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The Prescient Clues of an  Improbable Diagnosis

8/3/2015

 
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The impact of social determinants of health and psychosocial factors such as education and physical activity on Alzheimer's disease and dementia have been discussed in the literature.
 
Here are a few contextualized reports from the Alzheimers Association International Conference. I encourage you to comment, subscribe, or just start to question the data being peddled as fact and scientific advancement. Not all data is the same...
Early education impacts future risk for Alzheimer’s disease

Two studies from Sweden presented at AAIC 2015 suggest a correlation between childhood school performance (ages 9-10) and the development of late life dementia. Both studies analyzed the impact that early schooling, secondary education and occupational complexity have on the risk of developing dementia. In the first study of more than 7,500 individuals aged 65+, dementia risk was elevated 21 percent in people who were in the lowest 20 percent of childhood school grades, and dementia risk was reduced 23 percent among individuals in occupations characterized by high complexity with data and numbers. Importantly, high occupational complexity could not compensate for the effect of low childhood school marks. Results from the second study also found significant correlations between grades/work complexity and dementia risk. In this population of 440 men and women age 75 and older, dementia risk was elevated more than 50 percent in individuals over 75 with the lowest 20 percent of early-life school grades, even if they had more formal education or a job was associated with significant complexity. According to the Alzheimer’s Association’s 10 Ways to Love Your Brain, formal education in any stage of life will help reduce your risk of cognitive decline and dementia. 
Think what we could do with all of the research money looking at tau and beta if we invested in education, housing, and nutrition?
Researchers report new ways to predict the development of Alzheimer’s disease

Studies reported at AAIC 2015 indicate that brain scans, memory tests and body fluids may hold the keys to understanding a person’s likelihood of developing Alzheimer’s, even among those who don’t have memory and thinking problems associated with the disease. Especially intriguing is a small study that suggests it could someday be possible to detect Alzheimer’s-like changes in saliva, which is simple to obtain, easily transportable and has been successfully used in diagnosing a variety of diseases and conditions. Another study suggests positron emission tomography (PET) scans of brain inflammation could one day be used to detect the disease and track the impact of treatment. 
What if different measurable and avoidable risk factors were discussed? Perhaps the intersection of the environment with characteristics of the mind, life events, aging, and manifistations of diffuse pathological conditions? A recent issue of  Technological Forecasting & Social Change journal featured an article with a multi-modal lens, Science, technology and the ‘grand challenge’ of ageing—Understanding the socio-material constitution of later life. We need to start asking more questions or perhaps better questions.
Physical exercise may be an effective treatment for Alzheimer’s disease and vascular dementia

We know that regular physical activity may reduce the risk of cognitive decline, Alzheimer’s disease and other dementias. Three new research studies reported at AAIC 2015 demonstrated the value of moderate to high intensity aerobic exercise for people with Alzheimer’s and other dementias, finding that this type of exercise may help them live better with the disease. One study of 200 people with Alzheimer’s age 50-90 showed that study participants who completed a 4-month high intensity aerobic exercise program had fewer psychiatric symptoms, such as anxiety, irritability and depression. Those who exercised hardest also had improvements on mental speed and attention. A second study of moderate-to-high intensity aerobic exercise in 65 sedentary adults 55-89 years old with mild cognitive impairment found that exercise may reduce levels of abnormal proteins in cerebrospinal fluid and increase blood flow in the brain's memory and processing centers. This aerobic exercise program appears to improve attention, planning and organizing abilities. Finally, a six-month study of 71 adults 56-96 years old with vascular cognitive impairment found that participating in a supervised aerobic exercise program was associated with improvements in memory and attention. These studies highlight the potential value of non-drug therapies for Alzheimer’s and other dementias and remind us that research ought to adamantly pursue multiple approaches to Alzheimer’s therapy and prevention. 


Women are at greater risk for cognitive decline and dementia
Women are at the epicenter of Alzheimer’s disease. According to Alzheimer’s Association 2015 Alzheimer’s Disease Facts and Figures, almost two-thirds of American seniors living with Alzheimer’s disease are women. Women are also more likely to be caregivers of those with Alzheimer’s. The most recent data show that 63 percent of all unpaid Alzheimer’s and dementia caregivers are women.

At AAIC 2015, two studies revealed how the pace and impact of Alzheimer’s and cognitive decline may be different between the sexes. One study of about 400 people with mild cognitive impairment (141 women, 257 men), mostly in their mid-seventies, showed that women deteriorate twice as fast as men with the condition in both cognitive and functional abilities.

Additionally, women declined much more dramatically than men in cognition, function and brain size following surgery with general anesthesia, according to a separate study presented at the conference that reviewed 527 older adults from two different research program databases examining cognitive aging. There is a clear need to investigate why this is the case. Is it simply that women live longer than men, or is there something different in the anatomy, biology and/or genetics that contributes to higher prevalence and faster decline?

The data from the Alzheimer’s Disease Neuroimaging Initiative ADNI is presented without context regarding the limitations of the dataset. The population is what you would describe as a clinical trial population. Patients with a comorbidity such as cancer, heart failure, etc are excluded. The age range of the subjects is also limited. If we want to consider social determinants of health we are out of luck as lifestyle information isn't being collected. Unfortunately the need to standardize the data for broad application by pharmacuetical companies limits an appropriate infrastructure for advances outside of the pharmacologic solution.

Here is an interesting article. The image is a bit fuzzy but you can view it at the link.

Epidemiology of Alzheimer's disease: occurrence, determinants, and strategies toward intervention
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    Bonny

    A data analyst focuses the lens on the evolution of Alzheimer's Disease as a diagnosis into a billion dollar healthcare juggernaut

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