas in the UK study and 2022 US study, about 25% received other phosphodiesterase type-5 inhibitors.</p>
<p>Second, the duration of the study follow-up varied. This is an important factor to consider because Alzheimer’s may take time to develop. For example, the disease is predominantly diagnosed in over-65s, so if a participant was only aged 40 on entry to the study, they are very unlikely to have a diagnosis during its time period, even when following people up for a long time.</p>
<p>We need new treatment for Alzheimer’s disease. Observational studies can identify possible links between drugs and outcomes, and the latest study adds to the evidence that drugs such as sildenafil might protect against Alzheimer’s disease. But for clear evidence that sildenafil and related drugs are effective at reducing the risk of dementia, clinical trials are needed.</p><img src="https://counter.theconversation.com/content/223249/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ian Maidment has received funding from NIHR and Alzheimer's Society to investigate the link between medication and Alzheimer's disease.</span></em></p><p class="fine-print"><em><span>Hayley Gorton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Confused by conflicting studies about the link between viagra and Alzheimer’s? Two experts explain the disparatiesIan Maidment, Professor in Clinical Pharmacy, Aston UniversityHayley Gorton, Senior lecturer in Pharmacoepidemiology, Aston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2235932024-02-20T14:33:22Z2024-02-20T14:33:22ZDementia can be predicted more than a decade before diagnosis with these blood proteins<figure><img src="https://images.theconversation.com/files/575979/original/file-20240215-26-11ceaq.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C8736%2C5819&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/patient-blood-draw-by-doctor-people-1989864818">Andrey Popov/Shutterstock</a></span></figcaption></figure><p>In the largest study of its kind, scientists have <a href="https://www.nature.com/articles/s43587-023-00565-0">discovered</a> that a blood test detecting specific proteins could predict dementia up to 15 years before a person receives an official diagnosis. </p>
<p>The researchers found 11 proteins that have a remarkable 90% accuracy in predicting future dementia.</p>
<p>Dementia is the UK’s biggest <a href="https://dementiastatistics.org/about-dementia/deaths/#:%7E:text=The%20leading%20cause%20of%20death%20across%20the%20UK%20in%202022,in%202022%20compared%20to%202021.">killer</a>. Over 900,000 people in the UK are living with the memory-robbing condition, yet less than two-thirds of people receive a formal diagnosis. Diagnosing dementia is tricky and relies on various methods.</p>
<p>These include lumbar punctures (to look for certain telltale proteins in the cerebrospinal fluid), PET scans and memory tests. These methods are invasive, time-consuming and expensive, putting a heavy burden on the NHS. This means that many people are only diagnosed when they have memory and cognitive problems. By this point, the dementia may have been progressing for years and any support or health plan may be too late.</p>
<p>Those with undiagnosed dementia, and their families, cannot attend clinical trials, have an organised healthcare plan or access essential support. So improving dementia diagnosis would provide earlier support and give patients a longer, healthier and more prosperous life.</p>
<p>In this <a href="https://www.nature.com/articles/s43587-023-00565-0">latest study</a>, researchers at the University of Warwick in England and Fudan University in China examined blood samples from 52,645 healthy volunteers from the UK Biobank genetic database between 2006 and 2010. Over the ten- to 15-year follow-up period, around 1,400 developed dementia.</p>
<p>The researchers used artificial intelligence and machine learning to analyse 1,463 proteins in the blood. They identified 11 proteins associated with dementia, of which four could predict dementia up to 15 years before a clinical diagnosis. </p>
<p>When combining this data with more regular risk factors of age, sex, education and genetics, the dementia prediction rate was around 90%.</p>
<p>These proteins found in the plasma (the liquid component of blood) are biological markers for the changes that occur in dementia sufferers over a decade before clinical symptoms first appear. They act as warning signs of the disease.</p>
<h2>Why these proteins?</h2>
<p>The four proteins most strongly associated with all-cause dementia, Alzheimer’s disease (accounting for 70% of all dementias) and vascular dementia (accounting for 20%) are GFAP, NEFL, GDF15 and LTBP2.</p>
<p>Scientists showed GFAP to be the best “biomarker” for predicting dementia. GFAP’s function is to support nerve cells called astrocytes. </p>
<p>A symptom of Alzheimer’s disease is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8775769/#B42-ijms-23-00616">inflammation</a>, and this causes astrocytes to make a lot of GFAP. Consequently, people with dementia display increased inflammation, resulting in higher levels of GFAP, making it a prominent biomarker. </p>
<p>The study showed that people with higher GFAP were more than twice as likely to develop dementia as people with low levels. <a href="https://www.nature.com/articles/s41398-020-01137-1">Smaller studies</a> have also identified GFAP to be a potential marker for dementia.</p>
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<strong>
Read more:
<a href="https://theconversation.com/do-one-in-six-indians-over-59-really-have-a-mild-brain-disorder-as-a-new-study-suggests-222650">Do one in six Indians over 59 really have a mild brain disorder, as a new study suggests?</a>
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<p>NEFL is the second protein that is most strongly associated with dementia risk. This protein relates to nerve fibre damage. Combining NEFL or GFAP with demographic data and cognitive tests significantly improves the accuracy of dementia prediction.</p>
<p>Proteins GD15 and LTBP2, both involved in inflammation, cell growth and death, and cellular stress, are also strongly linked to increased dementia risk.</p>
<p>But despite the study’s discovery, other scientists <a href="https://www.tandfonline.com/doi/full/10.1080/14737159.2023.2289553">warn</a> that the new biomarkers require further validation before they can be used as a screening tool.</p>
<figure class="align-center ">
<img alt="A lumbar puncture being performed" src="https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/575981/original/file-20240215-28-ncb3gm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Lumbar puncture is one of the planks of an Alzheimer’s diagnosis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lumbar-puncture-procedures-collecting-samples-patient-791852374">Casa nayafana/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The bigger picture</h2>
<p>Other initiatives are also promoting the adoption of blood tests as a widespread screening method in diagnosing dementia, including the <a href="https://www.alzheimersresearchuk.org/news/a-five-year-project-to-bring-alzheimers-blood-tests-to-the-nhs/">Blood Biomarker Challenge</a>, a five-year project aiming to use NHS blood tests to diagnose diseases that lead to dementia by looking at traces of brain proteins leaked into the bloodstream.</p>
<p>The exciting advent of new dementia drugs such as <a href="https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval">lecanemab</a> and <a href="https://www.alz.org/alzheimers-dementia/treatments/donanemab#:%7E:text=Is%20donanemab%20FDA%2Dapproved%3F,expects%20action%20by%20early%202024.">donanemab</a>, not yet approved for use in the UK, has the potential to slow the progression of Alzheimer’s disease.</p>
<p>Patients seeking lecanemab or donanemab treatment would require an early-stage diagnosis of Alzheimer’s disease. Alzheimer’s Research UK <a href="https://www.alzheimersresearchuk.org/news/bbc-panorama-captures-the-promise-and-challenges-of-new-alzheimers-treatments/#:%7E:text=The%20diagnostic%20tests%2C%20a%20PET,around%202%2C000%20patients%20a%20year.">estimates</a> that only 2% of patients undergo such diagnostic testing.</p>
<p>The study shows that blood tests are an effective way to detect dementia early by identifying specific proteins, providing the patient with the best possible opportunity to receive life-changing treatment.</p>
<p>Early diagnosis of dementia would result in a more effective treatment. A simple blood test has the potential to replace the costly, time-consuming and invasive tests currently used for dementia patients, ultimately improving the quality of many lives.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/playing-a-musical-instrument-or-singing-in-a-choir-may-boost-your-brain-new-study-222195">Playing a musical instrument or singing in a choir may boost your brain – new study</a>
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<img src="https://counter.theconversation.com/content/223593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rahul Sidhu does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Artificial intelligence helped identify the blood proteins that are the best predictors of dementia.Rahul Sidhu, PhD Candidate, Neuroscience, University of SheffieldLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2227602024-02-19T03:49:58Z2024-02-19T03:49:58Z‘The future has a way of finding you’: Georgia Blain’s haunting final stories reveal the fragile moments that shape us<figure><img src="https://images.theconversation.com/files/574887/original/file-20240212-21-d186g8.jpg?ixlib=rb-1.1.0&rect=5%2C32%2C1202%2C768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Georgia Blain.</span> <span class="attribution"><span class="source">Scribe Publications</span></span></figcaption></figure><p>I first met Georgia Blain at The Basement. This was back in the 1990s, when the iconic underground jazz venue near Sydney’s Circular Quay still drew a vibrant, edgy crowd. We were young, in our late 20s, and had been invited to read for an event hosted by the Sydney Writers’ Festival; there to be the “bright young things”.</p>
<p>I look back and cringe at my awkward younger self, but I can see Georgia very clearly. Her pixie hairdo; her skin luminous in the semi-darkness. Georgia had a way of talking to you that was totally focused in the moment. </p>
<p>She read from her first novel, <a href="https://www.allenandunwin.com/browse/book/Georgia-Blain-Closed-for-Winter-9781743313374">Closed for Winter</a> – a fictional exploration of her grief at <a href="https://theconversation.com/belvoirs-tell-me-im-here-looks-at-the-impact-of-mental-illness-on-the-whole-family-it-is-a-wrenching-and-beautiful-work-188432">the loss of her brother to schizophrenia and drug addiction</a> at an early age. It was “material”, an emotional fabric, that Georgia would be drawn back to, again and again.</p>
<p>I can’t seem to find the passage in the book, but I remember how the words felt. There’s a kind of stillness at the centre of Georgia’s writing; a grief, an absence around which the characters swirl – in scenes always shapely, poised, sharply observed and elegantly suspenseful. </p>
<p>And so, it was with a small shock that I picked up and read the posthumously published <a href="https://scribepublications.com.au/books-authors/books/we-all-lived-in-bondi-then-9781761380730">We All Lived in Bondi Then</a>, the “new” collection of short stories Georgia wrote between 2012 and 2015, before her death from cancer in December 2016. </p>
<p>The voice is familiar, elegiac, but clear-eyed. There was never any artifice, melodrama or sentimentality in Georgia or her work. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/goodbye-georgia-blain-a-brave-and-true-chronicler-of-life-70329">Goodbye Georgia Blain: a brave and true chronicler of life</a>
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<h2>Familiar preoccupations</h2>
<p>The opening story, Australia Square, is frankly magnificent, weaving together Georgia’s familiar themes and preoccupations. A baby boy goes missing, then mysteriously reappears. Years later, his sister looks back on a childish mistake – the dropping of a stuffed toy – and is gripped by the idea that if just this one thing could be corrected, then perhaps the devastating aftermath, the loss of the baby, her parents’ divorce, the breakdown of her family, her brother’s psychotic episodes, would not have followed. </p>
<p>The thought is all the more poignant because the reader suspects the future has a way of finding you, regardless.</p>
<p>In Dear Professor Brewster, a daughter grapples with the onset and inexorable progress of her mother’s Alzheimer’s disease. The daughter’s finely wrought anguish is punctuated by the letters she writes to her mother’s treating doctor, who – bound by a code of medical ethics – sends only inscrutable, perfunctory replies. </p>
<p>Among the haunting stories in the collection, Ship to Shore features a mother paralysed with grief following the death of her four-year-old son. She embarks on a desperate journey down south, her visceral pain exquisitely rendered by the boom of artillery fire, as gunships practise manoeuvres on a nearby naval base. </p>
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<a href="https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The cover of We All Lived in Bondi Then" src="https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=928&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=928&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=928&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1166&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1166&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574831/original/file-20240212-23-vc8vu3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1166&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><span class="source">Goodreads</span></span>
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<p>The stories in the collection are mostly written from the vantage of middle age, looking back on a life that seems to turn on some impossibly fragile occurrence, a chance encounter, or small mistake. </p>
<p>The characters that flit through the pages – the would-be actors, artists and photographers, young and ageing singers, and environmental campaigners who represent the flotsam and jetsam of inner-city Sydney life – form a familiar generational milieu. </p>
<p>The characters live in Bondi flats “two up, two down”, or dark Marrickville semis, filled with salvaged street furniture, “sagging club lounges” and “glass-topped deco coffee tables”. They dress in op shop suits with shot-silk shirts, and other recycled discoveries.</p>
<p>It’s hard not to see the ghosts of real traumas here: the death of Georgia’s brother, her mother’s Alzheimer’s, their complicated family relationships. But as Georgia’s friend the novelist Charlotte Wood writes in her exquisite introduction to the work, there’s a world of difference between writing “close to home” and “writing memoir”. These nuanced stories contain revelations for everyone.</p>
<p>This is something Georgia’s friend the writer James Bradley, quoted in the introduction, identified in Georgia’s most powerful works – from <a href="https://www.penguin.com.au/books/births-deaths-marriages-9780143790693">Births, Deaths and Marriages</a> to <a href="https://scribepublications.com.au/books-authors/books/between-a-wolf-and-a-dog-9781761380778">Between a Wolf and a Dog</a> – as a sense of being “simultaneously more personal and more expansive”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/belvoirs-tell-me-im-here-looks-at-the-impact-of-mental-illness-on-the-whole-family-it-is-a-wrenching-and-beautiful-work-188432">Belvoir's Tell Me I'm Here looks at the impact of mental illness on the whole family. It is a wrenching and beautiful work</a>
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<hr>
<h2>When dreams were huge</h2>
<p>Some stories in the collection seem to strike a note of nostalgia, evoking shimmering visions of younger selves at a time when dreams were huge and life felt unlimited – always up ahead, as the narrator in Still Breathing says, “the self that I was to become beckoning, waiting”.</p>
<p>But these compassionately observed stories also show the reader that there is a sort of desperate awfulness that comes from being young, what Wood, in her introduction, calls the “brutal clumsiness of youth”. This is us before life throws up its damage, and knocks us flat, or takes the edges off.</p>
<p>Characters constantly try to outrun the damage, like the mother in Last Days, whose fear that she has lost herself in the wake of motherhood, materialises as an extended suburban electrical blackout. At the end of the story, she gets into a car, and drives, trying to locate the edge of the darkness. “Just one more street,” the narrator tells herself. But the streets fly by, and “the blackness stretches forever”.</p>
<p>The edge of the darkness, rather like the metaphor of the line in Still Breathing, is an illusion. As the narrator in Still Breathing says,</p>
<blockquote>
<p>It is strange how often we long for life to move forward; <em>I just have to get through this</em>, we think, as though the past, with all its fears and fuck-ups and anxieties, can be completely left behind, neat, contained, never spilling over the line we imagine is waiting for us. And yet the past is always there, hovering at the edge, teasing us, reappearing when we least expect it … </p>
</blockquote>
<p>I had been a little scared of picking up this “new” collection, almost eight years after Georgia’s death. Like the narrator in Still Breathing, I could sense the memories, with all their “fears and fuck-ups and anxieties”, that might be waiting. But I was wrong.</p>
<p>What Georgia’s work offers the reader is a clear-eyed, calm compassion, a capacity to live with, and alongside, damage, trauma and unspeakable loss, and a way of staying human.</p><img src="https://counter.theconversation.com/content/222760/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Camilla Nelson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Georgia Blain’s final, posthumous collection offers clear-eyed, calm compassion – and a capacity to live with, and alongside, damage, trauma and unspeakable loss, and a way of staying human.Camilla Nelson, Associate Professor in Media, University of Notre Dame AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199532024-02-12T13:26:57Z2024-02-12T13:26:57ZFamily caregivers face financial burdens, isolation and limited resources − a social worker explains how to improve quality of life for this growing population<figure><img src="https://images.theconversation.com/files/574183/original/file-20240207-27-pcczxx.jpg?ixlib=rb-1.1.0&rect=30%2C30%2C5061%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Family caregivers may be less likely to turn to others when they need their own support. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-pushing-father-in-wheelchair-royalty-free-image/494327497?phrase=caring+for+the+elderly&adppopup=true">Terry Vine/DigitalVision via Getty Images</a></span></figcaption></figure><p>Millions of Americans have <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">become informal family caregivers</a>: people who provide family members or friends with unpaid assistance in accomplishing daily tasks such as bathing, eating, transportation and managing medications. </p>
<p>Driven in part by a <a href="https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">preference for home-based care</a> rather than long-term care options such as assisted living facilities, and the <a href="https://doi.org/10.1155/2012/680265">limited availability and high cost</a> of formal care services, family caregivers play a pivotal role in the safety and well-being of their loved ones.</p>
<p>Approximately 34.2 million people in the United States <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">provide unpaid assistance</a> to adults age 50 or above, according to the Family Caregiver Alliance. Among them, about 15.7 million adult family caregivers care for someone with dementia.</p>
<p>I am a licensed clinical social worker and an assistant professor of social work <a href="https://scholar.google.com/citations?user=AikbrQ4AAAAJ&hl=en">studying disparities in health and health care systems</a>. I focus on underrepresented populations in the field of aging. </p>
<h2>Challenges for family caregivers</h2>
<p>In my research focusing on <a href="https://doi.org/10.1093/geront/gnad086">East Asian family caregivers</a> for people with Alzheimer’s and related dementia, I discovered that <a href="https://doi.org/10.1177/07334648221142600">Chinese American</a> and <a href="https://doi.org/10.1080/13607863.2022.2122932">Korean American caregivers</a> often encounter challenging situations. These include discrimination from health care facilities or providers, feelings of loneliness and financial issues. Some of these caregivers even find themselves <a href="https://doi.org/10.1080/13607863.2022.2122932">having to retire early</a> because they struggle to balance both work and caregiving responsibilities. </p>
<p>My findings join a growing body of research showing that <a href="https://doi.org/10.1111/scs.12463">family caregivers</a> commonly <a href="https://doi.org/10.1177/0733464818813466">encounter five specific challenges</a>: financial burdens, limited use of home- and community-based services, difficulties accessing resources, a lack of knowledge about existing educational programs, and physical and emotional challenges, such as feelings of helplessness and caregiver burnout. </p>
<p>However, researchers are also finding that family caregivers feel more capable of managing these challenges when they can tap into formal services that offer practical guidance and insights for their situations, as well as assistance with some unique challenges involved with family caregiving.</p>
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<figcaption><span class="caption">How to find your way back if you feel that you’ve lost yourself in a caregiving role.</span></figcaption>
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<h2>The demographics of informal caregivers</h2>
<p>More than 6 in 10 family caregivers are women. </p>
<p>Society has always expected <a href="https://doi.org/10.1093/geront/32.5.607">women to take on caregiving responsibilities</a>. Women also usually earn less money or rely on other family members for financial support. This is because equal pay in the workplace <a href="https://iwpr.org/wp-content/uploads/2020/09/C455.pdf">has been slow to happen</a>, and women often take on roles like becoming the primary caregiver for their own children as well as their aging relatives, which can drastically affect their earnings. </p>
<p>While nearly half of care recipients live in their own homes, 1 in 3 live <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">with their caregivers</a>.</p>
<p>Sometimes termed “resident caregivers,” these individuals are less likely to turn to others outside the family for caregiving support, often because they feel that it’s important to keep caregiving within the family. These caregivers <a href="https://doi.org/10.1080/13607863.2021.1935460">are typically older, retired or unemployed</a> and have lower income than caregivers who live separately.</p>
<p>According to a 2020 report from the AARP Public Policy Institute, about 1 in 3 family caregivers <a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">provide more than 21 hours of care a week</a> to a loved one. </p>
<p><iframe id="4L0re" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4L0re/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Juggling caregiving with everyday life</h2>
<p>Caregiving often creates financial burdens because it <a href="https://doi.org/10.1093/geronb/gbv095">makes it harder to hold a full-time or part-time job</a>, or to <a href="https://doi.org/10.1093/geronb/gbv095">return to work</a> after taking time off, particularly for spouses who are caregivers.</p>
<p>Often, community-based organizations such as nonprofits that serve older adults offer a variety of in-home services and educational programs. These can help family caregivers <a href="https://www.cdc.gov/aging/caregiving/caregiver-brief.html">manage or reduce</a> the physical and emotional strains of their responsibilities. However, these demands also can make it difficult for some caregivers to even learn that these resources exist, or take advantage of them, particularly as the care recipient’s condition progresses. </p>
<p>These challenges <a href="https://doi.org/10.23750/abm.v93iS2.12979">worsened at the height of the COVID-19 pandemic</a>. Many support programs were canceled, and it was hard to access health care, which made things even more stressful and tiring for caregivers. </p>
<p>Research shows that those who are new to family caregiving often take care of their loved ones <a href="https://www.ncbi.nlm.nih.gov/books/NBK2665/">without any formal support initially</a>. As a result, they may face increased emotional burdens. And caregivers age 70 and above face particular challenges, since they may be navigating their own health issues at the same time. These individuals are less likely to receive informal support, which can lead to social isolation and burnout.</p>
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<a href="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="Mature woman places a cardigan on an elderly adult." src="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Caregivers age 70 and above may be navigating their own health challenges with little support.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-caring-for-her-elderly-mother-royalty-free-image/1390975112?phrase=family+caregivers&adppopup=true">Alistair Berg/DigitalVision via Getty Images</a></span>
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<h2>Support for family caregivers</h2>
<p>There are numerous programs and services available for family caregivers and their loved ones, whether they reside at home or in a residential facility. These resources include government health and disability programs, legal assistance and disease-specific organizations, some of which are <a href="https://www.caregiver.org/connecting-caregivers/services-by-state/">specific to certain states</a>.</p>
<p>In addition, research has found that providing appropriate <a href="https://doi.org/10.1046/j.1532-5415.2001.49090.x">education and training</a> to people in the early stages of caregiving enables them to better balance their own health and well-being with successfully fulfilling their responsibilities. Many community-based organizations, such as local nonprofits focused on aging, as well as government programs or senior centers, <a href="https://doi.org/10.1111/jgs.14259">may offer case management services</a> for older adults, which can be beneficial for learning about existing resources and services. </p>
<p>For family caregivers of people with dementia, formal support services are particularly crucial to their <a href="https://doi.org/10.1590/1809-98232016019.150117">ability to cope and navigate the challenges</a> they face.</p>
<h2>The role of Medicaid</h2>
<p>Formal support may also be helpful in finding affordable home-based and community resources that can help compensate for a lack of informal support. These include <a href="https://www.medicare.gov/coverage/home-health-services">home health services</a> funded by Medicare and <a href="https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html">Medicaid-funded providers</a> of medical and nonmedical services, including transportation.</p>
<p>Medicaid, which targets low-income Americans, seniors, people with disabilities and a few select other groups, has certain income requirements. Determine the eligibility requirements first to find out whether your loved one qualifies for Medicaid.</p>
<p>The <a href="http://www.thescanfoundation.org/sites/default/files/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-aarp-ppi-ltc.pdf">services and support covered by Medicaid may vary</a> <a href="https://www.payingforseniorcare.com/medicaid-waivers/home-care">based on a number of factors</a>, such as timing of care, the specific needs of caregivers and their loved ones, the care plan in place for the loved one and the location or state in which the caregiver and their loved one reside. </p>
<p>Each state also has its own Medicaid program with unique rules, regulations and eligibility criteria. This can result in variations in the types of services covered, the extent of coverage and the specific requirements for <a href="https://www.medicaidplanningassistance.org/getting-paid-as-caregiver/">accessing Medicaid-funded support</a>.</p>
<p>If so, <a href="https://www.medicaid.gov/about-us/contact-us/index.html">contact your state’s Medicaid office</a> to get more information about self-directed services and whether you can become a paid family caregiver.</p>
<h2>Medicare might help</h2>
<p>Medicare may <a href="https://www.medicare.gov/coverage/home-health-services">help pay for certain home health services</a> if an older adult needs skilled services part time and is considered homebound.</p>
<p>This assistance can alleviate some of the caregiving responsibilities and financial burdens on the family caregiver, allowing them to focus on providing care and support to their loved ones without worrying about the cost of essential medical services. </p>
<p>Peer-to-peer support is also crucial. Family caregivers who join support groups tend to <a href="https://doi.org/10.1080/13607863.2016.1231169">manage their stress more effectively</a> and <a href="https://doi.org/10.3389/fpubh.2019.00122">experience an overall better</a> <a href="https://doi.org/10.1111/j.1532-5415.1990.tb03544.x">quality of life</a>.</p><img src="https://counter.theconversation.com/content/219953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Lee has received funding from the Alzheimer's Association - New to the Field (AARG-NTF-20-678171). </span></em></p>Family caregivers who have stronger support networks and positive communication with loved ones tend to be more resilient.Kathy L. Lee, Assistant Professor of Gerontological Social Work, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2226502024-02-08T16:28:03Z2024-02-08T16:28:03ZDo one in six Indians over 59 really have a mild brain disorder, as a new study suggests?<p>India is often perceived as a country with a <a href="https://ig.ft.com/india-population/">young population</a>, while European and North American populations are regarded as ageing. Although this is true, the country’s demographics are rapidly <a href="https://india.unfpa.org/en/news/india-ageing-report-2023-unveils-insights-elderly-care-challenges-and-solutions">shifting</a>, according to a UN study. And people aged 60 and over are expected to <a href="https://lasi.hsph.harvard.edu/files/lasi/files/lasi_india_report_2020.pdf?m=1610054498">constitute 20%</a> of the population by 2050.</p>
<p>Given this trend, there have been numerous attempts – using different methods – to determine the prevalence of dementia on the subcontinent. A new study, <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0297220">published in PLOS One</a>, suggests that the prevalence of dementia in India is higher than previously thought. </p>
<p>The researchers investigated the number of people with dementia in India by establishing how many people aged 60 and over in the country have a neurocognitive disorder. </p>
<p>Neurocognitive disorders – changes to cognition (thinking) because of a potential underlying brain disorder – are commonly divided into minor and major disorders. Dementia is considered a major neurocognitive disorder, while mild cognitive impairment, a common early stage of dementia, a minor neurocognitive disorder. </p>
<p>The study results showed that nearly one-sixth (17.6%) of people over 59 in India have a mild neurocognitive disorder, while 7.2% have a major neurocognitive disorder. </p>
<p>Extrapolating these estimates to the Indian population over 59 years of age (104 million) suggests that 24 million of those people have potentially mild cognitive impairment, while 9.9 million potentially have dementia. </p>
<p>There are 14.5 million people over 60 in the UK, meaning the dementia rate is about 6.5%, whereas, according to this latest study, the dementia rate in India is about 9.5%. However, the sheer size of the estimates in the study explains why the UN is paying closer attention to the ageing and dementia population in India. But how were mild cognitive impairment or dementia established in the study?</p>
<p>Mild cognitive impairment and dementia are commonly based on performance on cognitive tests and whether cognitive changes affect everyday activities. </p>
<p>For mild cognitive impairment, people will have mild cognitive changes, but they do not affect their everyday activities. Whereas for dementia, people will have cognitive changes that will affect their everyday activities. </p>
<p>Within the study, participants were asked to perform cognitive tests and their family members were asked to report changes in their everyday activities. For example, if they had slight memory changes but they did not affect their everyday activity would mean they would be considered to have mild cognitive impairment. </p>
<p>But if they had more significant memory problems and their family reported noticeable changes to their everyday activities, they then would be considered to have dementia. </p>
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<img alt="A busy street in Delhi, India" src="https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574364/original/file-20240208-20-5pusnq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">India’s demographics are rapidly changing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/crowded-street-scene-old-delhi-india-9050353">Jeremy Richards/Shutterstock</a></span>
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<h2>Shortcomings</h2>
<p>Despite cognition and everyday activity being key to dementia diagnostics worldwide, they have significant shortcomings, in particular for assessments in developing countries, such as India. </p>
<p>The main reason for this is that most cognitive tests were developed for literate populations with higher levels of formal education, whereas low formal education and illiteracy remain very prevalent in older and rural populations of developing countries. </p>
<p>For the current study, nearly half of their participants had either no formal education or were illiterate. This, therefore, creates uncertainty if the cognitive changes are because of the lower education or literacy levels of the person being tested or the first signs of dementia. </p>
<p>But what else can we do to determine if someone is either at risk or has dementia?</p>
<p>Blood might be the answer. A simple blood test to determine someone’s risk for dementia has been the holy grail in dementia research for decades. Now such blood tests have become a reality, at least in <a href="https://www.nih.gov/news-events/nih-research-matters/blood-test-early-alzheimer-s-detection">research studies</a>. </p>
<p>Dementia blood tests are still so new that they have not made it into the clinics, but it seems only a matter of time until these tests will be widely available across memory clinics and doctor’s surgeries. </p>
<p>Having a blood test result might remove the ambiguity of whether changes to cognition are the first signs of dementia or relate to other factors, such as level of formal education. </p>
<p>People in developing countries, such as India, will particularly benefit from such blood tests as the relevance of cognitive changes is then not as important anymore but can be used to support a diagnosis. </p>
<p>It will be interesting to see whether the estimates for mild cognitive impairment and dementia in the populations will change because of the new blood tests, as they might be more specific in determining who really has the disease or is at risk of it. A few drops of blood might change our perceptions of dementia in the future. </p>
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Read more:
<a href="https://theconversation.com/playing-a-musical-instrument-or-singing-in-a-choir-may-boost-your-brain-new-study-222195">Playing a musical instrument or singing in a choir may boost your brain – new study</a>
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<img src="https://counter.theconversation.com/content/222650/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Hornberger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A closer look at the study suggests something else might explain the high figure.Michael Hornberger, Professor of Applied Dementia Research, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2221952024-02-01T16:03:02Z2024-02-01T16:03:02ZPlaying a musical instrument or singing in a choir may boost your brain – new study<p>Generations of parents have told their children to practice their musical instruments. Parents have good reason to keep on top of their children’s musical education, since learning an instrument is not only associated with <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1540-6237.2009.00598.x">better educational attainment</a> but also <a href="https://www.frontiersin.org/articles/10.3389/fnins.2013.00279/full#B43">cognition (thinking)</a> and even <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0003566">intelligence scores</a> in children. But does this musicality translate to better cognition later in life?</p>
<p>A <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/gps.6061">recent study</a> in the International Journal of Geriatric Psychiatry investigated this question by asking middle-aged and older people to complete a questionnaire on their lifetime musical experience before completing cognitive (thinking) tests. The results showed that musical people had better memory and executive function (the ability to stay focused on tasks, plan and have self-control) than those with less or no musicality. </p>
<p>A good memory is important for playing a musical instrument, such as playing music from memory, and this seems to translate to people’s cognitive performance. Similarly, executive function is required when playing an instrument, and this too translated to improved cognitive performance. </p>
<p>This finding was similar, regardless of which instrument people played or the level of musical proficiency people acquired – although most people in the study played an instrument for only a few years of their lives. </p>
<p>What made a difference, however, was whether people still played an instrument or only played in the past, with current amateur musicians showing the highest cognitive performance of participants. </p>
<p>This makes sense as continued engagement in cognitively stimulating activities, such as playing an instrument, should result in continued brain health benefits, whereas having played the recorder for three years at primary school might not have that big an impact on our cognitive performance later in life. But how about being musical without playing an instrument?</p>
<p>Singing is a very popular musical activity as it allows joining musical groups, such as choirs, without the need to learn a musical instrument. But does singing provide the same cognitive benefit as playing an instrument? </p>
<p>According to the study findings, singing can result in better executive function but not memory, suggesting that playing an instrument has additional brain health benefits. </p>
<p>Why singing would help us with our executive function is not clear and requires further investigation. However, singing has a strong social benefit when done in choirs, and there is good evidence that being engaged in social activity is good for our brain health. </p>
<h2>The ‘Mozart effect’</h2>
<p>How about just listening to music? Does it also improve our cognition and potentially brain health? </p>
<p>Many people might remember the famous “Mozart effect”, which was based on a study published in <a href="https://www.nature.com/articles/365611a0">Nature</a> in 1993 showing that when students were played Mozart, they scored higher on intelligence tests. </p>
<p>This led to a whole industry promising us that playing such music to ourselves or even our babies could lead to cognitive benefits, even though the evidence for the original study is still controversially discussed to this day. </p>
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<img alt="A pregnant woman with headphones on her stomach" src="https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572783/original/file-20240201-29-fsngfl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Playing Mozart won’t make your baby smarter.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-women-listening-music-mozart-effect-1278569506">comzeal images/Shutterstock</a></span>
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<p>Sadly, the current study found no association between listening to music and cognitive performance. Cognitive stimulation depends on us being actively engaged in activities, so passively listening to music doesn’t seem to provide any cognitive benefits. </p>
<p>Playing an instrument or singing seems to have benefits to our brain health in ageing, according to the study. What is yet to be established is whether this would also help prevent future cognitive decline or dementia. </p>
<p>The study provides no evidence for this yet and it is also not clear how the findings apply to the general population, since most people in the study were female, well-educated and well-off. </p>
<p>Still, considering the overall cognitive and social benefits of learning an instrument or singing in a choir, it might be worth engaging in such cognitive stimulation as we age. Our parents would be proud of us.</p>
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Read more:
<a href="https://theconversation.com/how-music-heals-us-even-when-its-sad-by-a-neuroscientist-leading-a-new-study-of-musical-therapy-214924">How music heals us, even when it's sad – by a neuroscientist leading a new study of musical therapy</a>
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<img src="https://counter.theconversation.com/content/222195/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Hornberger does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Listening to music, though, doesn’t have the same benefits.Michael Hornberger, Professor of Applied Dementia Research, University of East AngliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2223742024-02-01T05:31:46Z2024-02-01T05:31:46ZAlzheimer’s may have once spread from person to person, but the risk of that happening today is incredibly low<figure><img src="https://images.theconversation.com/files/572598/original/file-20240131-25-8grmtv.jpg?ixlib=rb-1.1.0&rect=107%2C71%2C5883%2C3907&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/alzheimers-disease-mri-1025800153">Atthapon Raksthaput/Shutterstock</a></span></figcaption></figure><p>An article published this week in the prestigious journal <a href="https://www.nature.com/articles/s41591-023-02729-2">Nature Medicine</a> documents what is believed to be the first evidence that Alzheimer’s disease can be transmitted from person to person.</p>
<p>The finding arose from long-term follow up of patients who received human growth hormone (hGH) that was taken from brain tissue of deceased donors. </p>
<p>Preparations of donated hGH were used in medicine to treat a variety of conditions from 1959 onwards – including in Australia from the mid 60s. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1752026705428963582"}"></div></p>
<p>The practice stopped in 1985 when it was discovered around 200 patients worldwide who had received these donations went on to develop <a href="https://www.vdh.virginia.gov/epidemiology/epidemiology-fact-sheets/creutzfeldt-jakob-disease-cjd/">Creuztfeldt-Jakob disease</a> (CJD), which causes a rapidly progressive dementia. This is an otherwise extremely rare condition, affecting roughly one person in a million.</p>
<h2>What’s CJD got to do with Alzehimer’s?</h2>
<p>CJD is caused by prions: infective particles that are neither bacterial or viral, but consist of abnormally folded proteins that can be transmitted from cell to cell. </p>
<p>Other prion diseases include kuru, a dementia seen in New Guinea tribespeople caused by eating human tissue, scrapie (a disease of sheep) and variant CJD or bovine spongiform encephalopathy, otherwise known as mad cow disease. This raised <a href="https://en.wikipedia.org/wiki/United_Kingdom_BSE_outbreak">public health concerns</a> over the eating of beef products in the United Kingdom in the 1980s.</p>
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Read more:
<a href="https://theconversation.com/people-who-lived-in-the-uk-in-the-mad-cow-disease-years-may-now-be-able-to-give-blood-the-risk-of-vcjd-is-tiny-183521">People who lived in the UK in the 'mad cow disease' years may now be able to give blood. The risk of vCJD is tiny</a>
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<h2>Human growth hormone used to come from donated organs</h2>
<p>Human growth hormone (hGH) is produced in the brain by the pituitary gland. Treatments were originally prepared from purified human pituitary tissue.</p>
<p>But because the amount of hGH contained in a single gland is extremely small, any single dose given to any one patient could contain material from around <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/00000563.htm">16,000 donated glands</a>. </p>
<p>An average course of hGH treatment lasts around four years, so the chances of receiving contaminated material – even for a very rare condition such as CJD – became quite high for such people.</p>
<p>hGH is now manufactured synthetically in a laboratory, rather than from human tissue. So this particular mode of CJD transmission is no longer a risk. </p>
<figure class="align-center ">
<img alt="Scientist in a lab" src="https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572600/original/file-20240131-25-f3bxeg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Human growth hormone is now produced in a lab.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/woman-standing-in-front-of-the-sink-aelk4Tn0vlI">National Cancer Institute/Unsplash</a></span>
</figcaption>
</figure>
<h2>What are the latest findings about Alzheimer’s disease?</h2>
<p>The Nature Medicine paper provides the first evidence that transmission of Alzheimer’s disease can occur via human-to-human transmission. </p>
<p>The authors examined the outcomes of people who received donated hGH until 1985. They found five such recipients had developed early-onset Alzheimer’s disease. </p>
<p>They considered other explanations for the findings but concluded donated hGH was the likely cause.</p>
<p>Given Alzheimer’s disease is a much more common illness than CJD, the authors presume those who received donated hGH before 1985 may be at higher risk of developing Alzheimer’s disease.</p>
<p>Alzheimer’s disease is caused by presence of two abnormally folded proteins: amyloid and tau. There is <a href="https://actaneurocomms.biomedcentral.com/articles/10.1186/s40478-017-0488-7">increasing evidence</a> these proteins spread in the brain in a <a href="https://pubmed.ncbi.nlm.nih.gov/8086126/">similar way to prion diseases</a>. So the mode of transmission the authors propose is certainly plausible. </p>
<p>However, given the amyloid protein deposits in the brain <a href="https://www.nia.nih.gov/news/estimates-amyloid-onset-may-predict-alzheimers-progression">at least 20 years</a> before clinical Alzheimer’s disease develops, there is likely to be a considerable time lag before cases that might arise from the receipt of donated hGH become evident.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/size-of-brain-area-linked-with-cognitive-decline-even-in-people-with-no-other-warning-signs-of-alzheimers-disease-217729">Size of brain area linked with cognitive decline – even in people with no other warning signs of Alzheimer’s disease</a>
</strong>
</em>
</p>
<hr>
<h2>When was this process used in Australia?</h2>
<p>In Australia, donated pituitary material <a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">was used</a> from 1967 to 1985 to treat people with short stature and infertility. </p>
<p><a href="https://www.health.gov.au/sites/default/files/documents/2022/07/the-cjd-review-final-report.pdf">More than 2,000 people</a> received such treatment. Four developed CJD, the last case identified in 1991. All four cases were likely linked to a single contaminated batch. </p>
<p>The risks of any other cases of CJD developing now in pituitary material recipients, so long after the occurrence of the last identified case in Australia, are <a href="https://www.mja.com.au/journal/2010/193/6/iatrogenic-creutzfeldt-jakob-disease-australia-time-amend-infection-control">considered to be</a> incredibly small.</p>
<p>Early-onset Alzheimer’s disease (defined as occurring before the age of 65) is uncommon, accounting for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4356853/">around 5%</a> of all cases. Below the age of 50 it’s rare and likely to have a genetic contribution. </p>
<figure class="align-center ">
<img alt="Older man places his hands on his head" src="https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572596/original/file-20240131-17-v3sclo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Early onset Alzheimer’s means it occurs before age 65.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-elderly-man-covers-his-face-1999395698">perfectlab/Shutterstock</a></span>
</figcaption>
</figure>
<h2>The risk is very low – and you can’t ‘catch’ it like a virus</h2>
<p>The Nature Medicine paper identified five cases which were diagnosed in people aged 38 to 55. This is more than could be expected by chance, but still very low in comparison to the total number of patients treated worldwide. </p>
<p>Although the long “incubation period” of Alzheimer’s disease may mean more similar cases may be identified in the future, the absolute risk remains very low. The main scientific interest of the article lies in the fact it’s first to demonstrate that Alzheimer’s disease can be transmitted from person to person in a similar way to prion diseases, rather than in any public health risk.</p>
<p>The authors were keen to emphasise, as I will, that Alzheimer’s cannot be contracted via contact with or providing care to people with Alzheimer’s disease.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/young-onset-alzheimers-can-be-diagnosed-from-as-early-as-30-and-the-symptoms-are-often-different-209561">Young-onset Alzheimer’s can be diagnosed from as early as 30 – and the symptoms are often different</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/222374/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steve Macfarlane is affiliated with HammondCare, a not-for-profit aged care provider. </span></em></p>Scientists have published the first evidence that Alzheimer’s can be transmitted from person to person. Patients received human growth hormone from the tissue of donated brains.Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2214032024-01-31T13:36:42Z2024-01-31T13:36:42ZSleep can give athletes an edge over competitors − but few recognize how fundamental sleep is to performance<figure><img src="https://images.theconversation.com/files/571989/original/file-20240129-15-rvkoy3.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C2663%2C1778&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleep has been an underappreciated strategy for gaining an edge over an opponent at any level of athletic competition.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/ChiefsRavensFootball/47d36cdc32f2464d8b6aaed9cba32412/photo?Query=football%20playoffs&mediaType=photo,video,graphic,audio&sortBy=&dateRange=now-24h&totalCount=54&currentItemNo=44">AP Photo/Alex Brandon</a></span></figcaption></figure><p>In the adrenaline-packed world of professional sports, the power of sleep rarely gets adequate attention.</p>
<p>A healthy sleep pattern can be a stealthy game plan for athletes to gain an edge over their opponents. Only a <a href="https://www.cnbc.com/2018/12/21/lebron-james-reveals-the-nighttime-routine-that-sets-him-up-for-success.html">few top elite athletes</a> know the secret of early bedtimes for optimal performance.</p>
<p>Sleep is vital not only for keeping the mind sharp and body healthy but also for excelling in all fields in life – whether <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">in the classroom</a>, on the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5158299/">battlefield</a> or in <a href="https://doi.org/10.1093/sleep/zsab051">other professional arenas</a>. </p>
<p>As a <a href="https://www.neurology.pitt.edu/people/joanna-fong-isariyawongse-md-faes-faan">neurologist specializing in sleep medicine</a> at the University of Pittsburgh, I have devoted my career to understanding and advocating for the importance of sleep health. </p>
<p>Here are some key facts to understand why sleep matters.</p>
<h2>The critical role of sleep in performance</h2>
<p>Sleep is a complex, <a href="https://www.sleepfoundation.org/stages-of-sleep#">cyclical process</a> that progresses through several stages, each with distinct characteristics and functions. Initially, it begins with light sleep, <a href="https://www.ncbi.nlm.nih.gov/books/NBK526132/#">encompassing stages 1 and 2</a>, where the body starts to relax and brain wave activity begins to slow down. </p>
<p>These stages are followed by deep sleep, also known as <a href="https://www.sleepfoundation.org/stages-of-sleep/slow-wave-sleep#:">slow-wave sleep</a>, where the body undergoes significant restorative processes. The final stage is <a href="https://my.clevelandclinic.org/health/body/12148-sleep-basics">rapid eye movement</a>, or REM sleep, characterized by vivid dreams and increased brain activity. Typically, a person cycles through these stages four to six times each night, with each cycle lasting approximately 90 minutes. </p>
<p>Sleep is when our bodies heal. Deep sleep helps repair muscles and bones through several key mechanisms, including the release of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824213/">human growth hormone</a> – a protein produced in the pituitary gland – and various <a href="https://doi.org/10.1038/npp.2016.148">anti-inflammatory agents</a>. </p>
<p><a href="https://www.health.harvard.edu/diseases-and-conditions/growth-hormone-athletic-performance-and-aging">Human growth hormone is a key player</a> in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824213/">muscle development, tissue repair</a> and <a href="https://doi.org/10.1210/er.2008-0027">metabolism</a>, and is it vital for maintaining physical health. It significantly enhances the body’s capacity for self-repair, be it following an intense sports event or recovering from a sports-related injury. </p>
<p>In addition, sleep helps your brain to recalibrate through the waste-clearing <a href="https://doi.org/10.1016/j.sleep.2022.11.012">glymphatic system</a>, which is part of the central nervous system. Think of it as a dishwasher in your brain, flushing out waste products, including neurotoxic proteins such as <a href="https://doi.org/10.3389/fphar.2015.00221">amyloid-beta</a>, <a href="https://doi.org/10.1111%2Fj.1755-5949.2010.00177.x">abnormal tangles of a protein called tau</a> and <a href="https://doi.org/10.1101%2Fcshperspect.a009399">alpha-synuclein proteins</a>. </p>
<p>All three of those proteins have direct association with neurodegenerative diseases such as <a href="https://doi.org/10.1001/jamaneurol.2023.3889">Alzheimer’s dementia</a> and <a href="https://doi.org/10.1016/j.neubiorev.2017.08.016">chronic traumatic encephalopathy</a>, a disorder thought to be caused by repeated head injuries. For athletes, maintaining proper brain health and cognitive function is paramount.</p>
<p>In addition, deep sleep <a href="https://doi.org/10.1007/s00424-011-1044-0">strengthens the immune system</a> to help keep us healthy and free of illnesses.</p>
<p>REM sleep is the most active stage of sleep, the one in which we experience dreams. This contrasts with deep sleep, where the brain enters a state of synchronized slow waves, indicative of restorative rest. REM sleep is <a href="https://doi.org/10.1007/s11910-013-0430-8">essential for memory</a> and <a href="https://doi.org/10.3389/fpsyg.2019.00459">emotion processing</a>, which help with recall and reducing anxiety. </p>
<p>Athleticism by its purest definition and overall body control can often be linked to the benefits of Stage 2 sleep, which has been shown to play an instrumental role in the <a href="https://doi.org/10.1371/journal.pbio.1002429">consolidating of motor sequence memories</a> and physical skills learned during practice.</p>
<p>To fully benefit from these sleep cycles, adults need <a href="https://www.sciencedirect.com/science/article/abs/pii/S2352721815000157?via%3Dihub">seven to nine hours</a> of sleep per night. This duration ensures that they complete the necessary four to six sleep cycles, allowing their bodies and minds to fully experience the restorative effects of each sleep stage, which is essential for optimal health and performance.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/1uT4ldxU6l8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Sleep is a performance enhancer, if you do it right.</span></figcaption>
</figure>
<h2>How sleep helps prevent injuries</h2>
<p>In professional sports, more training and higher pressure increase the chances of getting hurt. Research shows that collegiate athletes who sleep less than seven hours per night are <a href="https://doi.org/10.1249/JSR.0000000000000849">nearly twice as likely to get injured</a> when compared with those who sleep more than eight hours. In a game like football, where split-second decisions can lead to a touchdown or interception, a well-rested brain is the best tool for quick thinking and staying free of injury. </p>
<p>Good sleep also cuts down on the <a href="https://doi.org/10.1016/j.sleep.2019.03.008">risk of concussions</a>, which, sadly, are pretty common in sports. Up to <a href="https://doi.org/10.1097/00001199-200609000-00001">3.8 million cases</a> of concussions occur annually in the U.S. during competitive sports. Studies have shown that <a href="https://doi.org/10.1016/j.sleep.2019.03.008">sleepy athletes</a> are nearly three times more likely to suffer a concussion.</p>
<p>Sleep deficits have been linked to decreased performance in every cognitive measure, including <a href="https://doi.org/10.1093/sleep/zsab051">vigilant attention, spatial cognition</a> and tasks involving <a href="https://doi.org/10.1016/j.jadohealth.2013.12.034">inhibitory control</a>. On the sports field, this translates to sleepy athletes making more impulsive and risky decisions. </p>
<h2>Enhancing athletic performance through ample sleep</h2>
<p>Athletes of any level, even at the highest levels of competition, could gain a competitive edge by giving more attention to the value of sleep. Studies focusing on <a href="https://doi.org/10.1249/MSS.0b013e31820abc5a">sprinters</a>, <a href="https://doi.org/10.1016/j.physbeh.2013.07.002">tennis players</a> and <a href="https://doi.org/10.1249/MSS.0b013e31820abc5a">endurance athletes</a> have found that sleep can enhance the following four key abilities: </p>
<ul>
<li><p><a href="https://doi.org/10.1249/MSS.0b013e31820abc5a">Speed, strength and endurance</a>: More sleep can lead to faster sprint times, greater strength and <a href="https://doi.org/10.1007/s00421-009-1103-9">higher endurance</a>, which are crucial in sports where every second counts. Adequate sleep enhances muscle recovery and energy restoration, which are crucial for the strength and power needed in sprinting. </p></li>
<li><p>Accuracy and reaction time: One study found that tennis players who got more sleep showed better <a href="https://doi.org/10.1016/j.physbeh.2013.07.002">accuracy and faster reaction times</a>. Increased sleep enhances brain function by boosting cognitive processes such as focus, <a href="https://doi.org/10.1093/sleep/zsab051">decision-making</a> and sensory perception. Well-rested individuals also experience <a href="https://doi.org/10.1371/journal.pbio.1002429">better neuromuscular coordination</a>, essential for precise movements and quick responses. </p></li>
</ul>
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<figcaption><span class="caption">Sleep can make a critical difference when it comes to split-second decision-making.</span></figcaption>
</figure>
<ul>
<li><p>Cognitive skills and inhibitory control: Good sleep helps with <a href="https://doi.org/10.1093/sleep/zsab051">strategizing and decision-making</a> through improved recall and a clearer mind, thanks to the cleansing action of the glymphatic system. Sleep deprivation, on the other hand, can impair cognitive abilities, as evidenced in <a href="https://doi.org/10.1093/sleep/zsab051">research involving NASA recruits</a>. </p></li>
<li><p>Pain tolerance: More sleep can lead to <a href="https://doi.org/10.5665/sleep.1830">increased pain tolerance</a>, playing a vital role in the quality of life and recovery process following injuries or intense physical exertion. While the exact mechanisms are complex and involve a two-way relationship between sleep and pain, this benefit is particularly important in physically demanding sports. Improved pain tolerance can aid athletes not only in recovery but also in maintaining mental well-being, allowing them to focus on rehabilitation and training without being overly hindered by discomfort. </p></li>
</ul>
<h2>Essential sleep tips for peak performance</h2>
<p>Here are some practical and effective sleep tips tailored for athletes, designed to help them harness the power of sleep for top-notch performance in their respective sports: </p>
<ul>
<li><p>Consistency and quantity: A regular sleep schedule is crucial for peak performance. Athletes should make sure they’re getting eight to 10 hours of sleep, not just the day before a big game but every day throughout the competitive season. </p></li>
<li><p>Environment: A sleep-conducive environment – dark, quiet and cool – is essential to getting a restful night’s sleep.</p></li>
<li><p>Pre-sleep routines: Relaxing activities such as reading, stretching and meditation before bed can enhance sleep quality.</p></li>
<li><p>Screen limits: <a href="https://theconversation.com/school-start-times-and-screen-time-late-in-the-evening-exacerbate-sleep-deprivation-in-us-teenagers-179178">Reducing screen time</a> before bed helps maintain natural sleep rhythms and the production of melatonin.</p></li>
<li><p><a href="https://theconversation.com/whats-the-best-diet-for-healthy-sleep-a-nutritional-epidemiologist-explains-what-food-choices-will-help-you-get-more-restful-zs-219955">Dietary considerations</a>: Avoiding caffeine, alcohol and heavy meals before sleep aids in restfulness.</p></li>
<li><p><a href="https://theconversation.com/short-naps-can-improve-memory-increase-productivity-reduce-stress-and-promote-a-healthier-heart-210449">Strategic napping</a>: Short, well-timed naps can be a valuable tool for recovery and achieving peak performance. </p></li>
<li><p>Sleep banking: To prepare for travel when you anticipate reduced sleep, consider sleeping longer beforehand. This can be achieved either through extra napping or by extending your regular nightly sleep. </p></li>
</ul>
<p>It’s important for any athlete to remember that sleep isn’t a weakness. Success as an athlete is about more than just physical training and tactical preparedness; it’s also about harnessing the power of sleep for optimal performance.</p><img src="https://counter.theconversation.com/content/221403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joanna Fong-Isariyawongse does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Studies show college athletes sleeping less than 7 hours per night are almost twice as likely to be injured when compared with athletes sleeping more than 8 hours.Joanna Fong-Isariyawongse, Associate Professor of Neurology, University of PittsburghLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2215382024-01-25T16:32:05Z2024-01-25T16:32:05ZWomen are more likely to develop Alzheimer’s – but our research suggests a specific brain enzyme could help protect them<figure><img src="https://images.theconversation.com/files/571499/original/file-20240125-31-5bjzgi.jpg?ixlib=rb-1.1.0&rect=763%2C424%2C4248%2C2588&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/womens-mental-health-concept-nervous-system-2198177721">Shutterstock/Pavlova Yuliia</a></span></figcaption></figure><p>The <a href="https://www.cdc.gov/aging/aginginfo/alzheimers.htm#:%7E:text=Alzheimer's%20disease%20is%20the%20most,and%20respond%20to%20the%20environment">most common form of dementia</a>, Alzheimer’s, is a progressive, life limiting, neurodegenerative condition, which damages and destroys parts of the nervous system, especially the brain, over time. </p>
<p>Women are most likely to be affected. They make up <a href="https://www.alz.org/alzheimers-dementia/what-is-alzheimers/women-and-alzheimer-s">two-thirds of people</a> with Alzheimer’s. It is not yet understood why <a href="https://www.alzheimers.org.uk/blog/why-dementia-different-women">women have greater risk</a> of developing the disease – but there does seem to be a link with the menopause.</p>
<p><a href="https://www.science.org/doi/10.1126/sciadv.adj1354">Our latest research</a> has examined this link <a href="https://www.science.org/doi/10.1126/sciadv.adj1354">and it suggests</a> that the activation of a brain protein called CYP46A1, using an anti-HIV drug, could help protect women from developing disease.</p>
<p><a href="https://www.medicalnewstoday.com/articles/155651#_noHeaderPrefixedContent">Women transition into menopause</a>, usually between 45 and 55 years of age. Menopause is caused by <a href="https://www.medicalnewstoday.com/articles/321064#symptoms">loss of oestrogen</a>, a hormone essential for maintaining brain health as well as learning and memory skills. </p>
<p>Early menopause, with onset before 45 years, is a risk factor for memory loss and for developing Alzheimer’s disease later in life. </p>
<p>Research suggests that women who experience <a href="https://www.medicalnewstoday.com/articles/alzheimers-early-age-at-menopause-late-start-to-hormone-therapy-may-be-a-risk-factor#:%7E:text=%E2%80%9CWe%20found%20that%20in%20multiple,years%20in%20the%20United%20States">early menopause</a> who go on to get Alzheimer’s disease have higher levels of a protein called <a href="https://www.alz.org/media/Documents/alzheimers-dementia-tau-ts.pdf">tau</a> in their brain, which is a hallmark of the disease. Tau is a protein that stabilises neurons – the nerve cells that send messages all over your body to allow you to do everything from breathing to talking, eating, walking, and thinking. In people with Alzheimer’s, tau forms toxic tangles, which contribute to the deterioration of brain functions and memory loss.</p>
<figure>
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<figcaption><span class="caption">Women and dementia, Alzheimer’s Research UK, 2015.</span></figcaption>
</figure>
<h2>Activating brain protein CYP46A1</h2>
<p><a href="https://www.science.org/doi/10.1126/sciadv.adj1354">Our study</a> shows that activation of a brain protein called CYP46A1 could protect women from developing Alzheimer’s disease. </p>
<p>The main function of this protein in the brain is to get rid of excess cholesterol by transforming it into a cholesterol product called 24S-hydroxycholesterol (24SOH). When CYP46A1 levels are increased in the brains of mice, also heightening the production of 24SOH, females present healthier neurons and higher oestrogen activity in the hippocampus – the brain region essential for memory. </p>
<p>The female mice with high CYP46A1 levels showed enhanced memory capacities. Just like humans, when mice get old their memory worsens compared to young mice, and the same is true for menopausal mice compared to non-menopausal mice. Activation of CYP46A1 counteracted memory loss both during aging and during menopause – but only in the female mice. </p>
<p>In male mice, activation of CYP46A1 led instead to worsening memory and accumulation of the male hormone <a href="https://my.clevelandclinic.org/health/articles/24555-dht-dihydrotestosterone">di-hydro-testosterone</a> in their brains.</p>
<p>To understand better how the CYP46A1 protein could have different effects in male and female mice, we grew neurons in culture (on plastic plates in the lab) and treated them with the CYP46A1 product, 24SOH. </p>
<p>In these neurons, 24SOH increased hormone activity, especially oestrogen. We found that increasing oestrogen activity develops healthier and better functioning neurons, explaining the protective effects of the hormone in female mice. However, the male mice did not benefit in the same way because high levels of dihydrotestosterone blocked the positive effects of oestrogen. </p>
<p>Results from mice were supported with studies in people with Alzheimer’s disease. In the <a href="https://www.science.org/doi/10.1126/sciadv.adj1354">human study</a>, 24SOH was measured in the cerebrospinal fluid (the liquid around the brain and spinal cord) of patients from Karolinska Hospital, Sweden. Higher 24SOH levels corresponded to lower levels of <a href="https://www.sciencedirect.com/science/article/pii/S2666144621000125#:%7E:text=Dynamic%20Biomarkers%20of%20AD%20Pathology,are%20drawn%20concordantly%20(orange).">Alzheimer’s pathological markers</a> like tau – but only in women. </p>
<p>This suggests that the possible protective effect of high levels of CYP46A1 and 24SOH on Alzheimer’s disease is exclusively for women.</p>
<h2>Anti-HIV drug helpful for Alzheimer’s</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9797897/">Previous research</a> has shown that CYP46A1 can be activated by low doses of the commercial <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9855767/">anti-HIV drug Efavirenz</a>. Efavirenz has been <a href="https://www.alzdiscovery.org/uploads/cognitive_vitality_media/Efavirenz-Cognitive-Vitality-For-Researchers.pdf">proposed as Alzheimer’s therapy</a> because lab studies showed beneficial effects against tau and amyloid plaques (where proteins clump together and disrupt cell function), which is known to accumulate in the brains of people with Alzheimer’s. </p>
<p>But the results from our study suggest different effects of CYP46A1 activation in men and women – with beneficial effects prominently in women.</p>
<figure class="align-center ">
<img alt="Gloved hand taking a pack of medication labelled Efaviernz 200mg from a box containing many packs of the drug" src="https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571153/original/file-20240124-15-br7ehw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">HIV drug Efavirenz may help to protect women from developing Alzheimer’s disease.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/news-photo/the-first-batch-of-aids-drug-efavirenz-produced-in-india-news-photo/157448055?adppopup=true">EVARISTO SA/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>CYP46A1 activators like Efavirenz may offer a new therapeutic approach to promote oestrogen-mediated brain protection in women at risk of Alzheimer’s disease – women with early menopause, for example. </p>
<p>This approach is different from hormone replacement therapies (HRT), which have <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-022-01121-5">yielded variable results so far</a>. The use of HRT seems to reduce the risk of women developing Alzheimer’s disease – but only if given at the time of menopause symptoms. There seems to be no protective effect if given after menopause – and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6780820/">HRT is controversial</a> after being <a href="https://www.breastcancer.org/risk/risk-factors/using-hormone-replacement-therapy">linked to a higher risk of cancer</a>. </p>
<p>New possibilities of increasing oestrogen activity in the brains of women, then, are welcome – and have the potential to become preventative therapy against devastating neurodegenerative diseases like Alzheimer’s.</p><img src="https://counter.theconversation.com/content/221538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Silvia Maioli receives funding from Margaretha af Ugglas Foundation, The private initiative "Innovative ways to fight Alzheimer´s disease - Leif Lundblad Family and others, NIH R01 grant, King Gustaf V:s and Queen Victorias Foundation, Gun & Bertil Stohnes Foundation, Foundation for Old Servants and Karolinska Institute KID funding.</span></em></p>Two thirds of people with Alzheimer’s disease are women – but activation of a brain protein called CYP46A1 might hold the key to prevention.Silvia Maioli, Senior Research Specialist and Associate professor, Neurobiology, Karolinska InstitutetLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2169802023-12-21T21:37:49Z2023-12-21T21:37:49ZThe Douglas-Bell Canada Brain Bank: a goldmine for research on brain diseases<figure><img src="https://images.theconversation.com/files/557356/original/file-20231005-26-rmh9lm.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4000%2C1508&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The experimental methods available today allow us to break the brain down into its elementary components in order to understand its functions and dysfunctions.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Human beings have always been fascinated by the brain. </p>
<p>Although scientific knowledge about this 1.3 kg of fragile substance embedded in our cranium has long been incomplete, dazzling technical breakthroughs made in recent years are now ushering in a Golden Age of molecular neuroscience. </p>
<p>These breakthroughs have been made possible partly thanks to brain banks, which preserve human brains in the best possible conditions for scientific research. Here in Montréal, we have one of the world’s largest such banks, the Douglas-Bell Canada Brain Bank (DBCBB), <a href="https://douglasbrainbank.ca">founded in 1980 at the Douglas Hospital</a>. </p>
<p>The DBCBB, which receives several brains each month, has collected over 3,600 specimens to date. Every year, its team processes dozens of tissue requests from scientists in Québec, Canada and abroad, preparing some 2,000 samples for research. </p>
<p>Over the past 40 years, these efforts have led to a considerable number of discoveries about different neurological and psychiatric diseases. </p>
<p>As a full professor in the department of psychiatry at McGill University, researcher at the Douglas Research Centre and director of the DBCBB since 2007, I work in close collaboration with <a href="https://www.mcgill.ca/psychiatry/gustavo-turecki">Dr. Gustavo Turecki</a>, co-director of the DBCBB and responsible for the component devoted to psychiatric illnesses and suicide.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&rect=14%2C2%2C1535%2C1231&q=45&auto=format&w=1000&fit=clip"><img alt="cerebral hemisphere" src="https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&rect=14%2C2%2C1535%2C1231&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=475&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=475&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=475&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=596&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=596&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552153/original/file-20231004-17-mdh992.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=596&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The Douglas-Bell Canada Brain Bank, which receives several brains each month, has collected over 3,600 specimens to date.</span>
<span class="attribution"><span class="source">(Naguib Mechawar)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>A brief history of research on the human brain</h2>
<p>Scientists only began to identify the microscopic elements that make up the human brain in the second half of the 19th century. </p>
<p>That was when brains were preserved for the first time in formalin, a solution that preserves biological tissue so that it can be handled more easily and stored over a longer term.</p>
<p>At the same time, precision instruments and protocols were being developed that made it possible to examine the microscopic characteristics of nervous tissue.</p>
<p>Until the middle of the 20th century, researchers were mainly satisfied with preserving the brains of patients, taken during autopsies, so they could use them to identify possible macroscopic or microscopic changes linked to either neurological or psychiatric symptoms.</p>
<p>This is in fact what the German neurologist Alois Alzheimer did when he analyzed the brain of one of his patients suffering from dementia. In 1906, he described, for the first time, the microscopic lesions which characterize the disease that now bears his name.</p>
<p>Until the end of the 1970s, numerous collections of brain specimens preserved in formalin were built in hospital environments, a bit like the cabinets of curiosities of olden days.</p>
<p>Towards the end of the 20th century, new experimental approaches were developed allowing the high-resolution analysis of cells and molecules within biological tissues.</p>
<p>It then became necessary to collect and preserve human brains, obtained with the consent of the individual or his or her family, in conditions compatible with modern scientific techniques.</p>
<p>Researchers began freezing one of the cerebral hemispheres in order to measure its various molecular components. The other hemisphere was preserved in formalin to be used for macroscopic and microscopic anatomical studies.</p>
<p>This was the context in which the Douglas-Bell Canada Brain Bank was created.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="The DBCBB premises" src="https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552154/original/file-20231004-25-z5k7jp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Montréal is home to one of the world’s largest brain banks, the Douglas-Bell Canada Brain Bank, which was founded in 1980 at the Douglas Hospital.</span>
<span class="attribution"><span class="source">(Naguib Mechawar)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>New experimental approaches are yielding results</h2>
<p>Leading researchers from many universities around the world now use DBCBB samples to advance their research. This, of course, includes a number of teams in Québec.</p>
<p>For example, with his team from the Douglas Research Centre, which is affiliated with McGill University, <a href="https://douglas.research.mcgill.ca/judes-poirier/">Judes Poirier</a> discovered that the APOE4 gene is a <a href="https://doi.org/10.1016/0140-6736(93)91705-Q">risk factor for Alzheimer’s disease</a>. More recently, the team of <a href="https://crhmr.ciusss-estmtl.gouv.qc.ca/en/researcher/gilbert-bernier">Gilbert Bernier</a>, professor in the department of neuroscience at Université de Montréal, discovered that the lesions characteristic of this disease are associated with <a href="https://doi.org/10.1038/s41598-018-37444-3">abnormal expression of the BMI1 gene</a>.</p>
<p>With regard to psychiatric illnesses, and more specifically depression, major progress has been made recently by the <a href="https://douglas.research.mcgill.ca/mcgill-group-suicide-studies-mgss/">McGill Group for Suicide Studies</a>. </p>
<p>Using cutting-edge methods to isolate and analyze human brain cells, Turecki’s team has succeeded in precisely identifying the cell types whose function is affected in men <a href="https://doi.org/10.1038/s41593-020-0621-y">who have suffered from major depression</a>, and then discovering that the cell types involved in this illness differ <a href="https://doi.org/10.1038/s41467-023-38530-5">between men and women</a>. </p>
<p>These experimental approaches generate huge data sets that can be examined in subsequent studies. This is the case, for example, of work carried out in my laboratory, which identified signs of persistent changes in neuroplasticity within the prefrontal cortex of people with a history of <a href="https://doi.org/10.1038/s41380-021-01372-y">child abuse</a>. In fact, the studies mentioned above enabled us to discover at least one of the cell types involved in this phenomenon. </p>
<p>In short, the experimental methods we have today allow us to break the brain down into its elementary components in order to understand its functions and dysfunctions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cerebral hemispheres preserved in formalin" src="https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/552155/original/file-20231004-27-62uc6y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Leading researchers from many universities around the world benefit from Douglas-Bell Canada Brain Bank samples to advance their research.</span>
<span class="attribution"><span class="source">(Naguib Mechawar)</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<h2>Identify, prevent, screen and treat</h2>
<p>Thanks to the hard work and dedication of the entire DBCBB team, as well as the unfailing support of all its partners, patrons (often anonymous) and funding bodies — particularly the FRQS research fund and Québec’s suicide research network, the <a href="https://reseausuicide.qc.ca">Réseau québécois sur le suicide, les troubles de l'humeur et les troubles associés</a> — this invaluable resource has not only managed to survive, but to grow and become one of the largest brain banks in the world. </p>
<p>There is every reason to believe that, in the years to come, the DBCBB will play an important role in the increasingly precise identification of the biological causes of brain diseases, and, as a result, will contribute to the identification of new targets for better approaches to prevention, screening and treatment.</p><img src="https://counter.theconversation.com/content/216980/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Naguib Mechawar has received funding from CIHR, NSERC, HBHL (CFREF) and FQRS (NEURON ERA-NET and RQSHA).</span></em></p>Montréal is home to one of the world’s largest brain banks, the Douglas-Bell Canada Brain Bank, where discoveries about different neurological and psychiatric diseases are made.Naguib Mechawar, Neurobiologiste, Institut Douglas; Professeur titulaire, Département de psychiatrie, McGill UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2191722023-12-06T13:34:40Z2023-12-06T13:34:40ZMore than a third of people with dementia don’t know they have it – what to do if you suspect your partner has the condition<figure><img src="https://images.theconversation.com/files/563720/original/file-20231205-15-abkk9.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7348%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/retired-couple-holding-hands-looking-each-1272275779">LightField Studios/Shutterstock</a></span></figcaption></figure><p>Around <a href="https://www.bbc.co.uk/news/uk-england-67613465">36% of people</a> in England with dementia are unaware they have the condition, according to a new report from the Dementia Commission.</p>
<p><a href="https://chamberuk.com/wp-content/uploads/2023/12/231127-Dementia-Commission-Report-Embargoed.pdf">The report</a> suggests things health and care professionals can do to improve spotting early signs of dementia. But what can you do if you think your partner has the condition? And how can you broach the topic with them?</p>
<p>If you are worried about your partner having dementia, here are some useful things to know. </p>
<p>Dementia is a term for a range of diseases (for example, Alzheimer’s) which develop over time (months and years) and cause problems with memory and reasoning, communication, changes in personality and a reduction in a person’s ability to carry out daily activities, such as shopping, washing, paying bills or cooking. </p>
<p>Dementia can present very differently in each person, so it’s about knowing what’s normal for your loved one. A person who has always been conscientious and organised starting to unravel is very different from a scatterbrained person just being slightly more scatterbrained. </p>
<p>Grief and stress can affect memory yet not be the start of dementia. But they can also mask the start of dementia: we call this “diagnostic over-shadowing”. </p>
<p>There are also age-related changes to cognition. For example, we take longer to learn when we get older. But a one-off event – no matter how dramatic – is not necessarily dementia. It’s about looking for a pattern of decline.</p>
<p>If you see these changes happen in a short space of time (weeks or days) it is unlikely to be dementia and could be something more serious. This requires urgent investigation by a doctor. </p>
<h2>Greatest fear</h2>
<p>Dementia is one of the greatest fears of our age. The horror of perceived loss of self can cause people to avoid discussing the issue, discussing it in an unhelpful way (such as criticising or inadvertently humiliating) or discussing it with other relatives, but not the person they are noticing changes in. </p>
<p>Over time, this can cause a lack of trust to develop. Discussing memory problems openly with the person at the point of a memory failure or if they raise the concern is best. Of course, it takes courage and makes us face our own vulnerability. </p>
<p>Sometimes the person will be in denial or lack insight into the memory problems (this can be a symptom of dementia, but isn’t always). If someone raises a concern about their memory issues, I would urge you not to minimise this, as it probably took courage to admit their concerns. </p>
<p>I heard a relative say to my mother: “Oh, you left the pot on the stove. I lost the car in the multistory the other day.” My mother had dementia – the relative did not. </p>
<p>If they are adamant that they do not have concerns, this is harder to deal with. One approach is to say: “I know you are not concerned, but I am concerned and I wonder if you would see a doctor to ease my worries?”</p>
<p>Also explaining that memory problems can at least to some extent have reversible causes means a visit to the doctor to at least rule these out is an important step. It may also be encouraging to say to the person: “If there is something with your memory that will get worse over time, would you want to know?” (Most people <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2408568/">answer yes</a> to this). </p>
<figure class="align-center ">
<img alt="A female doctor and an elderly male patient." src="https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/563724/original/file-20231205-25-nd88cq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Most people would want to know if they have dementia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/happy-optimistic-senior-80s-man-looking-2036344238">fizkes/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Seeing a GP</h2>
<p>If your partner agrees to visit a GP, it is helpful to prepare by filling in a diary for a week with the kind of memory (or other) problems experienced, what was happening at the time and the effect of the memory failure. This can be shared with a GP to help them to understand the issues.</p>
<p>When people hear even the suggestion of the word dementia, they are faced with the uncertainties of what will become of them, of what they will lose, what they can keep up and where they will end up. These uncertainties are often shared with family members. But research shows that positive aspects of timely diagnosis <a href="https://www.scie.org.uk/dementia/symptoms/diagnosis/early-diagnosis.asp">outweigh fears</a> over time. </p>
<p>At the same time, there are often ongoing stresses to do with memory impairments or confusion. With these stresses, everyday life can be troublesome, family relationships can suffer, and people can find it difficult to be supportive of each other. </p>
<p>Being honest and open is the best policy. Stating that we are in this together, I want to help, let’s meet whatever happens head on, can help. If a person becomes resistant, it may be there is another family member who might better assist the person.</p><img src="https://counter.theconversation.com/content/219172/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kate Irving receives funding from FP7, COST action, Atlantic Philanthropies. She is affiliated with Alzheimer Society of Ireland (Board Member)</span></em></p>How to have honest, open conversations with your partner about dementia.Kate Irving, Professor of Clinical Nursing, Dublin City UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2180032023-11-28T17:55:45Z2023-11-28T17:55:45ZLifestyle changes can reduce dementia risk by maintaining brain plasticity — but the time to act is now<figure><img src="https://images.theconversation.com/files/561624/original/file-20231125-24-4dpbbp.jpg?ixlib=rb-1.1.0&rect=0%2C704%2C5714%2C3742&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lifestyle changes may be our best hope of delaying dementia or not developing dementia at all.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/lifestyle-changes-can-reduce-dementia-risk-by-maintaining-brain-plasticity-but-the-time-to-act-is-now" width="100%" height="400"></iframe>
<p>Walk 10,000 steps a day, cut back alcohol, get better sleep at night, stay socially active — we’re told that changes like these can <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">prevent up to 40 per cent of dementia cases worldwide</a>. </p>
<p>Given that dementia is still one of <a href="https://doi.org/10.1186%2Fs12889-023-15772-y">the most feared diseases</a>, why aren’t we pushing our doctors and governments to support these lifestyle changes through new programs and policy initiatives?</p>
<p>The truth, however, is more complex. We know that <a href="https://theconversation.com/got-health-goals-research-based-tips-for-adopting-and-sticking-to-new-healthy-lifestyle-behaviours-173740">making lifestyle changes is hard</a>. Ask anyone who has tried to keep their New Year’s resolution to visit the gym three times a week. It can be doubly difficult when the changes we need to make now won’t show results for years, or even decades, and we don’t really understand why they work.</p>
<h2>Taking control of your health</h2>
<p>Anyone who has watched a loved one <a href="https://alzheimer.ca/en/about-dementia/what-dementia/common-questions-about-dementia">living with dementia</a>, facing the small and large indignities and declines that leave them eventually unable to eat, communicate or remember, knows it is a devastating disease. </p>
<p>There are <a href="https://alzheimer.ca/en/whats-happening/events/new-dementia-drugs-therapies-what-canadians-should-know">several new drugs</a> making their way to the market for Alzheimer’s disease (one of the most common forms of dementia). However, they are still far from a cure and are currently only effective for early-stage Alzheimer’s patients.</p>
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<strong>
Read more:
<a href="https://theconversation.com/lecanemab-experimental-drug-is-a-ray-of-hope-for-alzheimers-disease-196719">Lecanemab: Experimental drug is a ray of hope for Alzheimer's disease</a>
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</em>
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<p>So lifestyle changes may be our best hope of delaying dementia or not developing dementia at all. Actor <a href="https://www.vanityfair.com/hollywood/2022/11/chris-hemsworth-exclusive-interview-alzheimers-limitless">Chris Hemsworth</a> knows it. He watched his grandfather live with Alzheimer’s and is making lifestyle changes after learning he has two copies of the APOE4 gene. This <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/what-is-apoe4-how-does-it-relate-alzheimers-disease-2023-04-21/">gene</a> is a risk factor for Alzheimer’s, and having two copies significantly increases his risk of developing the same condition. </p>
<p>Research has identified <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">modifiable risk factors</a> that contribute to increasing the risk of dementia:</p>
<ul>
<li>physical inactivity</li>
<li>excessive use of alcohol</li>
<li>less sleep</li>
<li>social isolation</li>
<li>hearing loss</li>
<li>less cognitive engagement</li>
<li>poor diet</li>
<li>hypertension</li>
<li>obesity</li>
<li>diabetes</li>
<li>traumatic brain injury</li>
<li>smoking</li>
<li>depression</li>
<li>air pollution</li>
</ul>
<p>Our understanding of the biological mechanisms for these risk factors is varied, with some more clearly understood than others. </p>
<p>But there is a lot we do know — and here’s what you need to know as well.</p>
<h2>Cognitive reserve and neuroplasticity</h2>
<figure class="align-center ">
<img alt="Two older men on a park bench, on of whom is straining to hear the other speaking" src="https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561625/original/file-20231125-21-n964o8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As a person‘s hearing decreases, it can make it difficult to socially engage with others, resulting in a loss of sensory input. The brain has to work harder to compensate for this.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p><a href="https://doi.org/10.1016/j.neurobiolaging.2019.03.022">Cognitive reserve</a> is the brain’s ability to withstand damage or neurodegenerative disease. If there is tissue or functional loss in one part of the brain, other brain cells (neurons) work harder to compensate. In theory, this means lifelong experiences and activities create a dam against the damages of disease and aging in the brain.</p>
<p><a href="https://doi.org/10.3928/02793695-20100302-01">Neuroplasticity</a> is the brain’s amazing ability to adapt, learn and reorganize, create new pathways or rewire existing ones to recover from damage. The key takeaway is that neuroplasticity can happen at any time and any age, which means learning and activities should be lifelong.</p>
<p>Many of the risk factors linked to dementia likely work in combination, which is why an overall lifestyle approach is crucial. For example, <a href="https://doi.org/10.1007/s11920-016-0721-2">studies have shown</a> that exercise, cognitive and social engagement stimulate your brain and maintain its plasticity by growing new neural connections and building cognitive reserve.</p>
<p>The mechanism behind this is a combination of factors: increased oxygen and blood flow to the brain, stimulating growth factors that keep neurons healthy and reduced inflammation.</p>
<p>The opposite is also true. Poor sleep, diet, social isolation and untreated depression are linked to <a href="https://doi.org/10.3928/02793695-20100302-01">decreased cognitive reserve</a>. </p>
<p>The same rationale applies to hearing loss, a key emerging risk factor for dementia. As a person‘s hearing decreases, it can make it difficult to socially engage with others, resulting in a loss of sensory input. The <a href="https://doi.org/10.1097%2FWAD.0000000000000325">brain has to work harder</a> to compensate for this, potentially drawing down its cognitive reserve and leaving it less able to withstand dementia.</p>
<h2>The role of stress and inflammation</h2>
<figure class="align-center ">
<img alt="Illustration of hand drawing a brain with multicoloured chalk on blackboard" src="https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=222&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=222&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=222&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=279&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=279&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561626/original/file-20231125-17-6hps66.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=279&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic or prolonged inflammation disrupts normal function and causes damage to the brain’s cells.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Stress responses and inflammation are the body’s complex answer to injury. Inflammation is an important component of the body’s immune system, helping defend against threats and repair tissue damage. While short-term inflammation is a natural and good response, chronic or prolonged inflammation disrupts normal function and causes damage to the brain’s cells.</p>
<p>For example, one of the commonalities between dementia and untreated depression is the <a href="https://doi.org/10.17219/acem/149897%22%22">inflammatory process</a>. Prolonged exposure to stress hormones can lead to chronic inflammation. Hypertension, physical inactivity, smoking and air pollution are also associated with chronic inflammation and stress, which can damage blood vessels and neurons in the brain.</p>
<p>In a newer area of research still being explored, <a href="https://globalnews.ca/news/10095898/loneliness-global-public-health-concern-who/">social isolation</a> has also been <a href="https://doi.org/10.1016/j.yfrne.2023.101061">linked to inflammation</a>. As we learned during the COVID-19 pandemic, the brain is wired to respond to social engagement as a means of bonding and emotional support, especially in times of distress. </p>
<p>With surveys showing more than <a href="https://www.thestar.com/opinion/contributors/we-have-a-loneliness-crisis-it-s-time-to-act/article_30e6c996-a9e2-588b-a776-58addc503762.html">one in three Canadians</a> feel isolated, the lack of social connection and loneliness can trigger the body’s stress response and neuroendocrine changes, and prolonged exposure to this inflammatory process can damage the brain.</p>
<h2>Similar pathways across multiple diseases</h2>
<figure class="align-center ">
<img alt="Three women walking in exercise clothes" src="https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561627/original/file-20231125-27-f0h7c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While there are benefits to being physically and socially active at any age, some research shows the payoff from those gains can be higher after age 40 when the body’s metabolism slows, risk factors increase and cognitive reserve becomes even more essential to help protect against cognitive decline.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Several of these risk factors, and their biological pathways, cut across multiple chronic diseases. Accumulating evidence of <a href="https://doi.org/10.1016/S1474-4422(19)30087-0">decades of research</a> supports the concept of “what’s good for your heart is good for your head.” </p>
<p>This means that making these lifestyle changes not only reduces your risk of dementia, but also your risk of diabetes, hypertension and heart concerns. This highlights the complex nature of dementia but also offers a united strategy to deal with multiple health concerns that may arise as people age.</p>
<h2>It’s never too late</h2>
<figure class="align-center ">
<img alt="A man asleep in bed" src="https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/561628/original/file-20231125-27-dyme8y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Factors like not sleeping enough, having a poor diet and lacking social and cognitive engagement can increase the risk of developing dementia.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It’s never really too late to change. The human brain and body have a remarkable capacity for adaptation and resilience throughout life. </p>
<p>While there are benefits to being physically and socially active at any age, some research shows the <a href="https://doi.org/10.1016/j.smhs.2019.08.006">payoff from those gains can be higher</a> after age 40 when the body’s metabolism slows, risk factors increase and cognitive reserve becomes even more essential to help protect against <a href="https://doi.org/10.1212/WNL.0000000000007003">cognitive decline</a>.</p>
<p>If making lifestyle changes means you can watch your child navigate adulthood, stroll 20 blocks to your favourite café every day and continue to live in your own home, perhaps walking the daily 10,000 steps, changing diets and keeping your friendship network strong is worthwhile. At worst, you’ll be healthier and more independent with or without dementia. At best, you might completely avoid dementia and other major diseases and keep living your best possible life.</p><img src="https://counter.theconversation.com/content/218003/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Middleton receives funding from the Public Health Agency of Canada and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Saskia Sivananthan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Lifestyle-related dementia risks are complex, with factors like sleep, exercise, diet and social contact interacting with things like cognitive reserve, neuroplasticity and inflammation in the body.Saskia Sivananthan, Affiliate Professor, Department of Family Medicine, McGill UniversityLaura Middleton, Assistant Professor, Department of Kinesiology, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2177292023-11-23T13:13:16Z2023-11-23T13:13:16ZSize of brain area linked with cognitive decline – even in people with no other warning signs of Alzheimer’s disease<figure><img src="https://images.theconversation.com/files/560710/original/file-20231121-29-qfr9nm.jpg?ixlib=rb-1.1.0&rect=17%2C0%2C5973%2C3988&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Previous research has shown loss of volume in the hippocampus precedes signs of cognitive decline in people with Alzheimer's.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mri-brain-dementia-patient-hippocampal-atrophy-706998442">Atthapon Raksthaput/ Shutterstock</a></span></figcaption></figure><p>A small, seahorse-sized area of the brain is responsible for most of our learning and memory. Called the hippocampus, this <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3548359/">area is key</a> to many important brain functions, including turning short-term memories into long-term ones, regulating our emotions and making spatial navigation possible – essentially, our ability to plan where to go and how to get there.</p>
<p>As we get older, it’s normal for the hippocampus to shrink somewhat. But with certain health conditions, this volume loss is more rapid. Unsurprisingly, Alzheimer’s disease is one of these conditions. </p>
<p>Loss of volume in the hippocampus is often <a href="https://pubmed.ncbi.nlm.nih.gov/25260851">spotted early on</a> in patients with Alzheimer’s disease – and this volume loss tends to <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2017.00050/full#:%7E:text=Decreased%20hippocampal%20and%20right%20amygdala,cognition%20in%20these%20vulnerable%20cases">precede signs of cognitive decline</a>. </p>
<p>The presence of accumulated proteins in the brain – specifically the proteins <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387885/">amyloid beta</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/36357681/">tau</a> – have also been linked with cognitive decline in people with and without Alzheimer’s disease. </p>
<p>But a <a href="https://n.neurology.org/content/early/2023/11/15/WNL.0000000000207962">recent study</a> published in Neurology, has shown shrinkage in the hippocampus causes cognitive decline regardless of whether a person has amyloid or tau in their brain. This finding could be important not only in treating Alzheimer’s disease, but other neurodegenerative conditions as well.</p>
<p>To conduct their study, researchers collected data from 128 older adults over a period of ten years. Participants had no signs of cognitive impairment at the beginning of the study.</p>
<p>The researchers collected data on how participants performed on cognitive tests throughout the study. They also took brain imaging scans to look at the volume of a participant’s hippocampus, and to track whether they developed other markers of cognitive issues in the brain – such as <a href="https://pubmed.ncbi.nlm.nih.gov/37555516/">tau tangles</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6387885/">amyloid plaques</a>. </p>
<p>Tau and beta-amyloid are both important proteins for good brain function. But in conditions such as Alzheimer’s disease, these proteins turn toxic and clump together. Tau tangles destroy neurons from the inside, while amyloid plaques clump on the outside of neurons.</p>
<p>They found that shrinkage in the hippocampus correlated with cognitive decline. This was true even when they removed the influence of the other two factors – tau and amyloid – from their analyses. </p>
<p>They also found that the faster this shrinkage occurred, the faster a person’s cognitive decline. And, the lower a person’s hippocampal volume at the start of the study, the faster the shrinkage.</p>
<h2>Hippocampal volume</h2>
<p>These results indicate there are at least two potential pathways that lead to cognitive decline in Alzheimer’s disease and dementia. One pathway is due to the accumulation of tau and amyloid in certain areas of the brain, while the other is due to loss of hippocampal volume. </p>
<figure class="align-center ">
<img alt="A digital rendering of the brain, with the hippocampus highlighted in red." src="https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/560712/original/file-20231121-25-ikiqpu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The hippocampus is important to many everyday brain functions.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-illustration/3d-rendered-medical-illustration-hippocampus-plain-2256118539">SciePro/ Shutterstock</a></span>
</figcaption>
</figure>
<p>These results also suggest that cognitive decline caused by shrinkage in the hippocampus may indicate the presence of another condition. The authors of the study suggest that looking at hippocampal volume could be a useful biomarker (sign of a disease) in diagnosing other conditions that affect cognitive decline.</p>
<p>They also suggest this discovery could be used to determine whether or not a person will benefit from drugs that slow the progression of Alzheimer’s disease. So if a person’s cognitive decline is mainly due to their hippocampus shrinking, drugs which target amyloid plaques will probably not have any effect.</p>
<p>The researchers do acknowledge, however, that after all their analyses, there is some variance in the results that can’t be explained. For instance, some participants had hippocampal shrinkage yet showed no signs of cognitive decline, while others had little volume loss and higher levels of cognitive decline. </p>
<p>They attribute this to factors such as lifestyle, genetics or other neuropathologies such as <a href="https://www.mdpi.com/2075-1729/11/11/1239">alpha-synuclein</a>, which is involved in Parkinson’s disease and Lewy body dementia. This can’t be measured by focusing on the volume of the hippocampus.</p>
<p>They also acknowledge the fact that their data came from a population that’s not representative of the real world. Most of the participants were highly educated and white. Moreover, this was a group study, so individual differences – such as in genetics and lifestyle – were not investigated. It will be important for future studies to investigate the link between hippocampal volume and cognitive decline in a more diverse, representative population.</p>
<h2>Brain health</h2>
<p>Alongside Alzheimer’s disease, a lower hippocampal volume has been observed in people with many <a href="https://www.nature.com/articles/4000254">other conditions</a> – such as Cushing’s disease, depression, PTSD and anxiety.</p>
<p>Certain lifestyle habits can also worsen loss of hippocampus volume. For example, poor diet has been linked to a <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-015-0461-x">lower hippocampus volume</a>, as has excess alcohol consumption – even in <a href="https://sciencedirect.com/science/article/pii/S2451902218300545">young people</a>. </p>
<p>On the other hand, physical activity, including yoga, <a href="https://pubmed.ncbi.nlm.nih.gov/29113943/">cardio</a> and exercises which <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2014.00170/full">build balance and coordination</a>, have all been shown to increase <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3768219/">hippocampal volume in older people</a>.</p>
<p>So while cognitive decline can happen for many reasons, taking care of your brain through good lifestyle habits may have a positive effect on your brain health and delay it. </p>
<p>This research shows that amyloid plaques and tau tangles aren’t the only triggers of cognitive decline. But they also show that the various triggers may act together or independently of each other. </p>
<p>Developing tests and markers that can determine where a person’s cognitive decline originates from should be a future research focus. As should work on treatments that target different factors leading to cognitive decline.</p><img src="https://counter.theconversation.com/content/217729/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eleftheria Kodosaki does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This study shows at least two different mechanisms lead to cognitive decline – both in healthy people and people with Alzheimer’s.Eleftheria Kodosaki, Research Fellow in Neuroimmunology, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2174042023-11-17T17:18:16Z2023-11-17T17:18:16ZNew blood tests for dementia announced, but what can they tell us and who will benefit?<figure><img src="https://images.theconversation.com/files/559949/original/file-20231116-28-b88a0l.jpg?ixlib=rb-1.1.0&rect=27%2C18%2C6104%2C4063&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/lab-assistant-medical-scientist-chemistry-researcher-2248148893">Pickadook/Shutterstock</a></span></figcaption></figure><p>A five-year, £5 million initiative has just been launched to investigate the feasibility of using new blood tests in the diagnosis of Alzheimer’s disease. Alzheimer’s Research UK and the Alzheimer’s Society are working with the National Institute for Health and Care Research to <a href="https://www.alzheimersresearchuk.org/a-five-year-project-to-bring-alzheimers-blood-tests-to-the-nhs/">use these blood tests in the NHS</a>.</p>
<p>This funding, hot on the heels of <a href="https://theconversation.com/experimental-alzheimers-drug-shows-promise-but-there-are-many-hurdles-still-to-overcome-195383">recent drug trials</a> for Alzheimer’s disease, continues a wave of breathless excitement in a field that has traditionally found good news stories hard to come by. </p>
<p>Of those seen by specialists in memory services, the vast majority are <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/dementia-diagnosis/dementia-tests">given a diagnosis</a> of dementia based on their symptoms alongside cognitive tests, blood tests to rule out other explanations (such as hormone imbalances), and sometimes an MRI brain scan. </p>
<p>A small percentage, particularly those who are younger or who have more complex symptoms, may be offered a more detailed investigation to look for some proteins (amyloid and tau) that can build up in the brain. </p>
<p>At the moment, this would involve a lumbar puncture (placing a needle into the spine and removing some of the fluid) or a specialist brain scan called a PET scan. If simple blood tests can tell us the same information, with enough accuracy, then this will be preferable for this small group of people.</p>
<p>So far, so good. But what about those people who don’t need a lumbar puncture or PET scan? Will they see meaningful benefits from these new blood tests? It is far from certain. </p>
<p>Some argue that more “precision” in the diagnosis will help people understand what the coming years will entail. But this assumes that we can confidently place all people with dementia into the <a href="https://www.alzheimers.org.uk/about-dementia/types-dementia">various disease categories</a> (such as Alzheimer’s, vascular dementia, Lewy body dementia, frontotemporal dementia) based on the pathologies we find in their brains, and that we can then accurately predict how things will unfold for that person. </p>
<p>Unfortunately, we can’t. Instead, data show that many pathologies (disease-causing abnormalities such as protein build-up or damage to blood vessels) are linked to dementia, and most people with dementia have <a href="https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(23)00019-3/fulltext#seccestitle140">more than one</a>. This mixed disease is a big part of what makes researching the syndrome of dementia so complex. </p>
<p>The other suggested benefit is that the tests will tell us if the patient is eligible for the new drugs approved in the US (and currently being considered by UK and European regulators). But beyond the headlines, the current crop of new drugs <a href="https://theconversation.com/new-alzheimers-drugs-dont-deserve-the-hype-heres-why-211842">don’t stand up to scrutiny</a>.</p>
<h2>Beyond the amyloid theory</h2>
<p>The theory on which they are based (that the build-up of the amyloid protein is the trigger for everything that comes after) is increasingly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9997141/#:%7E:text=Taken%20together%2C%20the%20evidence%20is,initiation%20and%20progression%20of%20dementia">challenged</a> by <a href="https://academic.oup.com/brain/article-abstract/146/10/3969/7162122?redirectedFrom=fulltext&login=false">experts</a>. We need to better understand the complex biology of dementia. </p>
<p>In the past, this has been heavily focused on amyloid even though evidence has told us to <a href="https://mitpress.mit.edu/9780262546010/how-not-to-study-a-disease/#:%7E:text=Herrup%20presents%20a%20new%20and,of%20the%20Alzheimer%27s%20disease%20research">also look elsewhere</a>. </p>
<p>The ultimate frontier that many seek is screening people who have no symptoms but who would, if tested, be found to have raised protein levels. They hope that by detecting people at this stage, drugs could not just slow down the disease but prevent it altogether. </p>
<figure class="align-center ">
<img alt="Person receiving a lumbar puncture." src="https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/559961/original/file-20231116-19-knacv6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Person receiving a lumbar puncture.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/demonstration-simulator-lumbar-puncture-epidural-anesthesia-1946628973">Kittipong Somklang/Shutterstock</a></span>
</figcaption>
</figure>
<p>A recent trial tested this, in which people with raised amyloid but no symptoms took the amyloid-clearing drug <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa2305032">solazenumab</a> for more than four years. It had no effect on cognitive function compared with a placebo, confirming that this ambition is, sadly, not close. </p>
<p>It may not ever be realised for such a complex disease. The most significant problem is that many of those who have raised brain amyloid but no symptoms <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1016/j.jalz.2018.03.005">will die without developing dementia</a>. Therefore, most symptom-free people with a positive blood test have nothing to gain and can only experience harm – from anxiety, further tests, or treatments. Importantly, the focus of this new initiative is not people without symptoms. </p>
<h2>New initiative</h2>
<p>Several studies of new blood tests have been carried out already in people with dementia symptoms, showing they are almost as good as PET scans or lumbar punctures at detecting protein levels. But the people in these studies were typically younger (in their 60s and 70s), with minimal brain pathologies (except amyloid) and other disorders, and minimal ethnic and socioeconomic diversity. </p>
<p><a href="https://www.alzheimersresearchuk.org/wp-content/uploads/2023/05/Blood-Biomarker-Challenge-Request-for-Application.pdf">This initiative</a> will test how well these emerging blood tests perform for those with suspected dementia in the NHS. Most people in the UK who develop dementia are <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)61570-6/fulltext">in their 80s</a>, have mixed brain pathologies, commonly have other diseases (for example, kidney disease, which may <a href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2800717#:%7E:text=Kidney%20function%20might%20influence%20the,of%20the%20disease%20are%20multifactorial.">affect the accuracy of the blood tests</a>, and rates are higher among poorer groups and those <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12774">from some minority ethnic backgrounds</a>. </p>
<p>The results of this new initiative will tell us how well the new blood tests perform in these older, more complex people. The most important question, though, will be: do the results of protein tests change the way we look after people with dementia, resulting in a better quality of life?</p><img src="https://counter.theconversation.com/content/217404/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sebastian Walsh receives funding from the NIHR</span></em></p><p class="fine-print"><em><span>Edo Richard receives funding from The Netherlands Organisation for Health Research and Development (ZonMW) - public funding </span></em></p><p class="fine-print"><em><span>Carol Brayne does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The NHS will trial a new blood test for dementia, which could be widely available in five years.Sebastian Walsh, NIHR Doctoral Fellow in Public Health, University of CambridgeCarol Brayne, Professor of Public Health Medicine, University of CambridgeEdo Richard, Professor of Neurology, Radboud UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2150652023-10-13T00:42:54Z2023-10-13T00:42:54ZDo stress and depression increase the risk of Alzheimer’s disease? Here’s why there might be a link<figure><img src="https://images.theconversation.com/files/553406/original/file-20231012-29-jixwnd.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6709%2C4466&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-lonely-mature-grey-haired-lady-2159105651">fizkes/Shutterstock</a></span></figcaption></figure><p>Dementia affects more than <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">55 million people</a> around the world. A number of factors can increase a person’s risk of developing dementia, <a href="https://link.springer.com/article/10.14283/jpad.2023.119">including</a> high blood pressure, poor sleep, and physical inactivity. Meanwhile, keeping cognitively, physically, and socially active, and limiting alcohol consumption, can <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">reduce the risk</a>.</p>
<p>Recently, a <a href="https://alzres.biomedcentral.com/articles/10.1186/s13195-023-01308-4">large Swedish study</a> observed that chronic stress and depression were linked to a higher risk of developing <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1002/alz.12638">Alzheimer’s disease</a>, the most common form of dementia. The researchers found people with a history of both chronic stress and depression had an even greater risk of the disease.</p>
<p>Globally, around <a href="https://www.who.int/news-room/fact-sheets/detail/depression">280 million people</a> have depression, while roughly <a href="https://www.who.int/news-room/fact-sheets/detail/anxiety-disorders">300 million people</a> experience anxiety. With so many people facing mental health challenges at some stage in their lives, what can we make of this apparent link?</p>
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Read more:
<a href="https://theconversation.com/are-there-certain-foods-you-can-eat-to-reduce-your-risk-of-alzheimers-disease-117096">Are there certain foods you can eat to reduce your risk of Alzheimer's disease?</a>
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<h2>What the study did and found</h2>
<p>This study examined the health-care records of more than 1.3 million people in Sweden aged between 18 and 65. Researchers looked at people diagnosed with chronic stress (technically chronic stress-induced exhaustion disorder), depression, or both, between 2012 and 2013. They compared them with people not diagnosed with chronic stress or depression in the same period. </p>
<p>Participants were then followed between 2014 and 2022 to determine whether they received a diagnosis of mild cognitive impairment or dementia, in particular Alzheimer’s disease. <a href="https://alz-journals.onlinelibrary.wiley.com/doi/10.1016/j.jalz.2016.07.151">Mild cognitive impairment</a> is often seen as the precursor to dementia, although not everyone who has mild cognitive impairment will progress to dementia.</p>
<p>During the study period, people with a history of either chronic stress or depression were around twice as likely to be diagnosed with mild cognitive impairment or Alzheimer’s disease. Notably, people with both chronic stress and depression were up to four times more likely to be diagnosed with mild cognitive impairment or Alzheimer’s disease.</p>
<figure class="align-center ">
<img alt="A man sitting on a couch appears stressed." src="https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553407/original/file-20231012-15-mjic5v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Chronic stress or depression could increase the risk of Alzheimer’s disease, research shows.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stressed-young-african-american-man-feel-2160764959">Dragana Gordic/Shutterstock</a></span>
</figcaption>
</figure>
<h2>Important considerations</h2>
<p>In interpreting the results of this study, there are some key things to consider. First, the diagnosis of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9438479/">chronic stress-induced exhaustion disorder</a> is unique to the Swedish medical system. It is characterised by at least six months of intensive stress without adequate recovery. Symptoms include exhaustion, sleep disturbance and concentration difficulties, with a considerable reduction in ability to function. Mild stress may not have the same effect on dementia risk. </p>
<p>Second, the number of people diagnosed with dementia in this study (the absolute risk) was very low. Of the 1.3 million people studied, 4,346 were diagnosed with chronic stress, 40,101 with depression, and 1,898 with both. Of these, the number who went on to develop Alzheimer’s disease was 14 (0.32%), 148 (0.37%) and 9 (0.47%) respectively.</p>
<p>These small numbers may be due to a relatively young age profile. When the study began in 2012–2013, the average age of participants was around 40. This means the average age in 2022 was around 50. Dementia is typically diagnosed in <a href="https://www.health.gov.au/topics/dementia/about-dementia">people aged over 65</a> and diagnosis <a href="https://karger.com/dem/article-abstract/34/5-6/292/99009/Overdiagnosis-of-Dementia-in-Young-Patients-A?redirectedFrom=fulltext">in younger ages</a> may be less reliable.</p>
<p>Finally, it’s possible that in some cases stress and depressive symptoms may reflect an awareness of an already declining memory ability, rather than these symptoms constituting a risk factor in themselves.</p>
<p>This last consideration speaks to a broader point: the study is observational. This means it can’t tell us one thing caused the other – only that there is an association.</p>
<h2>What does other evidence say?</h2>
<p><a href="https://link.springer.com/article/10.14283/jpad.2023.119">Many studies</a> indicate that significant symptoms of depression, anxiety and stress are related to higher dementia risk. However, the nature of this relationship is unclear. For example, are depressive and anxiety symptoms a risk factor for dementia, or are they consequences of a declining cognition? It’s likely to be a bit of both.</p>
<p>High <a href="https://pubmed.ncbi.nlm.nih.gov/32082139/">depressive and anxiety symptoms</a> are commonly reported in people with mild cognitive impairment. However, studies in middle-aged or younger adults suggest they’re important dementia risk factors too. </p>
<p>For example, similar to the Swedish study, other <a href="https://www.sciencedirect.com/science/article/pii/S0165032719323031">studies</a> have suggested people with a history of depression are twice as likely to develop dementia than those without this history. In addition, in middle-aged adults, high anxiety symptoms are associated with <a href="https://pubmed.ncbi.nlm.nih.gov/34648818/">poorer cognitive function</a> and <a href="https://bmjopen.bmj.com/content/8/4/e019399">greater dementia risk</a> in later life.</p>
<figure class="align-center ">
<img alt="Two senior women doing a crossword." src="https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553408/original/file-20231012-19-n6xapk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">More than 55 million people around the world have dementia.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/two-seniors-solving-crossword-puzzles-brain-2142765903">Robert Kneschke/Shutterstock</a></span>
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<h2>Why the link?</h2>
<p>There are several potential pathways through which stress, anxiety and depression could increase the risk of dementia.</p>
<p>Animal studies suggest cortisol (a hormone produced when we’re stressed) can increase risk of Alzheimer’s disease by causing the accumulation of key proteins, <a href="https://pubmed.ncbi.nlm.nih.gov/34159699/">amyloid and tau</a>, in the brain. The accumulation of these proteins can result in increased <a href="https://www.mdpi.com/1422-0067/23/18/10572">brain inflammation</a>, which affects the brain’s nerves and supporting cells, and can ultimately lead to brain volume loss and memory decline.</p>
<p>Another potential pathway is through <a href="https://www.sciencedirect.com/science/article/pii/S1087079217300114?via%3Dihub">impaired sleep</a>. Sleep disturbances are common in people with chronic stress and depression. Similarly, people with Alzheimer’s disease commonly report sleep disturbances. Even in people with <a href="https://pubmed.ncbi.nlm.nih.gov/34668959/">early Alzheimer’s disease</a>, disturbed sleep is related to poorer memory performance. Animal studies suggest poor sleep can also enhance accumulation of <a href="https://pubmed.ncbi.nlm.nih.gov/31408876/">amyloid and tau</a>.</p>
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Read more:
<a href="https://theconversation.com/why-is-my-loved-one-with-dementia-sometimes-there-and-sometimes-not-200439">Why is my loved one with dementia sometimes 'there' and sometimes not?</a>
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<p>We still have a lot to learn about why this link might exist. But evidence-based strategies which target chronic stress, anxiety and depression may also play a role in reducing the risk of dementia.</p><img src="https://counter.theconversation.com/content/215065/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Yen Ying Lim receives funding from the NHMRC, ARC, MRFF and the Alzheimer's Association.</span></em></p><p class="fine-print"><em><span>Ivana Chan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A recent study from Sweden found people with a history of chronic stress or depression had a heightened risk of developing Alzheimer’s disease.Yen Ying Lim, Associate Professor, Turner Institute for Brain and Mental Health, Monash UniversityIvana Chan, PhD candidate, clinical psychology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139542023-10-01T15:12:14Z2023-10-01T15:12:14ZEarly indicators of dementia: 5 behaviour changes to look for after age 50<figure><img src="https://images.theconversation.com/files/551222/original/file-20230929-24-as88uw.jpg?ixlib=rb-1.1.0&rect=146%2C251%2C6514%2C4290&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Behaviour changes like apathy, lack of impulse control or socially inappropriate behaviour may indicate a risk of dementia in people over age 50.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/early-indicators-of-dementia-5-behaviour-changes-to-look-for-after-age-50" width="100%" height="400"></iframe>
<p>Dementia is often thought of as a memory problem, like when an elderly person asks the same questions or misplaces things. In reality, individuals with dementia will not only experience issues in other areas of cognition like learning, thinking, comprehension and judgement, but they may also experience <a href="https://www.alzint.org/u/World-Alzheimer-Report-2021.pdf">changes in behaviour</a>. </p>
<p>It’s important to understand what dementia is and how it manifests. I didn’t imagine my grandmother’s strange behaviours were an early warning sign of a far more serious condition. </p>
<p>She would become easily agitated if she wasn’t successful at completing tasks such as cooking or baking. She would claim to see a woman around the house even though no woman was really there. She also became distrustful of others and hid things in odd places. </p>
<p>These behaviours persisted for some time before she eventually received a dementia diagnosis.</p>
<h2>Cognitive and behavioural impairment</h2>
<p>When cognitive and behavioural changes interfere with an individual’s functional independence, that person is considered to have dementia. However, when cognitive and behavioural changes don’t interfere with an individual’s independence, yet still negatively affect relationships and workplace performance, they are referred to as <a href="https://alzheimer.ca/sites/default/files/documents/other-dementias_mild-cognitive-impairment.pdf">mild cognitive impairment (MCI)</a> and <a href="https://doi.org/10.1186/s13195-021-00949-7">mild behavioural impairment (MBI)</a>, respectively. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169943/">MCI and MBI can occur together</a>, but in one-third of people who develop Alzheimer’s dementia, the behavioural symptoms come <a href="http://dx.doi.org/10.1016/j.jagp.2019.01.215">before cognitive decline</a>. </p>
<p>Spotting these behavioural changes, which emerge in later life (ages 50 and over) and represent a persistent change from longstanding patterns, can be helpful for implementing preventive treatments before more severe symptoms arise. As a medical science PhD candidate, my research focuses on problem behaviours that arise later in life and indicate increased risk for dementia. </p>
<h2>Five behavioural signs to look for</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of five behaviour changes that may indicate risk of dementia" src="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=659&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=659&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=659&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Spotting behavioural changes can be helpful for implementing preventive treatments before more severe symptoms arise.</span>
<span class="attribution"><span class="source">(Daniella Vellone)</span></span>
</figcaption>
</figure>
<p>There are <a href="https://doi.org/10.3233%2FJAD-160979">five primary behaviours</a> we can look for in friends and family who are over the age of 50 that <a href="https://doi.org/10.1186/s13024-023-00631-6">might warrant further attention</a>. </p>
<h2>1. Apathy</h2>
<p><a href="https://doi.org/10.1002%2Ftrc2.12370">Apathy</a> is a decline in interest, motivation and drive.</p>
<p>An apathetic person might lose interest in friends, family or activities. They may lack curiosity in topics that normally would have interested them, lose the motivation to act on their obligations or become less spontaneous and active. They may also appear to lack emotions compared to their usual selves and seem like they no longer care about anything.</p>
<h2>2. Affective dysregulation</h2>
<p><a href="https://doi.org/10.1016/j.jad.2023.03.074">Affective dysregulation</a> includes mood or anxiety symptoms. Someone who shows affective dysregulation may develop sadness or mood instability or become more anxious or worried about routine things such as events or visits.</p>
<h2>3. Lack of impulse control</h2>
<p><a href="https://doi.org/10.1002%2Ftrc2.12016">Impulse dyscontrol</a> is the inability to delay gratification and control behaviour or impulses.</p>
<p>Someone who has impulse dyscontrol may become agitated, aggressive, irritable, temperamental, argumentative or easily frustrated. They may become more stubborn or rigid such that they are unwilling to see other views and are insistent on having their way. Sometimes they may develop sexually disinhibited or intrusive behaviours, exhibit repetitive behaviours or compulsions, start gambling or shoplifting, or experience difficulties regulating their consumption of substances like tobacco or alcohol.</p>
<h2>4. Social inappropriateness</h2>
<p><a href="http://dx.doi.org/10.1017/S1041610217001260">Social inappropriateness</a> includes difficulties adhering to societal norms in interactions with others.</p>
<p>Someone who is socially inappropriate may lose the social judgement they previously had about what to say or how to behave. They may become less concerned about how their words or actions affect others, discuss private matters openly, talk to strangers as if familiar, say rude things or lack empathy in interactions with others.</p>
<h2>5. Abnormal perceptions or thoughts</h2>
<p><a href="https://doi.org/10.1038/s44220-023-00043-x">Abnormal perception or thought content</a> refers to strongly held beliefs and sensory experiences.</p>
<p>Someone with abnormal perceptions or thoughts may become suspicious of other people’s intentions or think that others are planning to harm them or steal their belongings. They may also describe hearing voices or talk to imaginary people and/or act like they are seeing things that aren’t there.</p>
<p>Before considering any of these behaviours as a sign of a more serious problem, it’s important to rule out other potential causes of behavioural change such as drugs or medications, other medical conditions or infections, interpersonal conflict or stress, or a recurrence of psychiatric symptoms associated with a previous psychiatric diagnosis. If in doubt, it may be time for a doctor’s visit. </p>
<h2>The impact of dementia</h2>
<figure class="align-center ">
<img alt="A young man with his arms around an older man" src="https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some types of behaviour changes warrant further attention.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Many of us know someone who has either experienced dementia or cared for someone with dementia. This isn’t surprising, given that dementia is predicted to affect <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849#:">one million Canadians by 2030</a>.</p>
<p>While people between the ages of 20 and 40 may think that they have decades before dementia affects them, it’s important to realize that dementia isn’t an individual journey. In 2020, care partners — including family members, friends or neighbours — spent <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-1-Path-Forward-Alzheimer-Society-of-Canada-2022-wb.pdf">26 hours per week</a> assisting older Canadians living with dementia. This is equivalent to 235,000 full-time jobs or $7.3 billion annually. </p>
<p>These numbers are expected to triple by 2050, so it’s important to look for ways to offset these predicted trajectories by preventing or delaying the progression of dementia.</p>
<h2>Identifying those at risk</h2>
<p>While there is currently no cure for dementia, there has been progress towards <a href="https://alzheimer.ca/en/about-dementia/dementia-treatment-options-developments">developing effective treatments</a>, which <a href="https://alzheimer.ca/en/about-dementia/do-i-have-dementia/how-get-tested-dementia-tips-individuals-families-friends/10">may work better earlier in the disease course</a>. </p>
<p>More research is needed to understand dementia symptoms over time; for example, the online <a href="https://www.can-protect.ca/">CAN-PROTECT study</a> assesses many contributors to brain aging. </p>
<p>Identifying those at risk for dementia by recognizing later-life changes in cognition, function as well as behaviour is a step towards not only preventing consequences of those changes, but also potentially preventing the disease or its progression.</p><img src="https://counter.theconversation.com/content/213954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniella Vellone does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Dementia does not manifest solely as a memory problem. People with dementia can also experience issues with learning, comprehension and judgement, but they may also experience changes in behaviour.Daniella Vellone, Medical Science and Imaging PhD Candidate, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124332023-09-25T12:21:28Z2023-09-25T12:21:28ZAerobic and strength training exercise combined can be an elixir for better brain health in your 80s and 90s, new study finds<figure><img src="https://images.theconversation.com/files/549420/original/file-20230920-21-t9p644.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5475%2C3630&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pilates is a form of mind-body exercise that involves weight resistance and strength training. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-doing-mermaid-exercise-on-pilates-royalty-free-image/944882744?phrase=seniors+exercise&adppopup=true">Thomas Barwick/Stone via Getty Images</a></span></figcaption></figure><p>People in the oldest stage of life who regularly engage in aerobic activities and strength training exercises perform better on cognitive tests than those who are either sedentary or participate only in aerobic exercise. That is the <a href="https://doi.org/10.1007/s11357-023-00885-4">key finding of our new study</a>, published in the journal GeroScience.</p>
<p>We assessed 184 cognitively healthy people ranging in age from 85 to 99. Each participant reported their exercise habits and underwent a comprehensive battery of neuropsychological tests that were designed to evaluate various dimensions of cognitive function. </p>
<p>We found that those who incorporated both aerobic exercises, such as swimming and cycling, and strength exercises like weightlifting into their routines – regardless of intensity and duration – had better mental agility, quicker thinking and greater ability to shift or adapt their thinking.</p>
<p>Using a well-known cognitive screening tool called the <a href="https://mocacognition.com/">Montreal Cognitive Assessment</a> that provides a balanced view of many aspects of cognition, we found that people who didn’t engage in any physical exercise scored lower than those who did both cardio and strength training. This difference was slight but significant even when controlling for other factors like education and how much people exercised. In addition, the group that did both types of exercises did better in specific cognitive activities, like symbol coding, beyond just the screening results. </p>
<p>It’s important to note that while our study establishes a correlation between a mix of aerobic and strength training exercises and higher cognitive test scores, the design of the study did not enable us to determine a causal relationship.</p>
<p>Nonetheless, the results suggest that a varied exercise routine is associated with improved cognitive functioning in people who are in their late 80s and beyond. We conducted the study as part of a large, multisite collaboration with the <a href="https://mcknightbrain.org/">McKnight Brain Research Foundation</a>, which has institutes at the University of Florida, the University of Miami, the University of Arizona and the University of Alabama-Birmingham. </p>
<h2>Why it matters</h2>
<p>The aging of the global population makes cognitive health a pressing issue. The number of people diagnosed with Alzheimer’s disease in the U.S. is projected to reach <a href="https://www.statista.com/statistics/216624/projected-numbers-of-alzheimers-sufferers-aged-65-and-over-in-the-us/#statisticContainer">almost 14 million by 2060</a>, up from just over 6 million as of 2020. Our findings not only offer hope for healthier aging but also present a practical approach to maintaining or even enhancing cognitive health in the last decades of life.</p>
<p>These results are not just numbers; they represent real-world thinking abilities that can affect the quality of life for those entering their golden years.</p>
<p>The fact that nearly 70% of our study participants were already engaging in some physical exercise prior to signing up for our study challenges the stereotype that old age and physical inactivity must go hand in hand. </p>
<p>Our findings provide an evidence base for health care providers to consider recommending a mixed regimen of aerobic and strength exercises as part of their patients’ wellness plans. Studies show that when cognitive decline is slowed, people <a href="https://aspe.hhs.gov/reports/risk-costs-severe-cognitive-impairment-older-ages-key-findings-our-literature-review-projection-0">spend less on medical care</a> and experience a <a href="https://www.cdc.gov/aging/publications/chronic-diseases-brief.html">higher quality of life</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/FwQTCl1Yj3w?wmode=transparent&start=75" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The aging body is like a machine that needs more upkeep and maintenance to stay intact.</span></figcaption>
</figure>
<h2>What’s next</h2>
<p>Some of the next questions we hope to answer include: What types of aerobic and strength exercises are most effective for cognitive health? Is walking as effective as jogging? Does lifting weights have the same impact as resistance band exercises? And how much exercise is needed to see noticeable cognitive benefits? </p>
<p>Another critical question is the potential of exercise as a treatment for neurocognitive disorders among older people. Our results suggest that physical activity is a preventive measure. But could it also be an active treatment for cognitive decline? This is an exciting development and one that is opening up all sorts of new possibilities for helping people live fully across their entire life span.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/212433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s long been known that exercise helps maintain strength and agility as we age. New research points to the importance of exercise type in supporting cognitive health in the latest decades of life.Brian Ho, PhD Candidate in Clinical & Health Psychology, University of FloridaRonald Cohen, Professor of Clinical and Health Psychology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2122502023-09-24T20:02:40Z2023-09-24T20:02:40ZAre fish oil supplements as healthy as we think? And is eating fish better?<p>Fish oil, which contains omega-3 fatty acids, is promoted for a number of health benefits – from boosting our heart health, protecting our brain from dementia, and easing the symptoms of rheumatoid arthritis. </p>
<p>But what exactly are omega-3 fats and what does the evidence say about their benefits for keeping us healthy? </p>
<p>And if they <em>are</em> good for us, does eating fish provide the same benefit as supplements?</p>
<h2>What are omega-3 fats?</h2>
<p>Omega-3 fatty acids are a type of polyunsaturated fatty acid. They are essential to consume in our diet because we can’t make them in our body. </p>
<p>Three main types of omega-3 fats are important in our diet:</p>
<ul>
<li><p>alpha-linolenic acid (ALA), which is found in plant foods such as green leafy vegetables, walnuts, flaxseed and chia seeds</p></li>
<li><p>eicosapentanoic acid (EPA), which is only found in seafood, eggs (higher in free-range rather than cage eggs) and breast milk</p></li>
<li><p>docosahexaenoic acid (DHA) is also only found in seafood, eggs (again, higher in free-range eggs) and breast milk.</p></li>
</ul>
<p>Omega 3s are key to the structure of our cells, and help keep our heart, lungs, blood vessels, and immune system working.</p>
<h2>Eating fish vs taking a supplement</h2>
<p>The initial studies suggesting omega-3 fats may have health benefits came from <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.0954-6820.1976.tb08198.x">observational studies on people eating fish</a>, not from fish oil. </p>
<p>So are the “active ingredients” from supplements – the EPA and DHA – absorbed into our body in the same way as fish?</p>
<p>An <a href="https://www.sciencedirect.com/science/article/pii/S0002916523281484">intervention study</a> (where one group was given fish and one group fish oil supplements) found the levels of EPA and DHA in your body increase in a similar way when you consume equal amounts of them from either fish or fish oil. </p>
<figure class="align-center ">
<img alt="Raw salmon in paper" src="https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546820/original/file-20230907-21-g4294m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating fish might have other benefits that supplements can’t give.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/kC9KUtSiflw">Unsplash/CA Creative</a></span>
</figcaption>
</figure>
<p>But this assumes it is just the omega-3 fats that provide health benefits. There are other <a href="https://www.foodstandards.gov.au/science/monitoringnutrients/afcd/pages/default.aspx">components of fish</a>, such as protein, vitamins A and D, iodine, and selenium that could be wholly or jointly responsible for the health benefits.</p>
<p>The health benefits seen may also be partially due to the absence of certain nutrients that would have otherwise been consumed from other types of meat (red meat and processed meat) such as saturated fats and salt.</p>
<h2>So what are the benefits of omega 3 fats? And does the source matter?</h2>
<p>Let’s consider the evidence for heart disease, arthritis and dementia. </p>
<p><strong>Heart disease</strong></p>
<p>For cardiovascular disease (heart attacks and stroke), a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003177.pub3/full">meta-analysis</a>, which provides the highest quality evidence, has shown fish oil supplementation probably makes little or no difference. </p>
<p>Another <a href="https://www.mdpi.com/2072-6643/12/8/2278">meta-analysis</a> found for every 20 grams per day of fish consumed it reduced the risk of coronary heart disease by 4%. </p>
<p>The <a href="https://www.heartfoundation.org.au/getmedia/f1d22267-7381-4513-834b-df317bed9a40/Nutrition_Position_Statement_-_DIETARY_FAT_FINAL-4.pdf">National Heart Foundation</a> recommends, based on the scientific evidence, eating fish rich in omega-3 fats for optimal heart health. <a href="https://apjcn.nhri.org.tw/server/APJCN/17/3/385.pdf">Fish vary in their omega-3 levels</a> and generally the fishier they taste the more omega-3 fats they have – such as tuna, salmon, deep sea perch, trevally, mackeral and snook. </p>
<p>The foundation says fish oil may be beneficial for people with heart failure or high triglycerides, a type of fat that circulates in the blood that increases the risk of heart disease and stroke. But it doesn’t recommend fish oil for reducing the risk of cardiovascular diseases (heart attack and stroke).</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/omega-3-supplements-dont-protect-against-heart-disease-new-review-100111">Omega 3 supplements don't protect against heart disease – new review</a>
</strong>
</em>
</p>
<hr>
<p><strong>Arthritis</strong></p>
<p>For rheumatoid arthritis, <a href="https://arthritis-research.biomedcentral.com/articles/10.1186/s13075-022-02781-2">studies</a> have shown fish oil supplements do provide benefits in reducing the severity and the progression of the disease. </p>
<p>Eating fish also leads to these improvements, but as the level of EPA and DHA needed is high, often it’s difficult and expensive to consume that amount from fish alone. </p>
<p><a href="https://arthritisaustralia.com.au/managing-arthritis/living-with-arthritis/complementary-treatments-and-therapies/fish-oils/">Arthritis Australia</a> recommends, based on the evidence, about 2.7 grams of EPA and DHA a day to reduce joint inflammation. Most supplements contain about 300-400mg of omega-3 fats. </p>
<p>So depending on how much EPA and DHA is in each capsule, you may need nine to 14 capsules (or five to seven capsules of fish oil concentrate) a day. This is about 130g-140g of grilled salmon or mackeral, or 350g of canned tuna in brine (almost four small tins).</p>
<figure class="align-center ">
<img alt="Fish tacos" src="https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=512&fit=crop&dpr=1 600w, https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=512&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=512&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=644&fit=crop&dpr=1 754w, https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=644&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/546824/original/file-20230907-15-3ox0ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=644&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Eating fish also leads to improvements in arthritis, but you’d need to eat large quantities.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fish-tacos-slaw-lemon-zest-cilantro-256178206">Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>Dementia</strong></p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0952327807001421?via%3Dihub">Epidemiological studies</a> have shown a positive link between an increased DHA intake (from diet) and a lower risk of developing Alzheimer’s disease, a type of dementia.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0952327807001421?via%3Dihub">Animal studies</a> have shown DHA can alter markers that are used to assess brain function (such as accumulation of amyloid – a protein thought to be linked to dementia, and damage to tau protein, which helps stabilise nerve cells in the brain). But this hasn’t been shown in humans yet.</p>
<p>A systematic review of <a href="http://betamedarts.gr/wp-content/uploads/2021/05/31Psychiatriki03_2020.pdf#page=58">multiple studies in people</a> has shown different results for omega-3 fats from supplements.</p>
<p>In the two studies that gave omega-3 fats as supplements to people with dementia, there was no improvement. But when given to people with mild cognitive impairment, a condition associated with increased risk of progressing to dementia, there was an improvement. </p>
<p>Another <a href="https://pubmed.ncbi.nlm.nih.gov/25446949/">meta-anlayses</a> (a study of studies) showed a higher intake of fish was linked to lower risk of Alzheimers, but this relationship was not observed with total dietary intake of omega-3 fats. This indicates there may be other protective benefits derived from eating fish.</p>
<p>In line with the evidence, the <a href="https://www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/omega-3-and-dementia#:%7E:text=This%20could%20suggest%20that%20taking,its%20own%20may%20not%20be.">Alzheimer’s Society</a> recommends eating fish over taking fish oil supplements.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/are-there-certain-foods-you-can-eat-to-reduce-your-risk-of-alzheimers-disease-117096">Are there certain foods you can eat to reduce your risk of Alzheimer's disease?</a>
</strong>
</em>
</p>
<hr>
<h2>So what’s the bottom line?</h2>
<p>The more people stick to a healthy, plant-based diet with fish and minimal intakes of ultra-processed foods, the better their health will be. </p>
<p>At the moment, the evidence suggests fish oil is beneficial for rheumatoid arthritis, particularly if people find it difficult to eat large amounts of fish. </p>
<p>For dementia and heart disease, it’s best to try to eat your omega-3 fats from your diet. While plant foods contain ALA, this will not be as efficient as increasing EPA and DHA levels in your body by eating seafood.</p>
<p>Like any product that sits on the shop shelves, check the use-by date of the fish oil and make sure you will be able to consume it all by then. The chemical structure of EPA and DHA makes <a href="https://www.sciencedirect.com/science/article/pii/S0924224421005422">it susceptible to degradation</a>, which affects its nutritional value. Store it in cold conditions, preferably in the fridge, away from light.</p>
<p>Fish oil can have some annoying side effects, such as fishy burps, but generally there are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664575/">minimal serious side effects</a>. However, it’s important to discuss taking fish oil with all your treating doctors, particularly if you’re on other medication.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/can-supplements-or-diet-reduce-symptoms-of-arthritis-heres-what-the-evidence-says-184151">Can supplements or diet reduce symptoms of arthritis? Here's what the evidence says</a>
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</em>
</p>
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<img src="https://counter.theconversation.com/content/212250/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Fish oil has been promised to provide all sorts of health benefits – from boosting our heart health, protecting our brain and easing arthritis. Here’s how the claims stack up for fish and supplements.Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2127392023-09-20T15:34:32Z2023-09-20T15:34:32ZAlzheimer’s disease blood tests: here’s what they look for, and what they can tell you about your risk<figure><img src="https://images.theconversation.com/files/548347/original/file-20230914-17-84hld1.jpg?ixlib=rb-1.1.0&rect=48%2C0%2C5360%2C3570&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Blood tests would offer a faster, less invasive way of diagnosing Alzheimer's disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hands-lab-technician-tube-blood-sample-441264445">angellodeco/ Shutterstock</a></span></figcaption></figure><p>Despite affecting <a href="https://www.alzheimers.org.uk/about-us/news-and-media/facts-media">55 million people worldwide</a>, Alzheimer’s disease still has no cure. But recent advancements in the field have seen a number of <a href="https://theconversation.com/new-alzheimers-drug-what-you-need-to-know-about-donanemabs-promising-trial-results-205156">promising drugs</a> that can slow the disease’s progression pass late-stage clinical trials.</p>
<p>The catch with these types of drug is that they’re most effective when <a href="https://jamanetwork.com/journals/jama/article-abstract/2807533">taken soon after</a> symptoms begin. Unfortunately, current diagnostic techniques may not catch Alzheimer’s early enough for these drugs to have a marked effect. </p>
<p>Evidence suggests that signs of Alzheimer’s disease could be detected in the blood <a href="https://pubmed.ncbi.nlm.nih.gov/23477989/">up to 20 years</a> before symptoms start. Catching the disease this early could have a major effect on treatment outcomes for patients. </p>
<p>A couple of US companies have now developed Alzheimer’s blood tests that are available for consumers to purchase, either direct from the supplier or at the request of the patient’s doctor. But while these tests can detect signs of the disease, their results should still be interpreted with caution.</p>
<h2>Alzheimer’s disease diagnosis</h2>
<p>Alzheimer’s disease is diagnosed using a combination of tests.</p>
<p>Cognitive tests look at a person’s memory recall and thinking abilities. Biomarker tests look for signs of the disease in a person’s body, in a brain imaging scan or sample of cerebrospinal fluid (the liquid that surrounds the brain and spinal cord). These biomarkers have been found to correlate with three major signs of Alzheimer’s disease:</p>
<ol>
<li>An accumulation of amyloid-beta plaques outside brain cells</li>
<li>Tau protein tangles inside brain cells</li>
<li>Brain cell death (known as neurodegeneration).</li>
</ol>
<p>Not all of these signs need to be present for a person to be diagnosed with Alzheimer’s disease, although the presence of amyloid-beta plaques and/or tau tangles in the brain <a href="https://aaic.alz.org/downloads2023/NIA-AA-Revised-Clinical-Criteria-AAIC-2023.pdf">are essential</a>. Conversely, some people may have biomarker changes <a href="https://www.nia.nih.gov/health/how-biomarkers-help-diagnose-dementia#:%7E:text=A%20positive%20amyloid%20scan%20may,the%20results%20of%20other%20tests.">but may never</a> develop Alzheimer’s disease symptoms.</p>
<p>As these <a href="https://pubmed.ncbi.nlm.nih.gov/23477989/">biomarker changes</a> can be <a href="https://www.cell.com/neuron/pdf/S0896-6273(20)30433-5.pdf">detected in the blood years before</a> other signs appear in the brain, this could provide a faster and less invasive way of diagnosing Alzheimer’s disease.</p>
<h2>Blood tests</h2>
<p>Most of the blood tests currently available to purchase measure two different types of amyloid-beta in the blood: amyloid-beta 42 and amyloid-beta 40. The ratio between these two proteins is then calculated. The lower the ratio is, the higher a person’s likelihood of having <a href="https://www.sciencedirect.com/science/article/pii/S235287291730043X">amyloid plaques</a> and therefore <a href="https://pubmed.ncbi.nlm.nih.gov/30569084/">Alzheimer’s disease</a>.</p>
<p>One such test, <a href="https://www.sciencedirect.com/science/article/pii/S0009898121001601">PrecivityAD</a>, has been approved for doctors to use in people who exhibit symptoms of Alzheimer’s in the US, and has been <a href="https://single-market-economy.ec.europa.eu/single-market/ce-marking_en#:%7E:text=The%20letters%20'CE'%20appear%20on,health%2C%20and%20environmental%20protection%20requirements.">deemed safe for use</a> in the European Union. In patients with cognitive symptoms, doctors will send a blood sample to the company which then measures the amyloid-beta ratio. The company also looks for another protein, called apolipoprotein E, to investigate the patient’s genetic risk of Alzheimer’s.</p>
<figure class="align-center ">
<img alt="A nurse takes a blood sample from an elderly woman." src="https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548351/original/file-20230914-21-fixngd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">PrecivityAD looks for amyloid-beta.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nurse-taking-blood-samples-senior-female-1859594491">Newman Studio/ Shutterstock</a></span>
</figcaption>
</figure>
<p>An algorithm then accounts for the biomarker levels and patient’s age, providing a probability score. A high score means the patient probably has Alzheimer’s disease. Results are available within a few days.</p>
<p>The PrecivityAD test has been used in <a href="https://www.aafp.org/pubs/afp/issues/2022/0100/p79.html">several studies</a> and has shown a <a href="https://www.sciencedirect.com/science/article/pii/S0009898121001601">high correlation</a> with signs of Alzheimer’s disease. But this does not mean it’s 100% accurate all the time, and nor can it predict how the disease will progress in that person.</p>
<p>Studies that have used this test also excluded certain participants (such as those with chronic health conditions) to avoid affecting how the test’s results were interpreted. The majority of the participants were also white. This makes it uncertain how accurate these tests will be for people of diverse backgrounds or those with other health conditions.</p>
<p>Another test, produced by <a href="https://www.reuters.com/business/healthcare-pharmaceuticals/quest-diagnostics-launches-alzheimers-blood-test-consumers-2023-07-31/">Quest</a>, measures the same amyloid-beta ratio. This test can be purchased directly by the consumer without a doctor’s referral – although you’ll need to book a time to have your blood sample collected. </p>
<p>This test has not yet been approved in the US or EU, nor has it undergone the extensive testing PrecivityAD has. In addition, the results may be complicated for the average person to interpret without the help of a doctor. </p>
<h2>Accurate results</h2>
<p>It’s important to interpret your results from these tests carefully for a couple of reasons.</p>
<p>At the moment, these tests only look for one of the biomarkers of Alzheimer’s disease. This means that it can’t detect signs of other forms of dementia – and only provides information on one aspect of Alzheimer’s disease itself. So even if a person’s test comes back negative for Alzheimer’s, if they’re experiencing other concerning symptoms (such as memory loss), it’s important they visit a GP as they could still have another form of dementia – or another condition altogether.</p>
<p>On the other hand, if the test is used by someone with no symptoms but who has abnormal biomarkers, this could cause unnecessary distress – making them think they have, or will develop, Alzheimer’s. </p>
<p>Although these tests are useful in investigating the possibility of having Alzheimer’s disease, using them in isolation is still not as accurate as the tests currently used by qualified doctors. But this area is rapidly evolving and, someday, these tests may be just as good. </p>
<p>Researchers are now looking at how accurate tests looking at <a href="https://www.nature.com/articles/s43587-023-00471-5#:%7E:text=Step%201%20consisted%20of%20a,uncertain%20outcomes%20at%20step%201.">concentrations of tau protein</a> in a patient’s blood are. Tau may be <a href="https://aaic.alz.org/releases_2020/blood-biomarkers-tau.asp">more accurate</a> than amyloid-beta at detecting both plaques and tangles in a patient’s brain. </p>
<p>There are also a few tests in development that look at both tau and amyloid-beta – including a newer version of PrecivityAD, namely <a href="https://precivityad.com/news/c2n-diagnostics-introduces-the-precivityad2-blood-test">PrecivityAD2</a>. Other tests in development look at additional biomarkers, including a very promising <a href="https://www.nature.com/articles/s41582-023-00857-4">finger-prick test</a>, which has shown a good correlation with brain scans and cerebrospinal fluid results so far. </p>
<p>It’s clear that exciting advancements are happening in the field to make Alzheimer’s disease diagnoses more accessible and accurate. Once these tests are refined to improve accuracy, they could offer new hope to patients – allowing them to be diagnosed and treated in the early stages of the disease.</p><img src="https://counter.theconversation.com/content/212739/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>These blood tests results need care when interpreting, and they can not they predict how the disease will affect each person.Eleftheria Kodosaki, Research Fellow in Neuroimmunology, UCLDeborah Alawode, PhD Student, UCLLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059142023-09-15T12:36:15Z2023-09-15T12:36:15ZAlzheimer’s disease is partly genetic − studying the genes that delay decline in some may lead to treatments for all<figure><img src="https://images.theconversation.com/files/548111/original/file-20230913-29-y9h0zu.jpg?ixlib=rb-1.1.0&rect=8%2C8%2C5483%2C4108&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Researchers are zeroing in on understanding what goes awry in the brains of people with Alzheimer's disease.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/alzheimers-and-dementia-research-conceptual-image-royalty-free-image/1414387544?phrase=alzheimer%27s+disease&adppopup=true">Tek Image/Science Photo Library via Getty Images</a></span></figcaption></figure><p>Diseases that run in families usually have genetic causes. Some are <a href="https://www.genome.gov/For-Patients-and-Families/Genetic-Disorders">genetic mutations</a> that directly cause the disease if inherited. Others are <a href="https://theconversation.com/explainer-what-is-genetic-risk-25969">risk genes</a> that affect the body in a way that increases the chance someone will develop the disease. In <a href="https://www.nia.nih.gov/health/alzheimers-disease-genetics-fact-sheet">Alzheimer’s disease</a>, genetic mutations in any of three specific genes can cause the disease, and other risk genes either increase or decrease the risk of developing Alzheimer’s. </p>
<p>Some genetic mutations or variants interact with other genetic alterations that lead to Alzheimer’s disease. In some cases, gene alterations can interact with Alzheimer’s-causing genetic variants in a way that proves beneficial; they actually suppress the pathological brain changes the other mutations would normally lead to. These protective gene variants can drastically slow or prevent cognitive decline. In <a href="https://doi.org/10.1038/s41591-019-0611-3">two recent</a> <a href="https://doi.org/10.1038/s41591-023-02318-3">case reports</a> on familial Alzheimer’s disease, mutations delayed Alzheimer’s symptoms for decades.</p>
<p>I am a <a href="https://scholar.google.com/citations?user=Jbl0lnsAAAAJ&hl=en">neurologist and neuroscientist</a> who has spent my career studying Alzheimer’s disease and dementia both in the laboratory and in the clinic. Determining how genes affect brain chemistry is vital to understanding how Alzheimer’s disease progresses and devising interventions to prevent or delay cognitive decline.</p>
<h2>The amyloid hypothesis</h2>
<p>In the early 1990s, scientists proposed the <a href="https://doi.org/10.1111/j.1750-3639.1991.tb00667.x">amyloid hypothesis</a> to explain how Alzheimer’s disease develops. The first neuropathological changes detected in the brain of Alzheimer’s disease patients were the formation of <a href="https://doi.org/10.1016/0165-6147(91)90609-v">amyloid plaques</a> – clumps of protein pieces called beta-amyloid. Other changes in the Alzheimer’s brain, such as the accumulation of another type of abnormal protein called neurofibrillary tangles, were thought to develop later in the course of the disease.</p>
<p>Beta-amyloid begins to accumulate in the brain <a href="https://doi.org/10.1038/s41582-018-0116-6">up to 15 years</a> before symptoms emerge. Symptoms correlate with the <a href="https://doi.org/10.1007%2Fs00401-019-02036-6">number of neurofibrillary tangles</a> in the brain – the more tangles, the worse the cognition. Researchers have tried to determine whether preventing or removing amyloid plaques from the brain would be an effective treatment. </p>
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<figcaption><span class="caption">Alzheimer’s disease results from the accumulation of abnormal proteins in the brain.</span></figcaption>
</figure>
<p>Imagine the excitement of the scientific community in the 1990s when researchers identified three different genes causing familial Alzheimer’s disease – and all three were involved with beta-amyloid.</p>
<p>The first was the <a href="https://doi.org/10.1038/349704a0">amyloid precursor protein</a> gene. This gene directs cells to produce the amyloid precursor protein, which breaks down into smaller fragments, including the beta-amyloid that forms amyloid plaques in the brain.</p>
<p>The second gene was termed <a href="https://doi.org/10.1038/349704a0">presenilin 1, or PSEN-1</a>, a protein needed to cut the precursor protein into beta-amyloid. </p>
<p>The third gene, <a href="https://doi.org/10.1038/376775a0">presenilin 2, or PSEN-2</a>, is closely related to PSEN-1 but found in a smaller number of families with familial Alzheimer’s disease.</p>
<p>These findings added strength to the amyloid hypothesis explanation of the disease. However, <a href="https://doi.org/10.15252/emmm.201606210">uncertainty and opposition to the amyloid hypothesis</a> have developed over the past several decades. This was in part tied to a recognition that several other processes – neurofibrillary tangles, inflammation and immune system activation – are also involved in the neurodegeneration seen in Alzheimer’s. </p>
<p><a href="http://dx.doi.org/10.2174/1570159X15666170116143743">The hypothesis also</a> <a href="https://mitpress.mit.edu/9780262546010/how-not-to-study-a-disease/">got significant pushback</a> after <a href="https://doi.org/10.14283/jpad.2019.23">many clinical trials</a> attempting to block the effects of amyloid or remove it from the brain <a href="https://www.theatlantic.com/health/archive/2017/02/alzheimers-amyloid-hypothesis/517185/">were unsuccessful</a>. In some cases, treatments had significant side effects. Some researchers have <a href="https://doi.org/10.15252/emmm.201606210">come up with strong defenses</a> of the hypothesis. But until a clinical trial based on the amyloid hypothesis could show definitive results, uncertainty would remain. </p>
<h2>Genetic discoveries with treatment implications</h2>
<p>The vast majority – <a href="https://doi.org/10.1016/j.jalz.2016.01.012">more than 90%</a> – of Alzheimer’s cases occur in late life, with disease prevalence increasing progressively from age 65 and up. Such cases are mostly sporadic, with no clear family history of Alzheimer’s.</p>
<p>However, a relatively small number of families have one of the three known genetic mutations that cause the disease to be passed down. In <a href="http://dx.doi.org/10.1016/j.jalz.2016.01.012">familial Alzheimer’s</a>, 50% of each generation will inherit the mutated gene and develop the disease much earlier, usually from their 30s to early 50s.</p>
<p>In 2019 and 2023, researchers identified changes in at least two other genes that markedly delayed the onset of disease symptoms in people with familial Alzheimer’s disease mutations. These mutated genes were found in a very large family in Colombia whose members tended to develop Alzheimer’s symptoms by their 40s.</p>
<p>A <a href="https://doi.org/10.1038/s41591-019-0611-3">woman in the family</a> carrying a mutated PSEN-1 gene <a href="https://www.sciencenews.org/article/colombia-family-genetic-mutation-alzheimers-dementia-treatment">did not have any cognitive symptoms</a> until she was in her 70s. A genetic analysis showed that she had an additional mutation in a variant of the gene that codes for a <a href="https://doi.org/10.1126/science.aba0964">protein called apolipoprotein E</a>, or ApoE. Researchers believe the mutation, called the <a href="https://www.alz.org/news/2022/unlocking-the-christchurch-variant">Christchurch variant</a> – named after the city in New Zealand where the mutation was first discovered – is responsible for interfering with and slowing down her disease. </p>
<p>Importantly, her brain had a great deal of amyloid plaque but very few neurofibrillary tangles. This suggests that the link between the two was broken and that the suppressed number of neurofibrillary tangles also slowed down cognitive loss.</p>
<figure>
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<figcaption><span class="caption">Researchers have studied certain families in Colombia with rare genetic variants that slow the progression of Alzheimer’s disease.</span></figcaption>
</figure>
<p>In May 2023, researchers reported that <a href="https://doi.org/10.1038/s41591-023-02318-3">two siblings in the same large family</a> also did not develop memory problems until their 60s or late 70s and were found to carry a mutation in a gene that codes for a protein called reelin. Studies in mice suggest that reelin has <a href="https://doi.org/10.1038/ncomms4443">protective effects against amyloid plaque deposition</a> in the brain. In these patients’ brains, as with the patient who had the Christchurch variant, there were extensive amyloid plaques but very few neurofibrillary tangles. This observation confirmed that the tangles are responsible for the cognitive loss and that there are several ways to “disconnect” amyloid and neurofibrillary tangle accumulation.</p>
<p>Finding medicines that might mimic the protective effects of the Christchurch variant or the reelin mutation could help delay Alzheimer’s disease symptoms for all patients. Since the vast majority of nonfamilial Alzheimer’s manifests after age 70 or 75, a 10-year delay in the emergence of first symptoms of Alzheimer’s could have a massive effect in <a href="https://doi.org/10.1016/s1474-4422(14)70136-x">decreasing the prevalence of the disease</a>.</p>
<p>These findings demonstrate that Alzheimer’s can be slowed and will hopefully lead to additional new therapies that can someday not only treat the disease but prevent it as well.</p>
<h2>Starts and stops</h2>
<p>Despite over 20 years of doubts and therapy failures, the past several years have seen positive results from three different treatments – aducanumab, lecanemab and donanemab – that remove amyloid plaques and slow loss of cognitive function to some extent. Although there is still discussion of how much slowing of decline is clinically significant, these successes provide support for the amyloid hypothesis. They also suggest that other strategies will be needed for optimal treatment.</p>
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<figcaption><span class="caption">The FDA approved the Alzheimer’s drug aducanumab (Aduhelm) in June 2021, to much controversy.</span></figcaption>
</figure>
<p>The U.S. Food and Drug Administration’s 2021 approval of the first antibody treatment for Alzheimer’s, <a href="https://theconversation.com/the-fdas-big-gamble-on-the-new-alzheimers-drug-162396">aducanumab, sold under the brand name Aduhelm</a>, was controversial. Only one of the two clinical trials testing its safety and effectiveness in people yielded positive results. The FDA approved the drug on the basis of that single study through an <a href="https://theconversation.com/the-fda-approved-a-new-drug-to-treat-alzheimers-but-medicare-wont-always-pay-for-it-a-doctor-explains-what-researchers-know-about-biogens-aduhelm-179177">accelerated approval process</a> in which treatments meeting an unmet clinical need can receive expedited approval.</p>
<p>The second antibody, <a href="https://theconversation.com/what-the-fdas-accelerated-approval-of-a-new-alzheimers-drug-could-mean-for-those-with-the-disease-5-questions-answered-about-lecanemab-197460">lecanemab, sold as Leqembi</a>, was approved in January 2023 via the same accelerated approval pathway. It was then <a href="https://www.fda.gov/news-events/press-announcements/fda-converts-novel-alzheimers-disease-treatment-traditional-approval">fully approved</a> in July 2023.</p>
<p>The third antibody, donanemab, completed a successful <a href="https://doi.org/10.1001/jama.2023.13239">phase three clinical trial</a> and is awaiting more safety data. When that is submitted to the FDA, the agency will consider the drug for approval.</p><img src="https://counter.theconversation.com/content/205914/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven T. DeKosky consults for Brainstorm Cell Therapeutics and Novo Nordisk Pharmaceuticals; is the Editor for Dementia for Up-To-Date, a point of care electronic textbook of medicine and is Associate Editor of Neurotherapeutics-The Journal of the American Society for Experimental Therapeutics (ASENT); chairs Drug Monitoring Safety Boards for Biogen, Prevail Pharmaceuticals, and Vaccinex Pharmaceuticals; and chairs Scientific Advisory Boards for Acumen Pharmaceuticals and Cognition Therapeutics.</span></em></p>Despite decades of starts and stops, new treatments and key genetic discoveries are giving researchers great hope for slowing or eventually preventing Alzheimer’s disease.Steven DeKosky, Professor of Neurology and Neuroscience, University of FloridaLicensed as Creative Commons – attribution, no derivatives.