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Thursday, August 25, 2016
BY SARAH OWENS
Good news for those who make the effort to eat well, exercise, and maintain a healthy weight: Those three lifestyle factors may help reduce the buildup of proteins associated with the development of Alzheimer's disease, according to a new study published in the American Journal of Geriatric Psychiatry.
Researchers at UCLA Health System enrolled 44 adults (average age: 62.6 years) who had either self-reported memory loss, which did not yield any objective deficits on tests, or had been diagnosed with mild cognitive impairment after neurologic and psychiatric evaluations.
Participants' level of physical activity was determined using a test that measures activity related to work, transportation, home maintenance, and recreation or sports, which was modified for older adults.
Participants were also asked to report how closely they followed a Mediterranean diet (eating lots of fruits and vegetables, fish, olive oil, and moderate amounts of red wine) using a five-point Likert scale (which includes the answers "never," "not often," "sometimes," "often," and "all the time"). Based on participants' answers, the researchers separated them into two groups: the "rarely" group and the "often" group.
Finally, researchers assessed each participant's body mass index, which measures height and weight, then separated them into "normal range" (BMI of 25 or below) and "above normal range" (BMI greater than 25) groups.
To measure levels of amyloid and tau—major culprits in the development of Alzheimer's disease–in participants' brains, researchers used a type of positron emission tomography (PET) scan with a radiotracer called FDDNP that can show images of tangles in living people.
The Brain-Lifestyle Link
When they compared three lifestyle factors—amount of exercise, type of diet, and BMI number—with the PET scan results, researchers found that participants with mild cognitive impairment who had an above-normal BMI had more binding of amyloid plaques and tau tangles compared to normal-BMI participants.
The researchers also found that all subjects, whether they had mild cognitive impairment or subjective memory loss, who followed the Mediterranean diet more closely had a lower amount of plaque and tangle binding, corresponding to a lower risk of Alzheimer's disease.
Finally, they found that people who reported a higher level of physical activity had a lower amount of amyloid and tau binding in the brain, although this finding only held true for the mild cognitive impairment group, not for the group with self-reported memory loss.
Healthy Life Equals Healthy Brain
The results, the study's authors concluded, suggest that Alzheimer's disease risk may be at least partly modifiable for some people who have mild memory or cognitive impairment. Regular exercise, adherence to a healthy Mediterranean-style diet, and maintaining a low BMI are all ways that may help keep brains healthy as they age.
For more on how a Mediterranean-style diet may help reduce stroke risk and slow cognitive decline, go to bit.ly/DietForLife. For a sample Mediterranean diet menu, go to bit.ly/NN-MedDietMenu.
Monday, August 22, 2016
BY SARAH OWENS
A program to prevent falls that combined treadmill training with virtual reality training was more successful at reducing rates of falls in older adults than treadmill training alone, according to researchers at Tel Aviv Sourasky Medical Center in Tel Aviv, Israel. The success of the combination may pave the way for new fall-prevention programs at hospitals and care centers.
The Dangers of Falling
Falls are a major concern among older adults, especially those with neurologic conditions like mild cognitive impairment, dementia, and Parkinson's disease. Falling can lead to disability, social isolation, a loss of independence, and even death. Additionally, falls are a major expense for hospitals: by some researchers' estimates, they account for 1 to 2 percent of all health-care expenditures in many high-income countries.
Doctors and researchers have developed strategies and interventions to help prevent falls, including treadmill training, but most of them target individual risk factors, such as improving physical strength. Researchers involved in the new study sought to create a program that would combine physical training and cognitive training.
Combining Treadmills with Virtual Reality
Researchers enrolled 302 adults ranging in age from 60 to 90 who had a high risk of falls, based on a history of two or more falls in the past six months, and various motor and cognitive deficits. They randomly assigned 148 adults to six weeks of treadmill training alone and 154 adults to six weeks of treadmill training plus virtual reality.
The virtual-reality system included a motion-capture camera and a computer-generated simulation that was projected onto a large screen. While the participants walked on the treadmill for 45 minutes, the screen portrayed real-life challenges, including obstacles, multiple pathways, and distractions that required participants to adjust their steps continuously. The intensity of training was adjusted to each participant's level of physical fitness.
The researchers hoped to find a decrease in both the number and risk of falls. Risk factors for falling included variation in gait while walking, bypassing obstacles, and cognitive function.
Virtual Reality Leads to Better, Safer Mobility
Before the training program began, researchers noted that the rate of falls was similar among all participants. Six months after the participants completed the program, the group that was assigned to the treadmill training plus virtual reality had significantly lower incidents of falls than they had before the training. The treadmill-only group saw no significant decrease.
The overall risk of falls also decreased more significantly in the treadmill plus virtual reality group than in the treadmill-only group. People in the combinations group had less variation in gait (corresponding to better, safer walking), cleared obstacles better, and performed better on a short test assessing balance and mobility. Improvement in cognitive function was similar in both groups.
The decrease in fall risk was particularly strong for participants who had Parkinson's disease, the study's authors noted. They hypothesized this may be because Parkinson's disease itself involves an interplay between motor and cognitive deficits, which the treadmill plus VR program, with its combination of physical and cognitive training, is designed to address.
The results of the study, which was published online on August 11 in The Lancet, suggest that adding a virtual-reality training element to traditional treadmill training may further reduce the rate and risk of falling in older people at risk for falls. People with neurologic conditions like Parkinson's disease may benefit from similar training programs at other care centers.
Monday, August 15, 2016
BY HENRY BOLSTER
The Alzheimer's Foundation of America (AFA) (alzfdn.org) has been at the forefront of a new kind of care for dementia patients. Unofficially termed compassionate care, it's not a one-size-fits-all approach, but personalized care based on getting to know patients and learning their quirks. Once you get to know them, you can begin to enhance their capabilities. The AFA works with leading neurologists to develop training programs for caregivers that emphasize compassionate care tenets. One of their partner neurologists, Daniel C. Potts, MD, FAAN, says he learned this approach from his own father, Lester.
When Dr. Potts talks about Lester his gentle Alabama accent gets even softer. "Dad was a Korean War vet and just a really great guy. He was an Alabama sawmiller his whole life, very capable with his hands." When he began showing early signs of Alzheimer's in the late nineties, "we were devastated," Dr. Potts recalls.
At home, his father became increasingly hard to handle. Though Dr. Potts is a practicing neurologist, he struggled to advise his mother on caring for his father. As Lester's condition deteriorated, the family began looking for help. Their search led them to Caring Days, an adult day care center in their hometown of Tuscaloosa, AL. To convince Lester to visit Caring Days for the first time, Dr. Potts and his mother told Lester he was going there to make repairs.
Although Lester quickly realized that he wasn't there to fix leaky faucets or squeaky hinges, he did discover something else—watercolor classes taught by a retired artist. After his first class, Lester brought home a striking painting of a red and green hummingbird. When he showed it to his wife, she asked: "Honey, who gave you that?" Before long Lester moved beyond the still-lifes and photos provided by the teacher and began painting from memory.
Talking with Paint
As his verbal skills declined, Lester's painting allowed him to keep talking. "Because of painting, we were still able to have a relationship with Dad," says Dr. Potts. "He was sharing core elements of himself with us through his paintings." One of Lester's paintings depicted an old shoe and a hat hanging on top of a wooden cross—representatives of himself, his family believed. When asked about the painting, Lester, unable to speak, wept.
Lester, who died in the summer of 2007, painted almost to the end, although by then he was painting only small circles of color. His last piece was a rudimentary depiction of a gray crosscut saw, like the one his father taught him to use when Lester was a child.
Dr. Potts believes "pillars of personhood" still stood for Lester until the very end. "As caregivers we need to learn to listen mindfully, to be present mind, body, and spirit with the person we are caring for." Dr. Potts encourages caregivers to be open and free of judgment. Molly Fogel of the AFA offers similar advice. We, as caregivers need to remember that "this is a human being in front of us, not an illness."
The AFA, in their Partners-in-Care video series (bit.ly/AFA-PartnersInCare), offers tips on how to provide compassionate care for people with dementia:
1. Modify Your Speech. Speak calmly, clearly, and slowly. Ask one question at a time and leave space for the patient to respond. If, after repeating the question once or twice with the same phrasing, the patient still doesn't get it, try rewording it. When asking someone with Alzheimer's disease to complete a task, break it down into simple, manageable steps so he or she doesn't get confused and is still able to cooperate. Once your relative can no longer speak, continue to talk about things he or she cared about before the diagnosis. No matter how frustrated you get, try not to argue with the person who has dementia. You'll only hurt him or her and make yourself more frustrated in the process.
2. Master Nonverbal Cues. Nonverbal skills become more important, especially as your loved one loses the ability to speak. Be conscious of the power of body language. Slumped shoulders or crossed arms can signal exasperation even when you don't mean it. Positive physical cues like smiling and gentle touching help people feel loved and cared for. When caring for someone with dementia, always approach from the front. People with dementia are often disoriented to begin with and surprise touches from an unseen (albeit) loving caretaker can exacerbate those unsettled feelings. And whenever possible use visual cues to augment (or in lieu of) speech. For example, instead of simply saying "brush your teeth," mime it with a toothbrush in hand.
3. Create a Comforting Space. Deviation from routine and overstimulation can be disorienting and upsetting to people with dementia. To help make their space as comfortable and familiar as possible, make sure hearing aids and glasses are handy and functioning properly, and reduce ambient noise or excessive stimulation or commotion.
Friday, August 12, 2016
BY SARAH OWENS
Maintaining physical activity into old age may help reduce dementia risk, according a new study published in the Journals of Gerontology Series A: Biological Sciences and Medical Sciences.
Even better: The exercise does not have to be intense or heavy—or even a lot—to be beneficial, researchers said.
Researchers followed more than 3,700 adults in the Framingham Study Original Cohort, a large group of adults that have been evaluated twice a year for over 60 years, and about 2,000 adults participating in the Framingham Offspring cohort, which contains offspring or spouses of people in the Original cohort, who did not have dementia and were at least 60 years old at the beginning of the study. The researchers measured physical activity, brain volume, and dementia incidence in the study population.
Activity and Brain Health
To measure physical activity, researchers compiled a physical activity index (PAI), based on the participants' answers on a short questionnaire about sleep and activity. Each hour of sleep equaled one point on the index; sedentary activity equaled 1.1 points, slight activity 1.5 points, moderate activity 2.4 points, and heavy activity 5 points. Researchers added up the points to create a PAI score. So, for example, a person who sleeps continuously would have a score of 24; an office worker with no outside exercise might have a score of 27; and a laborer who does lots of heavy lifting might have a score of 47.
To assess the incidence of dementia in both study cohorts, the researchers examined the results of neurologic and neuropsychological tests, Framingham study records, hospital records, family interviews, and other records over a period of 10 years following the start of the study to determine the development of dementia among the participants. The researchers also examined magnetic resonance imaging and computed tomography scans of adults in the Framingham Offspring Cohort, looking for changes in brain volume over the 10-year study period.
Light Activity Is Best
At the end of the study period, 236 participants had developed dementia. Those with the lowest scores on the physical activity index had the highest risk of developing dementia. On brain scans, researchers discovered a linear association between PAI scores and brain volume: study participants with lower PAI scores had a lower brain volume, and participants with higher PAI scores had a higher brain volume.
The researchers also noted that there was a more dramatic reduction in risk between the sedentary group and those who did light physical activity than between light exercisers and heavy exercisers, indicating that modest amounts of exercise were more protective against dementia than more intense amounts.
Exercise for Your Brain
To maintain brain health into old age, research supports these tips:
Engage in light activity. Whether you'd like to stroll around the neighborhood with a friend, walk the dog, or play outside with your grandkids, all light activity helps reduce dementia risk.
Don't overdo it. Heavy activity wasn't more beneficial than light activity for protecting brain health, so don't feel like you have to run a marathon or hit the gym every day to reap the benefits of exercise.
Mix it up. Researchers saw the greatest benefit from "a balance of all types of activities," rather than bursts of a single, high-intensity activity. So include a mixture of light activities, such as walking, gardening, or housework – in your daily routine.
Exercise for your heart, too. Exercise benefits more than just your brain—it benefits all cardiovascular health, including blood pressure and blood lipids. All the more reason to get moving!
Wednesday, August 10, 2016
BY SARAH OWENS
Helping your child graduate from a pediatrician to a doctor who treats adults takes time and planning. When your child has a neurologic disorder such as Down syndrome, muscular dystrophy, or epilepsy, the process requires not just extra preparation and planning, but collaboration between neurologists and educational and community services.
To ease the transition, a multidisciplinary panel of experts released some guiding principles for child neurologists and the families in their care that may provide a framework for the transition.
Start talking about transitioning to the adult health care system before your child turns 13, the experts advise. This gives you and your child enough time to understand why a transition is necessary. It also gives your child's neurology team time to teach you and your child about your child's condition and how to manage it independently.
Be sure to ask your child's neurologist about how your child's health needs will be different when he or she becomes an adult. Ask for for tips on how your child can learn to manage his or her condition (how to take prescription medicine on time, for example) and advocate for his or her medical needs. Your neurologist should document all of these discussions so you and he or she can share them with other providers and with school and community services.
Talk to your child's neurology team about legal and insurance matters, including how your child can maintain health insurance throughout the transition and establish legal guardianship as an adult, if needed.
Check In Annually
Schedule yearly visits with your child's neurology team to discuss the transition. These visits should be in addition to regular checkups. These are opportunities to discuss your child's medical condition, current medications and side effects, any concerning symptoms, and adolescent issues, such as sexuality and abuse of drugs and alcohol. During these visits, your child's neurologist may ask you to complete a questionnaire that measures how ready you and your child are for the transition.
Find a New Care Team
It's never easy to leave a familiar doctor, and patients and parents often experience anxiety. To allay those fears, the panel recommends engaging the services of an adult health care provider one or two years before the actual transfer. Parents and caregivers should schedule preliminary visits with several providers before deciding on one.
If possible, visit a joint pediatric-adult transition clinic or consult with a transition coordinator during the planning process. Ask your child's neurologist if he or she can be available for consultation as needed following the transition. If a medical event or a lack of planning prevents you from finding a new care team by the time of the planned transition, your child's neurologist is responsible for continuing to assure your child receives adequate care, according to the panel.
For more information about managing your child's transition to adulthood, visit bit.ly/NN-IndependenceDay and bit.ly/NN-ProtectYourChildsFuture.