What are the risk factors associated with Alzheimer's disease? Besides genes, scientists are trying to address whether lifestyle factors or behavioral characteristics also contribute to the disease. Several studies presented today at the Alzheimer's Association International Conference shed some light on the question.
Previous research suggests that continued, regular social interaction provides some protection against cognitive decline. Researchers in Sweden have found that being unmarried in midlife seems to increase the risk of Alzheimer's disease. Those people who were married or lived with a significant other at midlife had a 50% lower risk of having dementia in late life compared to those who lived alone.
A study from Israel found that people who ruminate, that is, they think repetitively about their problems, may be less likely to develop Alzheimer's. They found higher rates of the disease in people who said they tended to forget their difficulties easily compared to those who ruminate over difficulties. The researchers say they don't understand how ruminating is protective, but the study suggests that individual personality and cognitive styles may contribute to the risk of dementia.
Regular exercise has also been tightly linked to a lower risk of Alzheimer's disease. A Brazil study found that people with metabolic syndrome (those who have a higher risk of developing diabetes, hypertension and stroke) also have an increased risk of developing Alzheimer's. Regular physical activity can lower the risks for developing all of those conditions.
Finally, a study from France examined more than 16,000 people as they aged to determine which risk factors were most predictive of developing Alzheimer's disease. Nine percent of the people developed dementia. The most predictive variables were (in order): impairment in planning, memory problems exhibited on tests, subjective complaints about memory or cognitive failure, presence of the ApoE gene, use of psychotropic medication, severe head trauma, diabetes, stroke and problems with language. Smoking, not drinking and being female also predicted dementia.
People who carry a genetic risk factor for Alzheimer's disease can begin to have changes in the brain that are visible in a functional MRI scan before clinical symptoms appear, researchers from the Medical College of Wisconsin reported today from the Alzheimer's Assn. International Conference in Chicago. They examined 28 adults ages 45 to 65. Twelve carried the APOE-4 gene, which predisposes individuals to Alzheimer's disease, and 16 people did not carry the gene. The gene-carriers had no symptoms of the disease, but the study found that people with the gene had reduced function in parts of the brain that are crucial for memory processing. While surely distressing to those at high risk for the disease, the fact that brain abnormalities can be identified before the disease onset raises hopes that treatments can be applied to arrest the disease at an early stage.
In other news from the meeting, researchers from Myriad Genetics today discussed the failure of the phase-three trial of Flurizan. In the study of 1,649 people with Alzheimer's, those taking the drug declined on a cognitive measurement scale at the same rate as people not taking the drug. The study was a disappointment because Flurizan represented the first disease-modifying treatment to advance to a late-stage clinical trial. The study was also the largest and longest placebo-controlled Alzheimer's experiment ever completed. Several questions about Flurizan remain, however, researchers said. They don't know if the dose was high enough or if the intervention started early enough in the course of the disease development. Flurizan is a drug that targets the buildup of amyloid plaque in the brain. Other drugs in development also target amyloid but by a different mechanism.
Another method to detect the disease early shows promise. Researchers at Washington University in St. Louis showed that a small sample of spinal fluid can be used to detect an amyloid protein that is a hallmark of the disease. The study found an inverse relationship between presence of the protein in the brain and the level found in cerebrospinal fluid. The test may be useful to show the presence of amyloid in the brain regardless of a person's cognitive status.
And, finally, the artwork posted here is part of a collection by William Utermohlen, a Philadelphia-born artist who was diagnosed with Alzheimer's disease in 1995 and died last year. An exhibit of his work "Portraits From the Mind" is on display this week at the Chicago Cultural Center in conjunction with the Alzheimer's Assn. meeting. Utermohlen continued to paint even as he lost his ability to communicate verbally. The self-portrait above was completed in 1997 and the one below in 1999 when the illness had progressed significantly.
"Mr. Utermohlen's art visually demonstrates the progression of this devastating disease," said Harry Johns, president and chief executive of the Alzheimer's Assn. "Today, there are an estimated 5.2 million Americans currently living with Alzheimer's in the United States. Unless we find effective treatments, this figure is estimated to grow to as many as 16 million by 2050."
A study showing effective and ineffective ways of conversing with Alzheimer's patients was among the research presented today at the Alzheimer's Assn. International Conference in Chicago. The meeting, which began Sunday, is a gathering of leading researchers, doctors and patient advocates working on Alzheimer's disease. Booster Shots will bring you updates from the meeting through its conclusion Wednesday.
Among the many challenges for caregivers of Alzheimer's patients is how to stay engaged in a conversation with someone who may have trouble remembering events, expressing thoughts and following a conversation. But two studies show that caregivers can communicate effectively with patients if they avoid a few traps. UCLA researcher Jeanne Katzman studied the dinner conversations of 30 families in which one member had a recent diagnosis of Alzheimer's. She found that when the Alzheimer's patient said something that was unexpected or disrupted the normal flow of conversation, family members tended to continue their talk as if the person with Alzheimer's had not spoken -- thus taking the person with Alzheimer's out of the conversation. In other cases, family members would try to reword the comment, expand on it and bring it to a close, also eclipsing the Alzheimer's patient's contribution. The study will help researchers design programs that teach family members how to facilitate conversation and enable the patient to participate. Another study, from researchers at the University of Kansas, found that adults with Alzheimer's in nursing homes who are talked to like children are more resistant to care.
A diagnosis of Alzheimer's disease shouldn't mean the end of physical exercise. Indeed, researchers at the University of Kansas found that people in early stages of the disease who had better fitness ratings also had less atrophy in a part of the brain linked to memory. This is the first study using MRI brain imaging to link cardiovascular fitness with specific brain changes in the hippocampus. The hippocampus is one of the first areas of the brain to suffer damage in the disease progression. "These studies reinforce the need for increased awareness and education about the importance of living a brain-healthy lifestyle, including staying physically active," said William Thies, vice president of medical and scientific research for the Alzheimer's Assn.
On the treatment front, scientists reported on a phase-two study of a compound targeting early abnormal brain changes in a protein called tau in people with mild cognitive impairment. The compound was able to improve various measures of memory. The drug, called AL-108, is under development by Allon Therapeutics. Another study revealed that people who took a combination of insulin and oral anti-diabetes medication had fewer Alzheimer's related brain changes. Doctors have known for years that people with diabetes have a higher risk of developing Alzheimer's disease than non-diabetics. But studies have also shown that some people with diabetes have fewer Alzheimer's-associated brain lesions than non-diabetics. Researchers think that a better understanding of insulin signaling in the brain may lead to new treatments for Alzheimer's disease.
People with Alzheimer's might be able to protect their brain -- or their brain size at least -- by exercising their body.
A recent study of 121 people age 60 and older (about half of whom were in the early stages of the disease) found that, among those with early dementia, the less physically fit had four times more brain shrinkage, compared to healthy people their age, than their more athletically inclined counterparts. (Brain shrinkage is not good.) There was no connection between fitness levels and brain volume among those without dementia.
* information from the Mayo Clinic about more obvious ways that exercise can help people with dementia.
* a blog, Ask Dutchy, that offers practical suggestions for helping people with dementia and others needing long-term care.
* some strength, flexibility and balance exercises for people with Alzheimer's.
* and, of course, a link to the Alzheimer's Assn., which offers news, a list of resources and a substantial listing of local support groups and other resources.
There are few medications to treat Alzheimer's disease, and none that reverse the disorder or come without troubling side effects. The most that the two types of FDA approved drugs for the disease can offer, for some people, is a moderate slowdown in the worsening of dementia symptoms. But the price many pay in side effects from the drugs can be high: vomiting, diarrhea, loss of appetite, headache, confusion or dizziness.
An alternative to drug treatment might be to simply replace dim light bulbs with bright ones, and keep them on all day, according to a study in the Journal of the American Medical Assn.
Dutch researchers studied 189 elderly patients in assisted care facilities for 3.5 years. Half the group were exposed daily, from 9 a.m. to 6 p.m., to bright, fluorescent light, while the other half were exposed to dim lighting all day. Within each group, half were also given 2.5 mg of melatonin, a hormone that influences the sleep-wake cycle and is available in health food stores and drugstores without a prescription.
Melatonin alone helped people sleep, but increased daytime agitation and depression. But bright daytime light eliminated those consequences of melatonin. The combination of bright light and melatonin helped people sleep better, and when they woke, they were less likely to be depressed and agitated. After 3.5 years, bright daytime light reduced cognitive decline by 5%.
Those results in slowing the decline of Alzheimer's patients are similar to the modest results seen from prescription drugs. "The size of this effect is pretty close to the size of the effects of drugs currently marketed for the treatment of dementia," says Dr. Peter Roy-Byrne, professor of psychiatry at the University of Washington. Roy-Byrne did not participate in the study, but commented on it for the Web journal, JournalWatch.
So far, nothing has been found to cure Alzheimer's. But this simple, environmental approach may slow down the disease, and in the process give caretakers a bit of a breather.
Tami Dennis, who takes the word "skeptic" to previously uncharted territory, is editor of The Times' Health section. She's adamant that pitches promoting awareness days, weeks or months are, by their nature, non-stories. And, because she's an adult, she refuses to use words like "veggies," "tummy" and "yummy."
Rosie Mestel, Health section deputy editor, studied genetics before abandoning flies, fungi and DNA for health/medical writing. Her hero is the biologist Ernst Haeckel, whose jellyfish paintings inspired snazzy chandeliers. Her favorite toast-spread is Marmite, a British delicacy made of yeast extract. Her least-favorite word is "millenniums."
Susan Brink has made health and medicine her beat for 26 of her 28 years in the business. She’s covered a wide range of disease and health policy stories, and is always on the lookout for fresh angles. Few things make her happier than busting through preconceived notions to give readers an accurate view of people behaving as…well, real people.
Melissa Healy is a staff writer for the Health section reporting from Washington D.C. Healy's a veteran of The Times' National staff, having covered the Pentagon, Congress, poverty and social welfare, the environment, and the White House before shifting to Health in 2003. She writes frequently about mental health and human behavior, about federal health policy, prescription medication and ethics in medicine. More wonk than wellness freak, Healy chooses to believe in the health benefits of coffee and wine, and considers water a better work-out medium than beverage.
After a brief stint as a sports writer, Shari Roan turned to health journalism and has covered the topic for The Times for 18 years. She is the author of three books and the mother of two daughters, both teenagers who refer to her as a "health freak." She likes to jog, watch baseball and is very happy that dark chocolate contains some health benefit.
Jeannine Stein writes about fitness, sports medicine and obesity for the Health section. She’s a gym rat from way back and never met an elliptical trainer she didn’t like. Well, maybe one or two. She tempers exercise with a steady diet of reality television because she believes it’s all about balance.
People who carry a genetic risk factor for Alzheimer's disease can begin to have changes in the brain that are visible in a functional MRI scan before clinical symptoms appear, researchers from the Medical College of Wisconsin reported today from the Alzheimer's Assn. International Conference in Chicago. They examined 28 adults ages 45 to 65. Twelve carried the APOE-4 gene, which predisposes individuals to Alzheimer's disease, and 16 people did not carry the gene. The gene-carriers had no symptoms of the disease, but the study found that people with the gene had reduced function in parts of the brain that are crucial for memory processing. While surely distressing to those at high risk for the disease, the fact that brain abnormalities can be identified before the disease onset raises hopes that treatments can be applied to arrest the disease at an early stage.
Another method to detect the disease early shows promise. Researchers at Washington University in St. Louis showed that a small sample of spinal fluid can be used to detect an amyloid protein that is a hallmark of the disease. The study found an inverse relationship between presence of the protein in the brain and the level found in cerebrospinal fluid. The test may be useful to show the presence of amyloid in the brain regardless of a person's cognitive status.
There are few medications to treat Alzheimer's disease, and none that reverse the disorder or come without troubling side effects. The most that the two types of 
