Could sleep apnea cause Alzheimer's

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


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

Research has long connected sleep apnea and Alzheimer's. A key study looking at Alzheimer's and sleep-disordered breathing (SDB) is opening up new "chicken-or-egg" questions: Which comes first? Just who is causing what?

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An important study looking at sleep-disordered breathing (SDB) and markers for Alzheimer's disease (AD) risk in cerebrospinal fluid (CSF) and neuroimaging adds to the growing body of research linking the two.

Increased SDB in Elderly?

But this latest study also poses an interesting question: Could AD in its "preclinical stages" also lead to SDB and explain the increased prevalence of SDB in the elderly?

"It's really a chicken and egg story," said Ricardo S. Osorio, MD, a research assistant professor at NYU School of Medicine who led the study. "Our study did not determine the direction of the causality, and, in fact, didn't uncover a significant association between the two, until we broke out the data on lean and obese patients."

When the researchers did consider body mass, they found that lean patients (defined as having a body mass index <25 ad-vulnerable="" ad="" among="" and="" atrophy="" biomarkers="" csf="" did="" fdg-pet="" glucose="" hippocampal="" hypometabolism="" in="" increased="" mri="" non-specific="" obese="" of="" p-tau="" patients="" possess="" regions="" risk="" sdb="" several="" specific="" structural="" t-tau="" using="" with="">25), glucose hypometabolism was also found in the medial temporal lobe, but was not significant in other AD-vulnerable regions.

10% to 20% Have SDB

"We know that about 10 to 20 percent of middle-aged adults in the United States have SDB [defined as an apnea-hypopnea index greater than 5] and that the number jumps dramatically in those over the age of 65," said Dr. Osorio, noting that studies put the percentage of people over the age of 65 with SDB between 30 and 60 percent. "We don't know why it becomes so prevalent, but one factor may be that some of these patients are in the earliest preclinical stages of AD."

According to Dr. Osorio, the biochemical harbingers of AD are present 15 to 20 years before any of its currently recognized symptoms become apparent.

The NYU study enrolled 68 cognitively normal elderly patients (mean age 71.4±5.6, range 64-87) who underwent two nights of home monitoring for SDB and were tested for at least one diagnostic indicator of AD. The researchers looked at P-Tau, T-Tau and Aβ42 in CSF, FDG-PET (to measure glucose metabolism), Pittsburgh compound B (PiB) PET to measure amyloid load, and/or structural MRI to measure hippocampal volume. Reduced glucose metabolism in AD-vulnerable regions, decreased hippocampal volume, changes in P-Tau, T-Tau and Aβ42, and increased binding of PiB-PET are recognized as markers of risk for AD and have been reported to be abnormal in healthy subjects before the disease onset.

Biomarkers for AD risk were found only among lean study participants with SDB. These patients showed a linear association between the severity of SDB and CSF levels of the biomarker P-Tau (F = 5.83, t=2.41, β=0.47; p< 0.05) and between SDB and glucose hypometabolism using FDG-PET, in the medial temporal lobe (F=6.34, t=-2.52, β=-0.57,p<0 .05="" a="" ad-vulnerable="" all="" also="" amyloid="" and="" as="" burden="" but="" cingulate="" compared="" composite="" controls="" cortex="" csf="" decreased="" differences="" found="" h3="" hippocampi="" in="" lean="" measures="" no="" of="" or="" p="" patients="" pib="" positive="" posterior="" precuneus="" regions="" scans.="" score="" sdb="" showed="" smaller="" style="color: #004e00; font-size: 28px; margin: 10px 0px 5px; padding-top: 5px; position: relative;" such="" t="-2.11," the="" to="" were="" when="">2-Year Study

Dr. Osorio and his colleagues are planning to test their hypothesis that very early stage preclinical AD brain injury that associates with these biomarkers can lead to SDB. They have proposed a two-year longitudinal study that would enroll 200 cognitively normal subjects, include AD biomarkers and treat those patients with moderate to severe SDB with continuous positive airway pressure, or CPAP, over time.

"Sleep Apnea Skyrockets in the Elderly"

The purpose of the new study would be to determine the "direction" of causality between SDB and preclinical AD in elderly patients. After an initial assessment, the patients would be given CPAP to treat their sleep apnea. After six months, they would be evaluated again for biomarker evidence of AD.

"If the biomarkers change, it may indicate that SDB is causing AD," explained Dr. Osorio. "If they don't change, the probable conclusion is that these patients are going to develop AD with or without CPAP, and that AD may either be causing the apneas or may simply coexist with SDB as part of aging."

Either way, Dr. Osorio believes the relationship between SDB and AD deserves further study. "Sleep apnea skyrockets in the elderly, and this fact hasn't been given the attention it deserves by the sleep world or the Alzheimer's world," Dr. Osorio said. "Sleep particularly suffers from an outmoded perception that it is an inactive physiological process, when, in reality, it is a very active part of the day for the brain."

MORE INFORMATION:

Abstract 38456
Sleep-Disordered Breathing, Aging And Risk For Alzheimer's Disease In Cognitively Normal Subjects

SOURCE:
American Thoracic Society

Top recipe for those with dementia

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

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Here is information on being the best caregiver you can be

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Enjoy a healthy brain-boost, along with great flavor, in a chicken-and-broccoli dish. This Mediterranean-style plate is loaded with neuroprotective turmeric & cumin, as well as ginger. Enhanced with brain-nutritious, delicious coconut or olive oil, the flavor is close-to-home, yet exotic at the same time!

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For information on the health benefits of these ingredients, check out:

1. J147, a Derivative of Turmeric, Outperforms Aricept (Donepezil) in Memory Tests
2. Coconut Oil & Dementia Videos & Articles
3. Olive Oil & Lettuce Protect Brain from Vascular Dementia
4. Videos & Articles on How A Mediterranean Diet Fights Dementia

Prep Time: 30 minutes
Total Time: 30 minutes
Servings: 5 Servings

Ingredients

• 1 Pound Chicken breasts
• 1 Large Head Broccoli
• 1 Onion
• 5 Cloves Garlic
• 2 Inches Ginger
• 1 Heaping Tablespoon Turmeric
• 1 Teaspoon Cumin
• 1/2 Teaspoon Chile Powder(optional)
• 3 -  6 Tablespoons coconut oil or olive oil
• 1 Lemon

DIRECTIONS

1. Slice the onions into strips. Slice the chicken also into strips. Cut the broccoli into bite size chunks
2. Mince the garlic and ginger together into one chunky paste.
3. Saute the onions in oil until softened. 5 minutes.
4. Add Ginger and Garlic Paste. Cook 1 minute
5. Add Spices. Cook 1 minute
6. Add chicken and broccoli. Cook until the chicken is no longer pink in the center and the broccoli has reached your desired texture. Add the juice from the lemon and mix.
7. Serve over brown rice or whole wheat couscous..

How to give those with dementia choices

Caregivers, and healthcare professionals,here is some great information

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

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

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

dementia care and choices

Honor Dementia Caregivers This Labor Day (part3)

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

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







How Extraordinary Americans Do Extraordinary Things
The fifth reason for honoring those caring for a dementia person is all the time they devote to this job. The caregiver is most likely responsible for everything from cleaning to cooking to shopping to yard work. The list seems endless. These tasks are even more difficult because while the caregiver is doing them, he must also keep the dementia person safe.

According to a report published by the national Alzheimer's Association, ten million caregivers provided 83 billion dollars worth of care in 2005.

So this Labor Day while you are relaxing or celebrating the end of summer, think about those 10 million dementia caregivers and all the under appreciated hard work they do, everyday, seven days a week, sometimes 24 hours a day. If you know someone with this challenging task, call them, thank them and offer a helping hand

Honor Dementia Caregivers This Labor Day (part 2)

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

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




The second reason to pay tribute to ones caring for someone with dementia is their resourcefulness. Caregivers are good at coming up with unique strategies for managing and paying for the supervision of their loved one. They may get help from attending a support group in person or online. However, they are the ones ultimately responsible for a workable plan of care.

Third is recognizing that many perform physically demanding aspects of a dementia persons' care. Many do the bathing, feeding and toileting of their family member with dementia. These tasks are difficult because many with dementia are confused and combative.

Next, these caregivers should be honored for all the time they devote to all aspects of a dementia persons' life. As just mentioned, most caregivers are responsible for the physical aspects of care. But they also must engage their loved ones in meaningful activities throughout the day and sometimes well into the night. Fortunately many take advantage of adult day care to ease the burden. Unfortunately, some dementia folks refuse to participate in or have behaviors that preclude them from attending these worthwhile programs.

Honor Dementia Caregivers This Labor Day

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







How Extraordinary Americans Do Extraordinary Things
According to the United States government Labor Day, celebrates the contributions workers have made to the strength, prosperity, and well-being of America. Dementia caregivers certainly meet these criteria. Because over 5 million Americans have been diagnosed with dementia, there are approximately 10 million caregivers attending to them. This is a hard job that they did not sign up for but was thrust upon them. Honor them this Labor Day for all the difficult work they do.

The first reason to honor a caregiver is for the financial burden they incur when caring for a person with dementia. First the family has consulted an Elder law attorney to get all the finances in order.

Most likely the caregiver had to cut back on the hours of paid employment. Despite using all the resources out there, all expenses for the care of a dementia person will not be covered. That means go without, or pay for necessary items out of pocket

come back soon for more on this

How to MEND memory

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MEND is UCLA's 25-step personalized program to reverse memory loss. Nine of 10 participants displayed significant memory improvements. Learn how. Includes a chart summing-up the 25 steps. 

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MEND is a novel, personalized and comprehensive program to reverse memory loss. In a recent MEND study, nine of 10 participants displayed subjective or objective improvement in their memories, beginning within three to six months after the program's start. Of the six patients who had to discontinue working or were struggling with their jobs at the time they joined the study, all were able to return to work or continue working with improved performance.

Continued below video...

Improvements have been sustained, and as of this writing, the longest patient follow-up is two and one-half years from initial treatment. These first ten included patients with memory loss associated with Alzheimer's disease (AD), amnestic mild cognitive impairment (aMCI), or subjective cognitive impairment (SCI; when a patient reports cognitive problems). One patient, diagnosed with late stage Alzheimer's, did not improve.

MEND: 25-Step Memory Program

Goal	Approach	Notes
Optimize diet: minimize simple carbohydrates, minimize inflammation.	Patients given choice of several low glycemic, low inflammatory, low grain diets.	Minimize inflammation, minimize insulin resistance.
Enhance autophagy, ketogenesis	Fast 12 hr each night, including 3 hr prior to bedtime.	Reduce insulin levels, reduce Aβ.
Reduce stress	Personalized—yoga or meditation or music, etc.	Reduction of cortisol, CRF, stress axis.
Optimize sleep	8 hr sleep per night; melatonin 0.5mg po qhs; Trp 500mg po 3x/wk if awakening. Exclude sleep apnea.
Exercise	30-60' per day, 4-6 days/wk
Brain stimulation	Posit or related
Homocysteine <7 font="">	Me-B12, MTHF, P5P; TMG if necessary
Serum B12 >500	Me-B12
CRP <1 .0="" a="">1.5	Anti-inflammatory diet; curcumin; DHA/EPA; optimize hygiene	Critical role of inflammation in AD
Fasting insulin <7 font="" hgba1c="">	Diet as above	Type II diabetes-AD relationship
Hormone balance	Optimize fT3, fT4, E2, T, progesterone, pregnenolone, cortisol
GI health	Repair if needed; prebiotics and probiotics	Avoid inflammation, autoimmunity
Reduction of Aβ	Curcumin, Ashwagandha
Cognitive enhancement	Bacopa monniera, MgT
25OH-D3 = 50-100ng/ml	Vitamins D3, K2
Increase NGF	H. erinaceus or ALCAR
Provide synaptic structural components	Citicoline, DHA
Optimize antioxidants	Mixed tocopherols and tocotrienols, Se, blueberries, NAC, ascorbate, α-lipoic acid
Optimize Zn:fCu ratio	Depends on values obtained
Ensure nocturnal oxygenation	Exclude or treat sleep apnea
Optimize mitochondrial function	CoQ or ubiquinol, α-lipoic acid, PQQ, NAC, ALCAR, Se, Zn, resveratrol, ascorbate, thiamine
Increase focus	Pantothenic acid	Acetylcholine synthesis requirement
Increase SirT1 function	Resveratrol
Exclude heavy metal toxicity	Evaluate Hg, Pb, Cd; chelate if indicated	CNS effects of heavy metals
MCT effects	Coconut oil or Axona

KEY:
Hg, mercury; Pb, lead; Cd, cadmium; MCT, medium chain triglycerides; PQQ, polyquinoline quinone; NAC, N-acetyl cysteine; CoQ, coenzyme Q; ALCAR, acetyl-L-carnitine; DHA, docosahexaenoic acid; MgT, magnesium threonate; fT3, free triiodothyronine; fT4, free thyroxine; E2, estradiol; T, testosterone; Me-B12, methylcobalamin; MTHF, methyltetrahydrofolate; P5P, pyridoxal-5-phosphate; TMG, trimethylglycine; Trp, tryptophan

Encouraging Findings

The study, which comes jointly from the UCLA Mary S. Easton Center for Alzheimer's Disease Research and the Buck Institute for Research on Aging, is the first to suggest that memory loss in patients may be reversed, and improvement sustained, using a complex therapeutic program that involves comprehensive changes in diet, brain stimulation, exercise, optimization of sleep, specific pharmaceuticals and vitamins, and multiple additional steps that affect brain chemistry.

The findings, published in the current online edition of the journal Aging, "are very encouraging. However, at the current time the results are anecdotal, and therefore a more extensive, controlled clinical trial is warranted," said Dale Bredesen, the Augustus Rose Professor of Neurology and Director of the Easton Center at UCLA, a professor at the Buck Institute, and the author of the paper.

In the case of Alzheimer's disease, Bredesen notes, there is not one drug that has been developed that stops or even slows the disease's progression, and drugs have only had modest effects on symptoms. "In the past decade alone, hundreds of clinical trials have been conducted for Alzheimer's at an aggregate cost of over a billion dollars, without success," he said.

Combination Therapy

Other chronic illnesses such as cardiovascular disease, cancer, and HIV, have been improved through the use of combination therapies, he noted. Yet in the case of Alzheimer's and other memory disorders, comprehensive combination therapies have not been explored. Yet over the past few decades, genetic and biochemical research has revealed an extensive network of molecular interactions involved in AD pathogenesis. "That suggested that a broader-based therapeutics approach, rather than a single drug that aims at a single target, may be feasible and potentially more effective for the treatment of cognitive decline due to Alzheimer's," said Bredesen.

While extensive preclinical studies from numerous laboratories have identified single pathogenetic targets for potential intervention, in human studies, such single target therapeutic approaches have not borne out. But, said Bredesen, it's possible addressing multiple targets within the network underlying Alzheimer's may be successful even when each target is affected in a relatively modest way. "In other words," he said, "the effects of the various targets may be additive, or even synergistic."

Given this, Bredesen thought that rather than a single targeted agent, the solution might be a systems type approach, the kind that is in line with the approach taken with other chronic illnesses -- a multiple-component system.

"The existing Alzheimer's drugs affect a single target, but Alzheimer's disease is more complex. Imagine having a roof with 36 holes in it, and your drug patched one hole very well -- the drug may have worked, a single "hole" may have been fixed, but you still have 35 other leaks, and so the underlying process may not be affected much."

“The shift to applying a broad combination therapy to Alzheimer’s is a crucial turning point towards effectively treating Alzheimer’s disease,” says Dr. Marwan N. Sabbagh, Research Professor of Neurology at the University of Arizona College of Medicine in Phoenix

Personalized Approach

Bredesen's approach is personalized to the patient, based on extensive testing to determine what is affecting the plasticity signaling network of the brain. As one example, in the case of the patient with a demanding job who was forgetting her way home, her therapeutic program consisted of some, but not all of the components involved with Bredesen's therapeutic program, and included:

• (1) eliminating all simple carbohydrates, leading to a weight loss of 20 pounds;
• (2) eliminating gluten and processed food from her diet, with increased vegetables, fruits, and non-farmed fish;
• (3) to reduce stress, she began yoga;
• (4) as a second measure to reduce the stress of her job, she began to meditate for 20 minutes twice per day;
• (5) she took melatonin each night;
• (6) she increased her sleep from 4-5 hours per night to 7-8 hours per night;
• (7) she took methylcobalamin each day;
• (8) she took vitamin D3 each day;
• (9) fish oil each day;
• (10) CoQ10 each day;
• (11) she optimized her oral hygiene using an electric flosser and electric toothbrush;
• (12) following discussion with her primary care provider, she reinstated hormone replacement therapy that had been discontinued;
• (13) she fasted for a minimum of 12 hours between dinner and breakfast, and for a minimum of three hours between dinner and bedtime;
• (14) she exercised for a minimum of 30 minutes, 4-6 days per week.

Pluses & Minuses

The results for nine of the 10 patients reported in the paper suggest that memory loss may be reversed, and improvement sustained with this therapeutic program, said Bredesen. "This is the first successful demonstration," he noted, but he cautioned that the results are anecdotal, and therefore a more extensive, controlled clinical trial is needed. "The current, anecdotal results require a larger trial, not only to confirm or refute the results reported here, but also to address key questions raised, such as the degree of improvement that can be achieved routinely, how late in the course of cognitive decline reversal can be effected, whether such an approach may be effective in patients with familial Alzheimer's disease, and last, how long improvement can be sustained," he said.

The downside to this program is its complexity. It is not easy to follow, with the burden falling on the patients and caregivers, and none of the patients were able to stick to the entire protocol.

On the other hand, the fact that there was such great memory improvement in so many patients shows that this is not an all-or-nothing program. Even doing some of the program's steps was enough to improve memory.

Even better, said Bredesen, are the program's side effects: "It is noteworthy that the major side effect of this therapeutic system is improved health and an optimal body mass index, a stark contrast to the side effects of many drugs."

Big Trial, Rapid Results

Muses Labs will soon launch a two-year observational study to conduct a large-scale trial of the MEND program. The trial will include 200+ participants with Alzheimer's disease, at selected medical facilities across the country.

Says Muses Labs’ CEO Vik Chandra, “Muses Labs intends to utilize the Internet and recent technology innovations to make personalized combination therapy practical and accessible to every individual with Alzheimer’s disease around the world.”

As the therapy does not rely upon new drugs, but rather an innovative combination of existing pharma and broader-based therapeutics, wider availability is only a couple of years away.

Sources:

• University of California, Los Angeles (UCLA), Health Sciences
• Muses Labs at www.museslabs.com.

Journal Reference:

1. Dale E. Bredesen. Reversal of cognitive decline: A novel therapeutic program.Aging, September 2014