New research adds further support to the idea that the higher your education level, the less likely you are to get Alzheimer’s disease and other forms of dementia.

The study found this to be the case even after adjusting for socioeconomic status and other medical diseases. [Education and dementia: what lies behind the association? 2007 Oct 2;69(14):1442-50. Neurology.]

The authors of the study conclude: “Higher educated persons may have a greater cognitive reserve that can postpone the clinical manifestation of dementia.”

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Last year I posted about the powerfully negative effects chronic stress has on your memory and brain. Now, a new study [Reference below] published in the June 12, 2007 journal of Neurology provides further evidence this is true by showing:

People who are chronically distressed are 40 percent more likely to develop Mild Cognitive Impairment (MCI) - a precursor to Alzheimer’s disease and other dementia syndromes.

These findings are consistent with dozens of earlier studies showing stress damages the hippocampus- the memory engine of the brain.

A related post relates how stress is sticky, and where in the brain it settles.

[Reference]: Chronic distress and incidence of mild cognitive impairment. R. S. Wilson, J. A. Schneider, P. A. Boyle, S. E. Arnold, Y. Tang, and D. A. Bennett. Neurology 2007 68: 2085-2092

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From a recent update posted on the Medscape Neurology section:

Researchers at the American Academy of Neurology 59th Annual Meeting presented preliminary results from a study showing that long term exposure to secondhand smoke alone increases your risk for dementia by about 30%.

If you’re interested in learning more about the potential mechansim by which cigarattes destroy your brain, click here to read this earlier post. 

Reference: American
Academy of Neurology 59th Annual Meeting: Abstract S01.005. April 28 – May
5, 2007.

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It is commonly said that "elephants never forget". From the website Elephant Voices:

Based on the evidence available, elephants seem to remember for years other individuals and places and learned skills. In experimental trials involving a large set of visual symbols and acoustic tones or commands captive elephants show exceptional ability to learn and retain information over long periods. Accounts by practised observers indicate that elephants are able to remember the voices (and perhaps scents) o individual people for over 12 years

How to explain this phenomenon? Recently came across some interesting research out of Caltech that looked at elephant brains with MRI technology:

The elephant has an unusually large and convoluted hippocampus compared to primates and especially to cetaceans.( MRI image above comes from the John Allman Lab at the California Institute of Technology).

In humans and other mammals, the hippocampus is the brain structure largely responsible for memory formation.

Within 5-8 years, I suspect neuroimaging technology will be far enough advanced that a quick 5 minute human brain scan will be able to assess hippocampal anatomy & connectivity, and rate a person’s:

1. Natural ability to memorize various pieces of information (semantic, episodic, procedural, etc…)
2. Susceptibility to develop Alzheimer’s disease and other types of dementia- decades before actual memory impairment sets in

On a further note regarding elephant intelligence, a recent study [Reference below] reveals that elephants can recognize themselves in mirrors- a sign of self-awareness.

To date, only 3 other animals have shown themselves capable of this task:

• humans
• dolphins
• apes

Reference: Plotnik JM, de Waal FBM, Reiss D. Self-recognition in an Asian elephant. Proc Natl Acad Sci U S A. 2006 Nov 7;103(45):17053-7

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Marijuana

This bit really caught me by surprise: Scientists at The Scripps Research Institute have found that the active ingredient in marijuana (THC) appears to be quite effective in preventing the brain buildup of amyloid plaque. Amyloid is one of the main pathologic markers for Alzheimer’s disease.

Additionally, the study found that THC also inhibits the enzyme acetylcholinesterase. This is the mechanism by which current Alzheimer drugs work to improve symptoms (but not reverse underlying disease process).

Kim Janda, PhD at Scripps notes:

While we are certainly not advocating the use of illegal drugs, these findings offer convincing evidence that THC possesses remarkable inhibitory qualities, especially when compared to AChE inhibitors currently available to patients

For a link to the article’s abstract, click here. To read the release on the Scripps Research Institute web site, click here.

Club Moss & Huperzine A

The National Institutes of Health is conducting a study to examine the effectiveness of Huperzine A, a natural chemical derived from an herb called Chinese Club Moss.

If you know someone with Alzheimer’s disease who may be interested in enrolling in this drug study, click here for a list of U.S. drug trial sites.

If you’d like to learn more about what Club Moss and Huperzine do in the brain, click here for an earlier smartkit post.

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Is the brain like the muscles in your body? Can it be trained with cognitive exercises to improve mental agility and sharpness as you get older?

Quite a bit of research has come out lately indicating that the answer to this question is a resounding ‘Yes’.

The most recent research I’ve come across is the ACTIVE study (Advanced Cognitive Training for Independent and Vital Elderly), published in the December issue of JAMA (reference below). The amazing findings indicate a mere 10 training sessions (each lasting 60-75 minutes) over a five week period was enough to significantly improve cognitive ability and brain power. Importantly, the brain boosting effect lasted more than five years.

The benefits were actually quite impressive. Dr. Sherry Willis, one of the chief authors of the study, notes: "The improvements seen after training roughly counteract the degree in decline in cognitive performance that we would expect to see over a 7-14 year period among older people without dementia".

The study included 2,832 participants over the age of 65.

For those over 50 looking for computer software that serves as a brain gym, check out our review of Mindfit brain trainig program.

JAMA. 2006;296:2805-2814. Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults.

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Back in medical school, I remember a professor teaching us older patients tend to overreport memory problems and don’t really have much insight into the true status of their memory ability.

Now, a recent study published in the journal Neurology indicates that this may not be true.

The study looked at 40 people over the age of 60 who complained of memory problems but still had normal performance on detailed neuropsychological testing (i.e. cognitive and memory testing). Interestingly, the researchers found these patients actually had a significant reduction in brain gray matter in several regions:

• Bilateral hippocampal areas (the hippocampus is critical for memory function)
• Bilateral frontal regions
• Several other cortical and subcortical regions

In addition to enhancing the credibility of a patient’s insight when it comes to memory function, this study also raises another very important issue: Detailed memory tests may not be very sensitive at picking up organic memory impairment

Reference: Older adults with cognitive complaints show brain atrophy similar to that of amnestic MCI. NEUROLOGY 2006;67:834-842

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Recent research out of the Rush University Alzheimer’s Disease center seems to indicate that loneliness- in the form of emotional isolation- appears to be a risk factor for Alzheimer’s disease.

As per the news release from Rush:

According to Wilson, loneliness is a risk factor for Alzheimer’s disease, not an early sign of the disease. Autopsies were performed on 90 individuals who died during the study. Loneliness during life was not related to any of the hallmark brain changes associated with Alzheimer’s disease, including nerve plaques and tangles, or tissue damaged by lack of blood flow.

The article was published in the February issue of the Archives of General Psychiatry. 2007;64:234-240.

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Andre Waters was an NFL defensive back for 12 years. During his playing years, he sustained multiple concussions. He committed suicide November 2006 at the age of 44.

The results of his brain autopsy have just been announced, and the pathologist from the University of Pittsburgh concluded that his brain cells had the appearance of an 85-year-old man with Alzheimer’s disease. The pathologist also contends that the severe brain changes were caused by the multiple concussions Andre Walters had while playing football.

There is little doubt in my mind that multiple concussions (even as few as 2 or 3) can seriously damage your brain and lead to cognitive impairment, personality changes, and depression. I’ve seen this scenario present itself many times in clinic. Importantly, even one concussion can take a significant toll on your brain power.

Despite the fact there’s been a large number of studies published that support this view, the NFL is in denial.

Unfortunately, this denial trickles down to high school and college athletics. With well over 300,000 concussions happening per year in the U.S., parents need to really think twice about letting their kids play contact sports like football and hockey.

And what most people don’t realize, interestingly, is that a concussion doesn’t always involve losing consciousness or passing out. If you develop any confusion or disorientation whatsoever, you’ve met the American Academy of Neurology’s criteria for having one.

[For further reading, Michael Kaplen has some good posts up on his blog about concussions and the NFL, as well as traumatic brain injury.]

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The headlines from the last few days would make you think so: “Folic Acid may boost brain power”, “Folic acid boosts minds of over-50’s”, “Folic acid improves memory in elderly”, “Folic acid boosts cognition in older adults”.

The truth, however, is that this new study published in The Lancet shows that folic acid provided cognitive benefits for those with high homocysteine levels. Patients (drawn from the Netherlands) that had normal homocysteine levels were not included in the study.

Is your homocysteine normal or elevated? If it is high, this study (along with several older studies) indicates your brain will likely benefit from folic acid supplementation.

Interestingly, however, there are many metabolic experts who believe that if your homocysteine level is at the upper limits of normal, there is still a benefit to be had from taking extra folic acid.

The metabolism of folic acid and homocysteine are closely intertwined. It has been shown that those who don’t consume enough folic acid will in turn have elevated homocysteine levels.

What are some good natural food sources of folic acid?

• Black-eyed peas, boiled, 1 cup: 210 mcg
• Lentils, 1/2 cup cooked: 179 mcg
• Beans, white, boiled, 1/2 cup 144 mcg
• Black-eyed peas, 1/2 cup cooked 120 mcg
• Broccoli, cooked, 1 cup 104 mcg
• Spinach, cooked, 1/2 cup 103 mcg
• Romaine lettuce, 1 cup 76 mcg
• Orange juice, 1 cup 75 mcg
• Wheat germ, raw, 2 Tbl 50 mcg
• Papaya cubes, 1 cup 53 mcg

[Source for Folate Food Content: Northwestern University]

The Lancet Folate study: Durga J, et al “Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomized, double blind, controlled trial” Lancet 2007; 369: 208-216.

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A study which appears in the January issue of Neuropsychology indicates that a simple blood test- checking for uric acid levels- may help predict risk of cognitive impairment in older adults.

Patients with high-normal uric acid levels were found to have lower scores on tests of:

• mental processing speed
• verbal memory
• working memory

The question remains whether readily available drugs that reduce uric acid levels (i.e., allopurinol, probenecid, sulfinpyrazone) may benefit brain function in older adults with high uric acid levels.

Interestingly, a diet rich in purine rich foods is thought to elevate uric acid levels. Purine rich foods include animal meats- particularly beef, pork, and lamb. Shellfish is also thought to be a purine-rich food.

While researchers don’t fully understand the underlying pathophysiology that may explain the correlation between high uric acid levels and impaired brain power, nonetheless, it is known that high uric acid levels do correlate with several dementia risk factors such as:

• type 2 diabetes
• high blood pressure
• atherosclerosis

Article: “Serum Uric Acid and Cognitive Function in Community-Dwelling Older Adults,” David J. Schretlen, PhD, Anjeli B. Inscore, PsyD, H. A. Jinnah, MD, PhD, Vani Rao, MD, and Barry Gordon, MD, PhD, Johns Hopkins University School of Medicine, Godfrey D. Pearlson, MD, Johns Hopkins School of Medicine, Hartford Hospital/Institute of Living, and Yale University School of Medicine; Neuropsychology, Vol 21, No. 1

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One of the most common reasons patients get upset with neurologists is when we tell them they should no longer drive. Most older folks are very independent, and when you take their car away from them, they are not happy. In fact, many become belligerent and act as if you’re personally out to get them.

The most common reasons for prohibiting driving include seizures, Parkinson’s disease, and dementia.

What is dementia? It is very broad term that encompasses all the hundreds of things that can lead to poor brain function. In addition to impairing memory and overall cognitive ability, dementia greatly diminishes reflexes and reaction time, visual-spatial processing, as well as hand-eye-leg coordination. And it is very common.

How common? It’s estimated that 5-10% of the population aged 65 years or older has it. My guess is that amounts to millions upon millions of unfit drivers.The scary thing, however, is that no one is doing anything about it.

The laws are incredibly strict when it comes to punishing and taking away licenses of people who get DUIs (driving under the influence of alcohol). And rightly so, of course. We don’t want them killing us or our children.
But what about the tens of millions of drivers over 65 that are demented? I believe they also represent a major road hazard, and need to have their licenses pulled.

Came across an article on physorg.com that recently notes:

Researchers at the Alzheimer’s Disease Research Center (ADRC) of Washington University School of Medicine in St. Louis and elsewhere have developed a three-hour workshop that trains health care providers to identify potentially unsafe drivers with dementia and to encourage appropriate retirement from driving.

This is all well and good, but the vast majority of primary care physicians are too busy taking care of medical issues to have to worry about this sort of thing, and many are not expert enough in neurological assessment to determine when “appropriate retirement from driving” should take place.

If a state can make laws prohibiting cell phone use while driving, why can’t they make laws subjecting everyone over 65 to another driving test?

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As strange as this may sound, currently, there is no good scientific test for Alzheimer’s disease. In other words, there is no specific blood test, spinal fluid test, or brain imaging study (MRI, CT, PET) that can definitely tell whether you have the disease or not.

The diagnosis mainly rests on the neurologist’s clinical impression, which is based on an interview, examination, as well as some blood tests and an MRI of the brain to rule out other conditions which may mimic Alzheimer’s. Many times, especially during the early stages of the disease, physicians are uncertain of the diagnosis. Families are told that more time is needed to observe the patient, to see how the disease process unfolds. This uncertainty can lead to frustration.

The only real way to be 100% certain of the diagnosis is to autopsy the brain, which of course is not a good option in a living person.

Things may have just changed though, as the UCLA School of Medicine has announced they’ve developed a PET scanning technique that seems to offer the promise of a definite answer.

While still experimental, the scan utilizes FDDNP, a radioactive tracer that binds to the plaques and tangles typically encountered in the Alzheimer brain. The PET technique then provides physicians an actual picture of how much and where this tracer shows up in the brain.

I’d say this is significant breakthrough, as we are now much closer to identifying which people are going to develop Alzheimer’s disease years before they become symptomatic (see a related post discussing the early signs of dementia).

Additionally, the new study will enable researchers to more rapidly develop effective treatments, since they’ll be able to more objectively see what drugs are effective and which ones aren’t.

The study was published in the New England Journal of Medicine, December 2006.

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Most everyone knows that when you develop Alzheimer’s disease, your memory begins to fail. Specifically, your short term memory begins to crumble. You may have a hard time remembering what you ate for dinner last night, or you may have a hard time recalling the details of a movie you saw a week ago. (Long term memory usually remains intact, so you can still remember kids you went to school with in 1st grade, and all the crazy things you and your neighborhood friends used to do while growing up.)

There are, however, other signs of dementia that may start before the short-term memory loss that are not so well known:

• Poor judgment and
• Changes in mood or behavior

The next time your parents (or grandparents) do or say things that manage to really upset you, take a step back and ask yourself: Could they have the very early stages of a dementia?

Let me share a little story. When I was about 9 or 10 years old, my mom took my brother and I to visit our grandparents. My dad’s parents, actually. It was my Grandma’s birthday, and we were going to give her this nice present my mom had picked out and wrapped. My dad wasn’t there, because he died when I was 5. And although his parents and my mom never really got along too well after his death, my brother and I were very close and used to see them 2 or 3 times a week.

When we arrived at my grandpa and grandma’s house to deliver the gift, we all went inside and wished grandma happy birthday. As she started to open the present on the kitchen table, however, she suddenly stopped. She backed away, and looked at my mom and told her she didn’t want it, and how she should return it to the store.

For a second, my mom looked puzzlingly at my grandma, and then slowly started to get incredibly angry. “How dare you tell me in front of the kids you don’t want our gift?” One word led to another, and before you know it, a full verbal fight had broken out. Voices were shouting, and then my normally sweet grandma did something entirely uncharacteristic and unexpected- she spit at my mom.

Within seconds, my mom went to go slap her. I’m not sure if she ever actually made contact, but I know she tried. My Grandpa rushed into the room and quickly urged her out of the house.

It was a disaster. My brother and I were very upset, and for about half a year, my mom never spoke to them, nor did she permit us our weekly visits.

Well, about 7 years later, my Grandma started to develop memory problems, and was finally diagnosed with Alzheimer’s disease.

In retrospect, I’m convinced that the birthday present fiasco, which caused quite a bit of emotional turmoil for everyone involved, was mainly due to the poor judgment and behavioral changes that can be seen in very early Alzheimer’s disease.

And I can tell you, after having seen thousands of patients and their brain MRI’s, and spoken with their families, these sort of things happen a lot. And the vast majority of the time, no one involved is aware of the true culprit- the pathologic changes of early dementia taking place in a loved one’s brain.

The end-of-year holidays are notoriously the most stressful times of the year for many. So as you head home for Christmas break, the next time your parents (or grandparents) do or say things that manage to really upset you, take a step back and ask yourself: Could it be due to the poor judgement and changes in mood and behavior that go hand in hand with very early stages of Alzheimer’s?

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Reading through the latest issue of Neurology Today, came across some interesting tidbits on how beneficial exercise