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Alzheimer's, Dementia & Mental Health
Treating Heart Disease Risk Factors - Hypertension,
Diabetes - May Slow Alzheimer’s
Late-life weight loss and “motivational reserve”
may also affect AD risk
 June 11, 2007 - A new study suggests that treating
risk factors for heart disease and stroke, such as high blood pressure
and diabetes, may slow the progression of Alzheimer’s disease, according
to research reported Sunday at the 2nd Alzheimer’s Association
International Conference on Prevention of Dementia in Washington, D.C.
Two new studies further confirm the close relationship between heart
health and brain health.
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Alzheimer's, Dementia & Mental Health |
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A third report, this one from the Nun Study,
suggests that unexplained weight changes in late life have an impact on
dementia risk and also may be useful, when combined with other factors
such as biomarkers, as an indicator for early detection of dementia.
Finally, a team of scientists has developed a new
concept called “motivational reserve,” similar to “cognitive reserve,”
that may be related to incidence and progression of Alzheimer’s.
“The best known and most solid risk factors for
Alzheimer’s are age, family history and genetics, but those are things
you can’t change,” said William Thies, Ph.D., vice president of Medical
and Scientific Relations for the Alzheimer’s Association.
“Research that identifies lifestyle risk factors
gives people actions they can do, and positive choices they can make, to
reduce their risk of Alzheimer’s – like lowering their blood pressure
and treating their diabetes, or better still avoiding them in the first
place. That’s a good research investment.”
Treating vascular risk factors may slow
progression of Alzheimer’s
There is growing evidence that factors that
increase the risk of vascular events like heart attack or stroke also
increase the risk of cognitive decline; and that treatment of some
vascular risk factors, such as use of blood pressure lowering
medication, may reduce dementia occurrence.
Yan Deschaintre, M.D., F.R.C.P.(C), of the Centre
Mémoire, Hôpital Roger Salengro, Lille, France and colleagues
investigated whether vascular risk factors treatment slows cognitive
decline once Alzheimer’s and/or vascular dementia is already evident.
The researchers analysed medical records of
patients attending their memory clinic for the first time between 1997
and 2003 inclusively who had a final diagnosis of Alzhiemer’s,
Alzhiemer’s with cerebro-vascular disease, or vascular dementia.
Vascular risk factors sought were high blood
pressure, diabetes, dyslipidemia, and atherosclerotic vascular disease.
The patients were considered treated if they received an
antihypertensive, an oral antihyperglycemic or insulin, a statin or a
fibrate, an antiplatelet, or an anticoagulant.
Among the 891 dementia patients studied, the
researchers found that those who had their vascular risk factors treated
declined less than those who had not. For people with Alzheimer’s
without signs of vascular dementia, vascular risk factors treatment
reduced yearly cognitive decline by almost one third, according to the
mini-mental state evaluation (MMSE) score.
“That means the patients whose vascular risk
factors were treated declined at a slower rate such that it took them
three years to decline as much as untreated patients did after two
years,” Deschaintre said.
“Most of the social and financial burden caused by
Alzheimer’s and dementia is generated by the later, more severe stages
of the disease,” Deschaintre said. “By slowing dementia progression,
vascular risk factors treatment may delay the severe stages and have a
significant impact on reducing the burden of dementia.”
Atherosclerosis surgery and stroke or TIA
associated with increased risk of MCI
Carotid endarterectomy is performed when a major
blood vessel that supplies blood to the brain is blocked as a result of
atherosclerosis. Atherosclerosis in blood vessels in the brain reduces
oxygen supply to the brain and could cause a stroke or a very mild
stroke known as a transient ischemic attack (TIA).
Rosebud O. Roberts, M.B., Ch.B., and colleagues at
the Mayo Clinic in Rochester, Minn., investigated whether people who
have had a carotid endarterectomy or stroke are more likely to have an
impairment in their memory and thinking skills known as mild cognitive
impairment (MCI), which is in some cases a precursor to Alzheimer’s.
A total of 885 persons aged 70 to 89 in Olmsted
County, Minn., received a comprehensive examination of memory and
thinking skills, and were asked if they had ever had a carotid
endarterectomy or a stroke or TIA. 295 persons in the study group were
found to have MCI and were age and sex-matched to 590 controls (persons
free of MCI).
Among those who had MCI, 13/295 (4.41%) reported
having had a carotid endarterectomy, but only 12/590 (2.03%) of controls
had this surgery. Similarly, 77 (26.1%) MCI cases reported having had a
stroke or TIA compared to 83 (14.07%) controls.
“In this population, elderly subjects who have had
a carotid endarterectomy or stroke or TIA are about two times more
likely to have MCI,” Roberts said. “This may be due to the effects of
the severe blockage of blood flow to the brain that made the surgery
necessary, or to the effects of the stroke or TIA.
Although carotid artery surgery could be associated
with complications, an alternate explanation for our findings is that
carotid artery surgery may be a marker for generalized atherosclerosis.”
Unexplained late-life weight loss may predict
risk of dementia
Some studies have suggested that weight loss may be
a predictor of incident Alzheimer’s disease. James Mortimer, Ph.D.,
Professor of Epidemiology and Biostatistics at the University of South
Florida, Tampa, and Co-Principal Investigator of the Nun Study, and
colleagues sought to determine whether there is an association of weight
at baseline and rate of weight loss with the risk of developing
dementia, and also whether there is an association of weight or weight
loss with the severity of Alzheimer’s disease changes in the brain seen
at autopsy.
Participants were 537 non-demented Catholic sisters
aged 75-102. They were followed for up to 10 years with annual clinical
assessments and determinations of weight in the Nun Study.
In a subset of 363 Catholic sisters who died during
the study, the associations of weight at baseline and the final weight
before death with Alzheimer brain changes (as measured using Braak
stages) were assessed. In the same group, age- and education-adjusted
associations of baseline weight and final weight with the final MMSE
score before death were evaluated.
Lower initial weight and higher rate of weight loss
were significantly associated with an increased risk of developing
dementia. Lower initial weight and lower final weight before death were
significantly associated with more severe Alzheimer’s changes in the
brain. Lower initial weight and final weight also were significantly
associated with lower final MMSE score before death.
However, when Braak stage was added to the latter
model, the association of weight with the final MMSE score was lost.
“This is the first study to show that lower weight
up to 10 years before death is specifically related to the severity of
Alzheimer’s disease,” Mortimer said.
“Given its very long duration prior to onset of
dementia, it is likely that weight loss is specifically associated with
the Alzheimer’s disease process and not to a restriction in food intake
due to cognitive decline.”
“In addition, unexplained weight loss late in life
coupled with other biomarkers may help to identify those at risk of
Alzheimer’s more than a decade before symptoms start to show,” Mortimer
said. “Identification of people who are at high risk of Alzheimer’s will
be critical once agents become available that slow the disease course.”
“Motivational reserve” is a new concept
complementing cognitive reserve
The idea of “cognitive reserve” is that the brains
of people with high intelligence and superior education have greater
resilience that enables them to cope better with the damage caused by
Alzheimer’s disease, resulting in later onset of cognitive symptoms
though more swift decline.
Simon Forstmeier, PhD, and Andreas Maercker, M.D.,
Ph.D., of the University of Zurich, Switzerland, and colleagues have
developed and are investigating a complementary concept called
“motivational reserve,” which suggests that qualities such as will
power, self-discipline, motivation and optimism may protect against
cognitive decline and delay the manifestation of Alzheimer’s.
The team is evaluating newly developed instruments
for measuring premorbid motivational competence. Established instruments
are considered insufficient because they rely mainly on self-report and
refer to the present state.
In new research presented at the Alzheimer’s
Association Prevention Conference, cognitive functions were assessed in
a sample of 120 non-demented individuals aged 60 to 95 years.
Motivational and cognitive abilities were estimated using these new
instruments and procedures based on the individual’s occupational
history. The researchers found that present cognitive abilities (e.g.,
verbal fluency and working memory) could be independently predicted by
former motivational and cognitive abilities.
An ongoing longitudinal study is investigating the
predictive power of motivational reserve on the incidence of MCI and
dementia.
“Previous research showed that motivational
abilities such as self-motivation, goal setting, and emotion regulation
can be trained in individuals with and without psychiatric disorders,”
Forstmeier said. “The next step is to apply these interventions in
people at risk for Alzheimer’s or in the early stages of the disease in
order to test their ability to delay onset or progression.”
Editor’s Notes:
About the Alzheimer’s Association Prevention
Conference
The Alzheimer’s Association International
Conference on Prevention of Dementia is the world's only
multidisciplinary forum to convene professionals from the fields of
bench research, drug discovery, medicine, care and public policy. More
than 1,000 dementia experts from around the world will gather to present
and discuss the latest detection, treatment and prevention research, and
address how together we can prevent Alzheimer's from becoming a global
health crisis. The 2007 Alzheimer’s Association Prevention Conference
will be held June 9-12 at the Marriott Wardman Park Hotel in Washington,
D.C.
About the Alzheimer’s Association
The Alzheimer’s Association is the leading
voluntary health organization in Alzheimer’s care, support and research.
Our mission is to eliminate Alzheimer’s disease through the advancement
of research, provide and enhance care and support for all affected, and
reduce the risk of dementia through the promotion of brain health. Our
vision is a world without Alzheimer’s. For more information, visit
www.alz.org.
References:
• Yan Deschaintre – Vascular Risk Factors
Treatment May Slow Dementia Progression. (Funders: Fondation du Centre
Hospitalier de l'Université de Montréal, Centre de prévention des
maladies neurovasculaires du Centre Hospitalier de l'Université de
Montréal, Centre Hospitalier Régional Universitaire de Lille)
• Rosebud O. Roberts – Carotid Endarterectomy and Stroke or TIA are
Associated with an Increased Risk of Mild Cognitive Impairment. (Funders:
National Institutes of Health, Robert H. Smith and Abigail VanBuren
Alzheimer’s Disease Research Program)
• James A. Mortimer – Lower Baseline Weight and Faster Weight Loss
Predict Time To Dement in the Nun Study. (Funders: National Institute on
Aging)
• Simon Forstmeier – Motivational Reserve: A New Concept Complementing
Cognitive Reserve. (Funder: University of Zurich)
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