Alzheimer's screening tool may be the eyes

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UW Medicine, University of Washington

Alzheimer’s is difficult to diagnose, but researchers now have a promising new screening tool, using the window to the brain: the eye. 

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A study of 3,877 randomly selected patients¹ found a significant link between three degenerative eye diseases – age-related macular degeneration, diabetic retinopathy and glaucoma – and Alzheimer’s disease. 

The results offer physicians a new way to detect those at higher risk of this disorder, which causes memory loss and other symptoms of cognitive decline. 

The researchers, from the University of Washington School of Medicine, the Kaiser Permanente Washington Health Institute and the UW School of Nursing, reported their findings in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Checking on Dementia

“We don’t mean people with these eye conditions will get Alzheimer’s disease,” said lead researcher Dr. Cecilia Lee, assistant professor of ophthalmology at the UW School of Medicine. “The main message from this study is that ophthalmologists should be more aware of the risks of developing dementia for people with these eye conditions, and primary care doctors seeing patients with these eye conditions might be more careful on checking on possible dementia or memory loss.” 

The participants in the study were age 65 and older and did not have Alzheimer’s disease at the time of enrollment. They were part of the Adult Changes in Thought database started in 1994 by Dr. Eric Larson, who is at Kaiser Permanente Washington Health Research Institute. 

Over the five-year study, 792 cases of Alzheimer’s disease were diagnosed by a committee of dementia experts. Patients with age-related macular degeneration, diabetic retinopathy, or glaucoma were at 40 % to 50% greater risk of developing Alzheimer’s disease compared to similar people without these eye conditions. Cataract diagnosis was not an Alzheimer’s disease risk factor.

Learn from the Brain by Looking at the Eye

“What we found was not subtle,” said Dr. Paul Crane, professor of medicine, Division of General Internal Medicine, at the UW School of Medicine. “This study solidifies that there are mechanistic things we can learn from the brain by looking at the eye.” 

More than 46 million older adults are affected by dementia worldwide and 131.5 million cases are expected by 2050, the researchers said. Alzheimer’ disease is the most common dementia,and discovering risk factors may lead to early detection and preventive measures, they said in their paper. 

Lee said anything happening in the eye may relate to what’s happening in the brain, an extension of the central nervous system. The possible connections need more study. She said a better understanding of neurodegeneration in the eye and the brain could bring more success in diagnosing Alzheimer’s early and developing better treatments.

New Area of Opportunity

The researchers said several factors suggest the effects they uncovered were specific to ophthalmic conditions and not merely age-related phenomenon. 

Larson said for years Alzheimer’s researchers were focused on amyloid buildup in brain tissue, but that hasn’t brought much benefit to patients. 

“This paper is pointing to a new area of opportunity,” he said. 

SUPPORT:

• Funding for this research came from the National Institutes of Health, National Institute of Aging, National Eye Institute, an Unrestricted grant from Research to Prevent Blindness, and royalties from UpToDate.

REFERENCE:

• ¹ Cecila S. Lee, et al., Associations between recent and established ophthalmic conditions and risk of Alzheimer's disease, August 8, 2018, Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

SOURCE:

• UW Medicine, University of Washington

Afib increases risk of dementia (part 2)

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Here is information on being the best caregiver you can be

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Group Health

Dr. Dublin's study, which ran from 1994 to 2008, followed 3,045 people. The researchers relied on Group Health's advanced electronic data systems to determine whether participants had atrial fibrillation. The cognitive function of all study participants was evaluated every two years with tests and interviews as part of ACT. Patients whose ACT tests indicated possible dementia had additional tests including physical, neurological, and psychological exams, and many also had brain scans. A panel of experts determined the correct diagnosis for patients with cognitive problems.

Atrial fibrillation affects 3 million Americans. Dr. Dublin says that some ways it might increase dementia risk are:


•weakening the heart's pumping ability, leading to less oxygen going to the brain;


•increasing the chance of tiny blood clots going to the brain, causing small, clinically undetected strokes;


•a combination of these plus other factors that contribute to dementia such as inflammation.

Dr. Dublin said an important next step is studying whether any treatments for atrial fibrillation reduce the risk of developing dementia. The researchers also hope their results reach primary care providers, who are often the main doctors caring for people with atrial fibrillation, dementia, or both.

"Right now, we think we are protecting our patients' brains as long as they don't have a stroke, but tiny insults over time can add up," said Dr. Dublin, who is a primary care physician at Group Health. "This paper is a wakeup call, telling us that we need to learn more about how to protect brain function, while continuing to give patients with atrial fibrillation the best possible care."


Source: Group Health Research Institute

Afib increases risk of dementia

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

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

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.