OHIO ELDER LAW BLAWG

Some Signs of Dementia may be B-12 Deficiency Instead

The NY Times today had a piece which described a woman's cognitive declines.  Her daughter noticed her becoming more and more confused.  When Aricept (a common Alzheimers' disease treatment) was prescribed, the woman became more confused. 

When blood work was done her B-12 level was well below normal.  When she recieved B-12 injections, she recovered. Now 87, the woman still lives alone in Manhattan and feels well enough to refuse outside assistance.

The link to the article is below.  It discusses not only the story, but information about B-12. 

http://www.nytimes.com/2011/11/29/health/vitamin-b12-deficiency-can-cause-symptoms-that-mimic-aging.html?src=me&ref=general

Alzheimer's: Earlier Diagnosis Creates Reform of Definition of the Disease

The definition of Alzheimer's disease is being updated and reformed in new medical guidelines that reflect fast-mounting evidence that the disease begins damaging the brain well before, perhaps years before, the symptoms begin to become apparent. 

The new guidelines by the National Institute on Aging and the Alzheimer’s Association, divide the disease into three stages, listed here in reverse in time:

1. A phase when dementia has developed;

2. A phase in which mild problems emerge but daily functions can still be performed; and

3. A phase, most recently discovered, in which there are no symptoms but changes are brewing in the brain.

Early diagnosis may become more prevelant and Medicare regulations may be updated to reflect the need for earlier discovery and intervention which hopefully can result in better planning and care. Edward Markey, Representative from Massachusetts has sponsored a bill to increase medicare reimbursement for such diagnosis.

For a more thorough review, please see the full article in the NY Times.

Health Benefits of Walking May Include Protection of Brain Size and Memory

The benefits of walking are probably more than just helping to remain fit and healthy. We know walking results in a reduced risk of disability in the elderly population, as well as it lowers chances of developing cancer in men. According to a recent study, walking at least six miles per week protects brain size and preserves memory in old age.

The study was initiated on 299 individuals who showed no signs of dementia. During the study, participants had to record the number of blocks walked each week. Nine years later brain scans were taken in order to measure brain size of the subjects. Having completed four more years, authors conducted a test for ascertaining the presence of cognitive impairment or dementia. People walking at least 72 blocks a week, (six to nine miles) may have greater gray matter volume than people who didn’t walk that much. The results were measured at the nine-year time point after recording activity.

Kirk I. Erickson, PhD, with the University of Pittsburgh in Pittsburgh and the study author explained, “Brain size shrinks in late adulthood, which can cause memory problems. Our results should encourage well-designed trials of physical exercise in older adults as a promising approach for preventing dementia and Alzheimer’s disease.”

       Gray matter volume did not seem to boost any further in those walking more than 72 blocks. After four years, 116 volunteers comprising 40 percent were apparently diagnosed with either cognitive impairment or dementia. Walking possibly lowers chances of developing memory problems. Experts presume that while regular exercose enhances brain health in midlife, thinking and memory is improved in later life.

The study was published in the October 13, 2010, online issue of Neurology, the medical journal of the American Academy of Neurology.  Excerpts of this article were taken from healthjockey.com.

Those Who Know, Know Longer?

A recent study in the Journal of the International Neuropsychological Society seems to indicate that people who are aware they are developing mild memory problems as they age develop Alzheimer’s disease at a slower rate than those who do are not aware that their memory is failing.

The study compared a group of people with Mild Cognitive Impairment (MCI) to a group of healthy older adults.  All were given neuropsychological tests and were required to perform tasks during functional magnetic resonance imaging (fMRI) testing.  The results indicated that the cortical midline area of the brain showed activity during self-assessment exercises and that MCI participants with less insight into their impairment had considerably less brain activity than those who were aware of their mental difficulties. 

While MCI is always a precursor to Alzheimer’s disease, people with MCI don’t always develop Alzheimer’s. "[U]nawareness of function loss is beginning to be recognized as an important clinical symptom of MCI, and with studies like this one, we are starting to understand how these symptoms develop,” says Michele Ries, a neuropsychologist and researcher at the the University of Wisconsin Alzheimer’s Disease Research Center.

According to the Alzheimer’s Association, 5.3 million Americans live with the disease.  There will be half a million new cases this year alone.

To me this raises the question of whether honestly and openly discussing memory loss with our friends and family who may have MCI would be of benefit to them, or whether some individuals (or some disease processes) simply cannot have (or allow) insight into their own cognitive limitations.

Maybe further study will reveal the answer to that question.

The Middle Aged Brain Ain't So Addled After All

There are many myths that have developed over the years about aging and brain health, but new studies and the use of technology is showing us that what we once thought about middle age brain health decline are largely incorrect. 

Here are ten myths about the aging brain, which have proven not to be true, excerpted from an article in the Huffington Post this morning.  Link is at the end:

1 MYTH ONE: We lose 30 percent of our brain cells as we age.

For many years, even the most eminent neuroscientists thought that millions of our brain cells simply shriveled up and died as we got aged. But new brain scanning studies show that, as long as we're healthy, we actually keep most of our brain cells for as long as we live.

2. MYTH TWO: Our brains stop developing in our 20s.

It's now known that our brain continue to develop, change and adapt. Growth of white matter and brain connections that we gain through years of experience allow us to recognize patterns faster, make better judgments and find unique solutions to problems. Scientist call these traits cognitive expertise and they reach their peak in middle age.

3. MYTH THREE: Midlife crises are inevitable.

Long-term studies now show that people find middle age the most satisfactory time in their lives. In fact, brain changes in midlife make us more optimistic, not less. And recent research shows that those who have emotional upheavals in midlife have, in many cases, had similar emotional distress at other times in their lives.

4. MYTH FOUR: The empty nest syndrome.

More recent studies of real people -- men and women -- find that our lives, and our moods, often improve when the kids leave home.

5. MYTH FIVE: Our brains operate best in our 20s.

In fact, our brains, in most important areas, reach their peak in midlife. We get better in a whole range of areas, including inductive reasoning, vocabulary, judgment, even the ability to get the "gist'' of an argument and find solutions. There is evidence that we can also become more creative as we age.

MYTH SIX: Our brains start to fade away.

Actually, brains in middle age begin to "power up'' not down. In some cases, we learn to use two parts of our brain instead of one to solve problems. And it is those with the highest cognitive abilities who learn to use their brains this way.

MYTH SEVEN: Dementia is inevitable.

On the contrary. We now have enough people living long enough to show that dementia is not inevitable. There are increasing numbers of what are called "pristine agers,'' whose brains remain largely intact well into their 90s.

MYTH EIGHT: There is nothing we can do to improve our brains.

New research shows that middle age is a time when the brain is "on the cusp,'' and that what we do matters, even what we think matters. There is increasing evidence -- not hype but solid evidence -- that shows that such things as exercise, education and even what we eat does make a difference. Since we now know that we do not lose whole swaths of brain cells, there is a full-tilt effort to find out how to keep those brain cells intact.

Those who research the ingredients in red wine, for instance, are racing to put it in a pill. New studies in animals and humans show that new baby brain cells are born in the brain, with something as simple as aerobic exercise.

And those who research how adults learn have found that one way to keep our brains alive and growing is to actively explore ideas -- and people -- that challenge our view of the world.

This can create what Jack Mezirow, professor emeritus at Columbia Teachers College, has called a "disorienting dilemma'' in our minds that, as another researcher put it, "shakes up the cognitive egg,'' prompting our brain cells to wake up, reconfigure and -- with a little luck -- rejuvenate.

Full article

I heard a story this morning on NPR about this, and it confirms what many of you have read on these pages, that exercise and diet help keep you healthy, brain and body.  In addition, it is becoming clear we can tease our brain into growing by doing new things, looking at things in new ways, and challenging our brain to work hard at something it normally does not do.

Maybe I will try to understand my son's calculus textbook tonight.

Those Extra Pounds: Bad for the Aging Brain?

According to research in the latest issue of The Journals of Gerontology Series A: Biological and Medical Sciences (Volume 65A, Number 1), the affects of being overweight are not only physical, but also affect neurological function.

The publication presents a collection of ten articles highlighting new findings related to obesity in older persons.

Anna Dahl, MS, of Sweden's Jönköping University, led a study which found that individuals with a midlife body mass index (BMI) score which was higher than thinner people's had lower general cognitive ability. These statistics were drawn from a 39 year study of twins in Sweeden, from 1963 to 2002. There was no difference in the results based on the participant's sex. 

Of course, more study is necessary. "One of the unanticipated consequences of improved medical management of cardiovascular disease is that many obese individuals reach old age," said Editor Luigi Ferrucci, MD, PhD, of the National Institute on Aging. "We need a better understanding of the causes and consequences of obesity in older individuals - especially when obesity is associated with sarcopenia."  (Sarcopenia is the loss of muscle mass and sometimes the replacement of muscle with fat). 

My Other Guilty Pleasure...The Wii

So, two Christmases ago, I bought the kids (ok, who am I kidding, I bought the kids and myself) a Nintendo Wii.  Its been fun to play, both with the kids, and with others around the world. (In a technologically savvy moment I got it hooked up to the internet so I can play other people I know as well as complete strangers).

Oh yeah...drop me a mail if you want to try to beat me in Super Mario Brothers or Super Smash Brothers.  If you want to play me in Guitar Hero, please know that I will likely use my son as a ringer, and he is pretty darned good.  I stink at it.

But I digress.  I really have fun playing my Wii and like it.  Apparently other people like it too. In a recent California study elderly people who exhibit depression and then play Wii Sports three times a week are likely to see their depression deminish.

In a pilot study, researchers found use of Wii Sports significantly improved mood and mental health-related quality of life in older adults with sub-syndromal depression. "The study suggests encouraging results from the use of the exergames," Dilip V.Jeste, M.D. said. "More than one-third of the participants had a 50-percent or greater reduction of depressive symptoms. any had a significant improvement in their mental health-related quality of life and increased cognitive stimulation."  Jeste is a Professor of psychiatry and neurosciences at University of California, San Diego, School of Medicine.

So, with all this snow, maybe we need a little wii time.

Full article here.  

P.S.  Oh, in case you were wondering, my original guilty pleasure was coffee.

Art and Alzheimers: New Collaboration Investigates New Therapies

WCPN hosted an interesting show regarding the effect of Art on Alzheimers, featuring visitors from The Cleveland Clinic Lou Ruvo Center for Brain Health.  The center has only been open for about 6 months, but they have been pursuing alternative ways of affecting Alzheimer's and Parkinson's and other brain disorders.  Among the interesting therapies they are finding to be effective involve music and art. (Hear program here).

The show discussed the fact that brain function that is affected by Alzheimer's will often cause memory loss, areas of the brain that involve visual appreciation may be left intact for longer, thus allowing for stimulation through exposure to art and creative outlets.

The show also addressed a new collaboration between CWRU, the Cleveland Clinic, and the Cleveland Art Museum. The Pee Dee discussed that here.

Senior Moments: When do they actually become a concern?

The Washington Post had a piece today regarding those "senior moments" that almost anyone experiences: a name on the tip of your tongue, an event that you can't remember, where you left your car in the parking lot.

The question is when are these forgetful moments an indication of a need to be evaluated for a cognitive problem?     

It seems memory lapses start in our 20s, even though we probably don't admit it to themselves. In the Neurobiology of Aging Journal, psychologists asked about 2,000 participants to engage in memory tests. The top performers were 22 years old; researchers saw a notable decline in the ability to make rapid comparisons, remember unrelated information and detect relationships by age 27.  A weakening memory can usually be detected by the late 30's, according to the study findings.

Discussing with your physician any issues of memory loss is better sooner than later.  Not only may there be treatment that will assist in prolonging memory, your doctor may uncover other causes and issues, including depression, stroke, contraindicated medications or a thyroid or other disorder.

Two Studies: Exercise's Positive Effect on Cognition

Glad I joined a gym recently.

In the e-magazine Endocrine Today, there is a story about the positive effects of exercise on cognition.  One study by the Mayo Clinic showed that "midlife moderate exercise was associated with a 39% reduction in the odds of developing the condition (P=.008), and moderate exercise in late life was associated with a 32% reduction (P=.02). The findings were consistent among men and women"  This was not true of light exercise such as bowling and slow dancing.

In a second study, participants were divided into two groups, one that engaged in stretching, the other in aerobic exercise. After six months, the aerobic exercise group were observed to have improved executive control processes of multitasking, cognitive flexibility, information processing efficiency and selective attention when  compared with the group that did only stretching exercises. 

The full article is here.