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Saturday, March 26, 2011

Alzheimer's disease: Best bets to hold off the disease

AARP

Alzheimer's disease: Best bets to hold off the disease

from: Los Angeles Times |

By Shari Roan

The audience wasn't happy. Its members, Jul. 30, 2010 (McClatchy-Tribune News Service delivered by Newstex) -- private citizens, healthcare professionals and advocates for the elderly _ had gathered to hear a report on how to prevent Alzheimer's; instead, they were told that, in fact, nothing has been proved to keep the disease at bay.

"We're not trying to take anyone's hope away," said report co-author Dr. Carl C. Bell, a professor of psychiatry and public health at the University of Illinois, Chicago, who noted the dejection in the air that day. "But we have to go with the hard science."

The bleak assessment was issued by a National Institutes of Health task force at an April meeting in Bethesda, Md. It was a State of the Science summary of more than 250 studies on potential ways to lower risk of the disease _ and it was entirely accurate: None of the data had been strong enough for experts to definitively say "Do this" or "Don't do that."

But that's not to say the prevention picture is without hope. Several healthy and inexpensive strategies are clearly worth trying, say neurologists and Alzheimer's researchers.

"There is an emerging body of evidence on what you can do to reduce your risk," said Debra Cherry, executive vice president of the California Southland Chapter of the Alzheimer's Association. "It's not at the levels of research from randomized, controlled trials, but it suggests things are moving in the right direction. We are learning how to reduce risk."

The strategies with the most support are regular physical activity, a Mediterranean diet and high levels of cognitive engagement.

There would appear to be little to lose. Among people 55 and older, 1 in 8 will develop Alzheimer's disease and 1 in 6 will develop some type of dementia.

Physical activity: Perhaps the best way to potentially cut the chance of developing Alzheimer's is to exercise _ regularly and with at least moderate intensity.

A large, long-term study presented earlier this month at the Alzheimer's Association International Conference on Alzheimer's Disease meeting in Honolulu found that people who perform moderate to heavy levels of exercise have a 40 percent lower risk of developing any type of dementia compared with people reporting the lowest level of exercise.

The study doesn't prove cause and effect, but it is noteworthy because of its size and the source of its data. The 1,200 participants, who had an average age of 76, were part of the long-running Framingham Study on cardiovascular health; their physical activity levels were recorded for at least a decade, along with the incidence of dementia.

Biological studies also support the idea that activity is good for the brain. In studies at the University of California Irvine, Dr. Carl Cotman has shown that exercise increases levels of a substance called brain-derived neurotrophic factor, which enhances brain function and promotes the survival of neurons.

"There is a lot of data from epidemiology studies and animal studies supporting physical activity," said Laurie Ryan, program director for Alzheimer's disease clinical trials at the National Institute on Aging. "Exercise really is promising."

But just any movement might not do. The data, she points out, suggest that moderate to heavier exercise is more beneficial than mild physical activity, such as stretching.

Diet: Numerous population-based studies suggest that people who eat a diet high in fruits, vegetables, nuts, red wine and omega-3 fatty acids _ and low in saturated fats _ have a reduced risk of dementia of any type.

"Dietary factors are important," Ryan said. "The Mediterranean diet seems more beneficial than the standard Western diet."

Omega-3 fatty acids, in particular, have been linked to a reduced risk of developing Alzheimer's. A 2005 Cochrane Review article stressed that research on omega-3s should be a priority. Because it can be hard to get enough of these nutrients from the diet _ they're found most plentifully in salmon and sardines _ some experts suggest taking a supplement of 1 or 2 grams a day.

Other dietary elements have also emerged as especially promising; among them are alcohol and tea.

Several studies have linked light to moderate alcohol intake with a reduced risk of dementia. One of the most solid pieces of research, published in the Lancet in 2002, followed more than 5,000 healthy people ages 55 and older for at least six years. That work, called the Rotterdam study, found that light-to-moderate drinkers had a 42 percent lower risk of dementia as compared with non-drinkers.

As for tea, a study presented at the recent International Conference on Alzheimer's Disease adds to the growing body of research suggesting its benefits. It found that, over time, tea drinkers have rates of cognitive decline 17 percent to 37 percent lower than non-tea drinkers.

The study's author, Lenore Arab, a professor of medicine at UCLA, examined data on 4,800 men and women 65 and older, recording their coffee and tea consumption and following them for up to 14 years. People who drank tea one to four times a week had the greatest reduced risk. Coffee intake was not linked to lower risk except among people who had the highest rate of consumption.

The reason why tea may have benefits is likely related to plant-based chemicals, not caffeine, Arab said.

Other nutritional gambits have proved spectacularly unimpressive. In particular, the once highly touted gingko biloba has not been found to reduce risk of dementia or Alzheimer's disease or, in fact, to improve cognitive performance in general. And there is little evidence that vitamin B, vitamin C, folate and beta-carotene are helpful in supplement form, as early studies had suggested.

"It could be that giving supplements is not the best way to do this," Ryan said. "It may be more important to get the nutrient in the diet."

The NIH's State of the Science panel appeared to take a dim view of supplements because of the potential for consumers to waste money.

"There is a cost to supplements," noted Dinesh Patel, a panel member and geriatrician at George Washington University School of Medicine. "For some of them, we don't even know the side effects or possible harms."

Cognitive engagement: Some studies suggest that living with someone is protective _ and there is strong evidence that the loss of a spouse leads to decline. Further, staying mentally engaged also seems to be beneficial.

One of the best-known studies on this second connection is the work by Dr. David Bennett, a professor of neurological sciences at Rush University Medical Center in Chicago. His research, called the Religious Orders Study, found that people who spent the most time engaged in mentally stimulating activities _ such as reading, playing cards or doing puzzles, going to the museum _ had a 47 percent reduced risk of developing dementia compared with those with the lowest rates of cognitive activity.

But studies that provide people with "brain games" and other tools to keep their minds busy and challenged have produced inconsistent findings. Such programs aim to improve memory training, reasoning and speed of thinking, and some studies show small effects over a five-year period. But no long-term data can attest to their effectiveness.

When to start: The timing of preventive strategies may prove crucial, with the notion of "the earlier, the better" seeming to hold true.

Research has suggested that highly educated people have a larger "cognitive reserve," and a study of more than 6,000 people published last year in the journal Neurology found that higher educational attainment appears to be linked to higher cognitive function. Once dementia sets in, however, level of education seems to have no bearing on how fast the dementia progresses.

Similarly, it may be wise to adopt a healthful diet and exercise regimen as soon as possible. "These lifestyle factors may have to occur early in life," Ryan said.

That doesn't mean that older people can't decrease their risk. Research strongly implies that diseases that develop later _ such as heart disease, diabetes, hypertension and obesity _ raise the possibility of dementia. Researchers are now exploring whether medications used to treat these conditions may also reduce Alzheimer's disease risk.

Some critics of the State of the Science report note that it may be difficult to ever prove whether some prevention strategies work; it would be unethical, for example, to assess the effect of hypertension on Alzheimer's by not treating some people.

Ultimately, the most reasonable approach would seem to boil down to this: Eat healthfully, exercise, maintain a pleasant social life and rigorously treat conditions like hypertension, high cholesterol, heart disease, obesity and diabetes.

"It will not hurt any of us to follow those suggestions," Cherry said. "To me, that's very optimistic."

___

AVAILABLE MEDICINES

Five medications have been approved to treat the cognitive symptoms of Alzheimer's disease. The drugs can reduce some symptoms _ such as difficulties with memory, language, attention and reasoning _ especially in the early stages of the disease. They can, accordingly, improve quality of life, but they don't work for everyone, and none of them works permanently. Eventually the disease will overtake the drugs' ability to compensate.

Four of the medications are cholinesterase inhibitors. These drugs appear to work by slowing the loss of acetylcholine in the brain, a chemical critical to cognitive function. The other, and newest drug, Namenda, is an N-methyl D-aspartate antagonist. It appears to work by regulating glutamate, a brain chemical that can cause cell death in excessive amounts.

A cholinesterase inhibitor and the NMDA antagonist are often prescribed together. In combination, or even taken alone, these medications can, in some people, improve the ability to perform simple tasks.

Namenda

Generic name: memantine

Approved: 2003

Used: In later stages

Razadyne or Reminyl

Generic name: galantamine

Approved: 2001

Used: Earlier stages

Exelon

Generic name: rivastigmine

Approved: 2000

Used: Earlier stages

Aricept

Generic name: donepezil

Approved: 1996

Use: Earlier stages

Cognex

Generic name: tacrine

Approved: 1993

Used: Rarely used due to serious side effects

___

WHERE TO TURN FOR SOME HELP

For basic information on Alzheimer's disease, including the latest research developments, go to the website of the National Institute on Aging.

For caregiving advice and guidance, contact the National Alliance for Caregiving.

For information and news on the disease, contact the national Alzheimer's Assn., which also showcases the latest in Alzheimer's research and science.

To participate in a new Alzheimer's Assn. program that matches people with the disease (and related dementias) to clinical trials for which they may be eligible, go the website or call (800) 272-3900. The service is free and confidential.

___



Newstex ID: KRTN-1429-47473338

New Test Could Help Detect Alzheimer’s Disease


AARP


Bulletin

New Test Could Help Detect Alzheimer’s Disease

Who should get it?

Used in conjunction with a PET scan, the radioactive "tracer" is injected into patients, where it quickly binds to sticky plaques in the brain that have long been considered a hallmark of Alzheimer's disease.

The plaques appear brighter on the scan-an image of changes in the living brain once observable only under a microscope at autopsy.

Results presented by the PET tracer's maker, Avid Radiopharmaceuticals, demonstrated at least a 97 percent agreement between the labeled brain scans and pathology examination at autopsy in the diagnosis of Alzheimer's, according to Michael Weiner, M.D., director of the Center for Imaging of Neurodegenerative Diseases at the San Francisco VA Medical Center, who attended the talk.

In a companion study examining the brains of young people not expected to have Alzheimer's, none had a positive scan. "Overall the results are very good," says Weiner, who also is principal investigator of a major government-industry research initiative to determine the best methods for observing Alzheimer's in clinical trials. "The results confirm the view that scanning with an amyloid PET scanning agent is going to detect amyloid in the brain."

Being able to "see" the plaques, made up of a sticky protein fragment called beta-amyloid, gives researchers a new window into the disease process and helps them track the effects of experimental Alzheimer's drugs on the brain.

If the new tracer is approved for marketing by the U.S. Food and Drug Administration-Avid, expects to apply within months-it also will be available to doctors around the country. There's little doubt that Avid's tracer, and perhaps similar ones in development, are a boon to Alzheimer's research. But it will take some time before doctors know what role the scan can play in answering the more immediate questions from patients worried about memory loss or other symptoms of mental decline.

What the test tells us

"We don't exactly know what the clinical use of these scans will be," says Weiner. "We don't know their predictive value."

Indeed, perhaps the most pressing research question the scans can help to answer is the precise role of the amyloid plaques themselves. They are always present in the brains of people with Alzheimer's. But do they cause the dementia and other problems connected to the disease? Some researchers are convinced the culprit is a different kind of amyloid-floating clumps-rather than hardened plaques.

It's not clear, for example, that a 75-year-old person with emerging memory problems and a positive scan showing amyloid will go on to become severely demented; more than 30 percent of older people with normal mental functions show amyloid in the brain.

But doctors might use the new test to help confirm or rule out a diagnosis of Alzheimer's in patients exhibiting some symptoms of dementia.

A negative scan, says Weiner, could be reassuring. "Let's say I have a person that's having quite a bit of memory problems, but the scan is negative. Well, that's good news. That's very good news. They are very unlikely to show a rapid deterioration from Alzheimer's."

The new tracer scans "should not be used in everybody," says James E. Galvin, M.D., director of the Pearl Barlow Center for Memory Evaluation and Treatment at New York University's Langone Medical Center. He says if the patient has symptoms consistent with Alzheimer's and the doctor is confident of the diagnosis, the scan would add little information.

Its utility, he believes, will be in helping to resolve "diagnostic dilemmas" where symptoms and other findings leave significant room for doubt. And in tracking the effects of experimental drugs.

One more tool to help with a cure

Finding Alzheimer’s early is critical both to discovering treatments that attack the disease—currently there are none—and not just its symptoms. Researchers believe the damage in the brain begins a decade or more before an individual notices symptoms. Indeed, it may be that many experimental drugs have failed to arrest or even slow Alzheimer’s because they came too late; dead brain cells don’t come back to life.

The new amyloid tracer (florbetapir F18) represents only one of several recent advances in techniques for observing Alzheimer’s disease in the brain, says Maria C. Carrillo, senior director for medical and scientific relations for the Alzheimer’s Association, host of the conference in Honolulu. “What’s exciting about our current state of knowledge,” she says, “is that we now understand that early detection is possible. That gives us so much hope.”

Other tests that measure signs of Alzheimer’s—from key proteins in spinal fluid to other kinds of imaging—seem to offer a telling glimpse into the disease at different points along its destructive path through the brain. Each may prove a useful source of information at different stages of Alzheimer’s.

The new tracer builds on scientific pioneering by University of Pittsburgh researchers who developed an agent that helped spotlight plaque in the brain. But their compound has a very short life and can only be used by high-tech research centers. Use by doctors in hospitals and clinics is out of the question.

Avid’s new tracer, on the other hand, lasts long enough to allow its transport from manufacturing sites to scanning clinics, potentially reaching about 90 percent of the country, says company spokesperson Christopher Bunting.

Will it be covered by insurance?

For these new brain scans to enter widespread use, both experts and insurers will need to be convinced that they provide some clear benefit—making it easier for patients to get treatment, for example.

Currently the standard evaluation for possible Alzheimer’s disease includes some type of brain imaging—a CT (computed tomography) or MRI—mostly to rule out other problems such as a stroke or tumor.

The more specialized PET test is used far less often, and is covered by Medicare only for the specific purpose of distinguishing Alzheimer’s from a relatively rare condition called fronto-temporal dementia, which typically produces quite different findings on the scan.

This new test should provide a clear benefit “in terms of accuracy of diagnosis,” says P. Murali Doraiswamy, M.D., a professor of psychiatry and geriatrics at Duke University Medical Center who was involved in Avid’s study of the new tracer. He believes it will prove a “game changer” when it comes to diagnosing the disease and getting patients started on treatments earlier.

Longer life, better studies

A study published last year by researchers at Washington University in St. Louis used the earlier Pittsburgh tracer on a small group of patients and found that mentally normal older adults with a positive amyloid scan were more likely than those without amyloid plaques to develop symptoms of Alzheimer’s.

The finding suggests the plaques are not benign, but it needs to be replicated in larger study groups, says Anne Fagan, a neuroscientist at Washington University and coauthor of this and other key work on the disease. Longer-lasting tracers than the Pittsburgh agent—like Avid’s new agent—could make those studies possible.

Katharine Greider lives in New York and writes about health and medicine.


Who Wants to Know?

Top images are from the brain of a cognitively normal person. The bottom images are from an Alzheimer’s patient; plaque buildup shows up in red.

Top images are from the brain of a cognitively normal person. The bottom images are from an Alzheimer’s patient; plaque buildup shows up in red. Martin Palm/Gallery Stock

Many older people who suffer from memory lapses are in no hurry to seek a diagnostic work-up for Alzheimer’s disease. What’s the benefit, they wonder, when the condition is not only terrible in its effects, but inexorably progressive and incurable?

Alzheimer’s experts are working hard to change this perception. “We want people to run toward a diagnosis rather than away from it,” says Eric Tangalos, M.D., codirector of education at the Alzheimer’s Disease Research Center of the Mayo Clinic. A diagnosis, these doctors argue, allows the patient to:

  • participate in planning his or her own future, including family, financial and legal planning.
  • take one of a handful of medications to treat the cognitive symptoms of Alzheimer’s. The drugs’ benefits are moderate and transient, but they seem to work best in the early stages of the disease.
  • join programs and pursue activities that use and reinforce retained abilities, while avoiding disruptive changes that can accelerate decline.
  • join a clinical trial. Patients in clinical research trials typically get a high quality of care. They may be assigned to receive either a harmless placebo or an experimental treatment. Either way their participation helps advance scientific understanding of the disease.

Related

10 Best-Rated States for Retirement

AARP


10 Best-Rated States for Retirement

A super-low crime rate and modest tax burden put New Hampshire at the top of Money-Rates.com's list.


10 Best-Rated States for Retirement

— Jose Azel/Aurora

Many highly personal factors come into play when it's time to pick the perfect place to retire. Everything from availability of tee times to proximity to grandkids can have an impact on your decision. There's no one-size-fits-all formula. After all, one retiree's paradise can be another's hellish nightmare.

Money-Rates.com is trying to add some objectivity to what's otherwise a very individualized life choice. The finance website looked at a number of factors to come up with a list of the 10 best states for retirement. The criteria include climate, crime rate, life expectancy and economic conditions such as cost of living, job opportunities and taxes.

The No. 1 state on the list might come as a surprise to many considering that it's a long way away from the Sun Belt. Despite its climate challenges, New Hampshire is the best-rated state to retire to because of its super-low crime rate, modest living costs and reasonable tax burden. Hawaii came in second, thanks to gorgeous weather and long life expectancy, followed by South Dakota, which is both safe and affordable.

Here are all 10 best states for retirement according to Money-Rates.com:

1. New Hampshire
2. Hawaii
3. South Dakota
4. North Dakota
5. Iowa
6. Virginia
7. Utah
8. Connecticut
9. Vermont
10. Idaho

Wondering which states to avoid? Check out the 10 worst states for retirement.

Worst States for Retirees

AARP


Toughest States for Retirees

Poor fiscal health lands Illinois at the bottom of TopRetirements.com's list.

En español | Choosing where to live after retirement is a huge decision — and a very personal one. A low cost of living is a priority for some, while being close to family takes precedence for others regardless of the cost. As you plan for retirement, one smart way to identify the best place to retire for you is to eliminate the places that don't meet your needs.

Toward that end, TopRetirements.com, a website that provides information on retirement communities, has issued its list of the 10 worst states for retirement. The list is subjective, of course, but it's a good starting point for research. Factor in your personal retirement preferences as your review the rationale for why each of these states landed in the bottom 10.

10 Worst Ranked States to Retire

Illinois retirees face frigid winters.
— Nam Y. Huh/AP

In compiling its list, TopRetirements.com gave the most weight to three criteria: taxes, fiscal health and climate. Each of these factors is important, generally speaking, to retirees. On the financial front, high taxes can eat away at limited incomes, while poor fiscal health can force state governments to raise revenue or cut services. A warm climate is a natural draw for many retirees. If those three criteria aren't among your top priorities, then the low rankings might not influence your decision.

Here are the 10 worst states for retirement, with No. 1 being the lowest ranked, according to TopRetirements.com:

Worst States for Retirement

Why You Should Think Twice

1) Illinois
Poor fiscal health
2) California Expensive, and its finances are in disarray
3) New York
Very high taxes, including property taxes
4) Rhode Island Worst-off state in the Northeast from a financial viewpoint; high taxes
5) New Jersey
Highest property taxes in the United States; has pension funding issues
6) Ohio High unemployment and cold winters
7) Wisconsin High property taxes and frigid weather
8) Massachusetts High cost of living and high property taxes
9) Connecticut Taxes Social Security and has high property taxes
10) Nevada
Foreclosure capital of the world

Visit TopRetirements.com for more details on why it ranked each state as low as it did. The information can be illuminating. Illinois, for example, is under such dire financial stress that it was forced to borrow money to fund its pension obligations. The state, however, doesn't tax retirees' Social Security income, which is a plus. The cold winters are inescapable.

You can also compare TopRetirements.com's choices to a similar list of the 10 worst-rated states for retirement that was compiled by Money-Rates.com, a finance website. Illinois didn't even make Money-Rates.com's list, which was topped instead by Nevada. Money-Rates.com gave significant weight to crime and unemployment rates.

Money-Rates.com also issued a list of the 10 best states for retirement.

Use this checklist to factor in personal retirement preference.>>


Use this checklist from TopRetirements.com as you evaluate potential retirement states. Give the most attention to the factors that you think will matter most to you in retirement:

  • Taxes (sales, income, property, inheritance and estate)
  • Climate and topography
  • Crime
  • Fiscal health of the state government
  • Recreation
  • Transportation
  • Health care
  • Cost of living (including housing)
  • Education (including colleges)
  • Cultural resources
  • Natural disasters
  • Proximity to friends and family
  • Fitting in socially, politically and religiously