Can poor vision predict dementia? Untreated, it's associated with cognitive decline

Poor vision that goes untreated is associated with cognitive decline, particularly Alzheimer's disease. Researchers from the University of Michigan, using Medicare data for 625 seniors, found those with vision problems who did not visit an ophthalmologist had a 9.5-fold increased risk of Alzheimer's disease.

”Our results indicate that it is important for elderly individuals with visual problems to seek medical attention so that the causes of the problems can be identified and treated,” says Mary Rogers, PhD. The types of vision treatment that were helpful in lowering the risk of dementia were surgery to correct cataracts and treatments for glaucoma, retinal disorders and other eye-related problems, she says. Rogers is a research assistant professor of internal medicine.

A theory about the association: visual disorders can interfere not only with normal mobility but other activities that may reduce the risk of Alzheimer's disease. These include reading, playing board games, other mentally stimulating activities and social networking.

The university news release.

The abstract from the American Journal of Epidemiology.

'I'm Still Here' tells us Alzheimer's does not mean life ends

It's the disease we dread the most, isn't it? We fear how Alzheimer's wreaks minds, steals memories and personalities. We don't want to be condemned to wandering in a fog. We translate a diagnosis to mean "the end."

But in fact, many people live 10 or 15 years with the disease. A diagnosis is just the beginning, and author John Zeisel argues that Alzheimer's is not the end of the world. His book, "I'm Still Here" (Penguin, $24.95) explains how to connect with someone who has dementia. Music, art, facial expressions and touch are abilities that don't diminish with time and can be the foundation for connection.

More than 5 million Americans are living with Alzheimer's (which represents from 60 to 80 percent of all dementias), and those numbers are set to explode as the Baby Boomers begin celebrating their 65th birthdays next year. So, the practical advice Zeisel offers is assisting a growing number of caregivers.

Though it makes perfect sense, how many of us think to introduce ourselves when greeting a loved one with Alzheimer's? This is done by sitting down next to the person, holding their hand, looking in their eye and saying, 'Hi, Mom, I'm your daughter Miriam, and I love talking to you about Oakland, where you were born.' This is in place of the "test" question, 'do you know who I am?' which may frustrate those we care about and will most certainly crush our spirits when we are reminded that, no, they don't.

Zeisel, who has a background in sociology and architecture, explains in his book how to build memory cues into living environments. He gives advice on preparing for visits with someone who has lost the knack for conversation. And, he reminds us of the importance of telling people with Alzheimer's that we love them.

"Alzheimer's is not the end of the world"
article from The Guardian

Science increasingly links exercise with cognition

I have an appreciation for running. When I'm injured or otherwise unable to run, I feel it--and not just physically. When I run, my mind recharges. It solves problems. It helps me think clearly.

Lenny Bernstein feels similarly. He is the author of an article about how a growing body of evidence links exercise with mental acuity. As a runner, he experiences that cognitive boost, and he writes in The Washington Post : "The tantalizing question for those of us in middle age and beyond (I am 52) is whether this short-term cognitive benefit can be replicated over the long haul. Can exercise help keep our minds sharp? And if so, can it help delay or prevent the truly terrifying mental deterioration of dementia, most commonly seen as Alzheimer's disease?

"Researchers studying both animals and humans increasingly say the answer is yes."

OK, we're not entirely there yet. The link has been observed.

Dr. John Ratey's book, "Spark, the Revolutionary New Science of Exercise and the Brain," ($24.99, Little, Brown and Company) gives lots of examples. It says aerobic exercise has been shown to be as effective as antidepressants; that women who exercise, lower their chances of developing dementia by 50 percent; that a revolutionary fitness program helped put one U.S. school district of 19,000 kids first in the world in science; and that exercise has been shown to spark new brain-cell growth.

"The evidence is incontrovertible: aerobic exercise physically transforms our brains for peak performance," Ratey's promotional materials say. "The major implication is that exercise not only keeps the brain from rotting, but it also reverses the cell deterioration associated with aging," the doctor told the newspaper.

The Washington Post article.

Clinical trials: Should you participate?

Alzheimer's disease and related dementias are still pretty much mysteries. We do not know what causes them. We do not know how to treat or prevent them. The drugs we have treat some symptoms, but not long-term.

Twenty years ago, long before dementia took over his life, my Dad told me about an extraordinary research project that began in 1986. Catholic nuns at Notre Dame had agreed to be studied and tested by researchers from the University of Kentucky. Upon death, all 678 of the sisters agreed that their brains would be analyzed and stored in a laboratory. All of this was in an effort to provide some Alzheimer's answers.

Lots of other studies are underway, that are not so involved. One that I'm aware of looks at whether Gammagard, a drug already used for immune disorders, can preserve thinking abilities in people with mild to moderate Alzheimer's. I found 18 studies having to do with frontotemporal dementia that are currently recruiting people through the U.S. Institutes of Health's clinicaltrials.gov website--which you can search for studies on other types of dementia.

If you or a loved one qualifies for a clinical trial, should you participate? It's something to discuss with your healthcare provider. The National Cancer Institute gives some guidelines, most of which could apply to any trial for any disease. Some things to ask:

How long will the trial last?

Where is the trial being conducted?

What treatments will be used, and how?

What is the main purpose of the trial?

How will patient safety be monitored?

Are there any risks involved?

What are the possible benefits?

What are the alternative treatments, besides the one being tested in the trial?

Who is sponsoring the trial?

Do I have to pay for any part of the trial?

Will I be compensated?

What happens if I am harmed by the trial?

Can I opt to remain on this treatment, even after termination of the trial?

Many people who choose to participate do so for altruistic reasons. Though they may reap some benefit, the real good comes from the incremental contributions they may make toward solving the mysteries of the brain.

Understanding dementia, from the Cleveland Clinic

Understanding dementia

Nine tips on caring for your aging parents

Lots of Baby Boomers transition into caring for aging parents. First you're doing their shopping. Then taking them to medical appointments. Soon, making sure bills get paid on time.

Personal finance expert Eric Tyson says "the best way to deal with this important life transition is to plan ahead for the impact the change will have on your parents, while not allowing these changes to take away from your own quality of life."

Easier said than done, right?

Tyson's new book, written with Bob Carlson, includes suggestions about how to help--without turning efforts into a depressing, full-time endeavor. They include:

1. Leverage other's experiences. Find others who have dealt with similar issues, through outreach coordinators or social workers at local senior centers. You may even discover support groups that are helpful. Also, speak with people you already know. You may be surprised how many friends and family members have been down the same road.

2. Ask for professional help. Tap social service agencies, which exist at all levels of government and are rarely advertised.

3. Invest in their health. Be proactive rather than having to react after a problem becomes evident. Focus on a concern that their health be the best it can be.

4. Get your parents' affairs in order. Contemplating one's mortality usually isn't enjoyable, but it's important to have a completed will and estate plan. "Although you may not have the slightest selfish interest in inheriting some of their money and assets, other family members may have a different take on your intentions," Tyson explains. "Be sensitive to their feelings and privacy regarding their finances and what happens with their estate upon passing."

5. Examine housing and medical care options. Be careful not to leap to conclusions about what is best for the situation.

6. Use caregiver agreements. In many families, younger members help care for older members for at least a brief period. Families should pay attention to the details and rules regarding this care partly to ensure they receive maximum benefits and partly so each member will feel he or she is treated fairly.

7. Separate living spaces if parents are moving in. Many families find that this will help set boundaries and cause less interruption of family time by the care needs of an elderly relative.

8. Take care of your family. It's easy to feel overwhelmed, between work and other commitments and caring for an elderly parent. But don't forget your immediate family, your spouse and children.

9. Take care of yourself. The best givers often tend to really neglect their own needs and their own health.

Another reason to maintain healthy weight: science connects belly fat and dementia

Being overweight or obese in your 30s puts you at greater risk for developing Alzheimer's later in life, says preliminary research from Boston University's School of Medicine. A study involving 730 subjects showed those with pot bellies in their 30s were more likely to have smaller brains by their 50s--which is associated with a greater risk for dementia.

"Our data suggests a stronger connection between central obesity, particularly the visceral fat component of abdominal obesity, and risk of dementia and Alzheimer’s disease,” Dr. Sudha Seshadri, an associate professor of neurology, told The Money Times. "While preliminary, (our data) provide greater understanding of the mechanisms underlying the link between obesity and dementia."

She told WebMD that the deep fat is the culprit. "We found that subcutaneous was not [significantly] associated with any adverse effect on the brain volume, whereas visceral fat was clearly associated with smaller brain volume." The link was also strong between those with a higher body mass index, and between those with a higher waist circumference.

Article in The Money Times

Story in WebMD

Read the abstract yourself

18 months later: physically healthy -- but my how that neuropsychological test was accurate

My Dad amiably answered the doctor's questions, even though the answers he provided were wrong. When asked to extend his arms, or draw shapes on paper, my Dad complied.

On the sidelines of the exam room in this geriatric psychiatrist's office in October 2008 at a medical center in downtown Dallas, I watched my Dad fail what I have since learned was a neuropsychological test. My Mom sat on my right. My then 10-year-old son sat on my left, and we all watched quietly. We encouraged husband/Dad/Grandpa with reassuring smiles and nods. But we all recognized he was not doing well.

My son stayed with his Grandpa in a waiting room while the doctor gave his assessment. It was most clearly frontotemporal dementia. He explained what that is. He mentioned some signs of Parkinson's disease, too. He told us Dad would likely live from 18 months to 3 years.

Which kind of knocked the wind out of us.

Physically, my Dad is so healthy. He was then, and he remains so now, 18 months later.

It would be easy--indeed, it was tempting--to dismiss the psychiatrist and the oddball "test" my Dad had "failed." But the doctor spoke with confidence about signs and symptoms we had not recognized previously. We still think back on things Dad said or did and wonder...was that the beginning of his decline? should that have signaled us that something was wrong with his brain? That gaze in his eyes? The appointments he showed up for a day early? The trouble he had hearing--or was it his comprehension that was off?

I asked the psychiatrist what would kill my Dad. He has this fatal disease, for which there is no treatment, but I wondered what would finally take my father down. Would his heart just stop? Would he just lapse into a coma?

The doctor explained that many people with FTD die after falls, or by choking on food, or by an out-of-control infection. They become incontinent. They forget how to swallow. It was both disconcerting and comforting to hear from a professional what lay ahead. My own subsequent research backed up every word.

So here we are, 18 months later. Dad very distinctly has that Parkison's gait. On most days, he is unaware of his loved ones, and I doubt that any pictures or memory cards I have sent him make any sense to him anymore--or that he can find them. I bet he still has his sweet tooth, but maybe not, (since some dementias steal taste, too.)

He used to fight the caregivers who tried to undress him for showers; now several of the female residents are on his arm. When we visited him once at Silverado where he lives now, Dad emphatically pointed out baboons in the trees outside his window. Since he managed a wildlife amusement park for several years, this "delusion" made sense. Sometimes I wonder if he still sees them. Or if FTD has replaced those delusions with others. He's also incontinent, a progression that adds $500 to the monthly bill.

And even though all of this was predicted by the doctor, even though we watched "Away From Her" and read Lisa Genova's "Still Alice," even though we prepared ourselves in the best ways possible.... sometimes I want to go back in time to that exam room and hear the doctor blame my Dad's confusion on his hearing, or a brain tumor. Something that could be fixed. Or if not fixed, treated. Or if not treated, immediately fatal. Anything but this lengthy deterioration that seems to be playing out just as the doctor predicted.

Cost of Alzheimer's: $20.4 trillion over 40 years

Cumulative costs of care for people with Alzheimer's disease from 2010 to 2050 will exceed $20 trillion, says a report from the Alzheimer’s Association. It also says that the number of Americans age 65 and older who have this type of dementia will increase from 5.1 million today to 13.5 million by mid-century.

“We know that Alzheimer’s disease is not just ‘a little memory loss. It is a national crisis that grows worse by the day,” says Harry Johns, President and CEO of the Alzheimer’s Association. “Alzheimer’s not only poses a significant threat to millions of families, but also drives tremendous costs for government programs like Medicare and Medicaid.” He refers to the disease as an "unfolding natural disaster" to which the government's response has been "stunningly neglectful."

The report, "Changing the Trajectory of Alzheimer’s Disease: A National Imperative," indicates that without disease-modifying treatments, total costs (not adjusted for inflation) of care for people with Alzheimer’s disease will climb from $172 billion in 2010 to more than $1 trillion in 2050. The cumulative yearly cost will reach $20.4 trillion.

Annual Medicare costs are expected to rise more than 600 percent--from $88 billion per year today to $627 billion in 2050. And, annual Medicaid costs will rise more than 400 percent--from $34 billion to $178 billion in the same time period.

A disease-modifying treatment that has the ability to delay the onset of Alzheimer's, or a treatment that slows the disease progression, could significantly improve the financial outlook.

“Today, there are no treatments that can prevent, delay, slow or stop the progression of Alzheimer’s disease,” Johns says. “While the ultimate goal is a treatment that can completely prevent or cure Alzheimer’s, we can now see that even modest improvements can have a huge impact.”

Read the full report yourself.

The story from Reuters.

Deciphering the role of plaques and tangles -- on the Huffington Post

Dr. Scott Mendelson, author of the book, "Beyond Alzheimer's: How to Avoid the Modern Epidemic of Dementia," is a psychiatrist in Roseburg, Ore. who writes for the Huffington Post.

I asked him about the debate among scientists about whether the "plaques" and "tangles" that are hallmarks of Alzheimer's are actually caused by the disease or byproducts of the neurodegeneration that takes place. And here is his reply:

"You ask a very interesting question. What appears to be the case is that the 'plaques and tangles' are both the cause and byproducts of the disease.

There is a big circle of damaging processes in the illness. Thus, for example, accumulation of amyloid plaque can cause inflammation and poor blood supply that can cause oxidative damage and other lesions. In turn, inflammation and oxidative stress can increase deposition of amyloid. Thus, the illness can begin with inflammation and oxidative damage, or with a genetic predisposition to amyloid deposition. There are many such 'circles' of damage in the illness than can be generated by different problems. I hope this oversimplified answer is helpful."

Read Dr. Scott Mendelson's "The Unfortunate NIH Report on Alzheimer's Disease"

Good news brewing: Caffeine in coffee seems to reduce amyloid-beta production in Alzheimer's

The caffeine in coffee may have the ability to slow Alzheimer's disease and other dementias, according to Portugese reseachers writing in The Journal of Alzheimer's Disease.

They told ScienceDaily that epidemiological studies showed an inverse relationship between chronic caffeine consumption and the motor deficits and neurodegeneration in Parkinson's disease. Later, similar studies showed a similar relationship between caffeine and Alzheimer's disease. The same has been demonstrated in animal models.

It's early, but researchers--Alexandre de Mendonça of the University of Lisbon and Rodrigo A. Cunha of the University of Coimbra--believe caffeine may prevent brain degeneration, play a role in improving thinking and memory, and protect against Alzheimer's.

Read the studies yourself, (for a fee.)

A dilemma for caregivers: How to occupy the time

My father's move to a memory care facility was much harder on us than it was on him. When he came to Silverado, he believed he ran the place. They placed him in an "office" to stuff envelopes, had him "lead" tours, allowed him to greet visitors and collect the mail from the mailbox at the street.

I fretted about how he would spend his days, and what I could do to help add some purpose.

A friend told me what helped her mom: a box (or cannister) full of memories written on paper. So I cut card stock into rectangles and typed memory after memory, a sentence or two each, and invited friends and relatives to do the same. Slowly we filled a plastic box the size of a shoe box with which--for a while--my Dad would not part. Of course they were all good memories. That was important. But to him, each time he read them, he relived those good times.

My Dad loved reading, but I knew he was no longer able to devour the Thomas Jefferson biographies he used to love. I struggled to find short stories that would hold his interest. I resorted to big coffee table books with photos he might like, and the "I Spy" series of children's books, (hoping he would not realize they were children's books.)

I'd send him letters and/or packages every other day, since I knew he would be getting the mail. But beyond that, from my distance, I was at a loss. Cynthia Green wrote recently in The New York Times' "The New Old Age" column about some ideas, and collected several from readers. Here are 10 of my favorite:

* Adapt a lifelong hobby--for instance, someone who loved cooking could help mash apples for applesauce; a gardener may work with planting small pots.

* Capitalize on interests--a golfer may enjoy watching videos of the game; a gardener may enjoy coffee table books featuring flowers, or even leafing through garden catalogs.

* Scrabble! Verbal skills may diminish, but this game is worth a try.

* Sort through a collection of buttons. They may tell stories about the clothing buttons came from, or comment on each button's characteristics.

* Jigsaw puzzles, the ones that are not too complicated. (You can have them made from a favorite photograph.)

* Sing the first line of a familiar song. They may sing the one that comes after.

* Create a photo book and/or photo DVD that they can look at and share with other residents whenever they want.

* Rhyming games. Have them come up with words that rhyme with a word you choose.

* Watch the cars go by, and start conversations based on what goes past.

* Painting. Potentially messy, but good way to stimulate creativity.

Some dementias rob taste sensation, too

We know that dementia robs our loved ones of memories and verbalization. Semantic dementia, which affects the temporal lobes, can also take away their ability to discern flavors, according to new research in the journal, Cortex.

Researchers from Washington University and City University London used flavored jelly beans in their study, which The Independent said "shows that the brain plays an integral role in unusual eating preferences and highlights how the brain manages and evaluates flavors and tastes."

"It's quite interesting and unexpected that one would find these sensory signals behaving in the same way words or music might behave," study researcher Jason Warren told MCNBC. "Flavor information is one example of a complex environmental signal that people can lose understanding about, it's part of a more general problem," he said.

Read the MSNBC story.

Read the Science Daily story.

Read the abstract in the journal, Cortex.

Grief poetry that leaves a nice feeling

The Dead, by Billy Collins

The dead are always looking down on us, they say,
while we are putting on our shoes or making a sandwich,
they are looking down through the glass-bottom boats of heaven
as they row themselves slowly through eternity.

They watch the tops of our heads moving below on earth,
and when we lie down in a field or on a couch,
drugged perhaps by the hum of a warm afternoon,
they think we are looking back at them,

which makes them lift their oars and fall silent
and wait, like parents, for us to close our eyes.

-from Kevin Young's collection, "The Art of Losing, Poems of Grief & Healing."

Forget-Me-Not Days are May 14 and 15

Donate money to the Alzheimer's Association during "Forget-Me-Not Days" and receive seeds to plant in your own garden. The fund-raiser brought in more than $229,000 in 2009.

This will be the eighth consecutive year that Bankers Life and Casualty Company, a national life and health insurer, has undertaken the fundraiser which puts volunteers in distinctive green aprons, handing out seed packets to raise awareness of the disease.

What a great idea.

These beautiful blueish-purple flowers will come back year after year. They're a pretty way to "carpet" an area of your garden. Plant them after the last frost, spacing them 4 to 5 inches apart and covering them with 1/8-inch of garden soil. They like the shade the best, must be kept moist, and in northern climates will require mulching over winter.

These are the flowers of remembrance, and of true love.

How to grow forget-me-nots from seed.

Certain about our times in Uncertain

They say it's the stomping grounds of the legendary Bigfoot, but our times at Caddo Lake on the Texas-Louisiana border never included a sighting. Our family camped in a rustic cabin in Uncertain, Texas on the banks of the swampy forest that is Caddo Lake. We did this during football season, for I remember listening to Cowboys games via radio. I remember hooking catfish. And traveling by boat to nearby restaurants. And how my Dad--who apparently explored the area extensively as a boy--could navigate without a map.

To understand what a big deal that is, you have to know Caddo Lake.

It's Texas' only natural lake. (Yes, all the rest are man-made.) It's the largest natural freshwater lake in the south, containing the largest cyprus forest in the world. Its trees are 400 years old. And they have a creepy beauty about them. It's a cinch to get lost within them, to look down one channel and convince yourself that's the way back to the cabin, only to discover you are deeper in trouble. That's probably what feeds the legend of Bigfoot. A person could easily disappear within, and survive upon, Caddo Lake.

We never got lost with Dad, though. Either he knew his way around, or he faked it well enough to get us where we were going.

I have good memories of our long weekends in Uncertain. And I was happy to see it made Texas Monthly's "bucket list" of 63 things all Texans should do before they die. I do not know if my Dad had his own personal bucket list, (though he did many bucket list-able things--Machu Picchu, scuba, Alaska) but I have no doubt if he did, Caddo Lake was on it.

The New York Times' "A passage into primeval on a bayou lake in East Texas"

Dementia destroys the father-daughter bond

"Do you have a boyfriend?" he asked me. He was about 84 years old and interested in a date.

Sitting before him with my young son on my lap, I gave him the bad news: "No, but I have a husband and two kids. And I am your daughter, Dad."

My father's confusion was the consequence of his battle with Alzheimer's disease. One day he recognized me, the next, maybe not. Though my brain could process that, my heart could not. No matter how realistic I tried to be about my father's decline and our awkward exchanges, I found it impossible to accept that he really didn't know me.
Kathy Tyrer writes in the Los Angeles Times about realizing that the father-daughter connection she had with her dad is gone. That's something to which I can relate.

In my case, it has been a gradual realization. Did our relationship disintegrate when he could no longer safely drive, and I was the one driving his car? Was it when he stopped saying my name or recognizing my voice? Or when I knew I could no longer seek his guidance?

If I lived close enough to visit at his memory care center, would that just prolong the process, make it more evident, more painful? Probably. Though, distance doesn't seem to make it easy. If I lived near my Dad, I could have transitioned if not from daughter to caregiver, at least to care helper or care over-seer, or even to daughter who dutifully visits.

From afar, I'm just daughter who reads about frontotemporal dementia and feels frustration and anger at how the disease has taken my Dad away from me.

3 important steps for adult children caring for parents, from Dr. Mom

5 ways to keep minds young, sharp -- and stave off Alzheimer's

What can we do to keep our brains healthy?

A new book by Paul David Nussbaum, a clinical neuropsychologist at the University of Pittsburgh School of Medicine, provides a recipe for a "brain health lifestyle."

"It does work," he says. "Research suggests if you engage in this type of proactive behavior, you build up brain reserves." A decade ago, science didn't understand that cellular connections in the brain continued to be made at any age, what Nussbaum calls "reserves."

Here's the recipe:

1. Physical activity. Did you know that 25 percent of blood flow from each heartbeat is used by the brain? That's why activity matters so much. Walking, aerobic exercise and dancing are good choices.

2. Nutrition. Our brains are comprised of 60 percent fat. To nourish them, we have to consume the right kinds of fats, unsaturated fats found in foods such as fish. Blueberries and spinach are also good choices.

3. Socialization. Brains that are isolated become lonely. It's important to stay integrated and involved, to have a reason for getting up in the morning.

4. Mental stimulation. We need to keep exposing our brains to things that are new and challenging in order to have a brain that develops brain cells. The more brain cells that we have that connect with each other, the more brain reserve we have. Those reserves can fight off dementia--not prevent it, not cure it, but fight it off.

5. Spirituality. Strong research indicates that chronic stress can lead to memory deficits and perhaps even structural problems in the brain. We combat this by relaxing, meditating and/or praying on a daily basis.

Nussbaum's book is called "Save Your Brain--5 Things You Must Do to Keep Your Mind Young and Sharp" (McGraw-Hill, $16.95.)

The Pittsburgh Post-Gazette story.

KDKA television interview with Nussbaum.

Poem about grief, healing

Kevin Young's "The Art of Losing, Poems of Grief and Healing" (Bloomsbury USA, $24) is an interesting collection of poetry, broken into sections: Reckoning, Regret, Remembrance, Ritual, Recovery and Redemption.

When a loved one has dementia, the stages of grief seem all out of whack. We cannot mourn a physical passing, but the person we so loved is--in many ways--gone. Sure, we see glimpses of the real person in the eyes, in familiar gestures, in quips. While our heart holds them dear, our mind mourns their impending passing. Anyway, maybe that's why I am drawn to a book such as this. One excerpt:


"The Reassurance" by Thom Gunn

About ten days or so
After we saw you dead
You came back in a dream.
I'm all right now you said.

And it was you, although
You were fleshed out again:
You hugged us all round then,
And gave your welcoming beam.

How like you to be kind,
Seeking to reassure.
And, yes, how like my mind
To make itself secure.

Spouse have dementia? Your risk increases

Married adults who have a spouse with dementia are much more likely themselves to develop dementia, says a study in the Journal of the American Geriatrics Society.

Why? Researchers theorize it could be because of the stress of being a caregiver or something about the shared environment of the couple.

Caregivers of people with dementia provide more assistance and report more personal sacrifices and stress than those who care for the physically-impaired elderly without dementia. Research has shown how that puts caregivers at risk for health problems and depression--but until now hadn't looked specifically at the risk for the caregiver developing dementia.

The study involved monitoring 1,221 married couples, who were intially symptom-free, for up to 12 years for onset of dementia in husbands, wives or both. The majority of individuals whose spouse developed dementia did not develop dementia themselves. However, a spouse's development of dementia meant the caregiving spouse had a six times increased risk of developing the same disease.

Researchers are not sure what factors make someone more vulnerable.

"Given the significant public health concern of Alzheimer's disease and other dementias, and the upcoming shift in population age composition, continued research into the causes of dementia is urgent," one of the researchers, Maria Norton of Utah State University, told HealthDay.

The Salt Lake Tribune story.

The Time Magazine story.

Searching for those who are wandering is not like looking for missing children

Wandering, confused dementia patients are becoming more frequent "missing person" cases than those of lost children. Numbers bear this out in Virginia, according to a New York Times story by Kirk Johnson. This demographic shift points out the need for retraining of public safety officials, who must "throw out just about every generally accepted idea when hunting for people who are, in many ways, lost from the inside out," writes Johnson.

Wanderers often follow fence or power lines, and tend to be drawn toward water. Calling out their name often does no good, since the people have often forgotten their names. But learning about their life can be helpful "because Alzheimer’s disease, the leading cause of dementia, works backward, destroying the most recent memories first.

"Wanderers are often traveling in time as well as space."

Johnson's article tells of World War II veterans traveling great distances believing they needed to report to base or the front lines, and of a man in Virginia who was lost for days until searchers learned he had been a dairy farmer long ago. The man had headed for a cow pasture not far from his home, believing it was time for the morning milking.

A retired FBI agent, Robert Schaefer leads two-day training sessions on how to look for dementia wanderers, who may take evasive action to avoid detection or be paranoid about authority figures, due to their disease. Schaefer cared for his wife for 15 years at home through her journey into Alzheimer's.

Schaefer answers reader questions.

This 4-minute video,

"Lessons from the Lost -- Searching for Alzheimer's Patients,"

is worth watching.

New book examines the middle-aged brain

Barbara Strauch's new book,"The Secret Life of the Grown-Up Brain" ($26.95, Viking) provides some good news about the state of human brains at middle age. They don't necessarily deteriorate, and they in many ways improve with age.

By the time we hit our 40s, our brains have created connections and pathways over time, and Strauch--the health editor at The New York Times--says studies show how humans and animals function better if we have background knowledge, if we know something about a situation before encountering it.

"By middle age we’ve seen a lot. We’ve been there, done that," she tells Tara Parker-Pope on the Times' "Well" blog. "Our brains are primed to navigate the world better because they’ve been navigating the world better for longer."

Is that fascinating, or what?

Parker-Pope asks Strauch (in a Q&A that's worth reading in its entirety) what a middle-aged brain does better than a younger brain.

Her answer: "Inductive reasoning and problem solving — the logical use of your brain and actually getting to solutions. We get the gist of an argument better. We’re better at sizing up a situation and reaching a creative solution. They found social expertise peaks in middle age. That’s basically sorting out the world: are you a good guy or a bad guy? Harvard has studied how people make financial judgments. It peaks, and we get the best at it in middle age."

National study underway: Can Gammagard preserve thinking abilities?

A national study is underway to determine if a drug used to treat immune deficiency and autoimmune disorders, Gammagard, can preserve thinking abilities in people with mild to moderate Alzheimer's disease.

Gammagard is made from human plasma and delivered through an intravenous infusion. It contains antibodies against beta-amyloid, which make up the plaques that develop in the brains of people with Alzheimers. A Syracuse neurologist is among the researchers participating in the GAP (Gammaglobulin Alzheimers Partnership) Study paid for by the National Institutes of Health and Baxter Healthcare Corporation, which makes Gammagard.

Find a research site near you.

To join the study, participants must have a mild to moderate Alzheimers diagnosis, be between 50 and 89 years of age and have relatively good health. You cannot enroll if you had cancer within the previous five years or if you take blood thinners.

Participants will continue to take their regular medications and will not know if they are assigned Gammagard through the study. Two thirds will receive the Gammagard infusions once every two weeks. The rest will take a placebo therapy.

After the first three infusions at an infusion center, participants will receive their infusions at their homes. The study continues for 18 months. It also involves office visits, regular blood work and five magnetic resonance imaging studies of the brain. The GAP Study pays for all costs.

Vintage objects can soothe those with memory troubles

One muggy, hot summer day in San Antonio, my Dad wore a khaki jacket with a stitched Six Flags emblem on the breast. He would not remove that jacket, no matter that his face was red and sweat beads covered his forehead.

We were at Fiesta Texas, in typical blazing heat, and we couldn't reason with him to peel down to the T-shirt he wore beneath. So we conspired to stand near a ride that splashed. If he got drenched--along with the rest of us, of course--surely Dad/Grandpa would remove the jacket. It worked.

We've joked about his attachment to that jacket ever since.

Recently, I've come across an explanation for why--maybe--Dad is so attached to his Six Flags jacket.

The health group Bupa Australia says it has evidence that providing famliar objects from the past can help settle dementia patients. The objects they're talking about are clothes lines, laminated kitchen tables, vegetable gardens and other items that people of a certain generation may appreciate.

Don't you bet certain music,
television shows and recipes
could have similar effects?

Maryann Curry, Bupa's group director of nursing, said there was anecdotal evidence that providing familiar objects from the past did help to settle patients and the company was examining just how significant a benefit it could be, particularly for patients who tended to aggression and hostility.

Maryann Curry, the group's director of nursing, told The Sydney Morning Herald that the pleasant experience might only last a minute or two, but the benefits in patient wellbeing lingered for some time until it was overridden by another sensory experience. "Their facial expression actually changes. We often see in their faces the joy of that moment. They are comfortable in that moment," she told the publication.

For many American Baby Boomers, vintage objects may be the laminated kitchen tables and the clotheslines. For my Dad, that vintage object is his Six Flags jacket.

The connection between hormone replacement therapy (estrogen) and Alzheimer's

Can estrogen help or hurt a woman's chances of developing Alzheimer's or another dementia?

Scientists are debating just that, and the concept of neuroprotective effects of the hormone remains controversial. Some research suggests it's protective, some that it's harmful depending on the age of the woman and the type of menopause (natural or surgical.)

Dr. Walter Rocca of the Mayo Clinic gives a concise description of "the timing hypothesis" in his abstract for Neurodegenitive Diseases, March 2010.

"Timing" refers to the time at which estrogen supplements are delivered--before, during or after menopause.

Rocca's team reviewed studies already published on the matter and, in some cases, reanalyzed data. They concluded that the neuroprotective effects of estrogen depend on age, type of menopause and the stage of menopause.

They found research suggesting that estrogen could be protective for women taking it in the premenopausal years, commonly before age 50; and also for women in the early postmenopausal phase (commonly from 50 to 60 years of age.) But they found recent trials that showed estrogen treatment initiated in the late postmenopausal phase (ages 65 to 79) led to an increased risk of dementia and cognitive decline.

A 2006 study in Menopause, the Journal of the North American Menopause Society, made the same suggestions--but also said more research is necessary.

The New York Times Magazine recently published a story called "The Estrogen Dilemma" in which the timing hypothesis was mentioned.

What mountaineering and Alzheimer's have in common

Alan Arnette reports on the people attempting to summit Mount Everest, and other mountains. He describes himself as a passionate amateur mountaineer and says Alzheimer's research is important to him, personally, because the disease took his mother in August 2009.

His climbing blog is soliciting votes (not money, just votes) to help raise money for the Cure Alzheimer's Fund. Pepsi is running the contest, and the cause that generates the most votes will receive a $250,000 donation. Wouldn't it be cool to have that money go toward Alzheimer's research? (Vote directly, here. Watch a 1:44-minute clip about the fund, below.)

I stumbled on Arnette's blog--and voted, of course--because I've been trying to keep track of a Central New York doctor who is climbing Everest and hoping to summit on May 17. Read about Dr. Manoj Vora, here.