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Update August 2017


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Health & Wellbeing
 

Update August 12, 2017

Hints that lifestyle changes might guard against dementia

A section of a human brain with Alzheimer’s disease is on display at the Museum of Neuroanatomy at the University at Buffalo, in Buffalo, N.Y. (AP Photo/David Duprey, File)

Lauran Neergaard

Washington (AP) - Seek a good education. Control blood pressure and diabetes. Get off the couch. There are some hints, but no proof yet, that these and other lifestyle changes just might help stave off dementia.

A provocative report in the British journal Lancet Thursday, July 20, raised the prospect that a third of dementia cases around the world could be delayed or even prevented by avoiding key risks starting in childhood that can make the brain more vulnerable to memory loss in old age.

A recent U.S. report was much more cautious, saying there are encouraging clues that a few lifestyle changes can bolster brain health and that more research is critical.

Still, it’s never too early to try, said Lancet lead author Gill Livingston, a psychiatry professor at University College London.

“Although dementia is diagnosed in later life, the brain changes usually begin to develop years before,” she noted.

Early next year, a $20 million U.S. study will begin rigorously testing if some simple day-to-day activities truly help older adults stay sharp.

“We are in a frustrating position science-wise in terms of what are our options?” said cognitive neuroscientist Laura Baker of Wake Forest School of Medicine in North Carolina, who will lead the new study to find out.

In the meantime, Alzheimer’s specialists say there’s little down side to following some common-sense recommendations.

Consider physical activity, crucial for heart health. “If in fact it should also improve the prospects for cognitive function and dementia, all the better,” said Dr. Richard Hodes, director of the U.S. National Institute on Aging and an avid exerciser.

“Increased health of the body supports increased health of the brain,” Baker added.

Here’s the latest from this week’s Alzheimer’s Association International Conference on possible ways to guard your brain:

 Key Risks

A Lancet-appointed panel created a model of dementia risks throughout life that estimates about 35 percent of all dementia cases are attributable to nine risk factors - risks that people potentially could change.

Their resulting recommendations: Ensure good childhood education; avoid high blood pressure, obesity and smoking; manage diabetes, depression and age-related hearing loss; be physically active; stay socially engaged in old age.

The theory: These factors together play a role in whether your brain is resilient enough to withstand years of silent damage that eventually leads to Alzheimer’s.

Does changing these or other lifestyle factors really help?

Last month, the U.S. National Academies of Sciences, Engineering and Medicine reported there’s little rigorous proof. That report found some evidence that controlling blood pressure, exercise and some forms of brain training - keeping intellectually stimulated - might work and couldn’t hurt.

Why? What’s good for the heart is generally good for the brain. In fact, high blood pressure that can trigger heart attacks and strokes also increases risk for what’s called “vascular dementia.”

And exercising your gray matter may bulk up the brain, whether it’s from childhood education or learning a new language as an adult. The more you learn, the more connections your brain forms, what scientists call cognitive reserve. Some U.S. studies have suggested that generations better educated than their grandparents have somewhat less risk of dementia.

Other factors have less scientific support. Studies show people with hearing loss are more likely to experience memory problems, and have speculated that it’s because hearing loss leads to depression and social isolation - or that the brain works harder to deal with garbled sound, at the expense of other thinking skills. But so far there aren’t studies proving hearing aids reverse that risk.

In fact, the strongest evidence that lifestyle changes help comes from Finland, where a large, randomized study found older adults at high risk of dementia scored better on brain tests after two years of exercise, diet, cognitive stimulation and social activities.

Hunting Proof

Would those strategies help Americans, who tend to be sicker, fatter and more sedentary than Scandinavians? The Alzheimer’s Association is funding a study to find out, with enrollment of 2,500 cognitively healthy but high-risk older adults to begin next year.

Want to try on your own? They’ll test:

- Walking - supervised, so no cheating. Wake Forest’s Baker puts seniors on treadmills at the local YMCA to avoid bumpy sidewalks. She advises exercise newbies to start slow - about 10 minutes a day for a few days - and work up to longer walks, and go with a buddy so it’s harder to back out.

- A diet that includes more leafy greens, vegetables, whole grains, fish and poultry than the typical American menu.

- Certain brain games and what Baker called an “intellectual stimulation barrage,” outings and other steps that keep people social, not sitting home on a computer, while they exercise their brains.

- Improving control of medical conditions like high blood pressure and diabetes that are toxic to the brain.


Update August 5, 2017

Hearing is believing: Speech may be a clue to mental decline

In this July 6, 2017 photo, Kim Mueller, left, administers a test to Alan Sweet, where he describes an illustration, as part of a University of Wisconsin-Madison study on dementia. (AP Photo/Carrie Antlfinger)

Marilynn Marchione

Your speech may, um, help reveal if you’re uh ... developing thinking problems. More pauses, filler words and other verbal changes might be an early sign of mental decline, which can lead to Alzheimer’s disease, a study suggests.

Researchers had people describe a picture they were shown in taped sessions two years apart. Those with early-stage mild cognitive impairment slid much faster on certain verbal skills than those who didn’t develop thinking problems.

“What we’ve discovered here is there are aspects of language that are affected earlier than we thought,” before or at the same time that memory problems emerge, said one study leader, Sterling Johnson of the University of Wisconsin-Madison.

This was the largest study ever done of speech analysis for this purpose, and if more testing confirms its value, it might offer a simple, cheap way to help screen people for very early signs of mental decline.

Don’t panic: Lots of people say “um” and have trouble quickly recalling names as they age, and that doesn’t mean trouble is on the way.

“In normal aging, it’s something that may come back to you later and it’s not going to disrupt the whole conversation,” another study leader, Kimberly Mueller, explained. “The difference here is, it is more frequent in a short period,” interferes with communication and gets worse over time.

The study was discussed Monday at the Alzheimer’s Association International Conference in London.

About 47 million people worldwide have dementia, and Alzheimer’s is the most common type. In the U.S., about 5.5 million people have the disease. Current drugs can’t slow or reverse it, just ease symptoms. Doctors think treatment might need to start sooner to do any good, so there’s a push to find early signs.

Mild cognitive impairment causes changes that are noticeable to the person or others, but not enough to interfere with daily life. It doesn’t mean these folks will develop Alzheimer’s, but many do - 15 to 20 percent per year.

To see if speech analysis can find early signs, researchers first did the picture-description test on 400 people without cognitive problems and saw no change over time in verbal skills. Next, they tested 264 participants in the Wisconsin Registry for Alzheimer’s Prevention, a long-running study of people in their 50s and 60s, most of whom have a parent with Alzheimer’s and might be at higher risk for the disease themselves. Of those, 64 already had signs of early decline or developed it over the next two years, according to other neurological tests they took.

In the second round of tests, they declined faster on content (ideas they expressed) and fluency (the flow of speech and how many pauses and filler words they used). They used more pronouns such as “it” or “they” instead of specific names for things, spoke in shorter sentences and took longer to convey what they had to say.

“Those are all indicators of struggling with that computational load that the brain has to conduct” and supports the role of this test to detect decline, said Julie Liss, a speech expert at Arizona State University with no role in the work.

She helped lead a study in 2015 that analyzed dozens of press conferences by former President Ronald Reagan and found evidence of speech changes more than a decade before he was diagnosed with Alzheimer’s. She also co-founded a company that analyzes speech for many neurological problems, including dementia, traumatic brain injury and Parkinson’s disease.

Researchers could not estimate the cost of testing for a single patient, but for a doctor to offer it requires only a digital tape recorder and a computer program or app to analyze results.

Alan Sweet, 72, a retired state of Wisconsin worker who lives in Madison, is taking part in the study and had the speech test earlier this month. His father had Alzheimer’s and his mother had a different type of dementia, Lewy body.

“Watching my parents decline into the awful world of dementia and being responsible for their medical care was the best and worst experience of my life,” he said. “I want to help the researchers learn, furthering medical knowledge of treatment and ultimately, cure.”

Participants don’t get individual results - it just aids science.

Another study at the conference on Monday, led by doctoral student Taylor Fields, hints that hearing loss may be another clue to possible mental decline. It involved 783 people from the same Wisconsin registry project. Those who said at the start of the study that they had been diagnosed with hearing loss were more than twice as likely to develop mild cognitive impairment over the next five years as those who did not start out with a hearing problem.

That sort of information is not strong evidence, but it fits with earlier work along those lines.

Family doctors “can do a lot to help us if they knew what to look for” to catch early signs of decline, said Maria Carrillo, the Alzheimer’s Association’s chief science officer. Hearing loss, verbal changes and other known risks such as sleep problems might warrant a referral to a neurologist for a dementia check, she said. (AP)

Online:

Audio of example test: http://bit.ly/2sZklbU.
 


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Hints that lifestyle changes might guard against dementia


Hearing is believing: Speech may be a clue to mental decline


 



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