Thursday, June 15, 2017

New data reveals increase in rate of deaths from Alzheimer's disease

The rate of death from Alzheimer's disease in the United States increased by more than 50 percent in the past 15 years, according to new data from the Centers for Disease Control and Prevention.

In part, it's because Americans are living longer – age is one of the biggest risk factors for developing Alzheimer's. But it's also because medical professionals can identify risk factors, recognize the symptoms and diagnose the disease earlier.

In addition to cognitive impairment and behavioral decline, Alzheimer's – which accounts for the majority of cases of dementia – causes deterioration of other systems of the body, leading physicians to include it as a cause of death alongside conditions it may cause, such as pneumonia or blot clots.

Now, Alzheimer's is the sixth leading cause of death nationwide. It is estimated that one in every 10 Americans age 65 and older has Alzheimer's dementia. Guidelines for diagnosing it were updated in 2012 to include use of biomarkers or genes to determine risk for the disease, in addition to family report, physician judgment and a neurological and cognitive exam.

"Those in their 80s are at the highest risk because that is the fastest-growing decade of Americans," said Dr. Paul Eslinger, a clinical neuropsychologist at Penn State Health Milton S. Hershey Medical Center.

Women account for two-thirds of Alzheimer's cases. In part that's because they typically live longer than men. Some recent studies also relate use of estrogen by women who have a genetic biomarker for Alzheimer's to a significantly increased risk of developing the disease.

Alzheimer's is typically considered to be a disease of the elderly because it is caused as brain cells gradually die off over the course of several years, even before the condition can be clinically diagnosed. Although its causes are unclear and there is no cure, some treatments can slow progression of the disease.

"Certain medications can provide the brain with some of the neurotransmitters it needs so it can function with the depleted number of cells it has and you can slow clinical symptoms such as memory loss," said Dr. Claire Flaherty, a clinical neuropsychologist at Hershey Medical Center.

Eslinger said about 80 clinical trials in progress nationwide are focusing on toxic proteins – called amyloid plaques – in the brains of Alzheimer's patients. They explore a range of approaches, including boosting brain immune function, cell metabolism, blood flow and neurotransmitter efficiency.

Early detection of the disease is important because it allows individuals an opportunity to participate in such treatment trials, most of which are geared toward the early stages of the disease, when treatments are thought to be most effective.

Early diagnosis can also help clarify for families whether a loved one has Alzheimer's or another condition that necessitates changes in their ability to work, drive, manage a household or live independently. Starting treatments early and managing lifestyle factors that can exacerbate symptoms are other benefits to detecting the disease sooner.

Advances in management of the medical and non-medical aspects of the disease are making it possible for more Alzheimer's patients to finish their lives at home. While that can improve a patient's quality of life, it can place incredible demands on caregivers.

The brunt of the burden falls on women, who account for two-thirds of all caregivers. They may need to leave the workforce early, reduce the hours they can work or make other career and lifestyle adjustments to provide the support an Alzheimer's patient requires.

Flaherty said the problem is finally being recognized by local and state governments, which are forming plans to care for an aging population and an estimated tripling in the cases of Alzheimer's in the next 30 years.

"We also have an extreme shortage of geriatric specialists in this country and those who are assigned to work with these Alzheimer's patients are not always that well trained," she said. "These are things that are now being addressed."


"Not only is healthy sleep essential for the prevention of brain degeneration as seen in Alzheimers and Parkinsons but it has also been shown to be effective treatment for sufferers of these conditions. Our brain relies so heavily on our sleep cycles to regenerate that studies have shown one missed night of sleep can impact sufferers of mental illnesses – particularly depression."

While we all sleep, we all have different experiences of sleep. Some of us feel like we can’t get enough of it, others really struggle to fall asleep. And for something that makes up decades of our lives, we don’t often think about it as important as more than rest. Even sleep researchers admit how little we know about sleep. But what we do know about sleep is fascinating.

Our sleep and awake patterns make up our circadian rhythm or clock. It is a biological timer of sorts that is created to be in synchronisation with the rotation of the earth.

Naturally, over the day, we accumulate sleep inducing hormones such as melatonin. Exposure to light, triggers different hormones such as serotonin which is what helps us wake up and stay awake during the day. Our stress hormone, cortisol, upsets the balance of these two hormones which is why stress not only affects our sleep but also affects our mood. In fact, sleeplessness is a key diagnostic criteria for depression.

With the modernisation of our society, artificial light has altered our lifestyles to the point where our circadian rhythms have become disrupted and out of rhythm with the rotation of the earth. For example, we are more often than not awake after sunset when in reality sunset was meant to be a signal to sleep. Also, one of the most effective ways to alter sleep patterns is with a blue based light - most of the devices in use today such as phones, tablets and televisions have a blue based light.

We see this disruption even more pronounced in shift workers, whose eating and sleeping habits don’t fit with a standard circadian rhythm. They commonly struggle with metabolic issues such as obesity and type 2 diabetes due to increased insulin resistance caused by altered sleep patterns. Even with the same energy intake, their body is not able to digest it in the same way because the cycle of fasting and food intake is out of routine.

Interestingly, it has been noticed that beta amyloid, one of the most significant risk factors of Alzheimer’s disease, is actively cleared from our brains while we sleep. Not only is healthy sleep essential for the prevention of brain degeneration as seen in Alzheimer's and Parkinson's but it has also been shown to be effective treatment for sufferers of these conditions. Our brain relies so heavily on our sleep cycles to regenerate that studies have shown one missed night of sleep can impact sufferers of mental illnesses – particularly depression.

Our immune system relies on sleep to rebuild all of the cells necessary for the immune system to function. This means that disrupted or missed sleep leaves our bodies at risk of infections and viruses which a rested body would be able to fight.

Also, improving sleep quality has also been shown to reduce inflammation and improve cholesterol regulation, both of which are major risk factors for cardiovascular disease.

So what can we do about our sleep habits? Sleep hygiene and lavender essential oils are the most promising when it comes to sleep quality research. Pharmaceutical drugs do little for sleep quality although they can improve sleep quantity. Sleep hygiene includes limiting blue or artificial light after sundown where practical, avoiding caffeine in the afternoon, and setting up a night time routine such as reading before going to bed. While there is significant hype around “morning routines” at the moment, I would argue that an evening routine which promotes quality sleep is of even more benefit.

Another option to improve the response of the body to the right sleep/wake hormones is to use an application on your phone or computer called f.lux. This app changes the light of your screen depending on the time of day to prepare your body for healthy and consistent sleep cycles.

Bridie Kersten is a registered nutritionist with an advanced diploma in nutrition and a Bachelor of Health Science (biochemistry and nutritional medicine).

Three Tips To Improve Your Um... Er... Memory

Memory difficulties are commonly thought of as a problem relating to older age. However the somewhat depressing news published in the British Medical Journal in 2012 revealed how cognitive decline starts in our forties and fifties, indicating it's never too early to be putting in place ways to help preserve cognitive function.

While there are a number of factors contributing to why we struggle with memory, one of the chief culprits is stress, identified by 80 percent of Americans as their most common workplace challenge.

With rates of presenteeism (low productivity due to working while sick) costing the Australian economy $34 billion a year, identifying ways to reduce the impact of stress and boost memory and cognition is becoming increasingly urgent.

To remember anything requires a three-phase step -- paying attention, encoding the material and recalling it at the appropriate time.

Poor workplace practices such as multitasking or working too many hours when already tired means the information we want to retain may never get encoded. We think we have forgotten, but the reality is we never remembered in the first place.

Thankfully there are three simple ways we can boost our memory.

Getting enough sleep

Chronic sleep deprivation increases daytime sleepiness, reduces attention and speed of processing information. Worse still, it increases the risk of the formation of false memories where your imagination creates its own version of reality.

Most people need between seven and nine hours of good quality uninterrupted sleep to think at their best. Overly busy brains benefit from an evening wind-down that includes switching off all technology at least one hour before bed, keeping to a regular bedtime routine, and keeping the room cool around 21°C, dark and quiet. Adding an additional 20 minutes of sleep time by going to bed earlier can make all the difference to your level of brainpower, as can adding in a daytime power nap of a similar time.

Increasing your exercise regime

Aerobic exercise enhances memory through increased cerebral blood flow, the associated elevation of mood, and reduction of stress, making it easier to learn and remember.

Maintaining a high level of brain fitness is the best way to enhance memory and cognition.

A new study has revealed that for the over fifties, undertaking several 45-60 minute sessions of moderate to vigorous walking, running, swimming, cycling or rowing each week can help boost general cognition, while resistance training using weights can improve executive function, memory and working memory.

Stilling the mind

Taking time out for quiet, reflective thought develops greater critical thinking, strengthens the understanding of what we learn and improves memory.

Regular mindfulness meditation practice has been shown to enhance working memory -- the additional bonus being it leads to structural changes in the brain associated with increased gray matter volume, along with improved psychological wellbeing and emotional regulation.

The most important appointment of the day is the one you make with yourself to press pause, quieten the mind and think. As with any skill you're seeking to improve in, it's always the practice that counts.

If we're always in a rush, doing too many things at once and chronically tired, it's always going to be more difficult to think well and remember what matters. While it can be tempting to take the easy option and outsource our memory to Google, choosing to exercise your mental muscle is what builds a stronger, more resilient brain. What counts is putting in the practice and keeping the brain in tip-top shape by embracing those lifestyle choices as shown by the brain science to make the biggest difference.

Maintaining a high level of brain fitness is the best way to enhance memory and cognition.

Dr. Jenny Brockis specialises in the science of high-performance thinking and is the author of Future Brain: The 12 Keys To Create Your High Performance Brain (Wiley).