Alzheimer’s May Affect the Brain Differently in African-Americans than European-Americans

Alzheimer’s disease may cause different changes in the brain, or pathologies, in African-Americans than in white Americans of European descent, according to a study published in the July 15, 2015, online issue of Neurology®, the medical journal of the American Academy of Neurology.

“Because some studies suggest that Alzheimer’s disease is more common among older African-Americans than European-Americans, we wanted to see whether the brain changes caused by Alzheimer’s are different in these two racial groups,” said study author Lisa L. Barnes, PhD, with Rush University Medical Center in Chicago. “Studying how Alzheimer’s disease looks in the brain in individuals of different races may help us to further understand the disease and pinpoint strategies for prevention and treatment.”

The study included 41 African-Americans with a clinical diagnosis of Alzheimer’s dementia from the memory clinic, who had an autopsy of their brain performed after death. They were then compared to 81 deceased European-Americans who had Alzheimer’s dementia with the same level of disease severity and were of the same age, sex and education level. Researchers looked for typical signs of Alzheimer’s disease (plaques and tangles) as well as other brain changes that can cause dementia, such as infarcts (the brain changes associated with stroke) and Lewy bodies (associated with Lewy body or Parkinson’s disease). They noted whether people had just one pathology or more than one. They also looked at small and large blood vessel disease.

Almost all participants in the study had Alzheimer’s disease in their brain. Only about half of the European-Americans had pure Alzheimer’s disease pathology (no additional pathologies contributing to dementia) whereas the rest had Alzheimer’s disease pathology with either infarcts or Lewy bodies. In contrast, less than 25 percent of the African Americans had pure Alzheimer’s disease pathology. On the other hand, almost three-quarters (71 percent) of African-Americans had Alzheimer’s disease pathology mixed with another type of pathology, compared to 51 percent of European-Americans. Clinical Alzheimer’s disease in African-Americans was much more likely to involve pathologies other than Alzheimer’s disease pathology. African-Americans also had more frequent and severe blood vessel disease.

“Our study has important clinical implications because it may suggest a need for different types of Alzheimer’s prevention and treatments in African-Americans. Indeed, current Alzheimer’s drugs primarily target specific Alzheimer pathologies in the brain. Given the mixed pattern of disease that we see in African American brains, it will be important to develop new treatments that target these other common pathologies, particularly for African-Americans,” said Barnes.

Commonly Prescribed Dementia Drugs Could Cause Harmful Weight Loss

Medications commonly used to treat dementia could result in harmful weight loss, according to UC San Francisco researchers, and clinicians need to account for this risk when prescribing these drugs to older adults, they said.

The research is in the Journal of the American Geriatrics Society. (full access paywall)

Research: “Weight Loss Associated with Cholinesterase Inhibitors in Individuals with Dementia in a National Healthcare System” by Meera Sheffrin, Yinghui Miao, W. John Boscardin and Michael A. Steinman in Journal of the American Geriatrics Society doi:10.1111/jgs.13511

Image: Alzheimer’s disease and other dementias are prevalent, affecting one in six people over age 80. The image is for illustrative purposes only. Image credit: NIH.

Alzheimer’s and Dementia

The Difference Between Alzheimer’s Disease and Dementia

Many people (including myself) use the terms Alzheimer’s and dementia interchangeably. Alzheimer’s is a disease, whereas dementia is a group of symptoms. Alzheimer’s is one of the most common causes of dementia, but there are some types of dementia that are completely unrelated to Alzheimer’s.

Alzheimer’s Disease

There are over 520,000 people in the UK with Alzheimer’s, and over 5 million in the US. It is a physical disease that affects the brain, during the course of which structures called ‘plaques’ and 'tangles’ form in the brain due to the build up of protein. Connections between nerve cells are lost, and eventually nerve cells die and brain tissue is lost.

Symptoms

Alzheimer’s is a progressive disease (as time goes on, more parts of the brain are damaged, more symptoms develop, and the symptoms are more severe). Alzheimer’s disease has common symptoms, but it is important to remember that everyone is unique: no two people are likely to experience Alzheimer’s the same way.

For most people, the earliest symptoms are memory lapses, particularly learning new information and recalling recent events. Long-term memory is often unaffected during the early stages of the disease.

Memory lapses can show itself in ways such as:

  • losing items around the house (keys, glasses, etc.)
  • forgetting people’s names
  • struggling to find the right word in a conversation
  • forgetting about recent conversations or events
  • forgetting appointments or anniversaries
  • getting lost in a familiar place or on a familiar journey

As the disease develops, the sufferer can go on to develop problems with other aspects of thinking, reasoning, communication, or perception:

  • language – struggling to follow a conversation or repeating themselves
  • visuospatial skills – problems judging distance or seeing objects in three dimensions; navigating stairs or parking the car becomes much harder
  • concentration, planning, organising – difficulties making decisions, solving problems, or carrying out a sequence of tasks (e.g. cooking a meal)
  • orientation – becoming confused or losing track of the day or date

In the earlier stages of Alzheimer’s, a person will often have changes in their mood. They may become anxious, irritable, or depressed. Many people become withdrawn and lose interest in activities and hobbies.

As the disease progresses, problems with memory loss, communication, reasoning, and orientation become more severe. The person will need more day-to-day support, either by someone moving in with them, or by moving into a nursing/care home.

Typical late stage symptoms include:

  • Delusions
  • Hallucinations
  • Agitation (restlessness, pacing, etc.)
  • Calling out
  • Disturbed sleep patterns
  • Repeating the same question
  • Reacting aggressively
  • Difficulties with everyday tasks (eating, walking, etc.)
  • Lack of awareness of what is happening around them
  • Increased fragility

These behaviours can be challenging for both the person and their carer. Eventually, the person will need help with all their daily activities.

The speed of progression of the disease, and the life expectancy of someone with it, varies. On average, life expectancy is eight to ten years after the first symptoms, though this varies, especially depending on the age of the person when they first developed Alzheimer’s.

Atypical Alzheimer’s

Sometimes, the earliest symptoms are not memory loss. This is called atypical Alzheimer’s, and occurs when a different part of the brain is attacked by the plaques and tangles than usual. It accounts for 5% of Alzheimer’s in those diagnosed over the age of 65, but is a far more common cause for those under the age of 65.

The atypical forms are:

  • Posterior cortical atrophy (PCA) – early symptoms include problems identifying objects or reading, even if the eyes are healthy, uncoordination (e.g. when dressing), or problems judging distances (e.g. when going downstairs)
  • Logopenic aphasia – the person’s speech may become laboured with long pauses
  • Frontal varient Alzheimer’s disease – symptoms include problems with planning and decision making, behaving in socially inappropriate ways, or not seeming to care about the feelings of others

Who Gets Alzheimer’s?

Age is the greatest risk factor for Alzheimer’s, with the disease mainly affecting people over the age of 65 (the risk of developing the disease doubles approximately every 5 years). However, early-onset Alzheimer’s disease affects about 40,000 people in the UK under the age of 65.

For reasons that remain unclear, twice as many women as men over 65 have Alzheimer’s, possibly down to women living, on average, longer than men, or the lack of the hormone oestrogen after menopause.

A member of your family having Alzheimer’s disease does not necessarily mean you will also develop the disease. There are a number of genes that can increase or decrease your chances of getting the disease, but a healthy lifestyle can also lower the chances. Taking regular physical exercise, keeping to a healthy weight, not smoking, eating a healthy balanced diet, and drinking only in moderation, especially from mid-life onwards, can lower your chances of developing Alzheimer’s. Leading an active lifestyle that combines regular physical, social, and mental activity will help lower the risk.

Medical conditions such as diabetes, stroke and heart problems, high blood pressure, high cholesterol, depression, and obesity in mid-life are all known to increase the risk.

Treatment and Support

There is currently no cure for Alzheimer’s (although I know personally that the Physics department at the University of St Andrews has found a possible cure that has yet to be tested on humans), but a lot can be done via drug and non-drug care, support, and activities to enable someone to live well with the condition.

Talking with a professional about their diagnosis can help. Talking therapies can help someone who is depressed or anxious, as well as counselling. There are drug treatments that can alleviate temporarily some symptoms, or slow down the progression in some people.

Keeping up with activities that they enjoy is beneficial, as well as exercising their mind with reading/puzzles. Reminiscing about the past can also be beneficial as the symptoms worsen. Agitation and aggression is likely to be caused by the person being in pain, misunderstanding what is happening, or by being frustrated or under-stimulated. Listening to music or doing an activity that the person enjoys can help fight this.

Support for carers is also important, as they are likely to find these behaviours distressing, especially in the later stages. When writing a character with Alzheimer’s, make sure you don’t forget about the characters around them.

Dementia

Dementia affects about 800,000 people in the UK. There are many similarities between Alzheimer’s and dementia, as Alzheimer’s is a common cause of dementia. It is a syndrome (group of related symptoms) associated with the decline of the brain and its abilities, including:

  • memory loss
  • thinking speed
  • mental agility
  • language
  • understanding
  • judgement

People with dementia can become uninterested in their usual activities, and have problems controlling their emotions. Social situations can be challenging, losing interest in socialising, and aspects of their personality may change. They can lose empathy for others, experience hallucinations, or make false claims or statements. As dementia affects a person’s mental abilities, they may find planning and organising difficult. Maintaining their independence can also become a problem, leading to them often needing a carer.

Other symptoms may include:

  • increasing difficulties with tasks and activities that require concentration and planning
  • depression
  • changes in personality and mood
  • periods of mental confusion
  • difficulty finding the right words

Most types of dementia can’t be cured, but if it is detected early there are ways you can slow it down and maintain mental function.

Mixed Dementia

Roughly 10% of people with dementia have more than one type at the same time, and this is called mixed dementia. The most common mix is Alzheimer’s disease with vascular dementia (problems with blood supply to the brain). The symptoms of this kind of mixed dementia are a mixture of the symptoms of Alzheimer’s and vascular dementia.

Extra Stuff

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'The Notebook’, starring Rachel McAdams and Ryan Gosling, has a major character who suffers from dementia. You will cry. I will judge you if you don’t.

~DP

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8 Nutrients to Protect the Aging Brain

Brain health is the second most important component in maintaining a healthy lifestyle according to a 2014 AARP study. As people age they can experience a range of cognitive issues from decreased critical thinking to dementia and Alzheimer’s disease. In the March issue of Food Technology published by the Institute of Food Technologists (IFT), contributing editor Linda Milo Ohr writes about eight nutrients that may help keep your brain in good shape.

1. Cocoa Flavanols: Cocoa flavanols have been linked to improved circulation and heart health, and preliminary research shows a possible connection to memory improvement as well. A study showed cocoa flavanols may improve the function of a specific part of the brain called the dentate gyrus, which is associated with age-related memory (Brickman, 2014).

2. Omega-3 Fatty Acids: Omega-3 fatty acids have long been shown to contribute to good heart health are now  playing a role in cognitive health as well. A study on mice found that omega-3 polyunsaturated fatty acid supplementation appeared to result in better object recognition memory, spatial and localizatory memory (memories that can be consciously recalled such as facts and knowledge), and adverse response retention (Cutuli, 2014). Foods rich in omega-3s include salmon, flaxseed oil, and chia seeds.

3. Phosphatidylserine and Phosphatidic Acid: Two pilot studies showed that a combination of phosphatidylserine and phosphatidic acid can help benefit memory, mood, and cognitive function in the elderly (Lonza, 2014).  

4. Walnuts: A diet supplemented with walnuts may have a beneficial effect in reducing the risk, delaying the onset, or slowing the progression of Alzheimer’s disease in mice (Muthaiyah, 2014).

5. Citicoline: Citicoline is a natural substance found in the body’s cells and helps in the development of brain tissue, which helps regulate memory and cognitive function, enhances communication between neurons, and protects neural structures from free radical damage. Clinical trials have shown citicoline supplements may help maintain normal cognitive function with aging and protect the brain from free radical damage. (Kyowa Hakko USA).

6. Choline: Choline, which is associated with liver health and women’s health, also helps with the communication systems for cells within the brain and the rest of the body. Choline may also support the brain during aging and help prevent changes in brain chemistry that result in cognitive decline and failure. A major source of choline in the diet are eggs.

7. Magnesium: Magnesium supplements are often recommended for those who experienced serious concussions. Magnesium-rich foods include avocado, soy beans, bananas and dark chocolate.

8. Blueberries: Blueberries are known to have antioxidant and anti-inflammatory activity because they boast a high concentration of anthocyanins, a flavonoid that enhances the health-promoting quality of foods. Moderate blueberry consumption could offer neurocognitive benefits such as increased neural signaling in the brain centers.

A doctor I interviewed for this story told me something that stuck with me. He said for every person with dementia he treats, he finds himself caring for two patients. That’s how hard it can be to be a caregiver for someone with dementia.

The doctor is Bruce Miller. He directs the Memory and Aging Center at the University of California, San Francisco. According to Miller, 50 percent of caregivers develop a major depressive illness because of the caregiving. “The caregiver is so overburdened that they don’t know what to do next,” he says. “This adds a huge burden to the medical system.”

This burden is going increase dramatically in the coming decade. By 2025, 7 million Americans will have Alzheimer’s disease, according to one recent estimate. Millions more will suffer from other types of dementia.

Can Technology Ease The Burden Of Caring For People With Dementia?

Photo Credit:  Lynne Shallcross for NPR

Earlier this year I took this picture of our #dementia #f1 #feminized #bluedream x #amnesia that was created by #loudfam in the #Tahoe area #2009ish it was a perfect blend of #California and #Europe. It was the first feminized seed in our line and to this day still my favorite feminized seed not just because of the stability. But, I don’t really like blue dream that much. It’s so linear in flavor and the dementia #phenotypes tend to have a #pungent nose burning lemon funk aroma to them. This pheno was selected by #mikeseeds and grown by #goldmemberog by @therealjamesloud

Strokes steal 8 years’ worth of brain function, new study suggests

Having a stroke ages a person’s brain function by almost eight years, new research finds – robbing them of memory and thinking speed as measured on cognitive tests.

In both black and white patients, having had a stroke meant that their score on a 27-item test of memory and thinking speed had dropped as much as it would have if they had aged 7.9 years overnight.

For the study, data from more than 4,900 black and white seniors over the age of 65 was analyzed by a team from the University of Michigan U-M Medical School and School of Public Health and the VA Center for Clinical Management Research. The results will be published in the July issue of Stroke and are available online.

Researchers married two sources of information for their analysis: detailed surveys and tests of memory and thinking speed over multiple years from participants in a large, national study of older Americans, and Medicare data from the same individuals.

They zeroed in on the 7.5 percent of black study participants, and the 6.7 percent of white participants, who had no recent history of stroke, dementia or other cognitive issues, but who suffered a documented stroke within 12 years of their first survey and cognitive test in 1998.

By measuring participants’ changes in cognitive test scores over time from 1998 to 2012, the researchers could see that both blacks and whites did significantly worse on the test after their stroke than they had before.

Although the size of the effect was the same among blacks and whites, past research has shown that the rates of cognitive problems in older blacks are generally twice that of non-Hispanic whites. So the new results mean that stroke doesn’t account for the mysterious differences in memory and cognition that grow along racial lines as people age.

The researchers say the findings underscore the importance of stroke prevention.

“As we search for the key drivers of the known disparities in cognitive decline between blacks and whites, we focus here on the role of ‘health shocks’ such as stroke,” says lead author and U-M Medical School assistant professor Deborah Levine, M.D., MPH. “Although we found that stroke does not explain the difference, these results show the amount of cognitive aging that stroke brings on, and therefore the importance of stroke prevention to reduce the risk of cognitive decline.”

Other research on disparities in cognitive decline has focused on racial differences in socioeconomic status, education, and vascular risk factors such as diabetes, high blood pressure and smoking that can all contribute to stroke risk. These factors may explain some but not all of the racial differences in cognitive decline.

Levine and her colleagues note that certain factors – such as how many years a person has vascular risk factors, and the quality of his or her education, as well as genetic and biological factors – might play a role in racial differences in long-term cognitive performance.

But one thing is clear: strokes have serious consequences for brain function. On average, they rob the brain of eight years of cognitive health. Therefore, people of all racial and ethnic backgrounds can benefit from taking steps to reduce their risk of a stroke. That includes controlling blood pressure and cholesterol, stopping or avoiding smoking, controlling blood sugar in diabetes, and being active even in older age.