Happy New Year

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

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The Dementia Caregiver's Little Book of Hope [Kindle Edition

To all the readers of this blog who are eager to learn more about dementia, I want to take this opportunity to wish you and yours a very happy new year

Try to relax. Enjoy the holiday. Remember it is not just about giving gifts, but more importantly, it is about being with family and friends and taking pleasure in their company.

It is about remembering the good times and forgetting the bad. It is about letting go of useless grudges.

It is about enjoying the moment because with dementia, that is all you may get. Remember to create your own moments of joy so you and your dementia friends can have the most joyous holiday possible

Thank you all for making “Dementia Views You Can Use” a stop on your blogging journey. In the days to come, I will be discussing more information about dementia that you will find most helpful. See you soon and…..

Happy New Year

From Susan Berg author of Adorable Photographs of Our Baby-Meaningful Mind Stimulating Activities and More for the Memory Challenged, Their Loved Ones and Involved Professionals a book for those with dementia and an excellent resource for caregivers and healthcare professionals.

Rosemary helps dementia

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

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The Dementia Caregiver's Little Book of Hope [Kindle Edition]

Green Pharmacy (Dr. Jim Duke's Botanical Desk Reference)

Aricept^® (generic: donepezil) treats Alzheimer's by blocking AChE. Rosemary does that naturally. Learn about rosemary's dementia-fighting benefits from USDA Dr. J. Duke. See how dietary rosemary strengthens memory.

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"Rosemary contains more than a dozen antioxidants and a half-dozen compounds reported to prevent the breakdown of acetylcholine. It's fabulous that the classical herb of remembrance has so many compounds that might help people suffering from Alzheimer's."

These are the words of Dr. James Duke, former U.S. Department of Agriculture (USDA) Chief of Medicinal Plant Research. 

 Dr. Duke is one of the world's leading authorities on medicinal plants. He helped build the USDA database that demonstrates how rosemary may slow the progress of Alzheimer's.

Techtalk

How Aricept^® and Rosemary Help

The brain depends on a neurotransmitter called acetylcholine, or ACh for short. The brain keeps making fresh batches. In order to keep the brain from getting flooded with it, there is an "esterase" that breaks it down after use. Think of the esterase as the garbage truck, carting away extra acetylcholine. In Alzheimer's, there is a shortage of acetylcholine, so we want to inhibit (or block) the esterase (the garbage collector), so that more acetylcholine stays in the brain. To do that, a person needs to consume an acetylcholine esterase inhibitor, such as Aricept^® or rosemary.

His strong advocacy of rosemary has to do with a chemical called acetylcholine. Anyone who has lived with Alzheimer's in the past decade has heard of the drug Aricept^®, sold generically as donepezil. It is the #1 drug therapy for Alzheimer's.

Aricept^® is a medicine that does one thing: it prevents the breakdown of acetylcholine.

So does rosemary.

Dr. Duke said that when he learned of the new medications that fought Alzheimer's by inhibiting the breakdown of acetylcholine, "I probed my U.S. Department of Agriculture (USDA) database for herbs with phytochemical constituents that were also reported to prevent the breakdown of ACh (acetylcholine).

"Even though I myself had been the source of the overwhelming proportion of the data in the database for more than a decade, I was surprised at the output. The database yielded about a half dozen anti-AChE (acetylcholine esterase) compounds, with Rosmarinus officinalis (rosemary) the proud winner in terms of their numbers and potencies." 

Dr. Duke's Big Bet

Back in 1994, Dr. James Duke publicly bet his hair that rosemary shampoo would do as well as over-the-counter medication in helping the symptoms of Alzheimer's.

Why?

"Because," he said, "aromatic phytochemicals are absorbed transdermally through the pores in the scalp just as elsewhere on hairy areas of the body, so it would be a very good bet indeed that some of the volatile aromatic phytochemicals in rosemary shampoo would make their way into the circulation and thence to the brain."

Probing the USDA phytochemical database once again on Labor Day 2007, he found that rosemary has now been reported to contain nearly a dozen aromatic compounds potentially active against AChE (acetylcholine esterase). 

Dr. Duke shares more about that memory from three years ago. "On that same day I heard, at least thrice, a commercial broadcast on NBC telling listeners that Aricept^®(donepezil HCl), the most heavily promoted of synthetic anti-Alzheimer's drugs, probably modifies a neurotransmitter involved in Alzheimer's. But Aricept^® consists only of a single AChE inhibitor, and it's synthetic and unnatural; rosemary contains nearly a dozen!!" 

Extra Bonus

In addition to its benefits to memory and cognition, herbs like rosemary also contain thousands of phytochemicals that have other positive effects on health. In addition, aromatic herbs like rosemary will also produce an attractive aroma in the otherwise depressing environment that Alzheimer's can often induce. 

Dr. Duke's Takeaway

Dr. James Duke sums up with the following advice: "All of this leads me to conclude that rosemary shampoo, rosemary tea (and aromatic mint teas), and rosemary in skin lotions and in bath water are safe and pleasant ways to reduce the risk of Alzheimer's disease. And cholinergic foods… chased down with an anti-AChE herbal tea… would be my suggestion for retarding dementia."

very medicinable for the head."

Stabilizing amyloid

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]

Lund University

Incredible images taken by the world's largest synchrotron exposed a missing link in the early-Alzheimer's cascade. They imply new drugs may do better stabilizing amyloid than eliminating it. Learn more about this course-changing discovery. 

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Researchers at Lund University in Sweden have used the MAX IV synchrotron in Lund - the strongest of its kind in the world - to produce images that predate the formation of toxic clumps of beta-amyloid, the protein believed to be at the root of Alzheimer's disease. 

The unique images appear to contradict a previously unchallenged consensus. Instead of attempting to eliminate beta-amyloid, or so-called plaques, the researchers now suggest stabilizing the protein. 

It is a long-held belief in the scientific community that the beta-amyloid plaques appear almost instantaneously. Hence the term "popcorn plaques". The infrared spectroscopy images, however, revealed something entirely different. 

The researchers could now see structural, molecular changes in the brain. 

"No one has used this method to look at Alzheimer's development before. The images tell us that the progression is slower than we thought and that there are steps in the development of Alzheimer's disease that we know little about. This, of course, sparked our curiosity," says Gunnar Gouras, professor in experimental neurology at Lund University and senior author of the study. 

What was happening at this previously unknown phase? Through biochemical identification the first author of the study, Oxana Klementieva, was able to look closer at these early brain changes. 

The results revealed another discovery. Namely, that the beta-amyloid did not appear as a single peptide, a widely held belief in the field, but as a unit of four peptides sticking together, a tetramer. 

This breakthrough offers a new hypothesis to the cause of the disease. The abnormal separation of these four peptides could be the start of the beta-amyloid aggregation that later turns into plaques. 

"This is very, very exciting. In another amyloid disease, transthyretin amyloidosis, the breaking up of the tetramer has been identified as key in disease development. For this disease, there is already a drug in the clinic that stabilizes the tetramers, consequently slowing down disease progression. We hope that stabilizing beta-amyloid in a similar fashion may be the way forward in developing future therapies" says Gunnar Gouras. 

The discovery could therefore alter the direction of therapy development for the disease. The aim of most clinical trials today is to eliminate plaques. 

Researchers at Lund University will now try to understand the interaction patterns of beta-amyloid preceding the aggregation process. Finding the antidote to whatever breaks the beta-amyloid protein apart could open doors towards a major shift in­ the development of therapies for Alzheimer's disease. 

Happy Holidays

Activities directors, caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition

To all the readers of this blog who are eager to learn more about dementia, I want to take this opportunity to wish you and yours a very merry Christmas.

Try to relax on Christmas day. Enjoy the holiday. Remember it is not just about giving gifts, but more importantly, it is about being with family and friends and taking pleasure in their company.

It is about remembering the good times and forgetting the bad. It is about letting go of useless grudges.

It is about enjoying the moment because with dementia, that is all you may get. Remember to create your own moments of joy so you and your dementia friends can have the most joyous holiday possible

Thank you all for making “Dementia Views You Can Use” a stop on your blogging journey. In the days to come, I will be discussing more information about dementia that you will find most helpful. See you soon and…..

MERRY CHRISTMAS or HAPPY CHANUKAH

From Susan Berg author of Adorable Photographs of Our Baby-Meaningful Mind Stimulating Activities and More for the Memory Challenged, Their Loved Ones and Involved Professionals a book for those with dementia and an excellent resource for caregivers and healthcare professionals.

Dementia less in the overweight

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]

Lancet

2 MILLION BRITONS (in the biggest study in history) astonished researchers with surprising results. Obese people had 29% less dementia risk than normal-weight people. Underweight people had an ever bigger risk. See what doctors say about these unexpected results. 

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Very obese people (BMI greater than 40 kg/m2) are 29% less likely to get dementia than people in the normal weight range. The unexpected results are according to new research published in The Lancet Diabetes & Endocrinology journal.

Largest Ever Study

The findings, which come from the largest ever study to examine the statistical association between BMI and dementia risk, also show that middle-aged obese people (BMI greater than 30 kg/m2) are nearly 30% less likely to develop dementia than people of a healthy weight, contradicting findings from some previous research, which suggested that obesity leads to an increased risk of dementia.

Researchers based at the London School of Hygiene & Tropical Medicine, and OXON Epidemiology, both in London, UK, analysed data from the Clinical Practice Research Datalink (CPRD), a large database of patient information recorded during routine general practice over nearly 20 years, representing around 9% of the UK population. 

2 Million People's Medical Records

The researchers analysed the medical records of nearly two million (1,958,191) people with an average (median) age of 55 years at the start of the study period, and an average (median) BMI of 26.5 kg/m2, just within the range usually classed as overweight.  During an average (median) of nine years follow-up, nearly fifty thousand (45,507) people were diagnosed with dementia.

People who were underweight in middle age were a third (34%) more likely to be diagnosed with dementia than those of a healthy weight, and this increased risk of dementia persisted even 15 years after the underweight was recorded.

Increase in BMI -> Decrease in Dementia

As participants’ BMI at middle age increased, the risk of dementia reduced, with very obese people (BMI greater than 40 kg/m2) 29% less likely to get dementia than people in the normal weight range.  An increase in BMI was associated with a substantial steadily decreasing risk of dementia for BMI of up to 25 kg/m² (classed as a healthy weight).  Above a BMI of 25 kg/m² (classed as overweight or obese), dementia risk decreased more gradually, and this trend continued up to a BMI of 35 kg/m² or higher.

The association between BMI and dementia risk wasn’t affected by the decade in which the participants were born, nor by their age at diagnosis. Adjusting for confounding factors known to increase the risk of dementia, such as alcohol use or smoking, made little difference to the results.

Need to Re-Think

According to study author Professor Stuart Pocock from the London School of Hygiene & Tropical Medicine, “Our results suggest that doctors, public health scientists, and policy makers need to re-think how to best identify who is at high risk of dementia.  We also need to pay attention to the causes and public health consequences of the link between underweight and increased dementia risk which our research has established.  However, our results also open up an intriguing new avenue in the search for protective factors for dementia – if we can understand why people with a high BMI have a reduced risk of dementia, it’s possible that further down the line, researchers might be able to use these insights to develop new treatments for dementia.” [2]

Protective?

“The reasons why a high BMI might be associated with a reduced risk of dementia aren’t clear, and further work is needed to understand why this might be the case,” adds Dr Nawab Qizilbash from OXON Epidemiology in London, UK and Madrid, Spain, the study’s lead author.  “If increased weight in mid-life is protective against dementia, the reasons for this inverse association are unclear at present. Many different issues related to diet, exercise, frailty, genetic factors, and weight change could play a part.” [2] 

Writing in a linked Comment, Professor Deborah Gustafson from SUNY Downstate Medical Center in New York, USA, says, “The published literature about BMI and dementia is equivocal. Some studies report a positive association between high mid-life BMI and dementia, whereas others do not… Many considerations are needed in the assessment of the epidemiology of the association between BMI and late-onset dementia, as is the case for many recorded associations involving late-life disorders. To understand the association between BMI and late-onset dementia should sober us as to the complexity of identifying risk and protective factors for dementia. The report by Qizilbash and colleagues is not the final word on this controversial topic.

When to use Alzheimer's medication

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]

St. Michael’s study

Alzheimer's drugs are classified as "Cognitive Enhancers". Learn why these medications are NOTfor mild memory problems. Find out why prescribing them for Mild Cognitive Impairment is bad practice. 

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There are 4 FDA-approved Alzheimer's drugs, also known as "Cognitive Enhancers". They help with concentration, memory, alertness and moods. 

When a person's brain is not working properly, though not to the point of being ill, (such as when a person experiences too much forgetfulness, while at the same time, they can still take care of their normal daily activities), doctors diagnose the problem as MCI (Mild Cognitive Impairment) or pre-dementia. 

An important study shows that cognitive enhancers do not improve cognition or function in people with MCI (Mild Cognitive Impairment) in the long term. The study was done by researchers at St. Michael’s Hospital. 

In fact, patients on these medications experienced significantly more nausea,diarrhea, vomiting and headaches, according to the study published today in the Canadian Medical Association Journal. 

“Our findings do not support the use of cognitive enhancers for mild cognitive impairment,” wrote Dr. Andrea Tricco and Dr. Sharon Straus, who are both scientists in the hospital’s Li Ka Shing Knowledge Institute. Dr. Straus is also a geriatrician at the hospital. 
  
Mild cognitive impairment is a condition characterized by memory complaints without significant limitations in everyday activity. Between 3 and 42 per cent of people are diagnosed with the condition each year, about 4.6 million people worldwide. Each year about 3 to 17 per cent of people with mild cognitive impairment will develop dementia, such as Alzheimer’s disease. Given the aging population, it’s estimated the number of Canadians with dementia will double to more than 1 million in the next 25 years. 

It has been hypothesized that cognitive enhancers may delay the onset of dementia. Families and patients are increasingly requesting these drugs even though their efficacy for patients with mild cognitive impairment has not been established. In Canada, cognitive enhancers can be obtained only with special authorization. 

Drs. Tricco and Straus conducted a review of existing evidence to understand the efficacy and safety of cognitive enhancers. They looked at eight randomized trials that compared one of four cognitive enhancers (donepezil, rivastigmine, galantamine or memantine) to a placebo among patients diagnosed with mild cognitive impairment. 

While they found short-term benefits to using these drugs on one cognition scale, there were no long-term effects after about a year and a half. No other benefits were observed on the second cognition scale or on function, behaviour, and mortality. As well, patients on these medications experienced significantly more nausea, diarrhea, vomiting and headaches. One study also found a higher risk of a heart condition known as bradycardia (slow heartbeat) among patients who received galantamine. 

“Our results do not support the use of cognitive enhancers for patients with mild cognitive impairment,” the authors wrote. “These agents were not associated with any benefit and led to an increase in harms. Patients and their families should consider this information when requesting these medications. Similarly, health care decision-makers may not wish to approve the use of these medications for mild cognitive impairment, because these drugs might not be effective and are likely associated with harm.” 

A new perspective on Alzheimer's disease

Here is a great dementia resource for caregivers and healthcare professionals,

Here is information on being the best caregiver you can be

ABC News
View by the Bay

A new perspective on Alzheimer's disease -- learn how it affects your family in a whole different way.

We as a society have spent so much money on trying to cure Alzheimer's disease and have yet to come with anything concrete, it is Dr. Shabahangi's belief that we need to focus on the care of these individuals and how we treat people them while we try to help them live in the "moment."
Forgetting is an incredible human invention, you can learn to be in the moment, and sometimes it's actually better when you do forget (especially when it concerns previous stress or trauma). When you are around people with Alzheimer's disease you learn to be in the present, you talk about what is happening now, and not what has happened in the past.

It changes your entire perspective for you and your loved ones.
It's not easy when a grandma doesn't remember your name. It's not easy when your 10-year-old laughs at your uncle or your 5-year-old is crying because grandpa doesn't remember her gifts last Christmas.
What can you do to make sure that the younger generation understands those with Alzheimer's and the elders who are forgetful are still included in your family celebrations?
Dr. Shabahangi believes you can follow these steps to reach so acceptance and understanding, and hopefully, you'll find peace and joy along the way for yourself as well:
Be grateful. Holidays is the time to reflect and be thankful for having all the people in your life - those who are forgetful and those who are not.


Be a good example. Model good behavior and inclusionary gestures for your children - they will notice and follow your lead. This is a great way to reduce fear in kids as it relates to Grandma's forgetfulness. Explain that forgetfulness doesn't = death.


Be in the moment. Those with dementia have a single point of focus, so don't dwell on "remember this" and "remember that." It may trigger unpleasant awkwardness and sense of embarrassment, and disappointment in young children. Instead talk about the here and now - the food, flowers, weather, pet, etc.


Be accepting. Alzheimer's is not contagious, but a welcoming attitude towards those dealing with it, is. It may require some patients and that's something to talk about with the younger members of your family.


Be curious. There's so much to learn from people with forgetfulness. They focus on one thing at a time&In fact, Alzheimer's is like a Zen teacher who reminds you to stay with the moment. It's a timely lesson for all of us, especially, during the busy holiday season.
About Dr. Nader Shabahangi:
Dr. Nader Shabahangi, a licensed psychotherapist, is a dedicated advocate for the elderly and focuses on creation of programs and environments that address physical, emotional and spiritual needs of the older population. He is a founder of Pacific Institute for Aging and has served as President and CEO of AgeSong since its formation in 1995.
In 1992, Nader established Pacific Institute, a nonprofit organization that helps the elderly enjoy meaningful and rewarding lives in the comfort of their home or in caring, therapeutic residential communities. Driven by his mission to transform the concept of eldership and improve the field of eldercare, Nader is the guiding spirit and visionary behind the founding of AgeSong.
Nader earned his doctorate degree from Stanford University, where he researched the philosophical assumptions that formed present-day psychotherapy approach.
Nader conducts frequent lectures across the San Francisco Bay Area and has presented at international conferences addressing the challenging and unique aspects of aging, mental health, and dementia.
He is the author of Faces of Aging and Deeper into the Soul: Beyond Dementia and Alzheimer's Towards Forgetfulness Care.

How to help veterans with dementia maintain function

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter

The Dementia Caregiver's Little Book of Hope [Kindle Edition

EurekAlert

AMERICAN GERIATRICS SOCIETY

People with dementia often have behavioral symptoms. These include problems with memory, language, and decision-making abilities. People with dementia can also experience changes in mood, such as increased irritability, depression, and anxiety. They often need assistance with their daily activities, such as feeding, dressing, using the toilet, and bathing themselves. These symptoms are often troubling for people with dementia, as well as for their caregivers.

These dementia symptoms can reduce quality of life for people as they age. This can make them dependent on other people, which can lead to caregivers feeling distressed. It may also lead to people with dementia being hospitalized or placed in a nursing home, even if it is not what they would prefer for their care.

There are no effective drug treatments for dementia or its symptoms. Therefore, researchers have been exploring treatment options to improve symptoms that don't involve using medication. A team of researchers studied one of those programs, called the Tailored Activity Program (TAP). TAP matches activities to the interests and abilities of people with dementia. Then it teaches caregivers how to use those activities daily.

The researchers initially reported positive results in a small study of 60 people. They then studied TAP in a larger group of veterans living with dementia. They reported their results in the Journal of the American Geriatrics Society.

The researchers studied 160 veterans diagnosed with dementia and whose average age was 80. The study also included 160 of the veterans' caregivers, who were mostly women around 72-years-old.

TAP included up to eight in-home sessions led by occupational therapists (health professionals who focus on helping us participate in the activities of everyday life). During the first two sessions, these health professionals evaluated the veterans' risk for falls, their daily routines and habits, and their previous and current interests. They also examined the veterans' home environment, including lighting, seating, clutter, and noise. They looked as well at the interests and abilities of the veterans' caregivers. Based on the assessment, the therapists provided an "assessment report" and offered three "activity prescriptions."

The therapists showed the veterans and caregivers how to set up the activities and use them every day. They also provided written instructions for the caregivers. The instructions covered activity goals for the individual veteran and communication strategies for the caregiver. They also instructed caregivers on ways that they could modify the home environment to help the veteran participate in the activity. The therapists worked with the veterans to show the caregivers how to use activities. They had caregivers practice recommended communication strategies. They also provided on-going education to help caregivers understand dementia and its behavioral symptoms.

During the last two sessions, caregivers learned how to simplify activities as the veterans' abilities declined. They also learned strategies to make care challenges like bathing easier.

A control group of caregivers received eight telephone sessions with a trained research team member who offered caregiver education about home safety and dementia. The researchers did not offer information about activities or behavioral symptoms to this group.

After four months, nearly 70 percent of the veterans in the TAP group either eliminated or reduced the frequency and severity of their dementia-related behaviors. This is compared to 46 percent of the veterans in the control group. Also, caregivers in the TAP group reported that the veterans were less dependent on them as they performed their daily activities. Caregivers in the TAP group reported less distress due to the veterans' behaviors, too.

The researchers concluded that TAP offers immediate benefits to the veterans and their caregivers.

Does Alzheimer's cause problems sleeping

Caregivers, and healthcare professionals,here is some great information

Here is a great dementia resource for caregivers and healthcare professionals,

Your residents will love the Amazon Kindle Fire

Here is information on being the best caregiver you can be

Here is a way for nurses administrators, social workers and other health care  professionals to get an easyceu or two

Follow alzheimersideas on twitter
The Dementia Caregiver's Little Book of Hope [Kindle Edition]

www.bidmc.org.

Alzheimer's can cause difficulty falling asleep, staying asleep and awakening too early. These often lead to nighttime confusion and wandering. Doctors now think they know why. 

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BOSTON – As people grow older, and especially if they get Alzheimer's, they often have difficulty falling asleep and staying asleep. They also tend to awaken too early in the morning. In individuals with Alzheimer’s disease, this often leads to nighttime confusion and wandering.

The Brain Cells Behind Sleep

A study led by researchers at Beth Israel Deaconess Medical Center (BIDMC) and the University of Toronto/Sunnybrook Health Sciences Center helps explain why sleep becomes more fragmented with age and Alzheimer's. Reported online today in the journal Brain, the new findings demonstrate for the first time that a group of inhibitory neurons, whose loss leads to sleep disruption in experimental animals, are substantially diminished among the elderly and individuals with Alzheimer’s disease, and that this, in turn, is accompanied by sleep disruption.

“On average, a person in his 70s has about one hour less sleep per night than a person in his 20s,” explains senior author Clifford B. Saper, MD, PhD, Chairman of Neurology at BIDMC and James Jackson Putnam Professor of Neurology at Harvard Medical School. “Sleep loss and sleep fragmentation is associated with a number of health issues, including cognitive dysfunction, increased blood pressure and vascular disease, and a tendency to develop type 2 diabetes. It now appears that loss of these neurons may be contributing to these various disorders as people age.”

Sleep Switch

In 1996, the Saper lab first discovered that the ventrolateral preoptic nucleus, a key cell group of inhibitory neurons, was functioning as a “sleep switch” in rats, turning off the brain’s arousal systems to enable animals to fall asleep. “Our experiments in animals showed that loss of these neurons produced profound insomnia, with animals sleeping only about 50 percent as much as normal and their remaining sleep being fragmented and disrupted,” he explains.

A group of cells in the human brain, the intermediate nucleus, is located in a similar location and has the same inhibitory neurotransmitter, galanin, as the vetrolateral preoptic nucleus in rats. The authors hypothesized that if the intermediate nucleus was important for human sleep and was homologous to the animal’s ventrolateral preoptic nucleus, then it may also similarly regulate humans’ sleep-wake cycles.

In order to test this hypothesis, the investigators analyzed data from the Rush Memory and Aging Project, a community-based study of aging and dementia which began in 1997 and has been following a group of almost 1,000 subjects who entered the study as healthy 65-year-olds and are followed until their deaths, at which point their brains are donated for research.

Actigraphic Recording

“Since 2005, most of the subjects in the Memory and Aging Project have been undergoing actigraphic recording every two years. This consists of their wearing a small wristwatch-type device on their non-dominant arm for seven to 10 days,” explains first author Andrew S. P. Lim, MD, of the University of Toronto and Sunnybrook Health Sciences Center and formerly a member of the Saper lab. The actigraphy device, which is waterproof, is worn 24 hours a day and thereby monitors all movements, large and small, divided into 15-second intervals. “Our previous work had determined that these actigraphic recordings are a good measure of the amount and quality of sleep,” adds Lim.

The authors examined the brains of 45 study subjects (median age at death, 89.2), identifying ventrolateral preoptic neurons by staining the brains for the neurotransmitter galanin. They then correlated the actigraphic rest-activity behavior of the 45 individuals in the year prior to their deaths with the number of remaining ventrolateral preoptic neurons at autopsy.

“We found that in the older patients who did not have Alzheimer’s disease, the number of ventrolateral preoptic neurons correlated inversely with the amount of sleep fragmentation,” says Saper. “The fewer the neurons, the more fragmented the sleep became.” The subjects with the largest amount of neurons (greater than 6,000) spent 50 percent or more of total rest time in the prolonged periods of non-movement most likely to represent sleep while subjects with the fewest ventrolateral preoptic neurons (less than 3,000) spent less than 40 percent of total rest time in extended periods of rest. The results further showed that among Alzheimer’s patients, most sleep impairment seemed to be related to the number of ventrolateral preoptic neurons that had been lost.

New Target for Improving Sleep

“These findings provide the first evidence that the ventrolateral preoptic nucleus in humans probably plays a key role in causing sleep, and functions in a similar way to other species that have been studied,” says Saper. “The loss of these neurons with aging and with Alzheimer’s disease may be an important reason why older individuals often face sleep disruptions. These results may, therefore, lead to new methods to diminish sleep problems in the elderly and prevent sleep-deprivation-related cognitive decline in people with dementia.”