Everything Alzheimer's Dementia

Can leptin help individuals with Alzheimer’s? Part 2

2010-11-27T09:40:00.000-08:00

The scientists observed that higher leptin levels were associated with a lower incidence of Alzheimer's and all other forms of dementia. At least ¼ of the study who had the lowest leptin levels had a 25% risk of developing AD over a 12-year period. On the other hand those with high levels of leptin had a much lower incidence of developing AD. Moreover, lower leptin levels were also linked to a decrease in brain size.

Dr Seshadri went on to say that at present the role of leptin in the brain is a mystery and, “we're not recommending that anyone get leptin or increase leptin levels."

As a final note, all consumers should know that there is no correlation between levels of leptin and AD. Even though low levels of leptin have been found in patients with AD, this is by no means a universal or reproducible finding.

Over the past decade, Leptin supplements have been widely sold in many health food stores and experts believe that these are just fake pills. Even though leptin is heavily marketed as a weight loss agent, there is no proof in humans that it does what the vendors of the products claim. At least for now, the only thing leptin can reduce is the weight of your hard earned money.

Study is reported in the Dec. 16 issue of Journal of the American Medical Association,

Can leptin help individuals with Alzheimer’s? Part 1

2010-11-27T09:39:00.001-08:00

Almost every week there is news about leptin. This small peptide hormone discovered about 12 years ago is still looking for a disease it can cure or prevent. In the past leptin has been promoted as a cure for aging, help with weight loss, improving depression, increasing libido and cognition. Now there is news that fat hormone may help prevent Alzheimer’s dementia (AD).

Said Dr Sudha Seshadri, an associate professor of neurology at the Boston University School of medicine, "Hopefully, in 10 or 15 years this may be one of many agents that we use to reduce the risk of Alzheimer's disease. Or it may be one of many markers that we measure in combination to predict risk.”

Dr Seshadri added, “But many more studies of different population groups are needed to determine whether leptin can play such a pivotal role in predicting the risk of Alzheimer's. There has been some data relating body weight to the risk of Alzheimer's disease. When we looked at animal studies, we found some data to indicate that leptin not only produces a feeling of satiety but also has a beneficial effect on the hippocampus. It was important to see if that was true in humans."

In the present study, 198 patients had MRI scans that calculated brain volume an average of 7.7 years after leptin was measured. The researchers also kept a lookout for all new patients diagnosed with AD among the study participants.

Big head- less dementia!

2010-11-26T16:23:00.000-08:00

While a big head may not always look attractive, there are some long-term benefits. The latest research from Germany indicates that people who have big heads may be protected against the depredation of dementia. In this study done in Munich, researchers followed people with big heads for many years. The patients had their head size measured, were given memory and cognitive skill tests followed by a brain scan to estimate the level of their disease. Over time, researchers discovered that individuals with Alzheimer dementia with the biggest heads had overall better cognition, memory and thinking skills compared to individuals with smaller skulls. A larger head was associated with better performance in the tests, even when individuals had similar amounts of Alzheimer's-related brain cell loss.

The Munich researchers speculate that having a large brain means that there is more brain reserves, which buffers against dementia related brain cell death. The study looked at over 270 patients recruited from registries across Europe and North America. The researchers observed that for every 1% brain cell death, an extra centimeter of skull size was associated with a greater than 6% score on the cognitive and memory tests.

So what does all this mean?

It is not as if someone can increase brain size overnight because brain size is genetically determined. However, these researchers say that the first few years of life are critical for brain growth and by age 6, the brain will have reached almost 94% of its absolute size.

"Improving prenatal and early life conditions could significantly increase brain reserve, which could have an impact on the risk of developing Alzheimer's disease or the severity of symptoms of the disease," lead researcher Dr Robert Perneczky said.

Dr Simon Ridley, head of research for the Alzheimer's Research Trust, said, "Alzheimer's is a very complex disease, so we should be careful not to focus too much on a single risk factor, particularly as there is little we can do about the size of our heads.”

Added Dr Simon, "The researchers have also posed the idea that nutrition, injury or infection in early life can have an impact on brain reserve, suggesting that we should look after our brain from day one. Research is the only answer to dementia. We must invest in research now to deliver the treatments needed to avert the coming dementia crisis."

The two major criticisms about the study is that 1) no one has ever shown that having a small brain or body stature leads to an increased risk of dementia and 2) it is the function of particular areas of the brain which are far more important than size.

Early diagnosis of dementia: Part 2

2010-11-14T05:24:00.000-08:00

Even though the MMSE is the current gold standard test for dementia testing, it is not ideal for all dementia and the test is not universally applicable to all patients with dementia.

The current 16-point test is heavily focused on ability to recall skills, verbal memory performance, and orientation issues such as the ability to identify a person, place, time and/or situation. The test is fast and does not involve any writing. When compared with the MMSE, it has been shown to have higher sensitivity in detecting cognitive impairment. However, experts also indicate that the test does give a high rate of false positives.

While no one disagrees for the need of better cognitive test, it is not known if this test will fit the bill. The MMSE is cumbersome, requires writing and it is also difficult to score.

Says Dr Gary J. Kennedy, director of geriatric psychiatry at Montefiore Medical Center in New York City, “I would say that reading this description of the 'Sweet 16,' it sounds like it's much more easily administrated. But still, I'm not convinced this is the answer to the problem. Because diagnosing cognitive impairment is not the same as diagnosing diabetes. It is much more complicated than that. People's cognition varies with life experience. It is not like simply testing for blood sugar levels. There isn't a single diagnostic marker."

Final point: With early diagnosis of dementia, will that mean doctors will start to prescribe more medications? The point to understand is that the majority of people who have early dementia do not require any treatment and the rates of progression of dementia are very variable.

Early diagnosis of dementia: Part 1

2010-11-14T05:23:00.001-08:00

In the last decade, there has been a major emphasis on early detection of dementia. Currently there are an estimated 3.4 million elderly Americans diagnosed with dementia, while another 5.4 million suffer from mild forms of cognitive impairment.

Recently, researchers from Boston developed a screening test to help identify individuals with early cognitive impairment. The test is designed to quickly identify people who have problem with learning, thinking and memory. Classified as “The Sweet 16" for its 16-point scale, the test rapidly exposes telltale signs of dementia through a cognition grading system that ranks mental skills from a low score of zero up to a high of 16.

However, the researchers who have formulated this test caution that it still needs further analysis to ascertain its reliability, particularly if it is to be compared to the already well -established measure of cognitive dysfunction-- the Mini-Mental State Examination (MMSE). The investigators indicate that unlike the MMSE the Sweet 16 is faster and can identify early cognitive impairment.

"For many older adults, cognitive impairment contributes to loss of independence, decreased quality of life and increased health-care costs. While the public health impact of cognitive impairment is clear, this condition is often under-recognized," said Dr. Tamara G. Fong, of Hebrew Senior Life, Beth Israel Deaconess Medical Center and Harvard Medical School .

Dr Fong also added, ""A simple, rapid cognitive assessment instrument is therefore a valuable tool for use in both clinical and research settings."

Omega 3 fatty acids do not slow down Alzheimer’s Dementia!

2010-11-02T15:21:00.001-07:00

The latest study published in the Journal Of the American Medical Association indicates that omega 3 fatty acids do not slow down or prevent Alzheimer’s dementia. This is just another study, which again casts uncertainty on the hype made about omega 3 fatty acids. For decades, these fish oil products have gained wide popularity in alternative health care for their medical benefits. However, in the past, no randomized studies were ever done and health supplements were rarely scrutinized. With more consumers turning towards alternative health care, researchers are now evaluating all the claims made by the health supplement industry.

The present study reveals that omega 3 fatty acids do not minimize the risk or damage of dementia.

Said Dr Steven Ferris, Director of Aging and Dementia at New York University, “DHA or fish-oil supplements aren't likely to cause any harm to Alzheimer's patients, but they aren't likely to do any good either.”
He added, “Fish oil "seems to be healthy in general, and maybe for other things it's helpful, but it doesn't benefit cognitive function in a person with Alzheimer's.”
In the past most of the research on omega 3 fatty acids and dementia was contradictory and inconclusive. Now there are several good randomized studies that show that omega 3 fatty acids supplements have no benefit on mental decline.

"It's not the first time something in large epidemiological datasets just didn't work out clinically," Ferris said. He also mentioned that many other pharmaceutical products like statins, estrogen pills, vitamins and anti-inflammatory drugs also failed to live up to the high expectations after initial promise in preventing Alzheimer’s dementia.

Even though the results are disappointing, there are some who believe that perhaps the omega 3 free fatty acid supplements were started too late in this study. There is evidence that dementia begins decades earlier before one observes any clear mental symptoms; and perhaps omega acids may help prevent dementia if started much earlier in life.

Said Dr Kristine Yaffe, professor of Psychiatry at UCSF, "Effective treatment strategies to prevent progression of [Alzheimer's disease] will likely need to be initiated earlier."

Vitamin E and Long term risk of dementia

2010-10-23T09:36:00.000-07:00

A recent study from Holland indicates that high intake of vitamins E may be associated with a reduced risk of dementia and Alzheimer disease (AD). This study which spanned many years looked at 5395 patients over the age of 55. The researchers looked at the relationship between dietary antioxidant intake and long-term risk of dementia over a period of 10 years.

The study showed that individuals who took vitamin E were at much lower risk for developing dementia. The study did adjust for variables like body mass index, age, smoking, geno type, smoking and use of other supplements. Unlike other previous studies, this study did not show any benefit from use of vitamin C, beta-carotene, and flavonoids.

An important aspect of this study is that it looked at a large population for over a decade and evaluated food based antioxidants found in a typical western diet. Despite study restrictions of observational aim with many influencing variables, the study did report a modest decrease in long-term risk for dementia and AD by regular intake of vitamin E enriched foods.

So what does this all mean for the consumer

Vitamin E is a is fat soluble anti oxidant found in cereals, various seeds, green leafy vegetables, tomatoes, crabs, mangoes, asparagus, papayas, and nuts. In moderation, like all foods and supplements, vitamin E is safe. However, consumers should understand that while this study shows positive benefits of Vitamin E, there are many more studies that show no benefit. The overall consensus in the medical community is that there is no solid evidence to support health benefits from vitamin E supplementation, but on the other hand there is a lot of evidence that taking more than 400 IU of vitamin E per day can increase the risk of death.

Therefore, if you want to prevent dementia or related disorders, the best advice is to eat adequate amounts of all foods and vitamins, exercise regularly, do not smoke and avoid reading too much into recent studies- all they do is create more confusion and apprehension.

Arch Neurol. 2010;67:819-825

Cure for Alzheimer’s in a bottle? Part 3

2010-01-13T06:20:00.000-08:00

So far it appears that we only have Dr Wurtman’s words to go on and more studies on diet and AD have to be done before making it sound like Souvenaid is the magic bullet for AD. These studies need to be compared to other similar diet supplements on the market. The studies have to be blinded with Dr Wurtman being not part of the study. Until objective randomized studies are done, this appears to be just another health supplement study looking for a disease it can cure.

One should note that the “Medical drink” did not improve any other memory test or cognition. The only improvement was in verbal recall.

Final note: There have been many studies which have looked at effects of vitamins and omega 3 fatty acid on AD and most have shown no benefits. Moreover, mild AD patients generally do not require any treatment in the first place because they are still capable of function. Moreover, there is not a single study which has shown that AD is due to a deficiency of any of these chemicals. Generally when doctors mix research with business, there is always a certain bias and results are usually hyped up to be more positive than what they appear. It appears that this antidote for AD appears to me more geared towards making money rather than helping patients.

The study is published in the journal Alzheimer's & Dementia.

Cure for Alzheimer’s in a bottle? Part 2

2010-01-13T06:19:00.000-08:00

Dr Wurtman says that since these nutrients are already present in the human body, they are safe- this there is no problem with side effects or toxicity. With this hypothesis their study looked at several hundred patients with mild AD. Some individuals took Souvenaid, and the control group participants received a non-medical drink, once a day for 12 weeks.

The study was not randomized or blind but the researchers observed that individuals who took this cocktail had improvement ONLY in “Verbal Recall.” Says Dr Wurtman, "There was a clear difference. The difference was greatest in people with very mild but quite real Alzheimer's but it is not a cure."

This cocktail mixture will be available on the market next year and will be distributed by Nutria America, for which Wurtman is a consultant.
Nutria is also planning more studies with the cocktail and will introduce the formulae to doctors so that they can recommend it to their patients. While Souvenaid is said to be very safe, it is only recommended in individuals with mild dementia or have early stage AD.

Speaking like a real businessman, Dr Wurtman explained that taking these supplements is similar to pregnant women taking folic acid. But what Dr Wurtman fails to mention that is that there is solid evidence to show that lack of folic acid during pregnancy can result in spinal cord defects- no such evidence exists for AD.

Cure for Alzheimer’s in a bottle? Part 1

2010-01-13T06:18:00.000-08:00

A great deal of research is being done on Alzheimer’s disease (AD) because there are close to 5 million individuals living with this incurable disorder. So far no treatment has helped but a recent study suggests that perhaps the cure for AD may be available in a bottle.

Some of the pathology behind AD is understood and most of the newer treatments are focusing on methods to replenish nerve function or replace the lost neurotransmitter in the brain. Researchers at MIT have come up with a drink called “Souvenaid” or “brain food” which is taken under the advice of a physician and can help restore neurotransmitter balance in patients with AD.

This medical drink has 3 chemicals- Uridine, choline, and the omega-3 fatty acids. When these three chemicals enter the brain, they restore brain function says researcher Dr. Richard Wurtman, professor at the Massachusetts Institute of Technology and co-author of the study. Uridine is a molecule utilized in the genetic code and a member of the vitamin B family and omega fatty acids are in ample quantities in fish (Mind you people have been taking both fish and mega doses of vitamins for the past 30 years and this has never been shown to decrease or prevent AD!).

Is Huperzine effective for Alzheimer’s Dementia? Part 2

2009-11-25T16:11:00.000-08:00

Now huperzine has been gathering interest by American researchers and is currently being evaluated for its benefit in AD patients and to treat epilepsy. So far the early results show that it is no more effective for AD patients than the conventional drugs. Its effect on memory and concentration are very mild and not consistent.

The herb also has a number of disturbing side effects like shortness of breath, chest pain, chest tightness, wheezing, skin hives, itchy skin, diarrhea, vomiting, acidity and inability to sleep. The early reports indicate that most patients tolerate these side effects.

At the moment huperzine is not been recommended by psychiatrists to treat AD because long term results on its safety are not available. Further, its effectiveness is also in doubt because numerous isolated reports indicate that the herb does very little for memory or concentration.

Current recommendation by the Alzheimer’s association is to keep away from huperzine. Before anyone decides to take huperzine, it is best to consult with your physician. The cost of huperzine is variable and so is the dosage. A month's supply of this herb costs anywhere from $35-$65 but neither the quality or quantity of the active product is guaranteed.

Is Huperzine effective for Alzheimer’s Dementia? Part 1

2009-11-25T16:06:00.000-08:00

Every week it seems that there is a new health supplement that is said to cure or prevent Alzheimer’s dementia (AD). For the consumer, it is very important to understand one very important concept about medicine. Whenever there are many drugs/herbs or novel compounds constantly being developed do treat a medical disorder- most likely none of them work.

Recently the dietary supplement huperzine A has been touted to treat and delay onset of Alzheimer’s disease. Huperzine is a naturally occurring alkaloid found in the plant firmoss Huperzia serrata. Laboratory work has shown that it can inhibit the enzyme, acetyl choline-esterase like Aricept, rivastigimine and galantamine. However, in the USA huperzine is sold as a health supplement and not as a pharmaceutical product.

The herb has been widely used in the orient, especially in china to treat a variety of medical disorders like fever, constipation, dry mouth, leg swelling and anemia. Isolated studies from China have shown that the herb is an effective treatment for AD and can enhance memory in young college students.