The Tangled Neuron

Exercise, Blood Flow and Alzheimer's

Summary:  A new study by Northwestern University researchers details the biochemistry of how reduced blood flow to aging brains might contribute to Alzheimer’s.  Regular exercise is the best way to improve that blood flow.

Have you made a New Year’s resolution to improve your diet and exercise?  If so, it might reduce your risk of Alzheimer’s.  A growing number of studies link lifestyle factors such as poor diet and lack of exercise to dementia, but it’s unclear exactly how these factors might contribute to the plaques and tangles some researchers think are responsible for the disease.

Robert Vassar, Ph.D.

A new study by Dr. Robert Vassar and his colleagues at Northwestern University sheds light on one mechanism by which lifestyle might contribute to Alzheimer’s pathology.  They conducted a complex series of experiments to show that reducing the amount of glucose available to brain cells sets off a chain reaction that increases beta amyloid, the protein involved in Alzheimer’s plaques. 

Video Book Review: The Myth of Alzheimer's

The The Myth of Alzheimer's is one of those books you read quickly and then process in the back of your mind over a longer period of time.  I read it more a year ago.  After many conversations with the authors, Peter Whitehouse and Danny George, I'm still mulling it over.  The video below reflects some of my thoughts at the end of 2008, three years after my father died.

Podcasts on Medicare, Medicaid and Alzheimer's

Sean Scott, an elder law attorney here in Tampa Bay, hosts a new podcast called Age with Confidence.  During his weekly podcasts, Sean and his guests cover topics like Medicare, Medicaid, Veteran’s benefits, caregiving and memory loss.

Last week, I visited Sean’s office.  Our talk about how people with mild memory loss can live a good life became podcast #3.

You can listen to our discussion and other Age with Confidence podcasts for free through iTunes or download them from the Age with Confidence site.

Potential Alzheimer's Drug Fails in Phase 2 Trials

Another potential Alzheimer's drug failed in Phase 2 trials.  The drug, MK-0677, increases levels of a hormone called insulin-like growth factor.  Scientists had hoped that increasing levels of that hormone would decrease levels of the beta amyloid protein some think causes Alzheimer's, and would thereby slow the progression of the disease.

In a trial involving over 400 people with mild to moderate Alzheimer's, those taking MK-0677 did no better than those taking a placebo.  It doesn't appear that the researchers tried to measure whether beta amyloid levels actually decreased.

Fading From Memory

When I started The Tangled Neuron, I quickly became part of a small circle of bloggers whose parents had dementia.  Many of them had TWO parents with dementia.

Mike Pritchard’s parents were diagnosed with Alzheimer’s three years apart.  Since July 2006, Mike has updated Fading From Memory with exquisite posts about helping to care for his mother and father in Sydney, Australia.  His dad died in September, and now his “mum” has followed. 

Mike’s careful account of the end of his parents’ lives made us think about love, family life, and the meaning of it all.  I hope he keeps writing.

Generic Razadyne: Price Decrease for Alzheimer's Drugs?

When my father started taking Aricept (a cholinesterase inhibitor) a few years ago, it cost my parents $138 per month.  When his doctor added Namenda, their monthly cost for just those two medicines was well over $200.

The price of cholinesterase inhibitors may be coming down soon, at least in the U.S.  This is because the Food and Drug Administration (FDA) has approved four companies’ applications to offer generic versions of Razadyne (galantamine).  Based on testing for “bioequivalence,” the FDA believes that these generic versions have the same therapeutic effects as branded Razadyne does.

Balance and Memory Loss (Part 2): Can Physical Therapy or Exercise Help?

In my last post, I wrote that some people with cognitive problems also have balance problems, and that many of them think these problems could be related.  Recent research at Rush University seems to confirm that view:  scientists there found that “impaired motor function” is increased in people with mild cognitive impairment, and is related to their risk of developing Alzheimer’s.

If you have both memory loss and balance problems, can physical therapy improve your balance?  “There are fierce proponents of this postulate,” says Joseph Friedman, MD, Director of the NeuroHealth Parkinson's Disease and Movement Disorders Center in Warwick, Rhode Island and Clinical Professor at Brown University Medical School. “My own belief is that exercise of all types is useful and that therapy is therefore useful but ONLY if the exercise program is maintained.”  He says his patients with dementia are more likely to stick to their exercise routine with caregiver participation and encouragement.

Balance and Memory Loss (part 1): Are Physical Symptoms Connected to Alzheimer's?

On the plane back from visiting my mom for Thanksgiving, I read Scott McCredie’s Balance: In Search of the Lost Sense.  An entire chapter in the book is devoted to improving cognitive function by improving balance.

The chapter in Balance is mostly about people with learning disabilities, and about the vestibular systems in the inner ears.  It is not about Alzheimer’s or other types of dementia.  But it got me to wondering about any connection between balance problems and memory loss.

Folic Acid and Other B Vitamins for Alzheimer's: An Update

A few months back, I wrote a really long post about whether folic acid, the synthetic version of vitamin B9, might prevent or treat Alzheimer’s.  The short answer was maybe not.

This fall, results of a University of California, San Diego trial of vitamins B9, B6 and B12 to treat Alzheimer’s added to the doubts about folic acid for treatment of memory problems.

Cholinesterase Inhibitors May Help Psychological Symptoms of Alzheimer's, At Least A Little

Researchers at Indiana University and at University of Kent and Kings College London in the U.K. recently combined the results of nine studies on whether cholinesterase inhibitors improve psychological symptoms in Alzheimer’s patients.  Cholinesterase inhibitors (Aricept, Exelon and Razadyne) are drugs prescribed to treat the cognitive symptoms of the disease.

Based on their “meta-analysis” of the combined results, the researchers concluded that these medicines appeared to reduce psychological symptoms in people with mild to moderate Alzheimer’s.  However, the positive effects were small enough that they might not make a difference for patients or caregivers.

The analysis did not show a positive effect for people with severe Alzheimer’s. 

Who Should Get Alzheimer's Drugs?

If you live in the U.K. and have been diagnosed with early stage Alzheimer’s, you might not be able to get Alzheimer’s drugs, at least not through the country’s National Health Service.  Based on cost-benefit analyses, the government agency NICE (National Institute for Health and Clinical Excellence) recommended in 2006 that cholinesterase inhibitors (Aricept, Reminyl, Exelon) should be offered only to people in the moderate stages of Alzheimer’s.  The agency also recommended against prescribing these drugs for the cognitive symptoms of people with vascular dementia, and against prescribing memantine (Namenda, Ebixa) outside of clinical trials.  These recommendations are still being appealed.

NICE considers the cost/benefit ratio for all new drugs (not just Alzheimer’s drugs) in deciding what will be covered by the National Health Service.  The New York Times reports that other countries, including the U.S., are looking at NICE’s methods.

With this as background, a recent commentary in the journal Nature seems ironic.  In the commentary, seven co-authors say the use of Alzheimer’s medicines and other cognition-enhancing drugs by cognitively “normal” people could benefit both individuals and society.  They call for more research to understand the potential benefits and harm that could result.

The Mom and Me Journals

For the past 15 years, Gail Rae Hudson has chronicled her adventures in caring for her mother, who had what Gail called "dementia lite."  I've been following her blog, the Mom and Me Journals, for more than three years now.  The site is full of caregiving tips, and, well, attitude. 

Gail's mom died this morning.  I'll miss hearing about her opinions and sense of humor, along with Gail's comments on caregiving and their life together.

To Whom I May Concern: Performing Alzheimer's Stories

I met Maureen Matthews at the Early Memory Loss Forum in Los Angeles last year.  Her program, "To Whom I May Concern" helps people with dementia tell their stories in scripted performances.  There's a nice profile of her work on lohud.com.

Richard Taylor on How to Encourage Someone With Dementia to Take a Shower

My friend Richard Taylor was diagnosed several years ago with dementia, probably of the Alzheimer’s type.  His book, Alzheimer's from the Inside Out, is a series of essays about how dementia changed his life, his relationships and his view of the world.

Richard, a retired psychologist, has found his calling in helping people with dementia and their families and friends navigate these changes. 

Check out Richard’s new website, and his thoughts on how to encourage someone with dementia to take a shower. Take some time to read his newsletters while you’re there.

Another Study Links Poor Diet and Alzheimer's

Another study has linked poor diet to Alzheimer's, at least for mice bred to develop the plaques and tangles in the brain associated with the disease.

Researchers at Laval University in Quebec found that feeding these mice a diet high in fat but low in Omega-3 fats increased the level of the proteins that make up plaques and tangles in the brain.  The scientists did not test whether this affected memory or performance in the mice.

Results of mouse studies don’t always hold up when applied to people.  But it can't hurt to eat a healthier diet in hopes of preventing Alzheimer’s and other diseases.

Lewy Body Dementia: The Importance of the Right Diagnosis

Every day is a great day for Harry Lewis.  “He’s so plugged into life that he wakes up singing 'You Are My Sunshine,'” says his wife Sue.  “He tells me ‘there’s nothing wrong with me – I feel great!’” she says.

It wasn’t always this way.  When he was diagnosed with Alzheimer’s several years ago, Harry was anxious and depressed.  When his doctors prescribed an antipsychotic medicine to control his hallucinations, he started having seizures.  There weren't any great days in the Lewis household back then.

Once Harry’s diagnosis was changed to dementia with Lewy bodies (DLB), Sue says, she was able to educate herself and work with his doctors to improve their quality of life.  Although there’s no treatment to stop progression of DLB, the medicines Harry takes have reduced his symptoms considerably.

   Angela Taylor

“Getting the right diagnosis and treating the many LBD symptoms correctly can make a significant difference in the quality of life of both the patient and his primary caregiver,” says Angela Taylor, board member and chair of the Science Committee for the Lewy Body Dementia Association.  Along with Sue Lewis and Joseph Friedman, M.D., she talks about why an accurate diagnosis is so important in Part 3 of the Tangled Neuron series on Lewy body dementia.

In addition to the right diagnosis and treatments, Sue thinks a good attitude is the key to living with the disease.  She focuses on the positive, and tries not to give in to what she sees as a common and deep-seated fear of dementia. 

“As I’ve grown as a caregiver and thrived through dementia, we’ve lost that mask - that bored look Harry used to have on his face,” she says.  “I’ve refused to let him be ‘unplugged.’  When he was mobile, I took him to concerts and potluck suppers, and everyone helped entertain him. He told everyone dementia made him a better dancer - he lost his inhibition!   Even now that he’s in a wheelchair, we’ve stayed social.  And I bought two guitars - it’s not pretty, but we play the blues.” 

Despite her positive attitude, Sue finds the fluctuations in Harry’s symptoms maddening, and she worries about how they would handle any change in the environment and routines she's created for her husband.  “I live with the fear that everything can crumble every day,” she says.  “What if our house burns down?  I can’t go live in a motel with Harry.  What if we need a new roof or a new furnace?  Harry couldn’t deal with that right now.”

Lewy Body Dementia: Hard to Diagnose

Harry Lewis was diagnosed with Alzheimer’s when he was 59.  Along with his problems with memory and thinking, he began to have hallucinations.  “Other people’s hallucinations are about small children, or maybe money,” his wife Sue says, laughing.  “My husband kept seeing a naked blond in the living room.” 

Harry’s doctor prescribed Zyprexa, an antipsychotic medicine, to control the hallucinations.  It seemed to work, but then Harry had two grand mal seizures in four days.  This kind of extreme sensitivity to antipsychotic medications is a symptom of dementia with Lewy bodies (DLB), and is one of the criteria doctors use to diagnose the disease.  On Harry's 60th birthday, his diagnosis was changed from Alzheimer’s to DLB.

Joseph Friedman, MD

It’s not unusual for people to be diagnosed with another dementia before getting a diagnosis of dementia with Lewy bodies.  In Part 2 of the Tangled Neuron series on Lewy bodies, Joseph Friedman M.D., Director of the NeuroHealth Parkinson's Disease and Movement Disorders Center in Warwick, Rhode Island and member of the Lewy Body Dementia Association Scientific Advisory Council, talks about why it’s so hard to diagnose this disease. 

A Physician Blogs About His Lewy Body Disease

I'm in the middle of posting a series of reports on dementia with Lewy bodies, so I was pleased to discover Diary of a Physician Psychiatrist with Lewy Body and Alzheimer's Dementia.  Dr. David Thomas was diagnosed with Lewy body disease in 2007, and brings both a patient and a physician perspective to his blog.

Make sure you check out the tab on "Knitting - A Manly Art."

Lewy Body Dementia: One Couple's Story

Twenty-some years ago, Sue Lewis gritted her teeth and walked into the VFW (Veterans of Foreign Wars) bar in her rural West Virginia town. It wasn’t her kind of place, but she had to pick up a girlfriend there because they were going to the movies.

Harry Lewis spotted her from across the room, and decided he wanted to get to know her. He bought her a drink. Not long after, they were married.

Harry and Sue Lewis

“On the surface, we were opposites,” Sue says. “He quit high school to go into the Navy, and he has very traditional values. I have a master’s degree in social work and am an old hippie. I grew up in Michigan in a house with six bathrooms; he grew up in West Virginia and had an outhouse. But I figured out, hey, this guy is intelligent – he stretched my thinking. We fed each other intellectually. We were so interesting to each other.”