The onset of Alzheimer’s disease: the importance of family history

News Release
February 26, 2018 | QUEBEC – The onset of Alzheimer’s disease: the importance of family history

You’re about to turn 60, and you’re fretting. Your mother has had Alzheimer’s disease since the age of 65. At what age will the disease strike you? A Canadian study published in JAMA Neurology shows that the closer a person gets to the age at which their parent exhibited the first signs of Alzheimer’s, the more likely they are to have amyloid plaques, the cause of the cognitive decline associated with the disease, in their brain.

In this study involving a cohort of 101 individuals, researcher Sylvia Villeneuve (Douglas Mental Health University Institute; CIUSSS de l’Ouest-de-l’Île-de-Montréal) shows that the difference between a person’s age and the age of their parent at the onset of the disease is a more important risk factor than their actual age.

A 60-year-old whose mother developed Alzheimer’s at age 63 would be more likely to have amyloid plaques in their brain than a 70-year-old whose mother developed the disease at age 85,” explains Villeneuve, an assistant professor at McGill University and a core faculty member at The Neuro’s McConnell Brain Imaging Centre.

Her team of scientists also found that the genetic impact of Alzheimer’s disease is much greater than previously thought.

“Upon examining changes in the amyloid biomarker in the cerebrospinal fluid samples from our subjects, we noticed that this link between parental age and amyloid deposits is stronger in women than in men. The link is also stronger in carriers of the ApoE4 gene, the so-called ‘Alzheimer’s gene’,” says Villeneuve.

Towards earlier detection of the disease

The researcher and her team successfully duplicated their results in two independent groups, one, consisting of 128 individuals from a University of Washington-St. Louis cohort, the other consisting of 135 individuals from a University of Wisconsin-Madison cohort. They also reproduced their results using an imaging technique that enables one to see amyloid plaques directly in the brains of living persons.

Their study is paving the way for the development of inexpensive methods for the early identification of people at risk for Alzheimer’s disease. According to the Alzheimer Society of Canada, 564,000 Canadians currently have Alzheimer’s disease or another form of dementia. The figure will be 937,000 within 15 years. Presently, there is no truly effective treatment for this disease.

This research was funded by grants from a Canadian research chair, the Canadian Institutes of Health Research, the Canadian Foundation for Innovation, the Canadian Brain Research Fund, the Alzheimer Society of Canada, and the Fonds de recherche du Québec — Santé.

The article entitled “Proximity to parental symptom onset and amyloid burden in sporadic Alzheimer’s disease” was published in JAMA Neurology on February 26, 2018. DOI:10.1001/jamaneurol.2017.5135

Source: http://www.douglas.qc.ca/?locale=en

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Bilingualism could offset brain changes in Alzheimer’s

A Concordia study sheds light on how language history relates to brain plasticity

News Release
February 6, 2018 | QUEBEC – Bilingualism could offset brain changes in Alzheimer’s

After more than a decade of research, this much we know: it’s good for your brain to know another language.

A new Concordia study goes further, however, focusing specifically on the effects of knowing a second language for patients with Alzheimer’s disease (AD) and mild cognitive impairment (MCI; a risk state for AD).

“Most of the previous research on brain structure was conducted with healthy younger or older adults,” says Natalie Phillips, a professor in the Department of Psychology.

“Our new study contributes to the hypothesis that having two languages exercises specific brain regions and can increase cortical thickness and grey matter density. And it extends these findings by demonstrating that these structural differences can be seen in the brains of multilingual AD and MCI patients.”

Phillips’s study, led by recent Concordia psychology grad Hilary D. Duncan (PhD 17), is soon to be published in Neuropsychologia(Jan, 2018).

New methods: Enter the MRI

Phillips and her team are the first to use high-resolution, whole-brain MRI data and sophisticated analysis techniques to measure cortical thickness and tissue density within specific brain areas.

Namely, they investigated language and cognition control areas in the frontal regions of the brain, and medial temporal lobe structures that are important for memory and are brain areas known to atrophy in MCI and AD patients.

“Previous studies used CT scans, which are a much less sensitive measure,” says Phillips, founding director of Concordia’s Cognition, Aging and Psychophysiology (CAP) Lab.

The study looked at MRIs from participating patients from the Jewish General Hospital Memory Clinic in Montreal.

Their sample included 34 monolingual MCI patients, 34 multilingual MCI patients, 13 monolingual AD patients and 13 multilingual AD patients.

Phillips believes their study is the first to assess the structure of MCI and AD patients’ language and cognition control regions. It is also the first to demonstrate an association between those regions of the brain and memory function in these groups, and the first to control for immigration status in these groups.

“Our results contribute to research that indicates that speaking more than one language is one of a number of lifestyle factors that contributes to cognitive reserve,” Phillips says.

“They support the notion that multilingualism and its associated cognitive and sociocultural benefits are associated with brain plasticity.”

What’s next?

Phillips and her team are already building on their findings.

“Our study seems to suggest that multilingual people are able to compensate for AD-related tissue loss by accessing alternative networks or other brain regions for memory processing. We’re actively investigating that hypothesis now.”

Read the cited study, “Structural brain differences between monolingual and multilingual patients with mild cognitive impairment and Alzheimer disease: Evidence for cognitive reserve.

Source: NEW RESEARCH: Bilingualism could offset brain changes in Alzheimer’s

If you develop Alzheimer’s, will your children get it too?

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Rebecca Sims, Cardiff University

The most common question I get asked is “Will my child get Alzheimer’s disease?” In my experience, this concern is one of the biggest worries for sufferers, and given the devastating effects of the disease, it is not hard to see why it is a difficult thought to contemplate.

For those people with a familial form of Alzheimer’s disease, the answer is quite straightforward. This type of disease is caused by one or more mutation(s) in one of three genes: the amyloid precursor protein (APP), Presenilin 1 (PSEN1) and Presenilin 2 (PSEN2). All of these genes are involved in the production of the amyloid protein. This protein accumulates to form sticky buildups known as plaques, which are found between the cells of the Alzheimer brain and are characteristic of disease.

Those of us who are concerned that they may be at risk from familial Alzheimer’s disease can get a definitive answer through one of the many genetic tests available. A single copy of the mutated gene inherited from an affected parent will ultimately cause disease, with symptoms likely to be noticed before the age of 65 and typically between 30 and 60 years of age. Anyone concerned that they may suffer from this form of Alzheimer’s should seek a referral to a genetic counsellor.

Fortunately, families with a familial form of disease represent less than 1% of all families afflicted by this debilitating disease. For the remaining Alzheimer’s disease families, the answer as to the inheritance of disease is much less clear, and disease onset is certainly not inevitable.

Influencing disease

A combination of both genetic and environmental factors, such as age and gender, contribute to non-familial (also known as sporadic) disease risk, but how these risk factors interact and how many risk factors are required to cause disease is still unknown.

The genetics of non-familial Alzheimer’s is complex: we know that nearly thirty genes, common in the general population, influence disease risk, with potentially hundreds more involved. Additionally, two genes of low frequency have consistently been identified, with an imminent publication by the International Genomics of Alzheimer’s Project, showing another two rare genes have a relatively large effect on disease risk.

Perhaps most excitingly for researchers, genetics scientists have shown that four biological processes in Alzheimer’s disease – that were not previously thought to play a casual role in disease onset – are actually involved. The first process is the immune response, in particular the actions of immune cells and how these potentially dysfunction, attacking the brain, which results in brain cell death.

The second is the transport of molecules into the cell, suggesting that there is a mechanism for the movement of damaging proteins into the brain. The third process that has a role in the onset of Alzheimer’s is the synthesis and breakdown of fatty molecules. And the fourth is the processing of proteins that alters protein breakdown, movement, activity and interactions – all of which are essential for normal protein function.

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Lifestyle risk

Age is the greatest risk factor for disease, with the likelihood of developing Alzheimer’s roughly doubling every five years over the age of 65. Women also have more chance of developing the disease than men, potentially due to a reduction in female hormones after menopause.

Medical conditions that increase risk for dementia include cardiovascular factors (type 2 diabetes, high blood pressure, cholesterol levels, and obesity), and depression. While lifestyle factors such as physical inactivity, a diet that increases cholesterol, smoking and excessive alcohol intake, have all been shown to influence disease risk.

Even for those with a high number of genetic, environmental and lifestyle risk factors, Alzheimer’s disease is not inevitable. Likewise, individuals with a low number of risk factors for disease are not precluded from developing Alzheimer’s.

Given this lack of certainty and the lack of effective treatments for Alzheimer’s, most experts don’t recommend genetic testing for non-familial disease. This thinking may well evolve in the future, however, when research identifies new risk genes and improves our understanding of the dysfunctional processes in Alzheimer’s disease.

The Conversation

Answering the burning question, whether you will pass Alzheimer’s disease on to your children, is therefore still a near impossibility. But, as early diagnostic techniques improve, and with the prospect of a number of vaccines and therapeutics currently in clinical trials, risk prediction for Alzheimer’s disease may become mainstream and part of a developing precision medicine culture.

Rebecca Sims, Research Fellow, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University

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

What is ‘cognitive reserve’?

What is ‘cognitive reserve’? How we can protect our brains from memory loss and dementia

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Engaging in cognitively stimulating activities can help build your resilience to cognitive decline.
Gene Wilburn/Flickr, CC BY

Michael Ridding, University of Adelaide

As we get older we have a greater risk of developing impairments in areas of cognitive function – such as memory, reasoning and verbal ability. We also have a greater risk of dementia, which is what we call cognitive decline that interferes with daily life. The trajectory of this cognitive decline can vary considerably from one person to the next.

Despite these varying trajectories, one thing is for sure: even cognitively normal people experience pathological changes in their brain, including degeneration and atrophy, as they age. By the time a person reaches the age of 70 to 80, these changes closely resemble those seen in the brains of people with Alzheimer’s Disease.

Even so, many people are able to function normally in the presence of significant brain damage and pathology. So why do some experience symptoms of Alzheimer’s and dementia, while others remain sharp of mind?

It comes down to something called cognitive reserve. This is a concept used to explain a person’s capacity to maintain normal cognitive function in the presence of brain pathology. To put it simply, some people have better cognitive reserve than others.

Evidence shows the extent of someone’s cognitive decline doesn’t occur in line with the amount of biological damage in their brain as it ages. Rather, certain life experiences determine someone’s cognitive reserve and, therefore, their ability to avoid dementia or memory loss.

How do we know?

Being educated, having higher levels of social interaction or working in cognitively demanding occupations (managerial or professional roles, for instance) increases resilience to cognitive decline and dementia. Many studies have shown this. These studies followed people over a number of years and looked for signs of them developing cognitive decline or dementia in that period.

As we get older we have a greater risk of developing impairments in cognitive function, such as memory.
from shutterstock.com

Cognitive reserve is traditionally measured and quantified based on self reports of life experience such as education level, occupational complexity and social engagement. While these measures provide an indication of reserve, they’re only of limited use if we want to identify those at risk of cognitive decline. Genetic influences obviously play a part in our brain development and will influence resilience.

Brain plasticity

The fundamental brain mechanisms that underpin cognitive reserve are still unclear.
The brain consists of complex, richly interconnected networks that are responsible for our cognitive ability. These networks have the capacity to change and adapt to task demands or brain damage. And this capacity is essential not only for normal brain function, but also for maintaining cognitive performance in later life.

This adaptation is governed by brain plasticity. This is the brain’s ability to continuously modulate its structure and function throughout life in response to different experiences. So, plasticity and flexibility in brain networks likely contribute in a major way to cognitive reserve and these processes are influenced by both genetic profiles and life experiences.

A major focus of our research is examining how brain connectivity and plasticity relate to reserve and cognitive function. We hope this will help identify a measure of reserve that reliably identifies individuals at risk of cognitive decline.

Strengthening your brain

While there is little we can do about our genetic profile, adapting our lifestyles to include certain types of behaviours offers a significant opportunity to improve our cognitive reserve.

Activities that engage your brain, such as learning a new language and completing crosswords, as well as having high levels of social interaction, increase reserve and can reduce your risk of developing dementia.

Regular physical activity increases cognitive reserve.
Jenny Hill/Unsplash, CC BY

Regular physical activity also improves cognitive function and reduces the risk of dementia. Unfortunately, little evidence is available to suggest what type of physical activity, as well as intensity and amount, is required to best increase reserve and protect against cognitive impairment.

There is also mounting evidence that being sedentary for long periods of the day is bad for health. This might even undo any benefits gained from periods of physical activity. So, it is important to understand how the composition of physical activity across the day impacts brain health and reserve, and this is an aim of our work.

The ConversationOur ongoing studies should contribute to the development of evidence-based guidelines that provide clear advice on physical activity patterns for optimising brain health and resilience.

Michael Ridding, Professor, University of Adelaide

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

Dementia, prevention & our children

There are 23 million people living with dementia in the Asia Pacific Region in 2015, costing the region a whopping US$185 billion. Little education exists on dementia for our children aside from countries such Australia, Japan, with some children attaining information in countries such as Korea, Singapore, Taiwan and China. However, there is nothing in the national curriculums to prepare children for Dementia or help children to fully understand  the need of dementia inclusive enabling communities or the preventative measures required for them to put in place at a young age to reduce their risk of dementia especially those brought about by lifestyle factors.

Ireland with slightly less than half the number of people living with dementia at approximately 20,000 people, and a population of 1.8 million and a land mass of 14,130 km2. Alzheimer’s Society reported that at least 30% of the young will know a person living with dementia. Last Wednesday it was announced on the Alzheimer’s Society website that Alzheimer’s Society and the Council for the Curriculum, Examinations and Assessment have included dementia in the school syllabus, making Northern Ireland the first to have a dementia friendly generation.

The resources are also available not just in English but also in the Irish language. Click here to view resources.

PRIMARY SCHOOL: The Archie Project from Reminiscence Learning has created a unique and innovative intergenerational awareness project to reduce the stigma associated with dementia. They believe that by engaging with young children they are dispelling the fear of dementia and changing the attitudes of our workforce for the future, providing education to support early diagnosis. Archie’s Story follows a scarecrow with dementia on his journey from exclusion to inclusion. The accompanying Archie workbook goes on to help children understand how Archie’s state of wellbeing improves by being understood, loved and included — a simple concept but one that both children and adults can relate to. The Archie Project provide books, workbooks, assemblies, scarecrow parades, Archie-related activities, training, drama and recognisable merchandise so that everyone can connect with the Archie character and learn how to engage with people with dementia in their families and communities. Links between schools and care homes enable children to put their new dementia awareness into practice. By increasing their knowledge of dementia, the project gives them confidence to interact with residents during visits to local care homes, where they take part in shared activities such as singing, gardening activities, coffee mornings, shared lunches, snooker, craft activities, tea dances and storytelling. Archie mascots encourage conversation and engagement with people at all stages of dementia. For more information visit www.reminiscencelearning.co.uk/archie (Source Alz Soc Youtube)

The promotion of dementia awareness not only helps us to create a better multi-generational dementia inclusive society but for our children, it will help them better understand the need for education and the impacts of negative lifestyle choices. A study based on a Comparison of the Prevalence of Dementia in the United States in 2000 and 2012 published in JAMA internal Medicine on the 21st November indicated that education appears to be a protector against dementia. Dr Kenneth Langa theorises that education “actually creates more, and more complicated, connections between the nerve cells so that you’re able to keep thinking normally later into life.”

In addition, Director of the Division of Behavioral and Social Research in the National Institute on Aging, John Haaga adds that “Education can not only change the brain, it can change your whole life… It affects what kind of work you do, of course. It also affects who your friends are, who you’re married to, whether you’re married. All aspects of life are affected by educational attainment.”

When children learn about dementia and the brain, they will also learn about the risk factors which will help them to adhere to healthier lifestyle choices. According to Dr Alina Cohen, “factors such as adhering to a healthy lifestyle including a diet that is rich in essential nutrients, regular exercise engagement, and having an adequate cardiovascular profile all seem to be effective ways by which to preserve cognitive function and delay cognitive decline.” This study by York University presented evidence that the delay of dementia is connected with healthy living which in turn aids higher brain function. On a whole, our children will understand the importance of education, strategies to building cognitive resilience and understand the need for a healthy lifestyle for a healthy brain. There are a whole lot more pros than cons in this picture and policy makers should really sit up and start using their brains to look at how this can be implemented. Students will be able to understand the effects of stress on the brain, the importance of prevention and help-seeking behaviours especially in the areas of anxiety and depression. On a systemic level, this will create not only a friendlier, integrated and healthier multi-generational society but one that in the future may potentially see a reduction in healthcare spending as a result of unhealthy lifestyle choices.

SECONDARY SCHOOL: In the summer of 2012, Stoke Damerel Community College was invited to become one of 21 Pioneer Schools as part of the Prime Minister’s Challenge on Dementia. The school took a unique approach to dementia education, placing it across the curriculum into as many subjects as possible and endeavouring to work in partnership with their community and local and national organisations. They placed emphasis on creative processes and outcomes, intergenerational contact and active learning. Subject leaders were actively engaged in determining the shape of dementia education in their own subjects. Some of the most successful projects at the school were those that involved creative ways of working and intergenerational activities. For example, as part of the PE curriculum, people with dementia visited the school to play croquet with year 7 students. For more information visit http://www.sdcc.net (Source Alz Soc Youtube)

In addition to Primary and Secondary school, Scout groups have also joined the cause On such program is A Million Hands a program that supports 4 main social issues, dementia being one of the four that have been selected by the young. The objective is to empower and enable the young and the youths to tackle these issues head on and have the courage to make a change. In the areas of dementia, Scouts may find themselves helping people with dementia to fight isolation or helping with awareness by teaching people to spot signs and symptoms of dementia.They may work to try and work to make communities more accessible and even work to campaign for a cure and improve the lives of people with dementia.

Dementia as part of the educational curriculum could well be a means to improve not just the future of our children but perhaps the society as a whole.

Probiotics and Alzheimer’s Disease

Good news for a lot of us in Asia whose probiotics drinking habits may be a daily run of the mill affair. From a young age, my parents would bottle me up with a small bottle of Yakult or Vitagen. These days if you walk into any 7-Eleven in Singapore, Korea, Japan or Taiwan you should be able to find a yoghurt drink rich with probiotics or just a probiotic supplement. Most of us in Asia would at least have heard of Lactobacillus acidophilus from our Yakult ads on television growing up.

New research published in the renown journal, Frontiers in Aging Neuroscience have shown that our daily dose of probiotics may have a positive impact on cognition. More research has to be carried out of course given this study is relatively new. The research, a randomised, double-blind controlled study conducted with 60 people living with dementia within a 12 week period. According to the study the participants consumed 200ml of probiotic milk daily containing Lactobacillus acidophilus, Lactobacillus casei, Bifidobacterium bifidum, and Lactobacillus fermentum.

Below is an infographic from the Internation Association for Probiotics and Prebiotics.

Looks like our recommended daily dose of probiotics may be doing us more good after all.

Reference:

Elmira Akbari, Zatollah Asemi, Reza Daneshvar Kakhaki, Fereshteh Bahmani, Ebrahim Kouchaki, Omid Reza Tamtaji, Gholam Ali Hamidi, Mahmoud Salami. Effect of Probiotic Supplementation on Cognitive Function and Metabolic Status in Alzheimer’s Disease: A Randomized, Double-Blind and Controlled Trial. Frontiers in Aging Neuroscience, 2016; 8 DOI: 10.3389/fnagi.2016.00256

http://journal.frontiersin.org/article/10.3389/fnagi.2016.00256/pdf