Vascular changes linked to dementia, say experts

Medical Research

THE same artery-clogging process (arteriosclerosis) that causes heart disease can also result in age-related vascular cognitive impairments (VCI), according to a new American Heart Association/American Stroke Association scientific statement published in Stroke: Journal of the American Heart Association. Cognitive impairment, also known as dementia, includes difficulty with thinking, reasoning and memory, and can be caused by vascular disease, Alzheimer’s disease, a combination of both and other causes. Arteriosclerosis is a build- up of plaque in the arteries associated with elevated blood pressure, cholesterol, smoking and other risk factors.

When it restricts or blocks blood flow to the brain, it is called cerebrovascular disease, which can result in vascular cognitive impairment. Alzheimer’s disease is a progressive brain disorder that damages and destroys brain cells. “We have learned that cerebrovascular disease and Alzheimer’s disease may work together to cause cognitive impairment and the mixed disorder may be the most common type of dementia in older persons,” said Philip B. Gorelick, M.D., M.P.H., co-chair of the writing group for the statement and director of the Centre for Stroke Research at the University of Illinois College of Medicine at Chicago.

Treating risk factors for heart disease and stroke with lifestyle changes and medical management may prevent or slow the development of dementia in some people, Gorelick said. Physical activity, healthy diet, healthy body weight, tobacco avoidance as well as blood pressure and cholesterol management could significantly help many people maintain their mental abilities as they age. “Generally speaking, what is good for the heart is good for the brain,” Gorelick said. “Although it is not definitely proven yet, treatment or prevention of major risk factors for stroke and heart disease may prove to also preserve cognitive function with age.” Understanding common causes of late-life cognitive impairment and dementia has advanced and many of the traditional risk factors for stroke also are risk markers for Alzheimer’s disease and vascular cognitive impairment.

For example: • Reducing high blood pressure is recommended to reduce the risk of vascular cognitive impairment. High blood pressure in mid-life may be an important risk factor for cognitive decline later in life. • Controlling high cholesterol and abnormal blood sugar may also help reduce the risk of vascular cognitive impairment, although more study is needed to confirm the role of these interventions. • Smoking cessation could lessen the risk of vascular cognitive impairment. • Increasing physical exercise, consuming a moderate level of alcohol (i.e., up to 2 drinks for men and 1 drink for non-pregnant women) for those who currently consume alcohol; and maintaining a healthy weight may also lessen the risk of VCI, but more study is needed to confirm usefulness. • Taking B vitamins or anti-oxidant supplements, however does not prevent vascular cognitive impairment, heart disease or stroke. Identifying people at risk for cognitive impairment is a promising strategy for preventing or postponing dementia and for public health cost savings,


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Financial Abuse of Elderly: A New Crime on The Rise

A California woman, 85, has been found in a cabin in Edgecomb, Maine -- under-nourished, disoriented and allegedly robbed of her life savings by three young "friends" who dragged her state-to-state.
The trio allegedly used her as their personal piggy bank until her funds ran out, then dumped her.
The woman, whose name police have not yet released, is only the latest casualty of a growing trend: financial crimes against the elderly.
Maine police have charged twins Barbara Davis and Nicholas Davis, 41, and their 20-year-old godson, Jonathan Stevens, with endangering the welfare of a dependent -- a felony. The three now are free on bail, due in Lincoln County Superior Court Sept. 29.
"They knowingly left her in a small cabin with no telephone and very little food," says Det. Robert McFetridge, who is investigating the case. "They left her to her own devices to take care of herself in 93-degree heat."
It's possible, he says, that other charges will be filed.
"We're looking into all aspects of the case -- including the financial," he says.
He calls the woman's abduction and exploitation a textbook example of elder financial abuse.
The woman told authorities that she had sold her Los Angeles home in 2008 for $600,000, moving into an apartment complex where she met the suspects, who gradually won her confidence and gained access to her bank accounts and investments. No befuddlement or impairment on the woman's part was to blame -- she was in good health physically and mentally. Rather, she was lonely.

It's easy for a charming outsider to insinuate himself into a lonely senior's life, says Maureen Symonds, director of programs for Senior Concerns of Thousand Oaks, Calif., which provides services to the elderly and to their families. One day the new friend needs something -- a quart of milk, perhaps -- but he's misplaced his cash. "OK if we use your debit card, Gladys?" he asks. "What's your pin number? Tell me, and I'll just punch it in." Symonds says exactly this happened to a close friend of hers.
"A week later, $50,000 was gone," she says.
Often as not, the thief may be a family member, says Dr. Judy Yates, affiliated with Senior Concerns. She works with a local Financial Abuse Specialist Team to investigate allegations of financial fraud against the elderly. Such FAST teams exist on the county level in California and other states.
She describes an all too common situation: Grandma needs help living on her own, so her family assigns a grandson or granddaughter the job of living with her and buying groceries. The grandchild is put on grandma's checking account or given access to her debit card.
"Next thing you know," says Yates, "the grandson buys a car to take grandma to and from the doctor -- except it's not a car, it's a monster truck."
If drugs enter the picture and the grandchild's habit needs subsidizing, grandma's accounts may be called into service.
How widespread is this kind of crime?
"It hard to get our hands on real numbers," says Sharon Merriman-Nai, co-manager of the National Center on Elder Abuse at the University of Delaware.
No single entity keeps tabs on the total number of crimes or the sum of money stolen. Experts believe, though, that for every case that gets reported, a dozen more do not, either because the perpetrator doesn't get caught or because the victim is too ashamed of being duped to contact authorities.

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Study of seven Alzheimer's risk factors

27 July, 2011

“Half of all Alzheimer’s disease cases could be prevented by lifestyle changes such as exercise, eating healthily and not smoking”, the Daily Mail has today reported. The newspaper says that around 820,000 people in Britain suffer from dementia, half of whom have Alzheimer’s disease.

The estimate is based on a large, well-conducted review that looked at how seven lifestyle-related risk factors relate to the risk of Alzheimer’s disease. The review determined how strongly the risk factors, which included obesity and smoking, were associated with Alzheimer’s disease and the proportion of people worldwide and in the US whose condition could be attributed to these factors.

The study found that approximately half of all cases of Alzheimer’s disease were associated with one or more of the risk factors - diabetes, midlife high blood pressure, midlife obesity, depression, physical inactivity, smoking and low education. Although this important research updates knowledge on potential risk factors for Alzheimer’s disease, it should be stressed that associations between these lifestyle factors and Alzheimer’s does not mean that they cause the disease. Also, the study did not specifically look at the UK population, therefore we cannot tell what proportion of UK cases might be linked to these factors. Ideally, these individual risk factors will now be fully investigated through high-quality trials.

Where did the story come from?

The study was carried out by researchers from the University of California, USA. The research was funded by the Alzheimer’s Association and the US National Institute on Aging. The study was published in the peer-reviewed medical journal, The Lancet Neurology.

Newspapers have reported that there potentially could be a 50% reduction in cases of Alzheimer’s, based on the study’s calculations. However, the study’s estimates of incidence and risk factors that were used to derive this figure are based on global and US rates of risk factors that may not be specifically attributable to a UK population.

What kind of research was this?

This was a systematic review that investigated how seven potentially modifiable risk factors affected the risk of developing Alzheimer’s disease. The seven risk factors included diabetes, midlife hypertension (high blood pressure), midlife obesity, smoking, depression, physical activity and cognitive inactivity/low educational attainment.

It should be noted that in this case the term ‘risk’ does not necessarily mean that a factor causes Alzheimer’s disease - it relates to the chance of people in different groups having Alzheimer’s disease. For example, when examining the risk associated with smoking it would examine the proportion of smokers and non-smokers with Alzheimer’s disease, but this does not necessarily mean that Alzheimer’s disease is directly caused by smoking.

The researchers performed a systematic search to find previously published systematic reviews and meta-analyses that had assessed the associations between these risk factors and Alzheimer’s disease or dementia. A systematic review objectively collects information from all relevant studies on a topic, and is therefore the best way to find risk factors associated with a disease. It can be used to determine overall effect by pooling the results from individual studies.

However, as the included studies may vary in their design and study populations, there can sometimes be a large degree of variation in the findings of individual studies, known as ‘heterogeneity’. A systematic review and meta-analysis therefore needs to calculate the heterogeneity of the included studies to ensure that its results are meaningful.

The researchers wanted to provide an updated summary of several modifiable risk factors for Alzheimer’s disease. They also wanted to estimate how reducing the number of people with each risk factor would affect the number of people who go on to have Alzheimer’s disease. This is important information for developing prevention strategies for Alzheimer’s disease.

What did the research involve?

The researchers first decided which risk factors to assess. Their final list was diabetes, hypertension, obesity, present smoking, depression, cognitive inactivity and physical inactivity. They decided not to look at diet owing to the variability in dietary factors studied and the absence of data on prevalence of dietary habits.

The researchers searched the Cochrane database (a scientific database of systematic reviews) and the scientific database PubMed. They looked for systematic reviews and meta-analyses, written in English and published between 2005 and 2011, which had examined the associations between these risk factors and Alzheimer’s disease or dementia.

Systematic reviews on risk factors tend to report their findings in terms of ‘relative risks’, which express the risk of a disease in people with a risk factor relative to people without this risk factor (e.g. smokers vs. non-smokers). Three of these “relative risk” calculations include Relative Risk (RR), Odds Ratios (OR) and Hazard Ratios (HR).

For their calculations of the association of each risk factor with Alzhiemer’s disease, the researchers used the best combination of risk calculations from all of the systematic reviews included in their review. If there had been no meta-analysis performed in previous reviews, the researchers performed their own. Relative risk estimates for Alzheimer’s disease were used when available; otherwise RR estimates for dementia were used.

Dementia is the term used to describe the symptoms of impaired brain function (e.g. memory loss and confusion) that occur in Alzheimer’s disease and other types of dementia with different causes. Alzheimer’s disease is a specific diagnosis with characteristic symptoms and suggestive signs that can be identified using brain imaging, although effective diagnosis in living patients is made based on excluding all other causes (e.g. vascular dementia). However, Alzheimer’s can only be definitively diagnosed by performing an autopsy.

The researchers wanted to calculate a measure called the Population Attributable Risk (PAR), which takes into account the prevalence of a given risk factor within a population as well as the strength of its association with a particular disease. For example, they would estimate the PAR associated with diabetes by calculating the risk of Alzheimer’s disease associated with diabetes, and looking at how many people within a population have diabetes.

In order to calculate PAR values for each risk factor, the researchers needed to estimate the prevalence of each risk factor. To do this they searched PubMed, Google and the US census website to estimate the present worldwide prevalence, as well as prevalence in the US. The researchers also made a calculation of the combined PAR for all of the risk factors together, expressing how many cases of dementia in total could be attributed to these seven risk factors.

The researchers then estimated the total number of AD cases attributable to risk factors by multiplying the PAR estimates by the current prevalence of AD.

What were the basic results?

It is important to remember that a PAR value represents the proportion of people with a disease in a given population who can attribute their disease to a particular risk factor. However, it assumes that there is a causal relationship, which may not necessarily be the case. In this case, it is not clear whether the risk factors assessed can directly cause Alzheimer’s disease or whether they are just associated with the condition.

The researchers presented their calculations for the worldwide population and the US population. For the worldwide population, 33.9 million people are estimated to have Alzheimer’s disease:

• Diabetes Mellitus: 6.4% of people have diabetes mellitus; it raises the risk of AD by 39% relative to people without diabetes. The PAR for diabetes is 2.4%, which means that 826,000 cases of AD are attributable to diabetes mellitus.
• Midlife hypertension: 8.9% of people have midlife hypertension; it raises the risk of AD by 61% relative to people without midlife hypertension. The PAR for midlife hypertension is 5.1%, which means that 1,746,000 AD cases are attributable to midlife hypertension.
• Midlife obesity: 3.4% of the world’s population are obese in midlife; it increases the risk by 60% relative to people who are not obese at this time. The PAR for midlife obesity is 2.0% which means that 678,000 cases of AD are attributable to midlife obesity.
• Depression: 13.3% of the world’s population suffer from depression; it increases the risk by 90% relative to people who are not depressed. The PAR for depression is 10.6%, which means that 3,600,000 cases of AD are attributable to depression.
• Physical inactivity: 17.7% of the world’s population is physically inactive; it increases the risk by 82% relative to people who are physically active. The PAR for physical inactivity is 12.7%, which means that 4,297,000 cases of AD are attributable to physical inactivity.
• Smoking: 27.4% of the world’s population smoke; it increases the risk by 59% relative to people who do not smoke. The PAR for smoking is 13.9%, which means that 4,718,000 cases of AD are attributable to smoking.
• Low education: 40% of the world’s population have low education; it increases the risk by 59% relative to people who have higher education. The PAR for low education is 19.1%, which means that 6,473,000 cases of AD are attributable to midlife obesity.

The same relative risks were then applied to the US population. In the US the prevalence of risk factors differed. For example, the proportion of people with low educational status in the US is 13.3% compared to 40% worldwide. The prevalence of midlife obesity in the US was 13.1% whereas worldwide this was 3.4%. The researchers found that when they combined the PARs for all the risk factors, the combined PAR was 50.7% worldwide and 54.1% in the US.

The researchers estimated that if the prevalence of all seven risk factors were 10% lower, there would be 1.1 million fewer AD cases worldwide. If risk factor prevalence were 25% lower, AD prevalence could be reduced by over 3.0 million cases worldwide.

How did the researchers interpret the results?

The researchers said that “Up to half of AD cases are potentially attributable to modifiable risk factors. Furthermore, we expect these findings will be similar for all-cause dementia”. They said that their review had focused on AD because most of the meta-analyses they identified focused on AD. However, they said that “AD contributes to most cases of dementia, and risk factors for AD and all-cause dementia are generally similar”.

Conclusion

This systematic review has assessed the strength of the association between seven risk factors and Alzheimer’s disease (or dementia in general when specific information on Alzheimer’s was not available). The causes of Alzheimer’s are not firmly established but are likely to include a combination of factors rather than a single cause. The most likely risk factors are non-modifiable – increasing age and genetics.

This review attempted to establish the potential effects of reducing modifiable risk factors that can potentially be managed through lifestyle changes or medical treatments. The researchers’ calculations took into account how common each modifiable risk factor was in the population and the strength of its association with Alzheimer’s disease. Overall, the researchers suggest that around half of AD cases could be associated with one or more of the risk factors.

This review has strength due to its use of estimates of relative risk made from pooling and meta-analysing data from systematic reviews. This means it is more likely to give an accurate estimate of the associations, and is preferable to relying on an estimate taken from a single study. However, there are several limitations to this study, some of which the researchers highlighted:

• Population Attributable Risk is a measure that assumes that the risk factors cause Alzheimer’s disease. It is not known whether the assessed risk factors do indeed cause Alzheimer’s disease or are just associated with the condition.
• Some of the risk factors could be associated with each other. For example, obesity and diabetes (being overweight or obese is a risk factor for diabetes). Equally, the association between low educational level and AD may not reflect differences in the brain, but could reflect differences in lifestyle (e.g. smoking, diet and physical activity) dependent on the types of jobs people do and their salary.
• The prevalence of risk factors differed between the worldwide population and the US. It is not clear what proportion of the UK population would have each risk factor.
• The researchers said there were potentially other modifiable risk factors that were not included in their estimates. The researchers highlighted that they had omitted diet from their estimations.
• The researchers grouped Alzheimer’s disease and all-cause dementia data together in some instances. Despite similarities in the risk factors for a variety of conditions leading to dementia, the underlying pathology of Alzheimer’s differs from that of other forms of dementia.
• When the researchers calculated the number of cases of Alzheimer’s that could be avoided if the prevalence of risk factors were reduced, they did not take into account lowering the prevalence of some risk factors worldwide (e.g. smoking or obesity), which could lead to longer life expectancy. The greatest risk factor for Alzheimer’s disease is age. If more people live to their 80s or 90s, the prevalence of Alzhiemer’s may increase.

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Care for Mom & Dad

Taking care of  Mom & Dad!!!


Taking care of Mom & Dad is a blog site based in the Inland empire that focuses on quality health care for our parents. If you are fortunate enough to live a long and fruitful life there will probably come a day when you may require some assistance. A day when your muscles and bones may no longer work they way they used to and you will no longer be able to fully take care of yourself the way you did in your youth. When that day comes you will want to have someone around you that you can trust with your health and well being.

Unfortunately in this day in age the world moves so fast that most of us between our 9 to 5 jobs and hectic home life cant provide the type of assistance that is necessary to fully take care of our parents and we need to look outside of family for assistance. How do you find someone that you can trust? That is where we come in at taking care of  Mom & Dad we work hard to not only give you the leads to the most Quality Elderly care facilities in the Inland Empire and Palm Desert areas but we also bring you the most up to date articles in Health care for seniors and Tips to keep you and your parents healthy in your Golden years !!!




                          Hospital chiefs ‘failing the elderly’

HOSPITAL bosses were under fire today after an independent health watchdog found they were failing elderly patients.

After an unannounced visit by a team from the Care Quality Commission (CQC) to two wards at South Tyneside District Hospital in South Shields, a report has highlighted a lack of dignity and respect shown to some old folk.

The visitors also raised concerns at the quality of provision to patients at meal times.

South Tyneside NHS Foundation Trust has a month to formally respond to the criticism, but borough health chiefs hit back today calling the assessment “wrong and out of context”.

The CQC’s report highlighted a series of incidents which raised concern during April’s visit.

One patient in a single room on the elderly care unit was seen to call for assistance for 25 minutes – during which time he rattled a bedrail – before help eventually arrived.

A health care assistant was witnessed being “verbally sharp” to another elderly patient, while another patient was spotted being wheeled across a corridor to and from the toilet with bare legs and feet exposed.

The report did find that the majority of patients were satisfied with the care and treatment they received, but added that “people were not consistently treated with respect, and their dignity was compromised.”

Criticism was also made that napkins were no longer provided at meal times and that no condiments were offered to patients.

And although the report found patients were offered a “healthy balanced diet”, the report added: “Practices and support needed to be developed to improve the meal time experience.”

Today a spokesman for South Tyneside NHS Foundation Trust questioned the findings, saying: “After a positive visit to two ward areas, the CQC team provided the Trust with verbal feedback which was largely very positive and did not highlight any issues of immediate or significant concern.

                                                
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PET Imaging May Aid Alzheimer's Diagnosis

                                       

                                                   



There were significant differences in brain amyloid content exhibited on positron emission tomography of patients with normal and impaired cognition, suggesting PET might have a role in differential diagnosis of dementia, investigators in a multicenter study concluded.
The standard uptake value ratios (SUVRs) for the tracer florbetapir F 18 declined in linear fashion from patients with probable Alzheimer's disease to those with mild cognitive impairment to a group of older normal controls.
The pattern of differences in SUVR persisted in analyses of mean cortical florbetapir, proportion of patients with amyloid levels associated with Alzheimer's disease, and the proportion with any identifiable fibrillar beta-amyloid (P<1 x 10^-7 for all comparisons), as reported online in Archives of Neurology.
"The findings of our analysis confirm the ability of florbetapir-PET SUVRs to characterize amyloid levels in clinically probable Alzheimer's disease, mild cognitive impairment, and older healthy control groups using continuous and binary measures of fibrillar beta-amyloid burden," Adam Fleisher, MD, of the Banner Alzheimer's Institute in Phoenix, and co-authors wrote in conclusion.
"It introduces criteria to determine whether an image is associated with an intermediate-to-high likelihood of pathologic Alzheimer's disease or with having any identifiable cortical amyloid level above that seen in low-risk young controls."
In another article published online ahead of print, investigators reported a significant association between PET tracer uptake and amount of beta-amyloid in patients with normal-pressure hydrocephalus.
Amyloid imaging has shown promise as a means of evaluating patients with Alzheimer's disease and other forms of dementia and cognitive impairment. In particular, florbetapir has demonstrated potential for measuring cortical fibrillar beta-amyloid in preclinical and clinical studies.
Continuing the investigation of florbetapir-PET imaging, Fleisher and colleagues analyzed pooled data from four phase I-II trials of the imaging modality. They sought to determine whether measures of florbetapir-PET activity would allow them to assess global differences between diagnostic groups, confirm expected regional distribution patterns of beta-amyloid, and calculate the proportion of positive scans by various cutoffs for tracer activity.
The investigators considered an SUVR ≥1.17 as reflecting amyloid levels associated with Alzheimer's disease, a threshold based on antemortem PET and postmortem neuropathologic data from 19 patients.
Additionally, the investigators considered an SUVR greater than 1.08 as the threshold for signifying the presence of any identifiable beta-amyloid, a cutoff derived from a study of younger individuals who were not APOE ε4 carriers.
The analysis involved 68 patients with probable Alzheimer's disease, 60 with mild cognitive impairment, and a control group of 82 healthy individuals 55 or older.
The three groups differed significantly with respect to:

• Mean cortical florbetapir SUVR (1.39, 1.17, and 1.05)
• Percentage with beta-amyloid levels associated with Alzheimer's disease (80.9%, 40.0%, and 20.7%)
• Percentage meeting SUVR criteria for presence of any beta-amyloid (85.3%, 46,6%, and 28.1%)

Among participants in the control group, florbetapir activity increased linearly by age decile (P=0.05).
Additionally, of the 54 control participants with known APOE ε4 status, carriers had a significantly higher mean cortical SUVR for florbetapir than did noncarriers (1.14 vs 1.03, P=0.048).
Limitations of this study included choice of whole cerebellum as the reference region for SUVR calculations as this has not been verified to be better than other regions and potential for cohort selection bias.
The second study of PET imaging of amyloid involved seven patients who had undergone previous cortical biopsy related to normal-pressure hydrocephalus.
The investigators compared brain uptake of ¹⁸F-labeled flutemetamol PET imaging with immunohistochemical estimates of amyloid levels in the biopsy specimens.
Comparison of the two measures showed 100% agreement between PET and immunohistochemical data.
Regression analysis revealed a significant relationship between tracer uptake on PET and the immunohistochemical results (P=0.01).
"To our knowledge, these data are the first to demonstrate the concordance of ¹⁸F-flutemetamol PET imaging with histopathology, supporting its sensitivity to detect amyloid and potential use in the study and detection of Alzheimer disease," David A. Wolk, MD, of the University of Pennsylvania in Philadelphia, and co-authors wrote in conclusion.                


                

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PET Imaging May Aid Alzheimer's Diagnosis

                    

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PET Imaging May Aid Alzheimer's Diagnosis

to everything MedPage Today has to offer!

PET Imaging May Aid Alzheimer's Diagnosis