Dementia: Why we find it difficult to stay awake in the day and sleep at night?

Study Suggests Tau Tangles, Not Amyloid Plaques, Drive Daytime Napping That Precedes Dementia

Researchers and caregivers have noted that excessive daytime napping can develop long before the memory problems associated with Alzheimer’s disease begin to unfold. Prior studies have considered this excessive daytime napping to be compensation for poor nighttime sleep caused by Alzheimer’s-related disruptions in sleep-promoting brain regions, while others have argued that the sleep problems themselves contribute to the progression of the disease. But now UC San Francisco scientists have provided a striking new biological explanation for this phenomenon, showing instead that Alzheimer’s disease directly attacks brain regions responsible for wakefulness during the day.

two people talk in a lab
Lea Grinberg (right), MD, PhD, the senior study author

The new research demonstrates that these brain regions (including the part of the brain impacted by narcolepsy) are among the first casualties of neurodegeneration in Alzheimer’s disease, and therefore that excessive daytime napping – particularly when it occurs in the absence of significant nighttime sleep problems – could serve as an early warning sign of the disease. In addition, by associating this damage with a protein known as tau, the study adds to evidence that tau contributes more directly to the brain degeneration that drives Alzheimer’s symptoms than the more extensively studied amyloid protein.

“Our work shows definitive evidence that the brain areas promoting wakefulness degenerate due to accumulation of tau – not amyloid protein – from the very earliest stages of the disease,” said study senior author Lea T. Grinberg, MD, PhD, an associate professor of neurology and pathology at the UCSF Memory and Aging Center and a member of the Global Brain Health Institute and UCSF Weill Institute for Neurosciences.

Wakefulness Centers Degenerate in Alzheimer’s Brains

In the new study, published August 12, 2019, in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, lead author Jun Oh, a Grinberg lab research associate, and colleagues precisely measured Alzheimer’s pathology, tau protein levels and neuron numbers in three brain regions involved in promoting wakefuless from 13 deceased Alzheimer’s patients and seven healthy control subjects, which were obtained from the UCSF Neurodegenerative Disease Brain Bank.

Compared to healthy brains, Oh and colleagues found that the brains of Alzheimer’s patients had significant tau buildup in all three wakefulness-promoting brain centers they studied – the locus coeruleus (LC), lateral hypothalamic area (LHA), and tuberomammillary nucleus (TMN) – and that these regions had lost as many as 75 percent of their neurons.

portrait on Jun Oh.
Jun Oh, lead author of the study. 

“It’s remarkable because it’s not just a single brain nucleus that’s degenerating, but the whole wakefulness-promoting network,” Oh said. “Crucially this means that the brain has no way to compensate because all of these functionally related cell types are being destroyed at the same time.”

Oh and colleagues also studied brain samples from seven patients with progressive supranuclear palsy (PSP) and corticobasal disease (CBD), two distinct forms of neurodegenerative dementia caused by tau accumulation. In contrast to the Alzheimer’s disease brains, wakefulness-promoting neurons appeared to be spared in the PSP and CBD brains, despite comparable levels of tau buildup in these tissue samples.

“It seems that the wakefulness-promoting network is particularly vulnerable in Alzheimer’s disease,” Oh said. “Understanding why this is the case is something we need to follow up in future research.”

Studies Point to Role of Tau Protein in Alzheimer’s Symptoms

The new results are in line with an earlier study by Grinberg’s group which showed that people who died with elevated levels of tau protein in their brainstem – corresponding to the earliest stages of Alzheimer’s disease – had already begun to experience changes in mood, such as anxiety and depression, as well as increased sleep disturbances.

“Our new evidence for tau-linked degeneration of the brain’s wakefulness centers provides a compelling neurobiological explanation for those findings,” Grinberg said. “It suggests we need to be much more focused on understanding the early stages of tau accumulation in these brain areas in our ongoing search for Alzheimer’s treatments.”

These studies add to a growing recognition among some researchers that tau buildup is more closely linked to the actual symptoms of Alzheimer’s than the more widely studied amyloid protein, which has so far failed to yield effective Alzheimer’s therapies.

For instance, another recent study by the Grinberg lab measured tau buildup in the brains of patients who died with different clinical manifestations of Alzheimer’s disease, including variants that involved language impairment or visual problems instead of more typical memory loss. They found that differences in local tau burden in these patients’ brains closely matched their symptoms: patients with language impairments had more tau accumulation in language related brain areas than in memory regions, while patients with visual problems had higher tau levels in visual brain areas.

“This research adds to a growing body of work showing that tau burden is likely a direct driver of cognitive decline,” Grinberg said.

Increased focus on the role of tau in Alzheimer’s suggests that treatments currently in development at UCSF’s Memory and Aging Center and elsewhere that directly tackle tau pathology have the potential to improve sleep and other early symptoms of Alzheimer’s disease, in addition to holding a key to slowing the progress of the disease overall, the authors say.

Authors: See study online for full list of authors.

Funding: This study was supported by The Rainwater Foundation and grants from the National Institutes of Health (R01AG064314, R01AG060477, P50AG023501, P01AG019724, K24AG053435), the Global Brain Health Institute, and the São Paulo Research Foundation (FAPESP).

Disclosures: The authors declare no conflicts of interest.

The University of California, San Francisco (UCSF) is exclusively focused on the health sciences and is dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes UCSF Health, which comprises three top-ranked hospitals, as well as affiliations throughout the Bay Area.

Source
August 2019| The Regents of The University of California – Alzheimer’s Disease Destroys Neurons that Keep Us Awake By Nicholas Weiler

Alzheimer associations in Asia

Asiaorg

Many caregivers in Asia can agree, it’s super hard to find resources and in some countries, it’s hard even to know where to start. When we go online there are so many websites and resources, it’s hard to even know where to start. It’s hard especially when a lot of information tends to be advertisements for private organisations promoting their services. When this post from Monica Cations post popped up on twitter, it was like, wow, what a great idea!

Let’s have one for countries in Asia. The list is below is one for Asia, and if you wish to view the full list of organisations, you can visit https://www.alz.co.uk/associations

Bangladesh *                     www.alzheimerbd.com

Brunei **                            demensia.brunei@gmail.com

China                                     www.adc.org.cn

Hong Kong SAR                 www.hkada.org.hk

Indonesia                            www.alzi.or.id

Japan                                    www.alzheimer.or.jp

Macau SAR                         www.mada.org.mo

Malaysia                              www.adfm.org.my

Philippines                          www.alzphilippines.com

Republic of Korea             www.silverweb.or.kr

Singapore                            www.alz.org.sg

Sri Lanka                              www.alzlanka.org

TADA Chinese Taipei       www.tada2002.org.tw

Thailand                               www.azthai.org

Learning from zoos – how our environment can influence our health

File 20170517 24330 1j3hzlq.jpg?ixlib=rb 1.1

CoolR/Shutterstock

Emmanuel Tsekleves, Lancaster University

We are told that we are a nation of couch potatoes, lacking the will and the strength to turn around the obesity tanker. We all need a little help in our quest for a healthier life and design can play a crucial part. If we designed our towns, cities, homes and workplaces more like animal experts design zoos, we could be one step nearer to reaching our fitness goals – as long as we can have some fun along the way.

It is reported that British people will be the fattest in Europe by 2025 and that if we want to reverse this we should have a healthier lifestyle by exercising more and eating less. But we are often made to feel guilty for not sticking to theses healthy lifestyle plans. I would suggest that before we start blaming people for adopting sedentary lifestyles, we should be taking a step back to look at the design of the environments, towns and cities in which we live.

The link between the design of the built and natural environment and its role in our health and well-being has been well explored. Now new research, led by Lancaster University, on “design for health” suggests that the environment, including buildings, cities, urban spaces and transport infrastructure, is closely linked to the lifestyles we adopt.

What is abundantly clear is that, as we shape our environment, it is also shaping us. Our psychological, physiological and physical status as well as our interactions with other people and with the natural environment are all affected. A key challenge that governments and policy makers worldwide are facing is how our built environment and infrastructure should be shaped to support healthier behaviours to prevent disease.

First, we should stop focusing on methods that tell people what to (or not to) do and which attempt to change their behaviour simply through media campaigns and punitive measures, such as tax schemes. While seeking to minimise the barriers that prevent healthy behaviours, we should make sure that the design of new environments is taken into account.

Looking to zoos

A good model would be to look at how zoos are designed. Before a zoo is built, it is common practice for zoologists, biologists, animal psychologists, nutritionists, architects, designers and landscape architects to work closely together to create an environment that optimises the living conditions for the animals.

Important environmental elements, such as vegetation, habitat, lighting, materials and each animal’s requirements are taken into account. The ultimate aim is to design an environment that fully supports the animals’ physical, psychological and social well-being. Ironically, we do not seem to make the same demands when a town, neighbourhood or workplace environment for humans is planned and designed.

Another opportunity that has recently emerged is the healthy new town NHS initiative. The aim is to radically rethink how we live and take an ambitious look at improving health through the built environment. Ten demonstrator towns will be built across England with community health and well-being as their main focus. Clinicians, designers and technology experts will reimagine how healthcare can be delivered in these places. Although this is a step in the right direction, what it is currently missing is the more holistic approach we have seen in the design of the zoos.

A crucial element in designing these towns so they are places that people would want to live in, is to include community members in their creation. This strategy would help design-in health-promoting behaviours, such as access to healthy food outlets or green spaces in which people can walk and exercise.

Embracing playfulness

Playful design – the mapping of playful experiences from games and toys to other non-game contexts – can play an important role here in inviting and encouraging people towards healthier alternatives. For example, the piano stairs project in Stockholm, which converts the metro stairs into a giant functioning piano keyboard – much like the piano made famous in the Tom Hanks movie Big (1988) – demonstrates great promise. It encourages commuters to opt for the intriguing new stairway instead of the escalators to enjoy making musical movements as they go up and down.

A project in The Netherlands, meanwhile, illustrates how everyday street furniture, such as lampposts, benches and bollards, can be inexpensively converted into impromptu exercise devices, inviting people to engage in casual activity and socialise with their neighbours. We could therefore envisage several other contexts were playfulness can transform mundane everyday activities into fun ones that encourage people into a more active and social lifestyle.

We could convert building walls into activity walls to encourage stretching of arms and legs through touch; redesign public squares and walkways into interactive dance floors that invite movement and guide you through a city; and transform workplace spaces and public places into “playgrounds” that boost movement and productivity and decrease lethargy.

The Conversation

So there you have it. If we want to be a nation of lean, mean and healthy citizens we need to learn from zoos and the animals that live in them. And we need to embrace playfulness and enjoy the place where we live. That way, we can tackle life with a hop, skip and a jump.

Emmanuel Tsekleves, Senior Lecturer in Design Interactions, Lancaster University

This article was originally published on The Conversation. Read the original article.

Australia’s Dogs 4 Dementia is Expanding!

Great news! Australia’s dogs 4 dementia program is expanding! Yeah! I remember seeing their booth at a dementia conference in 2012 thinking, wow I hope that this program continues to grow because it sure is a fantastic idea.

This is a collaboration between Hammondcare and Assistance Dogs Australia (ADA). A six to ten months training is required before the lovely dogs start assisting The assistance dogs can help to provide
– a routine
– help with reminders
– emotional support
– help around the house (close cupboards, pick up items etc.)

Here’s a video from ABC about Dogs 4 Dementia (See below), for an earlier post with more videos on dogs caring for people with dementia in Australia and in Scotland, read Happy National Dogs Day. Or click here for the ABC article on Dogs 4 Dementia.

An Amazing Music and Memory Program for Dementia

If you have 5 mins today, you’ve got to watch this video on music, memory and dementia that is being carried out in the Redleaf manor aged care home in New South Wales, Australia. The video (ABC iview-catalyst) shares with viewers insight into this new programme on personlised playlist that can greatly improve the quality of life and well-being of the individual.

The programme helps people to
– reconnect with family
– brings people out of their shell
– brings out positive emotions

Music should be accessible in all care facilities, and prescribed music can help to elevate agitation and reduce the use of antipsychotics (medications)in a study by Standford University.

Music is the only stimulus that activates a range of centres in the brain, aside from memories (temporal lobe and amygdala), music also touches on the movement centres and emotional. This gives answers to the reactions that occur when a person with dementia listens to music despite the progressive deterioration of the brain.

Looking back at our infants, how many of us have played music or sang our babies to sleep? In prelinguistic stages, the environment consists of music and sounds of happiness or sadness or fear. Babies react to the powerful effect of music.

Music is a powerful medium that it is pivotal to our brain’s health.

You can watch the 30min episode here but it’s only available for people living in Australia
http://iview.abc.net.au/programs/catalyst/SC1502H006S00, for those living outside of Australia you can try this link http://www.abc.net.au/catalyst/stories/4421003.htm .

Care staff gets a taste of living with dementia

Oxford Brookes University has devised a training programme to help staff working with people with dementia to come close to understanding the experience of living with dementia. This programme is carried out by a facilitator and participants have to wear a stimulation suit as part of the process. This aids the experiential learning process and creates some awareness of the needs of the individual with dementia.

The programme has proved to be successful and has helped care workers to better understand the experience of living with dementia; and in turn influence and improve the quality of care that they provide to the people they care for.

You can read more about the programme here here http://www.chc.brookes.ac.uk/training/dementia-simulation