Some Types of Skin Cancer Linked to Lower Chances of Alzheimer's

A weak immune response might allow skin cancer but protect brain from inflammation, expert suggests

By Barbara Bronson Gray

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- There's some good news for people who have had certain kinds of skin cancer: A new study suggests that their odds of developing Alzheimer's disease may be significantly lower than it is for others.

People who had non-melanoma skin cancer were nearly 80 percent less likely to develop Alzheimer's disease than people who did not. The association was not found with other types of dementia.

To understand the possible association between skin cancer and Alzheimer's, it is important to know that people have a combination of cells that are multiplying and others that are dying, explained study author Dr. Richard Lipton, a professor of neurology, epidemiology and population health at the Albert Einstein College of Medicine in New York City. The research was published online May 15 in the journal Neurology.

"When cell division gets out of control, we call that cancer. And when specific populations of brain cells die, we call that Alzheimer's," Lipton said. "So, there is a balance between cell division [growth] and cell death. If you have an individual with an increased risk of cell division over cell death, that may be linked to a decreased risk of Alzheimer's."

The finding was intriguing to one expert.

"It's fascinating that we can get clues about what's going on in the brain by looking at the periphery [skin]," said Terrence Town, a professor in the physiology and biophysics department at the Keck School of Medicine at the University of Southern California.

Non-melanoma skin cancer is the most common cancer in the United States; there were more than 2 million new cases in 2012, according to the U.S. National Cancer Institute.

What could be causing the possible association between skin cancer and a reduced risk of Alzheimer's?

"Either developing skin cancer is a marker for some biological process that protects against Alzheimer's or environmental factors may play a role," Lipton said. Genetics could be a factor, as could lots of outdoor physical activity and exercise, although Lipton cautioned people to avoid too much sun exposure and wear sunscreen.

Others think the link may be directly related to how the lowered immune response of skin cells in skin cancer corresponds to a similar immune response in the brain.

"This research is another piece of evidence that tells us that peripheral inflammation [in the skin] is very important in Alzheimer's disease," Town said. He thinks that people who develop non-melanoma skin cancers don't have an immune response in their skin, and thus develop skin cancers, because an immune response may be critical to fighting skin cancer. But that benefits them when it comes to developing Alzheimer's disease.

"This reduced inflammatory response that was permissive to the skin cancer was perhaps beneficial in the brain," said Town.

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Gene Studies Could Point to New Alzheimer's Treatments

THURSDAY, April 25 (HealthDay News) -- Insight into genes that play a key role in disrupting immune system pathways in the brains of people with Alzheimer's disease could offer a potential target for new drugs against the disease, two new studies show.

"Defining the precise steps of the inflammatory response crucial to causing Alzheimer's disease has been elusive. We are pleased to discover these novel insights into that process," Bin Zhang, lead author of one of the studies and an associate professor of genetics and genomic sciences at the Icahn School of Medicine at Mount Sinai in New York City, said in a school news release.

In the study, Zhang's team analyzed brain tissue samples from deceased Alzheimer's patients, as well as healthy people who had died. By measuring the activity level of thousands of genes in these tissue samples, the team identified which gene networks are disrupted in diseased brains.

Specifically, their analysis pinpointed the important role of a gene expressed in immune cells called microglia, which clean up debris and destroy pathogens in the brain.

This gene, called TYROBP, is overactive in the brains of Alzheimer's patients and plays a major role in disrupting the activity of many other genes that control microglia activation, according to the study, which was published April 25 in the journal Cell.

"As a next step, we will evaluate drugs that impact [this] pathway as potential therapies for the disease," Zhang said. "This discovery enables us to design more specific compounds that target these key steps precisely, in contrast to existing anti-inflammatory drugs that may be less ideal for hitting this target."

Another study, published online April 25 in the journal Neuron, may have uncovered another genetic clue to Alzheimer's disease.

Researchers looked at brain samples from deceased Alzheimer's patients and found that higher activity of a gene called CD33 in microglia was linked to higher levels of the beta-amyloid protein plaques that have long been associated with Alzheimer's disease.

In their experiments with mice, switching off CD33 activity seemed to help microglia sweep away the plaques.

"Our findings suggest that pharmaceutical inactivation of CD33 represents a potentially powerful new therapy for the treatment and prevention of Alzheimer's disease, and perhaps other neurodegenerative disorders," senior study author Rudolph Tanzi, of Massachusetts General Hospital and Harvard Medical School in Boston, said in a journal news release.

Another expert said the findings from both studies may help advance research.

"We have known for a long time that Alzheimer's disease is characterized by the presence of excessive inflammation in the brain," said Philippe Marambaud, an investigator at the Litwin-Zucker Research Center for the Study of Alzheimer's Disease at the Feinstein Institute for Medical Research in Manhasset, N.Y.

"The role of this inflammatory response in the pathogenic mechanisms of the disease, however, remains unclear," he said. "These two studies ... provide concordant evidence that the immune cells microglia actively participate in this disease process."

-- Robert Preidt
Copyright © 2013 HealthDay. All rights reserved. SOURCES: Philippe Marambaud, Ph.D., investigator, Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, N.Y.; Cell, news release, April 25, 2013; Neuron,news release, April 25, 2013; Icahn School of Medicine at Mount Sinai, New York City, news release, April 25, 2013

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Saturated Fat May Make the Brain Vulnerable to Alzheimer's

Researchers say a small, new study shows that fat cut the body's level of a chemical that keeps Alzheimer's at bay

By Dennis Thompson

HealthDay Reporter

MONDAY, June 17 (HealthDay News) -- A diet high in saturated fat can quickly rob the brain of a key chemical that helps protect against Alzheimer's disease, according to new research.

In a small study published online Monday in the journal JAMA Neurology, researchers found that dietary saturated fat cut the body's levels of the chemical apolipoprotein E, also called ApoE, which helps "chaperone" amyloid beta proteins out of the brain.

"People who received a high-saturated-fat, high-sugar diet showed a change in their ApoE, such that the ApoE would be less able to help clear the amyloid," said research team member Suzanne Craft, a professor of medicine at Wake Forest School of Medicine.

Amyloid beta proteins left loose in the brain are more likely to form plaques that interfere with neuron function, the kind of plaques found in the brains of people with Alzheimer's disease.

Diet also directly affected the amount of loose amyloid beta found in cerebrospinal fluid, Craft said. Those on a high-saturated-fat diet had higher levels of amyloid beta in their spinal fluid, while people on a low-saturated-fat diet actually saw a decline in such levels, she said.

"An amyloid that is not cleared -- or attached to ApoE to get cleared -- has a greater likelihood of becoming this toxic form," Craft said.

The clinical trial, led by Dr. Angela Hanson of the Veterans Affairs Puget Sound Health Care System in Seattle, involved 20 seniors with normal cognition and 27 with mild thinking impairment, a precursor to Alzheimer's disease.

The patients, all in their late 60s, were randomly assigned to diets that contained the same amount of calories but were either high or low in saturated fat. The high-saturated-fat diets had 45 percent of total energy coming from fat, and more than a quarter of the total fat came from saturated fats. The low-saturated-fat diets had 25 percent of energy coming from fat, with saturated fat contributing less than 7 percent to total fat.

After just a month, the diets caused changes in the amounts of amyloid beta and ApoE in the study participants' cerebrospinal fluid, researchers said.

"Diet can really change levels of these toxic proteins and of these mediators that help clear these amyloids," Craft said. "Diets that are very high in bad cholesterol seem to interfere with ApoE's ability to clear amyloid."

One gerontology expert, who wrote an editorial accompanying the study in the journal, didn't think the link was quite that clear.

Although the study shows that diet can affect brain chemistry, it does not definitely tie diet to a person's risk for Alzheimer's disease, said Dr. Deborah Blacker, director of the Gerontology Research Unit at Massachusetts General Hospital in Boston.

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Concussion Damage Looks Much Like Early Alzheimer's: Study

Preliminary finding suggests mild brain injury triggers long-lasting abnormalities in white matter

By Dennis Thompson

HealthDay Reporter

TUESDAY, June 18 (HealthDay News) -- Concussion can lead to damage in the white matter of the brain that resembles abnormalities found in people in the early stages of Alzheimer's disease, a new study suggests.

Researchers at the University of Pittsburgh School of Medicine said their findings should prompt a re-evaluation of the long-term effects of concussion, which affects more than 1.7 million people in the United States annually. About 15 percent of concussion patients suffer persistent neurological symptoms.

"The previous thinking before was you get a concussion, and that causes a certain damage from bopping your head and you get these symptoms," said study author Dr. Saeed Fakhran, an assistant professor of radiology at the University of Pittsburgh School of Medicine. "We found it acts as a kind of trigger, and lights a fuse that causes a neurodegenerative cascade that causes all these symptoms down the line. Once you've hit your head, the injury isn't done."

The findings are published online June 18 in the journal Radiology.

The study drew some criticism from concussion and Alzheimer's disease experts who said the findings, while provocative, should not be interpreted as drawing a clear link between a concussion suffered early in life with the development of Alzheimer's.

"I don't want a mom to pick this up and say, 'Oh my god, my 10-year-old is going to get Alzheimer's now,' because that is not the case," said Dr. Ken Podell, a neuropsychologist and co-director of the Methodist Concussion Center in Houston. "It's very inconclusive at this time, and there's no clinical application of this at this point of time."

White matter serves as the tissue through which messages pass between different areas of gray matter within the brain and spinal cord. Think of gray matter as the individual computers in a network, and white matter as the cables that connect the computer.

The researchers reviewed past brain scans of 64 people who had suffered a concussion, focusing on scans that used an advanced MRI technique called diffusion-tensor imaging, which spots microscopic changes in the brain's white matter.

The investigators then compared these brain scans to symptoms reported by concussed patients in a post-concussion questionnaire. They focused on symptoms shared with Alzheimer's patients, including memory problems, disturbances in sleep cycles and hearing problems.

The results showed a significant correlation between high concussion symptom scores and reduced water movement in the parts of the brain's white matter related to auditory processing and sleep-wake disturbances. Further, the researchers said, the distribution of white matter abnormalities in mildly concussed patients resembled the distribution of abnormalities in people with Alzheimer's disease.

"Basically, it looks a lot like Alzheimer's," said study co-author Dr. Lea Alhilali, an assistant professor of radiology at the University of Pittsburgh School of Medicine. "You get the same distribution of damage in the way that Alzheimer's disease affects the brain."

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Alzheimer's Patients May Face Looming Shortage of Neurologists

THURSDAY, April 18 (HealthDay News) -- For patients with Alzheimer's disease, Parkinson's disease, multiple sclerosis (MS) and other brain disorders, finding a specialist to treat their condition may be increasingly difficult, according to a new study.

Experts in the field of medicine that focuses on the brain and nervous system revealed that there is a shortage of neurologists in the United States as medical students and residents are choosing other more lucrative specialties. The study authors noted that patients with brain disorders who do find a neurologist would have to wait even longer to be treated.

"With the rapidly rising rates of brain diseases such as dementia and stroke at the same time as the number of U.S. medical residents choosing neurology over other specialties is clearly declining, the U.S. could face a crisis," explained study author Dr. Thomas Vidic, with Elkhart Clinic in Elkhart, Ind.

"Our study found that long wait times for patients to see a neurologist and difficulty finding neurologists to fill vacant positions are adding to the current national shortfall," Vidic, who is also a fellow with the American Academy of Neurology, said in an academy news release. "In addition, the demand for neurologists is expected to grow as people gain coverage through health care reform."

The study found that demand for neurologists would outpace supply over the next 12 years. Right now, 11 percent more neurologists are needed to meet patient demands. That number is expected to hit 19 percent by 2025. By that time, the researchers project the number of neurologists will increase to 18,060 as demand for this type of specialist surges to 21,440.

As a result, patients could be waiting even longer to get an appointment with a U.S. neurologist, the study findings indicate. Previous studies have shown new patients waited an average of 35 business days to see a neurologist last year.

The fact that the current Medicare payment system undervalues one-on-one evaluations by neurologists has led to the shortage of these specialists in the United States, the authors stated in the news release. They suggested that without fair reimbursement for neurological care, medical students and residents burdened by education debt will pursue more lucrative specialties.

This trend is particularly worrisome because brain diseases are becoming increasingly prevalent in the United States, the experts pointed out, with one in six Americans now currently affected by a neurological condition.

The study was published online April 17 in Neurology, just days before 150 neurologists were expected to head to Capitol Hill. The goal of the visit, scheduled for April 23, is to urge Congress to protect patients' access to neurologists through fair reimbursement for neurological care.

"We want Congress to act now to help alleviate this shortage at a time when baby boomers are aging and the number of people with Alzheimer's disease is expected to triple by 2050," American Academy of Neurology president, Dr. Timothy Pedley, said in the news release.

"Neurologists are the physicians best suited to care for the one in six people currently affected by neurological disease," Pedley explained. "It is therefore vital that they have access to neurologists who are specially trained in treating brain diseases."

-- Mary Elizabeth Dallas
Copyright © 2013 HealthDay. All rights reserved. SOURCE: American Academy of Neurology, news release, April 17, 2013

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Brain Changes Seen in Relatives of People With Alzheimer's

By Denise Mann
HealthDay Reporter

WEDNESDAY, April 17 (HealthDay News) -- If Alzheimer's disease runs in your family, you may be more likely to have brain changes associated with the disorder even before symptoms such as memory and thinking problems occur, according to new research.

An estimated 5.2 million Americans have Alzheimer's disease, a number expected to increase dramatically as the baby boomer generation ages. The Alzheimer's Association predicts that the number of people aged 65 and older with the condition will reach 7.1 million by 2025.

To get a better handle on risk for Alzheimer's disease, researchers at Duke University looked at brain scans of more than 250 adults aged 55 to 89. Some had no signs of memory or thinking problems, while others did.

The researchers also analyzed genes and other markers in spinal fluid that are known to help predict Alzheimer's risk. A variation in the APOE gene was seen among those participants who were at greater risk for earlier onset of Alzheimer's.

Individuals who had a parent or sibling with Alzheimer's disease showed silent brain changes, the study found.

Specifically, close to 50 percent of healthy participants with a positive family history would have met the criteria for early Alzheimer's disease based on measurements of their cerebrospinal fluid, but just 20 percent of those without a family history would have fulfilled such criteria. The findings appear online April 17 in the journal PLoS ONE.

"In early-onset Alzheimer's disease, the genetics are much more clear-cut and we can test family members and know if they will develop Alzheimer's," said senior author Dr. P. Murali Doraiswamy, a professor of psychiatry and medicine at Duke.

It is not as clear-cut, however, when it comes to later-onset Alzheimer's, Doraiswamy said. "The genetics are much more complex, and although we know these individuals are at a slightly greater risk, we don't know when they start developing silent brain changes," he said. "[The new study is] documenting very clearly that asymptomatic family members have twice the rate of silent brain changes and that these changes happen in certain pathways known to be related to Alzheimer's disease."

The findings may help advance research that seeks to prevent Alzheimer's disease by using drugs, he said, and it's not a reason to panic and start to think the worst if you have a family history of the disease. "The findings don't suggest you should worry any more or any less," he said.

Although the study found an association between having a family history of Alzheimer's and showing brain changes related to the disease, it did not prove a cause-and-effect relationship.

"Having a family history does not mean you will get Alzheimer's disease," said Dr. Richard Isaacson, director of the Alzheimer's division at the University of Miami Miller School of Medicine. You may be at a higher risk for developing it, but it is not predestined, said Isaacson, who was not involved with the new study.

"Make brain-healthy choices now to help lower this risk," he suggested. "We know that if it is good for the heart it is good for the brain." Such choices include engaging in regular physical activity and eating a healthy low-fat diet.

"It's also important to keep your brain fit by doing something you enjoy -- whether crossword puzzles or learning a foreign language -- every day," Isaacson said.

"If you have a family history, get educated and informed about positive lifestyle choices and consider taking part in an Alzheimer's prevention trial," he said. "We can finally say 'Alzheimer's disease' and 'prevention' in the same sentence, and that is a great thing."

Copyright © 2013 HealthDay. All rights reserved. SOURCES: P. Murali Doraiswamy, M.D., professor of psychiatry and medicine, Duke University Medical Center, Durham, N.C.; Richard Isaacson, M.D., director, Alzheimer's division, University of Miami Miller School of Medicine; April 17, 2013, PLoS ONE

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How will the doctor determine if my father’s forgetfulness is Alzheimer’s disease?

Posted June 14, 2013, 2:00 am

My father’s memory has worsened lately, and we suspect he may have Alzheimer’s disease. Can you tell us what is involved in making a diagnosis?

There is no single test for Alzheimer’s disease. Diagnosing it begins with identifying symptoms associated with Alzheimer’s and ruling out other possible causes of memory loss.

Your father should begin with his primary care physician. This doctor can combine his knowledge of your father and his medical history with results from a physical exam and blood tests. He may discover that your father’s symptoms are related to medications he’s taking or perhaps a medical condition.

There are many causes of forgetfulness, confusion and inattentiveness besides Alzheimer’s disease. Most of the patients I have seen who start to worry that they may be developing Alzheimer’s never actually develop the disease.

Your father should expect a lot of questions about his memory. And since answering questions about memory and thinking requires memory and thinking, the doctor might want a family member who knows your father well in the room. The questions the doctor is likely to ask include:

How long have you been having problems?Did the trouble come on gradually or suddenly?What sorts of things have become hard to remember?Are your difficulties preventing you from doing ordinary things like cooking or paying the bills?

Your father (or his spouse/caretaker) may need to track his symptoms for several months. This will show if his symptoms are improving, staying the same or getting worse.

The physician may refer your father to a neuropsychologist. Neuropsychologists typically use a battery of paper-and-pencil tests, or computer-administered tests, to evaluate cognitive function. The tests assess attention, memory, executive function, language, spatial ability and even mood.

A brain scan — usually either computed tomography (CT) or magnetic resonance imaging (MRI) — may also be done. These scans can help rule out other conditions that could contribute to memory loss. They also can show shrinkage of the brain in areas that tend to shrink with Alzheimer’s disease, but they cannot identify Alzheimer’s with certainty.

However, the ability of other types of brain scans to diagnose Alzheimer’s has improved greatly in recent years. Especially promising is a positron emission tomography (PET) scan that uses a chemical tracer known as PiB.

In Alzheimer’s disease, a substance called amyloid-beta slowly gets deposited in the brain. It is invisible on most types of brain scans. However, when PiB is injected into a person’s blood, it binds to amyloid deposits in the brain. When the PET scan is done, it can see all the places where there are amyloid deposits.

Tests of chemicals in the spinal fluid, the liquid that surrounds the brain and spinal cord, also show promise in diagnosing Alzheimer’s. Most of these new technologies are still used largely for research. I predict they are going to become important in regular clinical medicine very soon.

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Brain Changes Seen in Relatives of People With Alzheimer's

Study finding doesn't mean you'll get the disease if family members have it, experts stress

By Denise Mann

HealthDay Reporter

WEDNESDAY, April 17 (HealthDay News) -- If Alzheimer's disease runs in your family, you may be more likely to have brain changes associated with the disorder even before symptoms such as memory and thinking problems occur, according to new research.

An estimated 5.2 million Americans have Alzheimer's disease, a number expected to increase dramatically as the baby boomer generation ages. The Alzheimer's Association predicts that the number of people aged 65 and older with the condition will reach 7.1 million by 2025.

To get a better handle on risk for Alzheimer's disease, researchers at Duke University looked at brain scans of more than 250 adults aged 55 to 89. Some had no signs of memory or thinking problems, while others did.

The researchers also analyzed genes and other markers in spinal fluid that are known to help predict Alzheimer's risk. A variation in the APOE gene was seen among those participants who were at greater risk for earlier onset of Alzheimer's.

Individuals who had a parent or sibling with Alzheimer's disease showed silent brain changes, the study found.

Specifically, close to 50 percent of healthy participants with a positive family history would have met the criteria for early Alzheimer's disease based on measurements of their cerebrospinal fluid, but just 20 percent of those without a family history would have fulfilled such criteria. The findings appear online April 17 in the journal PLoS ONE.

"In early-onset Alzheimer's disease, the genetics are much more clear-cut and we can test family members and know if they will develop Alzheimer's," said senior author Dr. P. Murali Doraiswamy, a professor of psychiatry and medicine at Duke.

It is not as clear-cut, however, when it comes to later-onset Alzheimer's, Doraiswamy said. "The genetics are much more complex, and although we know these individuals are at a slightly greater risk, we don't know when they start developing silent brain changes," he said. "[The new study is] documenting very clearly that asymptomatic family members have twice the rate of silent brain changes and that these changes happen in certain pathways known to be related to Alzheimer's disease."

The findings may help advance research that seeks to prevent Alzheimer's disease by using drugs, he said, and it's not a reason to panic and start to think the worst if you have a family history of the disease. "The findings don't suggest you should worry any more or any less," he said.

Although the study found an association between having a family history of Alzheimer's and showing brain changes related to the disease, it did not prove a cause-and-effect relationship.

"Having a family history does not mean you will get Alzheimer's disease," said Dr. Richard Isaacson, director of the Alzheimer's division at the University of Miami Miller School of Medicine. You may be at a higher risk for developing it, but it is not predestined, said Isaacson, who was not involved with the new study.

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Scientists Find New Clues to Early Onset Alzheimer's

Too much plaque-building protein produced in people with certain genes, study finds

By Dennis Thompson

HealthDay Reporter

WEDNESDAY, June 12 (HealthDay News) -- People with genetic mutations that lead to inherited, early onset Alzheimer's disease overproduce a longer, stickier form of amyloid beta, the protein fragment that clumps into plaques in the brains of Alzheimer's patients, a small new study has found.

Researchers found that these people make about 20 percent more of a type of amyloid beta -- amyloid beta 42 -- than family members who do not carry the Alzheimer's mutation, according to research published in the June 12 edition of Science Translational Medicine.

Further, researchers Rachel Potter at Washington University School of Medicine in St. Louis and colleagues found that amyloid beta 42 disappears from cerebrospinal fluid much more quickly than other known forms of amyloid beta, possibly because it is being deposited on plaques in the brain.

Alzheimer's researchers have long believed that brain plaques created by amyloid beta cause the memory loss and thought impairment that comes with the disease.

This new study does not prove that amyloid plaques cause Alzheimer's, but it does provide more evidence regarding the way the disease develops and will guide future research into diagnosis and treatment, said Dr. Judy Willis, a neurologist and spokesperson for the American Academy of Neurology.

The mutation occurs in the presenilin gene and has previously been linked to increased production of amyloid beta 42 over amyloid beta 38 and 40, the other types of amyloid beta found in cerebrospinal fluid, the study said.

Earlier studies of the human brain after death and using animal research have suggested that amyloid beta 42 is the most important contributor to Alzheimer's.

The new study confirms that connection and also quantifies overproduction of amyloid beta 42 in living human brains. The investigators also found that amyloid beta 42 is exchanged and recycled in the body, slowing its exit from the brain.

"The amyloid protein buildup has been hypothesized to correlate with the symptoms of Alzheimer's by causing neuronal damage, but we do not know what causes the abnormalities of amyloid overproduction and decreased removal," Willis said.

The findings from the new study "are supportive of abnormal turnover of amyloid occurring in people with the genetic mutation decades before the onset of their symptoms," she said.

Researchers conducted the study by comparing 11 carriers of mutated presenilin genes with family members who do not have the mutation. They used advanced scanning technology that can "tag" and then track newly created proteins in the body. With this technology, they tracked the production and clearance of amyloid beta 40 and 42 in the participants' cerebrospinal fluid.

This research gives clinicians a potential "marker" to check when evaluating the Alzheimer's risk of a person with this genetic mutation, Willis said.

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For Alzheimer's Caregivers, a Much-Needed Break

Study confirms adult day care provides beneficial time off

By Amy Norton

HealthDay Reporter

FRIDAY, June 7 (HealthDay News) -- Day care centers for people with Alzheimer's disease can give their spouses and other family caregivers a much needed source of stress relief, a new study suggests.

Such centers offer people with dementia a chance to socialize and take part in activities that stimulate their minds. The programs can also give spouses, children and other caregivers a break.

Intuitively, that should ease some of caregivers' daily stress. But there hasn't been much research to prove it.

In the new study, published recently in the journal Gerontologist, researchers measured stress levels of 173 family caregivers in four U.S. states who used care centers for their relative with dementia.

Through phone interviews over one week, they found caregivers were less stressed and had fewer bouts of anger on day care days than other days. And when stressors did crop up -- such as problems at work -- they took less of an emotional toll.

"I think this reinforces the fact that caregivers can't do this all on their own," said Carol Steinberg, president of the Alzheimer's Foundation of America. "People need relief."

Study author Steven Zarit agreed. "There's a famous book [on caregiving] called 'The 36-Hour Day,' and I think that perfectly describes it," he said. "Caregivers need help. When they get a break, it's a way to restore."

Allan Vann, whose wife, Clare, has Alzheimer's, said he initially thought he could care for her on his own. A retired principal from Commack, N.Y., Vann said he was used to daily stress, and figured he had the "broad shoulders" that could bear the work of caring for his wife.

Clare Vann was diagnosed with Alzheimer's in 2009 at age 63 -- which is considered early-onset Alzheimer's. It took three years to get that diagnosis, however. Her husband had begun noticing symptoms three years earlier, when she was talking about their two grandchildren -- even though they had four -- and about a trip to France, even though they'd never been there.

These days, Clare needs help with everyday basics, such as hygiene and dressing. And she also attends adult care services most days of the week.

"I don't think I could live without that respite," Allan said.

It gives him time to take care of daily errands and chores -- and for some personal pleasures, such as reading and writing, he said. Journal writing, in particular, has offered a way to "vent."

Many caregivers don't know about adult day care because doctors don't tell them, said Zarit, who is head of human development and family studies at Penn State University. "We need to do a better job of getting the message out so that people can benefit," he said.

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Researchers Test Implanted Brain Stimulator for Alzheimer's

They hope the device will restore some thinking ability and improve focus, attention

By Barbara Bronson Gray

HealthDay Reporter

THURSDAY, March 28 (HealthDay News) -- Researchers are testing whether applying electrical stimulation directly to the brains of people with Alzheimer's disease might improve thinking, focus and alertness.

The process, called direct brain stimulation, or deep brain stimulation (DBS), has been used to treat Parkinson's disease and is being tested as a treatment for other conditions, including traumatic brain injuries and obesity, according to the researchers.

Two women have had the electronic brain stimulators implanted, and eight more patients will participate in this initial research.

"There are a lot of studies out there that say physical or mental stimulation may reduce the risk or impact of Alzheimer's disease, so we wondered if increasing stimulation to certain parts of the brain may be protective," explained study co-author Dr. Douglas Scharre, director of the division of cognitive neurology at Ohio State University.

Scharre said that while Alzheimer's tends to affect the temporal, parietal and frontal lobes of the brain, he wanted to focus particularly on the frontal lobe for two reasons: it's typically the last brain area to degenerate, and its functions -- decision-making, problem-solving, focus and alertness -- are necessary for a person to be independent.

Placing the DBS system involves two steps. First, in a surgical procedure that requires about a three-day hospital stay, the patient has tiny holes made in each side of the skull, and hair-thin wires are placed in precise spots of the brain using computer-guided technology. The wires are fed through the neck -- in the subcutaneous tissue just under the skin -- and left there for about a week while the burr holes heal, explained Scharre.

Then, in an outpatient surgery, the patient has two battery packs that look like heart pacemakers placed on each side of the chest. The wires placed the week before are then connected to the batteries.

Six weeks after the second surgery, the stimulator is turned on. "My job [as the neurologist] is to find the right settings to get the maximum benefit," said Scharre. Each wire has four contacts, providing a wide range of different voltage combinations, and the challenge is to determine the right amount to produce the best benefit, he explained.

The research could potentially be of value to millions of Americans: a recent report from the Alzheimer's Association found that one in every three seniors now dies while suffering from Alzheimer's or another form of dementia. Alzheimer's disease becomes progressively disabling with loss of memory, thinking skills, the ability to socialize and independence.

To assess the effects of DBS, the researchers give short tests to the patients, starting about two months after the surgeries, to evaluate their level of attention and alertness, and to see how fast they can complete a particular task. For example, one test shows a variety of different geometric shapes all over the page, and [the patient] is asked to pick out all the stars in a 30-second timeframe.

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Alzheimer's Drugs May Benefit Heart, Study Finds

Fewer heart attacks, deaths for patients taking cholinesterase inhibitors

By Robert Preidt

HealthDay Reporter

WEDNESDAY, June 5 (HealthDay News) -- Drugs used to treat early-stage Alzheimer's disease may also reduce patients' risk of heart attack and death, according to a new study.

Researchers followed more than 7,000 Alzheimer's disease patients in Sweden for more than three years. Those taking cholinesterase inhibitors had a 38 percent lower risk of heart attack, a 26 percent lower risk of death from cardiovascular causes such as stroke and a 36 percent lower risk of death from any cause, compared to those who did not take the drugs.

Patients who took the highest recommended doses of cholinesterase inhibitors (ChEIs) had the lowest risk of heart attack or death -- 65 percent and 46 percent lower, respectively, than those who never took the drugs, according to the study, which was published online June 5 in the European Heart Journal.

"If you translate these reductions in risk into absolute figures, it means that for every 100,000 people with Alzheimer's disease, there would be 180 fewer heart attacks (295 as opposed to 475) and 1,125 fewer deaths from all causes (2,000 versus 3,125) every year among those taking ChEIs compared to those not using them," study author Professor Peter Nordstrom, of Umea University in Sweden, said in a journal news release.

No cure exists for Alzheimer's disease, an age-related brain disorder and the most common form of dementia. However, cholinesterase inhibitors, such as donepezil (brand name Aricept), galantamine (Razadyne, Reminyl) and rivastigmine (Exelon), are prescribed to help manage symptoms and slow disease progression in people with early- to moderate-stage disease.

Previous research has found that these drugs have a beneficial effect on the vagus nerve, which controls heart rate, and may have anti-inflammatory properties.

"As far as we know, this is the first time that the use of ChEIs has been linked to a reduced risk of heart attacks and deaths from cardiovascular disease in general or from any cause," Nordstrom said.

"As this is an observational study, we cannot say that ChEI use is causing the reduction in risk, only that it is associated with a reduction," he said. "However, the strengths of the associations make them very interesting from the clinical point of view, although no clinical recommendations should be made on the basis of the results from our study."

An analysis of previous randomized, controlled trials would produce answers on which clinical recommendations could be based, Nordstrom added.

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Alzheimer's Patients Mimic Emotions of Those Around Them: Study

Findings may have implications for caregivers

By Steven Reinberg

HealthDay Reporter

TUESDAY, May 28 (HealthDay News) -- People with Alzheimer's disease or early thinking and memory problems tend to mirror the emotions of those around them, researchers find.

This transfer of emotions, known as emotional contagion, appears heightened in people with Alzheimer's and related mental decline, according to the University of California, San Francisco (UCSF) team. And it can be important in the management of these patients, they added.

"Calm begets calm," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City, who was not involved in the study.

Emotional contagion is a rudimentary form of empathy, enabling people to share and experience other people's emotions, said lead researcher Virginia Sturm, an assistant professor in the UCSF department of neurology.

"It's a way by which emotions travel across people quickly and even without awareness," explained Sturm. This process can shape behaviors and cause changes in the brain, she added.

In the early stages of Alzheimer's disease and in people with mild thinking and memory problems, emotional contagion increases, the researchers found. It is even more apparent in people with dementia, they noted.

"In Alzheimer's disease and other dementia we think some people may have an increased sensitivity to other people's emotions," Sturm said.

"As their memory and thinking abilities decline, it seems this is accompanied by the enhancement of other emotional processes," she said.

This means that if caregivers are anxious or angry, their patients will pick up and copy these emotions.

On the other hand, if the caregiver is calm and happy, patients will emulate these positive emotions, Sturm said.

"This is a way Alzheimer's patients connect with others, even though they don't have an understanding of the social situation," she said. "In order to manage patients, it might be that the caregivers being calm and happy would go a long way in keeping their patient calm and happy."

Alzheimer's disease is an age-related brain disorder that begins slowly and gradually robs people of their ability to lead their everyday lives. In the United States, one-third of the nation's seniors die with Alzheimer's or another type of dementia, according to the Alzheimer's Association.

The study, published online May 27 in the Proceedings of the National Academy of Sciences, involved 237 adults. Sixty-two patients had mild memory and thinking problems and 64 had Alzheimer's disease. The others were mentally healthy.

Participants took tests to identify depression and other mental health problems and also underwent MRI scans to identify changes in the brain related to emotional contagion.

The researchers found higher emotional contagion in those with mild mental impairment and Alzheimer's disease, compared with those who did not have these conditions.

This growth of emotional contagion paralleled the increase in damage to the right temporal lobe of the brain, reflecting biological changes in the neural system, the study found.

"The right temporal lobe is important for different aspects of emotion and social behavior," Sturm said.

Depression was also greater among those with mild mental impairment and Alzheimer's disease, the study found.

From a neurologist's perspective, "it is extraordinary that something so complex as emotional perception can be controlled by such a localized part of the brain," Gandy said.

"Also, classically it has been the frontal lobe damage that leads to emotional disturbance," Gandy added. "Now we know the temporal lobes can play similar roles."

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High Blood Pressure May Add to Alzheimer's Risk, Study Finds

Title: High Blood Pressure May Add to Alzheimer's Risk, Study Finds
Category: Health News
Created: 3/18/2013 4:36:00 PM
Last Editorial Review: 3/19/2013 12:00:00 AM

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High Blood Pressure May Add to Alzheimer's Risk, Study Finds

People with a genetic mutation plus hypertension have more brain plaque, researchers find

By Steven Reinberg

HealthDay Reporter

MONDAY, March 18 (HealthDay News) -- High blood pressure in people with a genetic risk for Alzheimer's disease may spur development of brain plaque, a hallmark of the age-related brain disorder, a new study suggests.

The findings suggest yet another reason for keeping blood pressure, also known as hypertension, under control, the researchers said.

"Maintaining good vascular health by avoiding or controlling diseases like hypertension has important benefits beyond keeping your heart healthy. It may promote good brain health as we age," said lead researcher Karen Rodrigue, an assistant professor of behavioral and brain sciences at the University of Texas at Dallas.

This is especially so for people who are genetically at risk for Alzheimer's disease, the study suggested. "Keeping good vascular health may limit or delay the brain changes associated with Alzheimer's disease and other aging-related neurological deterioration," Rodrigue said.

No cure exist for Alzheimer's, and experts anticipate that by 2050 the number of Americans with the brain disease will approach 14 million if no progress is made.

The study of nearly 120 adults found that people with this genetic risk factor for Alzheimer's disease -- called an apolipoprotein E 4 allele -- plus untreated high blood pressure have more beta-amyloid plaques compared to those with just one or neither of these risk factors.

One expert said the findings have important implications.

"This is good news," said Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center in New York City.

"This means that yet another simple intervention -- here, blood pressure control, but think also of physical exercise -- can have an important impact on dementia risk and rate of progression," Gandy said. "We must not overlook these simple effective interventions while developing new therapies."

For the study, which was published online March 18 in the journal JAMA Neurology, the researchers looked at 118 people with normal brain function who were between 47 and 89 years old. They divided the patients into those with high blood pressure and those without high blood pressure, and those with and without the genetic risk factor for Alzheimer's. The participants also were given brain scans to look for plaques.

The researchers found people with both high blood pressure and the genetic risk factor had significantly more brain plaque than those with only one or no risk factors.

Moreover, those with the highest blood pressure and the gene mutation tended to have the most plaque, they found. The study did not, however, prove a cause-and-effect relationship between high blood pressure, this genetic mutation and increased brain plaque.

High blood pressure is highly responsive to lifestyle changes and medical treatment, and it may provide a future target for delaying or preventing Alzheimer's disease, the researchers noted.

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Some Types of Skin Cancer Linked to Lower Chances of Alzheimer's

A weak immune response might allow skin cancer but protect brain from inflammation, expert suggests

By Barbara Bronson Gray

HealthDay Reporter

WEDNESDAY, May 15 (HealthDay News) -- There's some good news for people who have had certain kinds of skin cancer: A new study suggests that their odds of developing Alzheimer's disease may be significantly lower than it is for others.

People who had non-melanoma skin cancer were nearly 80 percent less likely to develop Alzheimer's disease than people who did not. The association was not found with other types of dementia.

To understand the possible association between skin cancer and Alzheimer's, it is important to know that people have a combination of cells that are multiplying and others that are dying, explained study author Dr. Richard Lipton, a professor of neurology, epidemiology and population health at the Albert Einstein College of Medicine in New York City. The research was published online May 15 in the journal Neurology.

"When cell division gets out of control, we call that cancer. And when specific populations of brain cells die, we call that Alzheimer's," Lipton said. "So, there is a balance between cell division [growth] and cell death. If you have an individual with an increased risk of cell division over cell death, that may be linked to a decreased risk of Alzheimer's."

The finding was intriguing to one expert.

"It's fascinating that we can get clues about what's going on in the brain by looking at the periphery [skin]," said Terrence Town, a professor in the physiology and biophysics department at the Keck School of Medicine at the University of Southern California.

Non-melanoma skin cancer is the most common cancer in the United States; there were more than 2 million new cases in 2012, according to the U.S. National Cancer Institute.

What could be causing the possible association between skin cancer and a reduced risk of Alzheimer's?

"Either developing skin cancer is a marker for some biological process that protects against Alzheimer's or environmental factors may play a role," Lipton said. Genetics could be a factor, as could lots of outdoor physical activity and exercise, although Lipton cautioned people to avoid too much sun exposure and wear sunscreen.

Others think the link may be directly related to how the lowered immune response of skin cells in skin cancer corresponds to a similar immune response in the brain.

"This research is another piece of evidence that tells us that peripheral inflammation [in the skin] is very important in Alzheimer's disease," Town said. He thinks that people who develop non-melanoma skin cancers don't have an immune response in their skin, and thus develop skin cancers, because an immune response may be critical to fighting skin cancer. But that benefits them when it comes to developing Alzheimer's disease.

"This reduced inflammatory response that was permissive to the skin cancer was perhaps beneficial in the brain," said Town.

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For Alzheimer's Caregivers, Patience and Compassion Are Key

By Serena Gordon

HealthDay Reporter

FRIDAY, Feb. 22 (HealthDay News) -- The picture isn't necessarily pretty when it comes to Alzheimer's disease.

More than 5 million Americans currently have the degenerative brain condition, there's no sure way to prevent it and current treatment options don't work for everyone. Even more millions are tasked with the sometimes difficult and frustrating daily care of those stricken with the memory-robbing disease, often with little experience or training.

But as the number of Americans with Alzheimer's has risen in the past few decades and continues to spiral upward, anecdotal and research evidence has accumulated on ways to make everyday life more bearable for those with the disease and to help those caring for them. It includes expanded knowledge of what works and what doesn't in areas of medication, living situations, everyday contact and more, and ranges from complex to simple solutions.

"There are times that it can be difficult to handle someone with Alzheimer's, but you have to have patience, and you have to put yourself in their shoes," said Teresa Dinau, a caregiver for Home Care Assistance, based in Palo Alto, Calif. "It's important to try to understand what they're going through."

Dr. Jacobo Mintzer, chairman of the Medical and Scientific Advisory Board for the Alzheimer's Foundation of America, said that the biggest initial problem for caregivers is often that "they're trying to preserve the person they knew as long as possible."

"That's usually where they get themselves into trouble," he said. "Because of this desperate need to try to preserve the person, caregivers will put themselves in dangerous situations, like letting the person with Alzheimer's drive because it has always been important to them."

Not pushing someone with Alzheimer's to be who they used to be makes some caregivers feel like they've given up on their loved one, added Mintzer, who's also a physician at the Ralph H. Johnson VA Medical Center in Charleston, S.C.

But he said that's not the case and that there are plenty of safe ways to keep a connection. If someone with Alzheimer's used to like to swing dance, for instance, and you put on music and swing dance with them, it will often be calming, he said. Or, people with Alzheimer's usually enjoy looking at photos from the past, according to the Alzheimer's Association.

Mintzer said there are no treatments currently available to alter the course of the disease. However, two types of medications have been approved in the United States to help with memory loss: a group of drugs called cholinesterase inhibitors (brand names include Aricept, Exelon, Razadyne and Cognex) and memantine (brand name Namenda). However, the Alzheimer's Association reports that these medications don't work for everyone and, on average, delay worsening of symptoms only by about six to 12 months.

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Blood Pressure Drug May Lower Alzheimer's Risk

Jan. 7, 2013 -- Can commonly prescribed blood pressure pills help reduce the risk of developing dementia?

Maybe, according to a new study of 774 elderly Japanese-American men.

While it’s well known that high blood pressure in midlife raises a person’s risk for developing thinking and memory problems as they age, and that certain types of blood pressure medications may help lower this risk, little was known about how a class of drugs called beta-blockers stacked up, until now.

According to the new findings, men who took beta-blockers were less likely to have changes in their brains that can be signs of Alzheimer’s disease and other types of dementia, compared to men who took other types of blood-pressure-lowering drugs.

The findings will be presented at the American Academy of Neurology’s 65th Annual Meeting in San Diego.

All of the men took part in the Honolulu-Asia Aging Study. Of the 774 men, 610 had high blood pressure or were being treated for high blood pressure. Among about 350 who had been treated, 15% received a beta-blocker, 18% received a beta-blocker plus one or more other medications, and the rest received other blood pressure drugs.

All types of blood pressure medications seemed to have a positive effect on the risk of dementia, the study shows.

Researchers led by Lon White, MD, of the Pacific Health Research and Education Institute in Honolulu, Hawaii, performed autopsies on the brains of these men. They looked for brain lesions indicating Alzheimer’s disease and microinfarcts, scars left behind most likely from unrecognized mini-strokes. 

Men who had received beta-blockers alone showed fewer brain abnormalities than those who had not been treated for high blood pressure or who had received other blood pressure drugs. Study participants who had taken beta-blockers alone or in combination with another blood pressure medication showed less shrinkage in their brains.

Richard Isaacson, MD, says the new study findings add more grist to the mill when it comes to preventing Alzheimer’s disease. Isaacson is an associate professor of clinical neurology and the director of the Alzheimer's division at the University of Miami Miller School of Medicine.

“Treating blood pressure, in general, is quite likely to reduce the risk of cognitive decline and Alzheimer’s disease, and specific treatments may be preferential,” he says.

Exactly how high blood pressure increases the chances of dementia, and how treating it reduces this risk, is not fully understood, Isaacson says. It may reduce the risk of mini-strokes that can lead to dementia or help brains maintain their volume. “We know that treating high blood pressure reduces your risk for stroke and heart attack, and now the icing on the cake may be that it can also delay the onset of Alzheimer’s disease and other forms of cognitive decline.”

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