Veterans with stress disorder appear more likely to develop dementia

Older veterans with post-traumatic stress disorder are nearly twice as likely to develop dementia as those who do not have the disorder, according to a new study presented today at an Alzheimer's disease conference.

"These findings are important because PTSD has become a common consequence of combat and exposure to trauma," said Dr. Kristine Yaffe, the paper's lead author, in a statement.

Previous studies had found that 15% to 20% of military service members returning from Iraq and Afghanistan have developed post-traumatic stress disorder, but that research has not fully explored the potential risk the disorder holds for dementia, said Yaffe, chief of geriatric psychiatry at the San Francisco Veterans Affairs Medical Center and a professor at UC San Francisco.

In the study presented at the International Conference on Alzheimer's Disease in Vienna, Yaffe and her colleagues followed about 181,000 veterans age 55 and older in the VA's National Patient Care Database. About 30% of these veterans had post-traumatic stress disorder.

The researchers found that about 11% of the veterans with the disorder developed new cases of dementia over the seven-year study period, compared with about 7% of those who did not have a post-traumatic stress disorder diagnosis.

Even when researchers filtered out for potentially confounding factors such as other brain injuries and depression, the risk remained nearly double for the veterans with post-traumatic stress disorder.

Unfortunately, Yaffe said, researchers do not yet understand the relationship between the two disorders.

"It is critical that we identify the mechanisms," she said.

-- Jia-Rui Chong

Alzheimer's films chronicle the scope of the disease

"The Alzheimer's Project" kicks off this Sunday on HBO with a series of documentaries about this devastating disease that affects so many people.

The first doc up is "The Memory Loss Tapes," chronicling Alzheimer's from the perspective of seven people who have it. Each person is in a different stage of the disease, and the film recounts their struggles as they cope with becoming burdens on their families, plus losing their identity and their independence.

Other films in the series include "Momentum in Science" (May 11 and 12), a two-part film that gives an inside look at Alzheimer's research; "Grandpa, Do You Know Who I Am?" (May 11), with Maria Shriver, a take on what children and grandchildren of those with Alzheimer's go through; and "Caregivers," (May 12), which tells the story of those who selflessly help their loved ones. Shriver and Sheila Nevins were executive producers for the series, which was produced by John Hoffman.

If you don't get HBO, not to worry -- a spokeswoman said the network will stream the films free on their website after they air. The site also features links to Alzheimer's-related organizations, plus downloadable podcasts, other short films about Alzheimer's and a link to a Facebook page where people can write tributes to family members and friends with the disease.

-Jeannine Stein

Photo of Josephine Mickow from "The Memory Loss Tapes" by Elyssa Hess / HBO, courtesy of HBO

Education doesn't slow rate of decline in Alzheimer's patients

Having more years of formal education appears to reduce the risk of dementia and Alzheimer's disease, according to several published studies. But new research suggests that education probably has less effect on the disease than those other studies suggest.

The paper, published today in the journal Neurology, found that though the symptoms of cognitive decline are less apparent in well-educated people, once memory loss begins those people tend to decline just as rapidly as less-educated people with the disease. The researchers, from the Alzheimer's Disease Center at Rush University Medical Center in Chicago, reviewed data of 6,000 older African American and white residents of a community on the south side of Chicago. The study participants completed cognitive tests at three-year intervals for up to 14 years. The study concluded that one's level of education was strongly related to cognitive function at the start of the study and was associated with reduced cognitive decline in the early years of follow-up. But it ultimately did not protect people against how fast they lost their memory.

It is possible, the researchers said, that a high educational level may protect against some aspects of cognitive decline in old age -- for example, problem-solving skills -- but not others, such as memory.

-- Shari Roan

Photo credit: Mel Melcon / Los Angeles Times

Alzheimer's and the holidays: Tips from the Alzheimer's Assn.

Even at the best of times, holiday celebrations can bring stress as well as pleasure. When a member of the family has Alzheimer's disease or some other form of dementia, such gatherings present extra challenges and need more careful planning. The Alzheimer's Assn. California Southland Chapter has a booklet at its website that should help anyone coping with this -- you can access the booklet in full right here. (Or in Spanish, here.)

Among the many tips are practical ways that family, friends and the individual with Alzheimer's can all get more out of a celebration. Such as, by helping friends and family understand, in a letter, what to expect in the demeanor and condition of your loved one and letting them know what gifts would be useful and which would not work. (The booklet notes that friends and family may not know what to expect or how to act and may be nervous about all that. They'd probably welcome some guidance.)

Tips also include ways to orient the person with memory loss to the season that's at hand -- decorations, etc. -- and ways to provide seasonal activities that he or she can take part in with pleasure. Among these are soothing, "quiet time" activities, such as shelling peas or folding napkins or simply taking a walk. And the booklet reminds you it might be practical to plan celebrations earlier in the day rather than later, to avoid the extra confusion that comes very often in the evenings to people with Alzheimer's. (It's called Sundowner Syndrome.)

"Make sure your family understands your needs and wishes," the booklet advises. "Give yourself permission to do only what you can reasonably manage."

You can read many more tips by accessing the booklet. And you can read more on Alzheimer's and memory loss in a Nov. 17 package of stories by Times staff writer Melissa Healy.

-- Rosie Mestel

News from the Alzheimer's conference in Chicago

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.

- Shari Roan

Update from the Alzheimer's international conference

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."

-- Shari Roan

How to converse with someone who has Alzheimer's

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.

For more on treatments and research on Alzheimer's disease, see today's story in the L.A .Times. For more information on Alzheimer's disease contact the Alzheimer's Assn.

-- Shari Roan

How to keep the brain big, even with Alzheimer's

 

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.

Want to know more? Here's ...

* a USA Today story about the study.

* the abstract, in the journal Neurology.

* 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.

-- Tami Dennis

Photo: A CT scan of a normal human brain.

Credit: Custom Medical Stock Photo

Bright light for Alzheimer's

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.

--Susan Brink

Photo: Carolyn Kaster / Associated Press