We can delay onset of dementia

Here is a very thoughtful piece by the ever-helpful ANDRÉ PICARD in a recent Globe & Mail column. He notes from a study that in fact, we can delay the onset of dementia by taking some proactive steps for ourselves and our aging loved ones.

 

There are few things that aging baby boomers fear more than dementia, a condition that robs one of memory – and too often dignity – and leaves you dying little by little, piece by piece.
The numbers are frightful: An estimated 564,000 Canadians are currently living with dementia, and that figure is expected to rise to 937,000 within 15 years.


Globally, it is estimated that almost 50 million people are afflicted with dementia and that is forecast to rise to 131 million by 2050.


The data are grim – even without mentioning the impact on caregivers, the health system and the economy. Yet, there are little glimmers of hope – in particular, research showing that dementia is preventable, at least in part.


A study published in medical journal The Lancet shows one in three cases could be prevented or delayed if people took better care of their brains.


Based on a review of scientific literature and mathematical modelling, a panel of 24 global experts identified nine factors that increase the risk of dementia and how much those risks could be lowered if they were addressed:
Mid-life hearing loss: 9 per cent;
Failing to complete secondary (high-school and above) education: 8 per cent;
Smoking: 6 per cent;
Failing to seek early treatment for depression: 4 per cent; Physical inactivity: 3 per cent; Social isolation: 2 per cent; High blood pressure: 2 per cent; Obesity: 1 per cent;
Type 2 diabetes: 1 per cent. All told, the potential risk reduction adds up to 36 per cent – but, of course, health problems are easier to avoid in theory than in practice.


Still, some important lessons can be drawn from this list of modifiable risk factors. While things such as smoking and inactivity are commonly seen as lifestyle choices, they are largely symptoms of poor socioeconomic conditions.


That’s a reminder that, as Dr. Martin Prince of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London writes in The Lancet: “Dementia selectively affects the old and frail, women and the socioeconomically and educationally disadvantaged.”
The research also drives home another key point: The brain changes at the root of dementia occur years before the onset of symptoms.


Dr. Antoine Hakim, emeritus professor of neurology at the University of Ottawa, stresses this point in his new book, Save Your Mind: Seven Rules To Avoid Dementia. While the script for dementia is written early, perhaps as early as our teenage years, he writes, the risk of dementia is modifiable – up to and including when symptoms of cognitive decline begin – because of the plasticity of the brain.


Dementia is caused by the death of brain cells. But Dr. Hakim notes that most cases are not Alzheimer’s – characterized by tangles and plaques in the brain – but caused by vascular problems such as high blood pressure and stroke. In other words, what’s good for the heart is good for the brain (and vice versa).


Of his seven golden rules for brain health and reducing dementia risk, Dr. Hakim’s No. 1 recommendation is to “save for a rainy day,” to grow the brain’s capacity and resiliency by exercising it like a muscle.


We can’t prevent dementia from killing people, but we can delay its onset. A one-year delay would translate into nine million fewer cases by 2050; a five-year delay would halve the prevalence of dementia globally in that same time period.


Want to stave off dementia? Read. Write. Play music. Be physically active. Be socially engaged. Eat healthy food. Maintain a healthy weight. Sleep well. Don’t sit mindlessly in front of the TV. Those simple counsels are the best tools we have in a world in which there are no drugs or treatments that prevent dementia.


There are 100 billion neurons, trillions of contact points known as synapses and 600 kilometres of blood vessels in the brain, and “everything we do – and don’t do – affects the health of these cells and their connections,” Dr. Hakim writes.


Dementia is not a natural consequence of aging. Risk depends, in part, on genetics, and on the lifestyle “choices” we make. (And we have to be careful with that word because major factors such as poverty and education are rarely a choice.)


As The Lancet notes, “dementia is the greatest global challenge for health and social care in the 21st century.” But it is not a runaway train. We have the ability prevent – or more realistically, delay – the disease. And keeping dementia at bay, even temporarily, can change a lot of lives.


We can save a lot of minds by using our heads.

Three lifestyle changes to help ward off dementia

Here is a recent excellent article that appeared on Global News online, written by carmen.chai@globalnews.ca

If you’re worried about keeping your brain healthy and staving off dementia, new research is pointing to three lifestyle changes you can make.

Keep your brain sharp with cognitive training, manage your blood pressure levels and always make time for exercise, American scientists say. While studies are still confirming their effectiveness, the study suggests they offer a “modest” effect in keeping dementia away.


“There is good cause for hope that in the next several years much more will be known about how to prevent cognitive decline and dementia, as more clinical trial results become available and more evidence emerges,” Dr. Alan Leshner, CEO emeritus at the American Association for the Advancement of Science, said in a statement.

Leshner is also chair of the committee that pulled together the report.

“Even though clinical trials have not conclusively supported the three interventions discussed in our report, the evidence is strong enough to suggest the public should at least have access to these results to help inform their decisions about how they can invest their time and resources to maintain brain health with aging,” he said.

In 2010, another review committee decided there was “insufficient evidence” to make recommendations about how to keep your brain healthy and away from disease. Since then, research has come a long way, though.


“The evidence is getting stronger that there are things we can do to potentially lower our risk of developing Alzheimer’s disease or another form of dementia. Previously, before this evidence came to light, people … said it’s luck of the draw if they’ll get this disease and there was a real sense of helplessness and lack and control,” Mary Schulz, director of education at the Alzheimer Society of Canada, said.

“There are no guarantees that if you follow these [lifestyle habits] to a letter that you won’t develop a form of dementia but we’re learning that they have some protective measures,” she told Global News.

Now, the scientists are pointing to three measures people can take:

Cognitive training

This includes problem solving, memory and speed of processing. It’s supposed to delay or slow age-related cognitive decline. Right now, research suggests that cognitive training can improve performance on a task, at least in the short term.

Learn a new language, take up chess or even take piano lessons. Stimulating your brain helps to reinvigorate it, Schulz said.

“It’s something new and it wakes up your brain, giving it a jolt and startling it. You’re also teaching it to adapt, and be flexible as you have messages fired around in your brain in a way it doesn’t normally,” she explained.

Managing blood pressure

Avoiding high blood pressure is key, especially in your middle years, between 35 to 65 years old, the scientists say.

It prevents stroke and heart disease, and in turn, prevents Alzheimer’s-type dementia.

Keep in mind, last year, Heart & Stroke doctors warned that there’s an “increasingly powerful” relationship between stroke and dementia.

“Stroke and dementia need to be studied together because in some ways they are one and the same,” Dr. Andrew Demchuk, director of the Calgary Stroke program and spokesman for the foundation, said.

“Stroke causes brain cells to die and this can precipitate dementia or worsen pre-existing dementia. There are different causes of dementia, and research now shows that stroke is a major contributor,” Demchuk said.

Stroke happens when blood stops flowing to parts of the brain, causing cells to die. Having a stroke more than doubles your risk of developing dementia later on in life.

Out of every 100 stroke patients without a past history of dementia, 16 are likely to develop dementia after their first or subsequent stroke.

Exercise

Physical activity comes with handfuls of benefits, including stroke prevention – they all benefit brain health.

The review pointed to a number of randomized controlled trials that found exercise being effective in keeping away cognitive decline.

You don’t need to run marathons to keep dementia at bay, but doing some form of physical activity goes a long way in keeping your brain young.

Exercise gets your heart rate up, which increases blood flow to the brain, nourishing cells with nutrients and oxygen. It also encourages the development of new cells, all factors in reducing your risk of stroke, Schulz said.

Gym memberships aren’t necessary — walk to the grocery store instead of driving, take the stairs instead of the escalator and get off of the bus two stops ahead on your way home.

Your brain is just like your heart. They’re both muscles that need to be given a workout to stay healthy.

 

Looks like dementia, but it’s not!

There is a disorder that's been identified that looks like dementia, but it's not! Apparently, it presents a number of similar symtoms and so can be disdiagnosed as some variation of dementia. However, in this case, it can be treated if identified correctly

To read more about this form CTV, look here: www.ctvnews.ca/health/little-known-disorder-looks-just-like-dementia-but-can-be-reversed-1.3373866

Ultra sound for Alzheimer’s?

There is some interesting evolving research that might show some promise in treating Alzheimer's disease.

Is it possible: ultra sound for Alzheimer's?

Read this recent CTV News story of what is being done in Canada here: www.ctvnews.ca/health/alzheimer-s-patients-treated-with-ultrasound-to-open-the-blood-brain-barrier-1.3394807

Living close to high-traffic roads raises dementia risk: study

People who live in close proximity to high-traffic roadways appear to have a higher risk of dementia than those who live farther away, say researchers, suggesting that air pollution from vehicles may be a factor in the development of the neurological disease. Read more here:

http://ctv.news/2vCUSzD

How can we look after our aging brains?

How can we look after our aging brains? If you're interested, the following article from the January 4th issues of the Los Angeles Times is a must read. 

The aging brain is a shrinking brain, and a shrinking brain is, generally speaking, a brain whose performance and reaction time are declining: That is a harsh reality of growing older.

But new research shows that brain shrinkage is less pronounced in older folks whose diets hew closely to the traditional diet of Mediterranean peoples — including lots of fruits, vegetables, legumes, nuts and olive oil, little red meat and poultry, and regular, moderate consumption of fish and red wine.

In a group of 562 Scots in their 70s, those whose consumption patterns more closely followed the Mediterranean diet experienced, on average, half the brain shrinkage that was normal for the group as a whole over a three-year period.

To glean how diet might influence brain aging, researchers tapped into a large group of Scottish people who were all born in 1936 and had many measures of health status and lifestyle tracked from an early age.

Around the time they reached age 70, 843 members of the “Lothian Birth Cohort” filled out a dietary frequency form that gave researchers a broad look at what foods they ate, which they avoided, and how often they consumed them. At about age 73 and again around age 76, their brains were scanned to gauge the volume of the overall organ and a few of its key components.

The researchers used the food-frequency surveys to divide the group into two — those who at least approximated a Mediterranean-style diet and those who came nowhere close. Even though many in the Med-diet group were far from perfect in their adherence, the average brain-volume loss differed significantly between the two groups.

Findings on the impact of Mediterranean diet on healthy aging have been pretty strong — this is generally a good way to eat. Studies large and small have established that following a Mediterranean diet is effective at driving down heart attack, stroke and premature death risks, and improving the health conditions — including hypertension, worrisome cholesterol levels and metabolic problems — that raise those risks.

But researchers are less sure of the particulars of how the diet promotes better health.

In recent years, studies have sought to tease out not only how great the benefits are, but how they work: whether healthier brain-aging is a function of better vascular health or preserved brain volume, and whether the diet’s advantages lie in its dearth of red meat, the positive effects of the fatty acids in fish or olive oil, or the combined benefits of its plant-based foods.

Researchers also must demonstrate that, in their measurements of dietary intake and health, they’re not actually capturing well-understood relationships between intelligence, education and long-term health: People with certain cognitive strengths do better and stay longer in school and earn more; yes, the better educated and paid may consume healthier diets, but they are generally healthier anyway, so maybe the healthier diet is incidental.

The newest study, published Wednesday in the journal Neurology, helps untangle many of those mysteries. But it also leaves many questions unanswered.

Contrary to some research findings on the Mediterranean diet, the findings suggest that reduced brain shrinkage is not specifically linked to low intake of meat and high intake of fish. Maybe, the authors suggest (and many researchers believe this), the magic in the Mediterranean diet is all those plant-based foods, acting collectively to improve subjects’ cognitive health.

The study also finds that subjects across the spectrum of intellect and educational attainment reaped the benefits of the Mediterranean diet in reducing brain shrinkage (or, alternatively, suffered the effects of diets that departed sharply from that diet’s emphasis on plants, fish and polyunsaturated fats). That suggests the researchers are not wrongly crediting subjects’ dietary choices for advantages that may actually stem from higher intelligence and educational attainment.

Finally, the researchers wrote, the study’s design helps establish that the brain-shrinkage rates seen are likely to be the result of dietary patterns, and not just an association. That’s because the subjects’ dietary patterns were measured first, about the time that participants reached 70 years old. Their brain volumes were then measured by imaging scans three and six years later.

Assuming that people did not dramatically change their dietary patterns — a shift that is considered unlikely for folks in their 70s — researchers believe that the dietary habits that Scots reported as they entered older age played some role in the brain changes they detected further down the road.

Left unexplored here is whether a midlife shift toward the Mediterranean diet could have the same effects, or whether the group differences in brain volume are the rewards or penalties for a lifetime of dietary choices.

There’s good evidence that, when it comes to making better dietary choices, earlier is better. In a 2013 study of more than 10,000 women, researchers found that those who followed a Mediterranean-style diet in their 50s and 60s were about 40% more likely to live past the age of 70 without chronic illness and without physical or mental problems than were those with less-healthy diets. 

Antipsychotic medications are warranted, but being relied upon far too often in seniors with dementia

Antipsychotic medications are warranted, but are being relied upon far too often in seniors with dementia.

Here is a recent Globe and Mail article exploring this important issue: Read this on The Globe and Mail

Caring for a parent afflicted with Alzheimers

Caring for a parent afflicated with Alzheimers is challenging.

Listen here https://soundcloud.com/680cjob/parenting-our-parents​ as Dr. Michael Gordan discusses key considerations in a CJOB 680 interivew with host Jeff Currier in Winnipeg.

Nursing home drama: wrong treatment

This is an email from a long time friend on the west coast. 

Her point is simple and poignent… a nursing home drama: wrong treatment.

Her challenge: how to help her failing fahter.

It's not pretty, and so many of us experience the same trauma. 

Please read on.

On Thursday, dad's geriatric psychiatrist contacted me to discuss his treatment. The facility is saying he is being aggressive, so they are looking at his meds to adjust. Less than a half hour later the doctor called me back asking if the facility had contacted me because they are indicating they will send him to emergency where he will essentially be sedated. The doctor doesn't agree with this and has him on the waiting list to get into the geriatric floor at the hospital. 

Dad is physically fine, he gets around and is busy. He tends to get into other people's rooms and moves everything around and tries to fix things. His eyesight is really bad, so he feels for things. One care aide at the home is calling this aggressive behaviour. He has had a couple of incidents, but they were because he was alone and could have been redirected, no one was hurt or even close to being hurt. Dad jokingly does a one two jab action, then laughs. It is a jest, not aggressive whatsoever. His main care aides say he is the least aggressive person, but busy and gets into things. The facility have told us we have to be there from the time he wakes until he goes to sleep or they will send him to emergency here he will be sedated and returned to the facility or he may not have anywhere to go. 

The home has a lack of staff and often there is often no LPN on his floor. If they are on breaks there is no one there. This is a dementia unit for high needs patients. They will move in temporary replacement staff that do not have dementia training, nor read the patients charts and make comments such as why are we even feeding these people.

They have lost his shoes, his dentures, his glasses, they don't shave him and I have to ask for him to be changed. They are supposed to contact us when incidents occur and they haven't.

It is appalling. I am putting in a formal complaint to the health authority, licensing board, and ministry. The disease is hard enough on its own without having to deal with the system. Not sure why I am sharing, except that I know you went through the disease part. This is not the norm as far as care, is it? I am working with the doctor and hopefully we can get him into a place that has adequate care. 

Maybe you need a follow up book on how to ensure your parent is being cared for?

Clearly, her father needs the right kind of care. 

He seems to need regular attention and care. And a way to vent his interets and energy.  It seems he's not violent or dangerous. But ongoing stimulation may be needed.

Bottom line: the system needs stronger checks and balances. It needs to be able to effectively understand and manage the needs to those who are suffering from various stages of dementia. 

 

Free course about understanding dementia

We tripped across this multi-week free course offered online by the University of Tasmania in Australia. We did not sign up, but we did poke around and it looks interesting, engaging, and helpful. 

It's worth checkng out. 

Go here: https://mooc.utas.edu.au/?utm_source=Facebook&utm_medium=Landing%20Page&utm_campaign=UDMOOC