(CHICAGO) –  People with Alzheimer’s disease experience an acceleration in the rate of cognitive decline after being placed in a nursing home according to a new study by the Rush Alzheimer’s Disease Center. The study, published in the June issue of the American Journal of Psychiatry, finds that prior experience in adult day care may lessen this association.

The observational study involved 432 older persons with Alzheimer’s disease who were recruited from health care settings in the Chicago area. At baseline, they lived in the community and 196 participants were using day care services from 2 to 6 days a week for an overall mean of 1.7 days a week. At six month intervals for up to four years, they completed nine cognitive tests from which a composite measure of global cognition was derived.

On average, cognition declined at a gradually increasing rate for all participants.  During the study period, 155 persons were placed in a nursing home, and placement was associated with a lower level of cognition and more rapid cognitive decline.

Study participants who had previous adult day care experience fared better.   As level of day care use at study onset increased, the association of nursing home placement with accelerated cognitive decline substantially decreased.  Thus, people using day care 3 to 4 days a week at the beginning of the study showed no increase in cognitive decline upon nursing home placement.

“The findings suggest that experience in day care may help individuals with Alzheimer’s disease make the transition from the community to institutional residence,” said study author Robert S. Wilson, Ph.D., a neuropsychologist at the Rush Alzheimer’s Disease Center.

The study also found that a higher level of education was associated with accelerated cognitive decline upon nursing home placement. Yet, day care use markedly reduced the association of education with accelerated cognitive decline in the nursing home; further evidence that there is a robust association between day care experience and cognition during the transition to a nursing home.

The authors considered the possibility that nursing home placement is simply a sign of increased severity of Alzheimer’s disease. Yet, the nursing-home-related increase in cognitive decline was observed even after simultaneous control for cognitive and noncognitive indicators of dementia severity at the time of nursing home entry.

Alternatively, the increased cognitive decline upon placement may reflect difficulty adapting to an unfamiliar environment, consistent with clinical reports of increased confusion and behavior problems in those with dementia during acute hospitalization or trips away from home. Patients who had prior adult day care services may have been better able to adjust to the unfamiliar environment.

“The findings suggest that the transition from the community to a nursing home is particularly difficult for people with Alzheimer’s disease and that those planning for their care should consider the possibility that experience in adult day care programs may help prepare affected persons for institutional living,” said Wilson.

The research was supported by grants from the National Institutes on Aging, which leads the federal effort supporting and conducting research on aging and the medical, social and behavioral issues of older people, including Alzheimer’s disease and age-related cognitive decline.

The Rush Alzheimer's Disease Center is one of  approximately 30 NIA-supported Alzheimer's Disease Centers across the U.S. which conduct basic science, clinical, and social and behavioral research on dementia and AD. General information on aging and aging research can be viewed at the NIA's home website, www.nia.nih.gov.

Diagnosis of Alzheimer's disease decades before symptoms appear would soon be possible, courtesy a 30-second test being developed by scientists.

The simple procedure, which detects the signs of Alzheimer's in those in their 40s, brings the hope of routine screening for dementia in as little as two years.

Those found to have a tiny piece of tell-tale damage to their brains could take preventative measures such as changing their diet and taking more exercise.

Quicker detection would allow earlier treatment and, with the help of new drugs, some who test positive might never develop the disease.

"The study lays open the possibilities for screening, early detection and intervention. The earlier we can intervene with people vulnerable to eventual dementia, the greater the chances of preventing or delaying the disease onset," the Daily Mail quoted David Bunce, lead researcher, as saying.

Experts said that delaying the onset of Alzheimer's by five years could halve the number of people who die with the condition, currently a third of over-65s.

At the moment, diagnosis is based on memory tests or expensive brain scans.

By contrast, the computer procedure, based on a simple test of reaction times, would be quick and easy.

Bunce, of Brunel University, used brain scans to find tiny lesions, each smaller than a grain of rice, in the white matter of apparently healthy men and women aged 44 to 48.

Around 15% of the 428 tested had the abnormalities, which occurred in the brain's memory hub.

Although the research did not show that these people went on to develop dementia, the lesions were similar to those discovered in post-mortem examinations of Alzheimer's patients - and were found in the same part of the brain.

The professor saw that those with the brain lesions performed more erratically in a test of reaction times, which involved watching for one of two lights on a screen and hitting a corresponding button.

Those with lesions had a mixture of slow and fast reaction times, whereas those with healthy brains had either consistently fast or slow responses.

The September issue of Archives of Neurology, one of the JAMA/Archives journals, features research, which finds that a simple blood test could diagnose Alzheimer’s disease.

Researcher Sid E. O’Bryant, Ph.D., of the Texas Tech University Health Sciences Center found that an initial analysis suggests that biomarkers in blood serum can be combined with clinical information to accurately classify patients with Alzheimer’s disease.

“There is clearly a need for reliable and valid diagnostic and prognostic biomarkers of Alzheimer’s disease, and in recent years, there has been an explosive increase of effort aimed at identifying such markers,” the authors write as background information in the article.
 
“It has been previously argued that, because of significant advantages, the ideal biomarkers would be gleaned from peripheral blood.” Identifying biomarkers in the blood has several advantages over other methods of classifying patients with Alzheimer’s disease, including detecting biomarkers in the cerebrospinal fluid and neuroimaging. Blood can be collected at any clinic or in-home visit and most patients will agree to the process, whereas not all facilities can conduct lumbar punctures to obtain cerebrospinal fluid. Older patients may not consent to lumbar puncture and may not be able to undergo neuroimaging because of pacemakers or other health issues.

O’Bryant along with colleagues in the Texas Alzheimer’s Research Consortium analyzed proteins in the serum of 197 patients diagnosed with Alzheimer’s disease and 203 controls without Alzheimer’s disease. Statistical analyses were used to create a biomarker risk score, which included levels of a number of protein biomarkers, including fibrinogen (a clotting protein), interleukin-10 (associated with the immune system) and C-reactive protein (an inflammatory marker).

The final biomarker risk score correctly identified 80 percent of the individuals with Alzheimer’s disease and accurately excluded 91 percent of the individuals without Alzheimer’s disease. When other factors were also considered—age, sex, education and whether an individual had the APOE gene, which is associated with risk for Alzheimer’s disease—the score correctly identified 94 percent of the individuals with Alzheimer’s disease and accurately classified 84 percent of participants who did not have the disease.

“In addition to offering more accessible, rapid and cost- and time-effective methods for assessment, biomarkers (or panels of biomarkers) also hold great potential for the identification of endophenotypes within Alzheimer’s disease populations that are associated with particular disease mechanisms,” the authors write. In the current study, “a disproportionate number of inflammatory and vascular markers were weighted most heavily in the analyses.” The findings provide support for the existence of an inflammatory subtype of Alzheimer’s disease, they note.

“The identification of blood-based biomarker profiles with good diagnostic accuracy would have a profound impact worldwide and requires further validation,” the authors conclude. “Additionally, the identification of pathway-specific endophenotypes among patients with Alzheimer’s disease would likewise have implications for targeted therapeutics as well as understanding differential progression among diagnosed cases. With the rapidly evolving technology and the analytic techniques available, Alzheimer’s disease researchers now have the tools to simultaneously analyze exponentially more information from a host of modalities, which is likely going to be necessary to understand this very complex disease.”

ST. PAUL, Minn. – People with insulin resistance and type 2 diabetes appear to be at an increased risk of developing plaques in the brain that are associated with Alzheimer’s disease, according to new research published in the August 25, 2010, issue of Neurology®, the medical journal of the American Academy of Neurology.

Insulin resistance, or the stage diabetes, happens when insulin, a hormone in the body, becomes less effective in lowering blood sugar.

“Type 2 diabetes and Alzheimer’s disease are two epidemics growing at alarming levels around the world,” said study author Kensuke Sasaki, MD, PhD, with Kyushu University in Fukuoka, Japan. “With the rising obesity rates and the fact that obesity is related to the rise in type 2 diabetes, these results are very concerning.”

The study involved 135 people with an average age of 67 from Hisayama, Japan. The participants had several diabetes glucose tests to measure blood sugar levels. They were also monitored for symptoms of Alzheimer’s disease over the next 10 to 15 years. During that time, about 16 percent developed Alzheimer’s disease.

After the participants died, researchers examined their autopsied brains for the physical signs of Alzheimer’s disease, called plaques and tangles. While 16 percent had symptoms of Alzheimer’s disease while alive, a total of 65 percent had plaques.

The study found that people who had abnormal results on three tests of blood sugar control had an increased risk of developing plaques. Plaques were found in 72 percent of people with insulin resistance and 62 percent of people with no indication of insulin resistance. However, the study did not find a link between diabetes factors and tangles in the brain.

“Further studies are needed to determine if insulin resistance is a cause of the development of these plaques,” said Sasaki. “It’s possible that by controlling or preventing diabetes, we might also be helping to prevent Alzheimer’s disease.”

Squirting insulin up the noses of patients with early forms of Alzheimer’s disease showed signs of improving their memory, US researchers say.

For the study, researchers examined research data on 949 people with an average age of 79 from the Framingham Heart Study. At the start of the study, participants were free of dementia and were tested for depressive symptoms based on questions about general depression, sleep complaints, social relationships and other factors. A total of 125 people, or 13 percent, were classified as having depression at the start of the study.

The participants were followed for up to 17 years.

At the end of the study, 164 people had developed dementia with 136 specifically diagnosed with Alzheimer’s disease. Nearly 22 percent of people who were depressed at the start of the study developed dementia compared to about 17 percent of those who were not depressed, a 70 percent increased risk in those who were depressed. The 10-year absolute risk for dementia was 0.21 in people without depressive symptoms and 0.34 in people with depressive symptoms. The results were the same regardless of a person’s age, sex, education and whether they had the APOE gene that increases a person’s risk of Alzheimer’s disease.

“While it’s unclear if depression causes dementia, there are a number of ways depression might impact the risk of dementia,” said study author Jane Saczynski, PhD, with the University of Massachusetts Medical School in Worcester, MA. “Inflammation of brain tissue that occurs when a person is depressed might contribute to dementia. Certain proteins found in the brain that increase with depression may also increase the risk of developing dementia. In addition, several lifestyle factors related to long-term depression, such as diet and the amount of exercise and social time a person engages in, could also affect whether they develop dementia.”

Saczynski hopes the study, which is one of the largest and longest population based studies to date, helps clear up confusion over earlier studies that reported inconsistent results about the link between depression and dementia.

The study was supported by the National Institute on Aging, the National Institute of Neurological Disorders and Stroke, and the National Heart Lung and Blood Institute and was made possible by the continued participation of the study participants.

The American Academy of Neurology, an association of more than 22,000 neurologists and neuroscience professionals, is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as stroke, Alzheimer’s disease, epilepsy, Parkinson’s disease, and multiple sclerosis.

For more information about the American Academy of Neurology, visit http://www.aan.com.

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Patients in the early to moderate stages of Alzheimer’s Disease could have their cognitive impairment slowed or even reversed by switching to a healthier diet, according to researchers at Temple University.

In a previous study, researchers led by Domenico Praticò, an associate professor of pharmacology in Temple’s School of Medicine, demonstrated that a diet rich in methionine could increase the risk of developing Alzheimer’s Disease. Methionine is an amino acid typically found in red meats, fish, beans, eggs, garlic, lentils, onions, yogurt and seeds.

“The question we asked now as a follow-up is if, for whatever reason, you had made bad choices in your diet, is there a chance you can slow down or even reverse the disease or is it too late — that there is nothing you could do,” said Praticò.

As in the previous study, the researchers fed one group of mice a diet high in methionine and another group a regular, healthy diet. After five months, they split the group receiving the methionine-rich diet into two, with one group continuing the amino-heavy diet while the second switched to the healthy diet for an additional two months.

“At the end of the study, when we looked at these mice, what we found — very surprisingly — was that switching to a more healthy diet reversed the cognitive impairment that had built up over the first three months of eating the methionine-rich diet,” said Praticò. “This improvement was associated with less amyloid plaques — another sign of the disease — in their brains.

Pratico said that the cognitive impairment that had been observed in the mice after three months on the methionine-rich diet was completely reversed after two months on the healthier diet, and they were now able to function normally.

“We believe this finding shows that, even if you suffer from the early effects of MCI or Alzheimer’s, switching to a healthier diet that is lower in methionine could be helpful in that memory capacity could be improved,” he said.

Pratico stressed that this was not a drug therapy for curing MCI or Alzheimer’s, but that it did demonstrate that a lifestyle change such as diet can improve some of the impairments that have already occurred in the brain.

“What it tells us is that the brain has this plasticity to reverse a lot of the bad things that have occurred; the ability to recoup a lot of things such as memory that were apparently lost, but obviously not totally lost,” he said.

Pratico also emphasized that the researchers believe that in addition to switching to a healthy diet, patients diagnosed with MCI or Alzheimer’s also need a regiment of physical as well as mental exercises.

“This combination won’t cure you, but we believe, as we saw in this study, that it will be able to slow down or even possibly reverse the effects on the cognitive impairment,” he said.

The study, “Normalization of hyperhomocysteinemia improves cognitive deficits and ameliorates brain amyloidosis of a transgenic mouse model of Alzheimer’s disease,” is being published in the Journal of the Federation of American Societies for Experimental Biology . It was funded by a grant from the National Institutes of Health.

Copies of this study are available to working journalists and may be obtained by contacting Preston M. Moretz in Temple’s Office of University Communications at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Researchers from Boston University School of Medicine determined that excess abdominal fat places otherwise healthy, middle-aged people at risk for dementia later in life.  Preliminary findings suggest a relationship between obesity and dementia that could lead to promising prevention strategies in the future.  Results of this study are published early online in Annals of Neurology, a journal of the American Neurological Association.

 A 2005 World Health Organization (WHO) report estimated that 24.3 million people have some form of dementia, with 4.6 million new cases annually.  Individuals with dementia exhibit a decline in short-term and long-term memory, language processing, problem solving capabilities, and other cognitive function.  Clinical diagnosis of dementia is made when two or more brain functions are significantly impaired.  Symptoms of dementia can be attributed to irreversible causes such Alzheimer’s disease, vascular dementia, and Huntington’s disease, or caused by treatable conditions such as brain tumor, medication reaction, or metabolic issues.

For the current study, Sudha Seshadri, M.D. and colleagues recruited participants from the Framingham Heart Study Offspring Cohort.  The sample included 733 community participants who had a mean age of 60 years with roughly 70% of the study group comprised of women.  Researchers examined the association between Body Mass Index (BMI), waist circumference, waist to hip ratio, CT-based measures of abdominal fat, with MRI measures of total brain volume (TCBV), temporal horn volume (THV), white matter hyperintensity volume (WMHV) and brain infarcts in the middle-aged participants.

“Our results confirm the inverse association of increasing BMI with lower brain volumes in older adults and with younger, middle-aged adults and extends the findings to a much larger study sample,” noted Dr. Seshadri.  Prior studies were conducted in cohorts with less than 300 participants and the current study includes over 700 individuals.

“More importantly 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. Seshadri added.  The research showed the association between VAT and TCBV was most robust and was also independent of BMI and insulin resistance.   Researchers did not observe a statistically significant correlation between CT-based abdominal fat measures and THV, WMHV or BI.

 “Our findings, while preliminary, provide greater understanding of the mechanisms underlying the link between obesity and dementia,” concluded Dr. Seshadri.  “Further studies will add to our knowledge and offer important methods of prevention.”

"Sunrise's long-standing commitment to excellent memory care and highly trained staff is unparalleled," said Mark Ordan, chief executive officer for Sunrise. "This opportunity to certify Sunrise team members sets a new standard for care in assisted living communities that deliver the dignity and respect deserved by seniors and their loved ones." 

The Validation Method is a globally acclaimed protocol for care developed by Naomi Feil, M.S., A.C.S.W., who wrote her seminal book, Validation: The Feil Method in 1982. Her breakthroughs in dementia care take a holistic approach and are rooted in the understanding that unusual behaviors expressed by dementia sufferers are often due to a combination of cognitive, physical, and social losses, and represent an attempt to express unresolved feelings and emotions. Caregivers can deliver more ease, pleasure and dignity to those with dementia by using empathy to validate these individuals' desire to communicate. 

"Sunrise Senior Living's new certification is a major milestone for the Validation Method in America," said Ms. Feil. "Their leadership will have an enormous positive impact on the quality of care for seniors with memory loss and on the quality of training for care providers." 

Sunrise has long used techniques from the Validation Method to train team members and benefit its residents. This new opportunity for certification, however, will deepen its professional caregivers' understanding of the Validation Method and enhance their ability to care for residents as well as educate and support their family members. 

Sunrise's flagship memory care program, called Reminiscence, provides a safe and stimulating environment for individuals to enjoy esteem-building activities. In recent years, the company has added Terrace Club, designed for residents with early stages of dementia, and Edna's Place, for residents in advanced stage of dementia. 

"It is thrilling to be able to work more closely with Naomi Feil, whose groundbreaking work has taught us all that listening with empathy to those with dementia can reveal so much about our shared humanity," said Rita Altman, national director of Memory Care Services for Sunrise. 

"Much of the frustration and anxiety of trying to care for those with dementia can be eliminated once caregivers understand how to reestablish the lines of communication," said Altman, who is one of only four Validation Masters in the world. "The Validation Method is also in keeping with Sunrise's principles of service - encouraging independence, enabling freedom of choice, preserving dignity, celebrating individuality, nurturing the spirit and involving family and friends - and will enhance what has already been established at Sunrise allowing us to truly improve the quality of life for our residents."

In 2009, Sunrise created a new position in each community called a "Life Enrichment Manager." The sole responsibility of these trained professionals is to work with memory care residents and their families to create activities that enrich residents' lives and keep their cognitive functions active. 

"Our singular focus is on providing the services that best meet the needs of our residents - a focus that requires continual self-assessment, innovation and training," said Altman.