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. 

CHICAGO—Individuals whose diet includes more salad dressing, nuts, fish, poultry and certain fruits and vegetables and fewer high-fat dairy products, red meats, organ meats and butter appear less likely to develop Alzheimer's disease, according to a report posted online today that will appear in the June print issue of Archives of Neurology, one of the JAMA/Archives journals.

Editor's Note: This work was supported by federal National Institute on Aging grants. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

For more information, contact JAMA/Archives media relations at 312/464-JAMA (5262) or e-mail This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

ST. PAUL, Minn. – Memory and thinking skills may decline rapidly for people who have mild cognitive impairment, which is the stage before Alzheimer’s disease when people have mild memory problems but no dementia symptoms, and even more rapidly when dementia begins, which is when Alzheimer’s disease is usually diagnosed. The research is published in the March 23, 2010, print issue of Neurology®, the medical journal of the American Academy of Neurology.

“These results show that we need to pay attention to this time before Alzheimer’s disease is diagnosed, when people are just starting to have problems forgetting things,” said study author Robert S. Wilson, PhD, of Rush University Medical Center in Chicago.
 

The study involved 1,158 people living in Chicago with an average age of 79. A total of 149 of the participants had Alzheimer’s disease, 395 had mild cognitive impairment, and 614 had no thinking or memory problems.

Memory and thinking skills tests were given to the participants at the beginning of the study and again every three years. People took part in the study for an average of 5.5 years, and up to 11 years.

The thinking skills of those with mild cognitive impairment declined twice as fast each year as those who had no cognitive problems, while the skills of those with Alzheimer’s disease declined four times as fast as those with no cognitive problems.

At the beginning of the study, scores on a global cognition test ranged from an average of 0.5 for people with no thinking problems to 0.2 for people with mild cognitive impairment to -0.5 for people with Alzheimer’s disease. Scores declined by 0.04 per year for those with no thinking problems, by 0.09 for those with mild cognitive impairment, and by 0.17 for those with Alzheimer’s.

“The changes in rate of decline occur as the brain atrophies due to the disease, first mainly in the hippocampus during the initial symptomatic stage, referred to as mild cognitive impairment, then in the temporal, parietal and frontal cortex during the dementing illness phase of Alzheimer’s disease,” said David S. Knopman, MD, of the Mayo Clinic in Rochester, Minn., and Fellow of the American Academy of Neurology, who wrote an editorial accompanying the article.

The study was supported by the National Institute on Aging and the National Institute of Environmental Health Sciences.

KNOXVILLE – Early detection is key to more effective treatment for Alzheimer’s disease and other forms of cognitive impairment, and new research shows that a test developed at the University of Tennessee is more than 95 percent effective in detecting cognitive abnormalities associated with these diseases.

The test, called CST — for computerized self test — was designed to be both effective and relatively simple for medical professionals to administer and for patients to take.

Rex Cannon, an adjunct research assistant professor of psychology at UT Knoxville, and Dr. John Dougherty, an associate professor in the UT Graduate School of Medicine, worked with a team of researchers to develop CST. The impetus for the test came from data showing that 60 percent of Alzheimer’s cases are not diagnosed in the primary care setting, and that those delays lead to missed treatment opportunities.

“Early detection is at the forefront of the clinical effort in Alzheimer’s research, and application of instruments like CST in the primary care setting is of extreme importance,” said Cannon.

The CST is a brief, interactive online test that works to asses various impairments in functional cognitive domains – in essence, it’s a “fitness test” of sorts for the basic functions of thinking and processing information that are affected by Alzheimer’s and milder forms of cognitive impairment.

Cannon and Dougherty’s research, published in the April issue of the Journal of Alzheimer’s Disease and in an early online edition of the journal, showed that the CST was substantially more effective and more accurate in detecting the presence of Alzheimer’s and other forms of cognitive impairment in patients than other existing tests. The CST had a 96 percent accuracy rate compared to 71 percent and 69 percent for the tests that are currently in use.

Part of the goal in developing the test, according to Cannon, was to ensure that the test is useful in the primary care setting, where physicians may not have detailed training in recognizing cognitive impairments, but where an early diagnosis may do the most good for patients.

“Computerized testing is a developing and exciting area for research,” said Cannon, who noted that the test can provide an objective way to determine what diseases may affect the patient and provide information to begin treatments that can blunt the effects of Alzheimer’s.

Cannon and Dougherty, who also are affiliated with the Cole Neuroscience Center at the UT Medical Center, collaborated with Medical Interactive Education in developing the CST over the past two years.

The journal article is titled “The Computerized Self Test (CST): An Interactive, Internet Accessible Cognitive Screening Test For Dementia” and can be found at http://iospress.metapress.com/content/a1242×878323454x/fulltext.pdf.

Researchers at NYU School of Medicine have found that elevated cerebrospinal fluid levels of phosphorylated tau231 (P-tau231), a damaged tau protein found in patients with Alzheimer’s disease, may be an early diagnostic biomarker for Alzheimer’s disease in healthy adults. 

The study, published this month online by Neurobiology of Aging, shows that high levels of P-tau231 predict future memory decline and loss of brain gray matter in the medial temporal lobe—a key memory center. Prior studies found the medial temporal lobe to be the most vulnerable brain region in the early stages of Alzheimer’s disease, accumulating damaged tau proteins in the form of neurofibrillary tangles. Tangles are one of the signature indicators of Alzheimer’s disease, in addition to beta amyloid plaques.  

“Our research results show for the first time that elevated levels of P-tau 231 in normal individuals can predict memory decline and accompanying brain atrophy,” said lead author Lidia Glodzik MD, PhD, assistant research professor, Department of Psychiatry at the Center for Brain Health and Center of Excellence on Brain Aging at NYU School of Medicine. “Our findings suggest that P-tau231 has the potential to be an important diagnostic tool in the pre-symptomatic stages of Alzheimer’s disease.”  

Researchers evaluated 57 cognitively healthy older adults and studied the relationships between baseline cerebrospinal fluid biomarkers, longitudinal memory performance and longitudinal measures of the medial temporal lobe gray matter using magnetic resonance imaging, or MRI. Two years later, researchers found that 20 out of 57 healthy adults showed decreased memory performance. The group with worsened memory had higher baseline levels of P-tau231 and more atrophy in the medial temporal lobe. The higher P-tau231 levels were associated with reductions in medial temporal lobe gray matter. Authors concluded that elevated P-tau231 predicts both memory decline and medial temporal lobe atrophy. 

“Indentifying people at risk for Alzheimer’s disease is the necessary first step in developing preventive therapies,” said co-author Mony de Leon, EdD, professor, Department of Psychiatry, and director of the Center for Brain Health at the Center of Excellence on Brain Aging at NYU School of Medicine and research scientist at the Nathan S. Kline Institute for Psychiatric Research. “This study shows that Alzheimer’s disease pathology may be recognized in the normal stages of cognition. This observation may be of value in future studies investigating mechanisms that cause or accelerate dementia.”  

This study was done in collaboration with the Nathan S. Kline Institute for Psychiatric Research (NY), Applied NeuroSolutions, Inc. (IL), QiLu Hospital of Shandong University (China), The Sahlgrenska Academy at University of Gothenburg and Sahlgrenska University Hospital (Sweden) and the Institute for Basic Research (NY).  

Funding for this study was provided by the National Institutes of Health (NIH) in Bethesda, Maryland.