Afib increases risk of dementia

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Group Health

The most common kind of chronically irregular heartbeat, known as atrial fibrillation, is associated with a greater risk of dementia, including Alzheimer's disease. This discovery by scientists at Group Health Research Institute and their collaborators was published online in advance of print on August 1 in the Journal of the American Geriatrics Society.

"Both atrial fibrillation and dementia increase with age," said Sascha Dublin, MD, PhD, a Group Health Research Institute assistant investigator who led the research. "Before our prospective cohort study, we knew that atrial fibrillation can cause stroke, which can lead to dementia. Now we've learned that atrial fibrillation may increase dementia risk in other, more subtle ways as well."

The results of Dr. Dublin's study suggest a relationship between atrial fibrillation and dementia beyond the connection through stroke. The people in the study had a mean age of 74 years when the study began. None had dementia or a history of stroke. At the beginning of the study, 4.3 percent had atrial fibrillation, and an additional 12.2 percent developed it during the study. In the course of the study, 18.8 percent developed some type of dementia. People with atrial fibrillation were more likely to have other cardiovascular risk factors and disease than were those without the condition. So the researchers looked to see if atrial fibrillation increased dementia risk more than just through its association with other kinds of heart disease.

Participants were followed for an average of seven years. Over this time, those with atrial fibrillation had a 40 percent to 50 percent higher risk of developing dementia of any type, including probable Alzheimer's disease, compared to those without atrial fibrillation. This was true even for people who did not also have a stroke during the follow-up period.

The research was part of Adult Changes in Thought (ACT), an ongoing joint project of the Group Health and University of Washington studying risk factors for dementia in older adults. Started in 1994 ACT is led by Dr. Dublin's co-author Group Health Vice President for Research and Group Health Research Institute Executive Director Eric B. Larson, MD, MPH. ACT focuses on finding ways to delay or prevent dementia, including Alzheimer's disease, and declines in memory and thinking. It aims to deepen understanding of how the body-especially the brain-ages. ACT participants are members of Group Health Cooperative, a nonprofit health care system in the U.S. Pacific Northwest.

Four factors increase brain shrinkage

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Time


The study included 1,352 adults who had an average age of 54 and did not have dementia at the start of the study. All were participants of the Framingham Offspring Cohort Study (the children of the participants of the original Framingham Heart Study).

To start, researchers administered a battery of tests, including measures for obesity, high blood pressure, diabetes and high cholesterol. Starting seven years later, they measured the participants' brain size using MRI scans and also gave participants cognitive tests to gauge executive function, planning and organizational skills.

The researchers found that all four risk factors were associated with faster declines in brain size: people with high blood pressure in midlife more quickly developed a condition called white matter change, in which areas of blood vessels in the brain are damaged, compared with those who had normal blood pressure.

People with diabetes had faster shrinkage in a brain region called the hippocampus, which is involved with memory. Smokers had more rapid overall brain shrinkage than nonsmokers, and also showed faster white matter changes.

On cognitive tests, these participants showed declines in executive function, or the ability to make decisions, plan, organize, and pay attention to and remember details. People who were overweight or obese in middle age, for example, were more likely to be among the top quartile of those with the fastest rates of decrease in brain volume and the most rapid declines in executive function.

"We can't cure disease or cure aging, but the idea of a healthy body, healthy mind is very real," said Dr. Charles DeCarli, director of U.C. Davis' Alzheimer's Disease Center and a lead author of the study, in a statement. "People should stop smoking, control their blood pressure, avoid diabetes and lose weight."

The findings are in line with previous research showing that damage to the cardiovascular system is associated with cognitive decline and increased risk of dementia. Controllable lifestyle factors like smoking, high blood pressure, obesity and diabetes all increase the chances of cardiovascular-system damage. This is among the first studies, however, to link these risk factors with reductions in brain size.

Based on their findings, the authors think brain shrinkage and reduced cognitive function may be more widespread than we know: while only 5% of the study participants had diabetes, for example, nearly 50% of all Hispanics in the U.S. who are over the age of 65 have the disease.

The study was published in Neurology, the medical journal of the American Academy of Neurology.

Read more about shrinking brain

Proven to help memory

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Quincy Bioscience

Key research findings:

•The double blind, placebo-controlled study of 218 adults demonstrated apoaequorin was able to significantly improve executive function, word recall, and short-term memory compared to placebo over 90 days.
•The apoaequorin arm was able to reduce the total number of errors in a measure of cognitive function by 19 percent compared to baseline and significantly fewer errors than placebo.
• In a task requiring participants to learn a grocery shopping list, the apoaequorin group was able to recall significantly more items at Day 90 compared to baseline.
Quincy Bioscience is advancing Alzheimer’s research by utilizing a calcium-binding protein called apoaequorin which neutralizes excessive levels of calcium in the neurons that would otherwise destroy the cell.

“The Alzheimer’s research community has known for some time that unregulated calcium is a culprit.” explains Underwood. “There just haven’t been any solutions to address this cause. Our research is one very promising step which demonstrates that we can help people with memory concerns. Our next step is a larger scale study specifically targeting the Alzheimer’s population. We are very hopeful based on these results.”

More dementia preventing foods

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By: Celeste Perron

Some "superfood" fruits and vegetables get all the fanfare. You know the ones: Those richly-colored berries and beets, the Brussels sprouts and broccoli you avoided for the first twenty years of your life, only to shovel them in now.

But then there are the humble wallflowers of the salad bar, the varieties of produce that don't usually get much attention—iceberg lettuce, celery, cucumbers and the like. We tend to think of this stuff as not terribly impressive . . good low-calorie stomach fillers with a little fiber, but certainly not as disease-preventing powerhouses.

Well at least one of these veggies has recently seen its stock rise: Celery. Celery contains a compound called Luteolin that may prevent inflammation in the brain, and related conditions such as dementia and other types of memory impairment.

Research published last fall in the Journal of Nutrition found that aged mice fed a luteolin-heavy diet improved on tests of learning and memory, and had less of a certain type of inflammation in their brains. They also did experiments at the cellular level which showed that luteolin can prevent inflammatory processes in the brain from damaging neurons.

Although similar studies of luteolin have yet to be done on humans, the researchers concluded that eating luteolin-containing foods can have a beneficial effect on the aging brain, and possibly prevent aging-related mental decline.

Aside from celery, luteolin can be found in carrots, peppers, olive oil, peppermint, rosemary and chamomile. Isn't it nice to hear that such simple, inexpensive foods might prevent a disease as serious as dementia? Too often when I write about disease-fighting compounds they're found in exotic ingredients or can only be easily accessed in expensive supplements (see 4 Supplements to Stop Heart Disease, 2 Anti-Aging "Miracle" Pills)

So I'm going to start looking at celery, and those other luteolin-packed foods, as something more than salad filler.

Two supplements that may raise dementia risk

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health.lifegoesstrong.com

The brains of people with Alzheimer's, Parkinson's and similar neurodegenerative diseases are often found to contain high levels of iron and copper, and new research suggests a possible explanation.

According to scientists at the University of Texas Medical Branch at Galveston, copper and iron cause cells to generate reactive oxygen molecules, which damage brain DNA, and also inhibit the brain's natural DNA repair mechanisms. Of course, our bodies need some amount of iron and copper to function, but it appears that having too much of these minerals circulating in the blood can be a problem.

These aren't the first researchers to raise alarms about copper and iron. Last year an article in the journal Chemical Research in Toxicology suggested that people over 50 take steps to limit their exposure to copper and iron. The author of the article, Dr. George J. Brewer, a University of Michigan Medical School researcher, said at the time:

Both copper and iron toxicity are likely contributing to Alzheimer's disease. There is a major epidemic of Alzheimer's disease in the industrialized world (but) . . . it is still rare in India and Africa. There is something about industrialization that has brought this disease on in the developed world in epidemic proportions . . I think it may be due, in part, to increased meat ingestion because of the increased bioavailability of copper and iron from meat, but may also be due in part to the increased use of copper pipes for plumbing in developed countries, and the increased ingestion of copper supplements."

5 Ways to Protect Yourself

Dr. Brewer laid out some simple steps that mid-lifers can take to lower the risks of excess iron and copper (though he emphasized that these are not medical recommendations, and that you should consult your doctor):

1.Throw away supplements containing iron and copper
2.Lower your meat intake
3.Avoid drinking water with elevated levels of copper
4.Take zinc supplements to lower copper levels
5.Donate blood periodically to lower iron levels
The Supplement We Should Take

Another thing that might protect your brain from the possibly damaging effects of copper and iron: Curcumin, the main ingredient in the bright yellow spice tumeric. The University of Texas researchers found that when they exposed copper and iron to curcumin in the lab the spice binded with the metals in a way that stopped them from interfering with DNA repair.

Unless you eat curries every night, it might be a good idea to take a curcumin supplement. When I interviewed Dr. Jacob Teitelbaum on the subject late last year, he said that it's hard for our bodies to absorb curry powder, and recommended the supplements Curamed and Curamin. And the mysterious "miracle" pill Protandim contains it as well.

I don't take a curcumin supplement, but am always planning to start—because the spice has also been linked to reduced risk of cancer, heart disease and chronic pain. What's been holding me back is the price, since these supplements ain't cheap. But now that Alzheimer's and Parkinson's have been added to the list of things that curcumin might prevent, that price tag might start to look like a bargain!

Study: Lifelong stress increases risk of Alzheimer's disease

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Nutrition.diet News

LOGAN, UTAH, July 29, 2011 /NewsRelease/ - Chronic psychological stress throughout a lifespan might increase an individual’s risk for Alzheimer’s and dementia later in life, according to research from the Emma Eccles Jones College of Education and Human Services at Utah State University.

■Chronic Stress Produces Chemicals That Over Time Can Increase Rate of Neuronal Cell Death
■Stress Management Interventions Could Reduce Risk for Alzheimer’s
■Study Used Objective Data From a Recently Completed 15-Year Alzheimer’s Study
The research, led by Maria Norton, Ph.D., built off the recently completed 15-year Cache County Memory Study (CCMS) and used that data to focus on the role psychological stress has on dementia. The findings are consistent with the hypothesis that chronic stress can expose an individual to long-term levels of stress-related hormones, which results in chronically high levels of glucocorticoids, a natural chemical, shown in both animal and human studies to increase the rate of neuronal cell death with long-term exposure.

“Using this objective data, such as death records, medical information, and the cognitive evaluations from the CCMS, we were able to see that people who experienced particularly stressful life events, such as a parent’s death during one’s childhood, death of a child or spouse, or living with a spouse who is afflicted with dementia is associated with significantly higher rates of dementia later in life,” Norton said.

Norton also found that there were some factors that were associated with lower rates of depression and stress, such as individuals who had high levels of religious involvement, thus indicating that the ability to cope with psychological adversity might reduce the risk of Alzheimer’s.

“There are certainly some individuals who seem to weather stress and trials better than others, and as such they don’t tend to develop depression or face the long-term chronic exposure to the stress-related hormones that are linked to dementia,” added Norton. “This indicates that there may be preventative measures that can be taken to prevent or delay dementia. This study has helped us determine how to identify the more vulnerable subgroups of people who might benefit from stress management or other preventive interventions.”

Norton is an associate professor at Utah State University’s Department of Family, Consumer and Human Development. The Emma Eccles Jones College of Education is currently ranked fifth in the nation in terms of external funding for research.

The “Lifespan Stressors and Alzheimer’s Disease” study was funded by the National Institute on Aging. Findings from this study have been published in the Journal of the American Geriatrics Society, the Journals of Gerontology, and Age and Aging.

Study: Hospice helps those with dementia

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OzarksFirst.com

(Providence, RI) -- A newly-released survey indicates hospice care is significantly improving life for patients with dementia and their families.

Brown University gerontologist Dr. Joan Teno says people responding to the survey noted enhanced care and a perception that the quality of dying was also improved.

The report notes family members were 51-percent less likely to report unmet needs and concerns with the care received.

They also note the peacefulness and quality of dying was more positive than families whose loved ones did not receive hospice care.

The study appears in the "Journal of the American Geriatrics Society."

Drug Improves Brain Function in Condition That Leads to Alzheimer’s

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UK Press

Priya Lopes

An existing anti-seizure drug improves memory and brain function in adults with a form of cognitive impairment that often leads to full-blown Alzheimer’s disease, a Johns Hopkins University study has found.

The findings raise the possibility that doctors will someday be able to use the drug, levetiracetam, already approved for use in epilepsy patients, to slow the abnormal loss of brain function in some aging patients before their condition becomes Alzheimer’s. The researchers emphasize, however, that more studies are necessary before any such recommendation can be made to doctors and patients.

The effects seen in the study “could be like taking your foot off the accelerator or tapping the brakes, and possibly could slow the progression on that path [to Alzheimer's],” said principal investigator and neuroscientist Michela Gallagher. “We need further clinical studies with longer exposure to the drug to, first of all, make sure with rigorous evaluation that the drug is effective in the longer term and, equally important, that it does no harm.”

The new study, presented July 20 at the International Congress on Alzheimer’s Disease in Paris, also shows that excess brain activity in patients with a condition known as amnestic mild cognitive impairment, or aMCI, contributes to brain dysfunction that underlies memory loss. Previously, it had been thought that this hyperactivity was the brain’s attempt to “make up” for weakness in its ability to form new memories.

The clinical study, funded by the National Institutes of Health, tested 34 participants, some of whom were healthy older adults and others who had aMCI, meaning that they had memory difficulties greater than would be expected at their age. Each person participated in a sequence of two treatment phases lasting two weeks each. Patients received a low dose of levetiracetam during one phase and a placebo during the other.

After each treatment phase, the researchers evaluated subjects’ memory and conducted functional magnetic resonance imaging of their brains. These scans were used to map brain activity during performance of a memory task, allowing the researchers to compare each individual’s status both on and off the drug. Compared to the normal participants, subjects with amnestic MCI who took the placebo had excess activity in the hippocampus, a part of the brain essential for memory. But when they had been taking levetiracetam for two weeks, the excess activity was reduced to the same level as that of the control subjects; memory performance in the task they performed also was improved to the level of the controls’.

The findings have possible implications for the progression to Alzheimer’s disease. Studies showing excess activity in the hippocampus in patients with aMCI have found that if these patients are followed for a number of years, those with the greatest excess activation have the greatest further drop in memory and are more likely to receive a diagnosis of Alzheimer’s over the next four to six years.

Other recent research provides a clue as to why this might be the case, says Gallagher, the Krieger-Eisenhower Professor of Psychological and Brain Sciences in Johns Hopkins’ Krieger School of Arts and Sciences.

“Because some of the physiology that creates Alzheimer’s disease in the brain is driven by greater brain activity, this excess activity might be like having your foot on the accelerator if you are on the path to Alzheimer’s,” Gallagher said. “So the next step in this line of research will be to test that idea to see whether reducing excess activity might actually slow progression to Alzheimer’s for patients with aMCI.”

Between 8 and 15 percent of patients with aMCI progress to an Alzheimer’s diagnosis every year, making aMCI a stage of transition between normal aging and neurodegenerative disease. At present there is no effective treatment to modify this progression before irreversible damage has occurred in the brain. It would be a significant breakthrough to slow the progression of Alzheimer’s, a disease that is expected to affect as many as 16 million Americans by 2050.

Levetiracetam, the drug used in the study, is an anticonvulsant that decreases abnormally high activity in the brain. It is combined with other drugs to treat certain types of epileptic seizures.

The team that conducted the Johns Hopkins study included Marilyn Albert and Gregory Krauss, both professors of neurology at the Johns Hopkins University School of Medicine, and Arnold Bakker, a graduate student in Gallagher’s laboratory, who presented the findings at the Alzheimer’s conference.

Gallagher is the founder of, and a member of the scientific board of, AgeneBio, a biotechnology company focused on developing treatments for diseases that have an impact on memory, such as amnestic mild cognitive impairment and Alzheimer’s disease. The company is headquartered in Indianapolis. Gallagher owns AgeneBio stock, which is subject to certain restrictions under Johns Hopkins policy. She is entitled to shares of any royalties received by the university on sales of products related to her inventorship of intellectual property. The terms of these arrangements are managed by the university in accordance with its conflict-of-interest policies.

Sleep apnea linked to dementia

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Seattle Post

People who suffer from sleep apnea are at a high risk of developing memory problems and dementia as they get older, according to a recent study by the University of California, San Francisco and California Medical Center.

Sleeping disorders, and sleep apnea in particular, have long been associated with dementia, but this is the first time researchers have suggested that sleep problems may actually contribute to the development of cognitive impairment as we age.

For the study, a team of scientists followed almost 300 women in their early eighties for an average period of five years. At the outset, all participants tested normal in terms of cognitive abilities. The researchers found that the women who were diagnosed with sleep apnea were twice as likely to develop memory decline and other symptoms of dementia.

Although this particular study involved only women, there is no reason to believe that the results won’t apply to men as well. The disorder affects between 10 and 20 percent of middle-aged and older adults in the U.S., according to the Agency for Healthcare Research and Quality (AHRQ).

Sleep apnea causes sufferers to literally stop breathing while they’re asleep, sometimes hundreds of times a night. The reason is blockage of the airways. Consequently, blood oxygenation levels fall lower and lower until the body wakes up and normal breathing is resumed again – but only for a while. Typically, the person does not fully awake and is not aware that this is happening.

For their tests, the researchers looked at a number of specific factors connected with sleep apnea, including oxygen flow during sleep, duration of sleep and frequency of interruptions throughout the night. The risk of developing dementia appeared to be directly linked to the amount of time the women experienced a decrease of oxygen flow – not to the hours of sleep they had or the number of sleep interruptions they went through.

“The findings indicate that people with sleep apnea should be screened for cognitive problems,” said Dr. Kristine Yaffe, professor of psychiatry, neurology and epidemiology and lead author of the report that was published in the Journal of the American Medical Association (JAMA).

Although additional research is required, the study has already been acknowledged as an important step toward a better understanding of the seriousness of sleep apnea and the need for more effective treatment. “It makes sense that good sleep is going to be protective to the brain,” said Dr. Robert Thomas of Harvard Medical School in Boston, Massachusetts, who is an expert on the subject but was not involved in this study.

The most common way to treat sleep apnea is to force oxygen up a patient’s airways to prevent blockage with the help of a device that is placed in the mouth, a.k.a. Continuous Positive Airway Pressure (CPAP). Unfortunately, not everyone gets easily used to this procedure.

The disease affects often people who are overweight or have heart- and blood pressure problems. “There is only one cure for apnea so far we’ve found, and this is weight loss,” said Dr. Seva Polotsky, a researcher at Johns Hopkins University School of Medicine in Baltimore.

Aside from the issue of effective treatment, the study also gives rise to questions about the importance of sleep for both physical and mental health. The problem is that we don’t really understand yet what sleep does for us. “There is quite a broad consensus that supports the notion that memories are consolidated during sleep. But obviously the field is still not clear about what the mechanisms for memory formation are,” said Dr. Luis de Lecea, professor of psychiatry and behavioral sciences at Stanford University in California, who studies sleep disorders and their effects on memory and other brain functions in lab animals. “The new research shows a much more dramatic effect from sleep disorders than simple memory loss. Cognitive impairment is a whole different ballgame,” he added.

Of course, treating sleep apnea does not prevent all age-related decline of cognitive functions. But these latest results could change how the medical profession views the importance of sleep for both physical and mental health in general. The hope is that early diagnosis and effective treatment of chronic sleep disorders could at least help to slow down the spreading development of dementia as the average life expectancy continues to rise.

Timi Gustafson R.D. is a clinical dietitian and author of “The Healthy Diner –

Brain Protective Diet

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FYI Living


Brain Protective Diet

The study’s authors note that each nutrient likely aids in Alzheimer’s prevention in different ways. For example, vitamin E offers its strong antioxidant effect for the prevention of the disease, while omega-3 fatty acids may be related to dementia and cognitive function through an anti-inflammatory effect.

To Try the “Brain Protective” Diet

Part of the diet means a lower intake of high-fat dairy, butter, red meat and organ meat. But great foods to add to your diet include:

•Beets
•Olive oil
•Nuts
•Fish
•Tomatoes
•Poultry
•Cruciferous vegetables (broccoli, bok choy, cauliflower)
•Fruits
•Leafy green vegetables
While there is no cure for Alzheimer’s and the causes are still largely unknown, we can all benefit from adding these brain-friendly foods into our diets.

Falls Could Signal Early Alzheimer's Disease

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MedicineNet.com

Compared with older people with no signs of Alzheimer's, those whose brains show early signs of the disease are twice as likely to experience a fall, researchers have found.

In the new study, investigators looked at brain scans of 125 older adults who were participating in a study of memory and aging. The seniors were also asked to keep track of how many times they fell over the course of eight months.

An increased risk of falls was noted among individuals whose scans showed early signs of Alzheimer's. The study authors suggested that falls could indicate the need for an evaluation for the memory-robbing disease.

"To our knowledge, this is the first study to identify a risk of increased falls related to a diagnosis of preclinical Alzheimer's disease," study author Susan Stark, an assistant professor of occupational therapy and neurology at Washington University in St. Louis, said in a news release from the Alzheimer's Association International Conference.

"This finding is consistent with previous studies of mobility problems among persons with very early symptomatic Alzheimer's or mild cognitive impairment. It suggests that higher rates of falls can occur very early in the disease process," Stark added.

The study, which was slated for presentation Sunday at the Alzheimer's Association International Conference in Paris, found that of the 125 adults studied, 48 people experienced at least one fall.

The brain scans of the participants showed that higher levels of an imaging agent that binds to the abnormal protein growth that is a signature of Alzheimer's disease, was associated with a 2.7 times higher risk of a fall for each unit of increase on the scan.

The researchers noted that Alzheimer's has been linked to balance and gait disorders, as well as problems with visual and spatial perception, which could put people with the disease at higher risk for falls. Based on their findings, they added, these symptoms may appear before other more obvious signs of the disease, such as memory loss and impaired thinking.

"Growing scientific evidence suggests that 'silent' biological changes may be occurring in the brain a decade or more before we can see the outward symptoms of Alzheimer's," Maria Carrillo, Alzheimer's Association senior director of medical and scientific relations, said in the news release. "According to this study, a fall by an older adult who otherwise has a low risk of falling may signal a need for diagnostic evaluation for Alzheimer's."

The study authors concluded that additional research is needed to improve early detection and intervention in Alzheimer's disease. Lowering the risk of falls, they added, could also have an economic impact since these incidents contribute to higher rates of disability among older adults, premature placements in nursing homes and more than $19 billion in direct medical costs in 2000 alone.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

-- Mary Elizabeth Dallas

Managing insomnia in patients with dementia

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Clinincal Advisor

Experts are not certain why this behavior occurs, but it may be related to late-day confusion, end-of-day exhaustion, and reduced lighting, which can increase shadows and possibly contribute to additional confusion. However, many times a reversed sleep-wake cycle is related to individuals napping during the day and not feeling sleepy at night.

Consider adding some structure and stimulation by encouraging more planned activities during the patient's day, such as taking a walk or attending a group daycare for older adults. Pay attention to the foods the patient is consuming, and encourage eating dinner early in the evening. Advise patients to avoid the use of caffeinated beverages, sweets, tobacco or alcohol, all which can cause hyperactivity when taken late in the day or early evening.

Increased activity at night may be attributable to an underlying condition, such as restless legs syndrome, bladder infection, incontinence and uncontrolled pain. Review all medications and be sure they are not contributing to the problem.

A mild sleep aid (e.g., trazodone [Desyrel, Oleptro] 25 mg) at night can help, but use with caution. For more information, visit the National Institute on Aging website.—Deborah L. Cross, MPH, CRNP, ANP-BC (153-06)

Aggression and Alzheimer's disease

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EmpowHER
Patricia Grace

One of the most difficult, distressing and frightening situations for home caregivers or staff in care facilities is aggressive or combative behavior from someone who has Alzheimer's disease. Aggression such as shouting, raising a hand to someone, pushing, biting and hitting, is not uncommon amongst people with Alzheimer's. It can happen suddenly and without warning, at other times there is a clear build-up of emotion and disturbance prior to the outburst.

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Saved My Life The chief cause of behavioral symptoms is the progressive deterioration of brain cells. However, environmental influences can also cause symptoms or make them worse. Aggression can be caused by many factors including physical discomfort, environmental factors and poor communication. Aggressive behaviors can occur suddenly, with no apparent reason, or can result from a frustrating situation.
Behavior management experts define "agitation behavior" as "inappropriate verbal or motor activity."

• Non-aggressive Verbal Behavior: Incoherent babbling, screaming or repetitive questions is frustrating to the caregiver and family members, especially as a sign that your loved one is "losing it."

• Non-aggressive Physical Behavior: Pacing, wandering, repetitive body motions, hoarding or shadowing represent ways for your loved one to communication boredom, fear, confusion, search for safety or inability to verbalize a request for help or a feeling of pain.

• Aggressive Verbal Behavior: Cursing and abusive language can be shocking when your loved one was previously upright and proper.

• Aggressive Physical Behavior: Clearly, physically aggressive behavior such as hitting, scratching or kicking can be dangerous or life-threatening to the caregiver and care recipient.

The Alzheimer's Association suggests how to calmly respond when a person with Alzheimer's becomes confused or disoriented:

• Don't take any comments personally.

• Stay calm, and try not to react if your feelings are hurt.

• Offer an explanation, but keep it simple and brief.

• Show your loved one photo’s or other familiar reminders to help him or her remember.

• Approach someone from the front -- where he or she can see you -- rather than the back.

• Always be gentle, instead of scolding.

Watch out for warning signs, such as anxious or agitated behavior or restlessness, and take action immediately to help the person feel more calm and reassure.

sources:
http://www.alz.org/living_with_alzheimers_aggression.asp ?

http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=96 ?

Success: Smell Test for Cognitive Decline

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WebMD

Researchers Report Early Success With Smell Test for Cognitive Decline

Australian researchers say they’re a step closer to developing a simple smell test that may help predict which older adults will develop cognitive impairment and Alzheimer's disease.

The work is still very preliminary. But it appears that people who have memory loss and other signs of mental decline that can lead to Alzheimer's may have trouble discriminating between smells, says study leader Hamid R. Sohrabi, PhD, a neuropsychologist at Edith Cowan University in Perth, Australia.

William Thies, PhD, chief medical and scientific officer at the Alzheimer’s Association, tells WebMD that animal and lab research suggests there is an association between cognitive decline and smell, but that efforts to develop a commercial test have failed to date.

"It's not too surprising that the sense of smell changes, as the amyloid plaques and tangles that are thought to cause Alzheimer's develop in the same area of the brain that houses our olfactory pathway," he says.

The Sniffin' Stick Test
To determine whether cognitive impairment is associated with trouble smelling, Sohrabi and colleagues studied 308 people aged 46 to 86 with no memory problems.

All were given the "Sniffin' Stick" test, in which a person is presented three sticks, two of which have the same odor. Then he or she needs to pick out the one with the different odor. If the wrong stick is identified, the test is repeated with a slightly higher concentration of the odor, for a total of up to 16 times.

Over the next three years, 58 participants showed signs of cognitive decline, as determined by worsening scores on a simple questionnaire called CAMCOG that is used to assess memory and assist in the diagnosis of Alzheimer's.

Results showed that participants who had more trouble distinguishing between smells at the start of the study were more likely to shows signs of mental decline.

The analysis took into account other factors that can affect memory loss, such as age, sex, and education.

The findings were presented here at the Alzheimer's Association International Conference 2011.

Sohrabi says he hopes that test can be refined and someday be used to detect Alzheimer's disease early, before symptoms develop.

Other tests are further along in development, but none yet ready for clinical use.

"There is a long way to go,” Thies says. “You have to figure out which odor is best, test it in hundreds of people and validate it and then standardize the test so results are the same from one place to the next.”

Other tests are further along in development. These include tests that look for changes in the blood and cerebrospinal fluid that have been linked to the amount of Alzheimer's-associated plaque in the brain and an experimental test that looks for changes in the eye that can precede the development of Alzheimer's.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

Study Helps Explain "Sundowning" in Elderly Dementia Patients

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Sleep Review

A new study finds that late-day anxiety and agitation sometimes seen in older institutionalized adults, especially those with dementia, has a biological basis in the brain. The findings could help explain "sundowning,” a syndrome in which older adults show high levels of anxiety, agitation, general activity, and delirium in late afternoon and evening before they would normally go to bed. The findings appear in the Proceedings of the National Academy of Sciences.

Using lab mice, the researchers found that, similar to sundowning in humans, the aged mice showed significantly more activity and more anxiety-like behaviors in the hours before they would normally sleep when compared to middle-aged mice. Mice that were genetically engineered to have an Alzheimer's-like disease also showed more anxiety before sleep than did other mice.

"Some people have argued that sundowning could be explained just by a buildup of frustration of older people who couldn't communicate their needs over the course of the day, or by other factors," said Randy Nelson, co-author of the study and professor of neuroscience and psychology at Ohio State University. "But our findings suggest there is a real phenomenon going on here that has a biological basis."

Results showed that the aged mice were significantly more active than middle-aged mice in the 2 to 3 hours before they would normally go to sleep.

“The middle-aged mice had a distinct pattern of activity, with 3 peaks of activity during their waking hours,” said Tracy Bedrosian, lead author of the study and doctoral student in neuroscience at Ohio State University. “But the aged mice had a flattened rhythm in which they showed the same level of activity throughout their active period.”

The mice were also tested for anxiety-like behaviors at two different times during their waking hours. The mice were placed in a maze where they were allowed to explore open areas—which are more anxiety-producing—or hide in enclosed areas. The middle-aged mice showed consistent levels of anxiety at both times of the day. However, the aged mice showed more anxiety when tested soon before they would have gone to sleep, which is consistent with sundowning, according to Bedrosian.

Differences were also found in the brains of the aged mice when compared to the middle-aged mice. Looking specifically at the cholinergic system, because loss of function in that system is associated with dementia and many circadian changes associated with ageing, the researchers found the aged mice showed greater expression of the enzyme acetylcholinesterase before sleep than earlier in the day. High levels of this enzyme are associated with anxiety and agitation. The middle-aged mice, however, demonstrated no time-of-day differences in the expression of this enzyme.

The researchers noted that drugs used to control levels of acetylcholinesterase are sometimes used with dementia patients, although there has been no research evidence that it actually has an effect on sundowning.