Eating away at cognitive decline: MIND diet may slow brain from aging by 7.5 years

While cognitive abilities naturally diminish as part of the normal aging process, it may be possible to take a bite out of this expected decline.

04 aug 2015--Eating a group of specific foods known as the MIND diet may slow cognitive decline among aging adults, even when the person is not at risk of developing Alzheimer's disease, according to researchers at Rush University Medical Center. This finding is in addition to a previous study by the research team that found that the MIND diet may reduce a person's risk in developing Alzheimer's disease.

The recent study shows that older adults who followed the MIND diet more rigorously showed an equivalent of being 7.5 years younger cognitively than those who followed the diet least.The results of the study recently were published online in the journal Alzheimer's & Dementia: The Journal of the Alzheimer's Association.

Mediterranean, with a DASH of other ingredients

The National Institute of Aging funded study evaluated cognitive change over a period of 4.7 years among 960 older adults who were free of dementia on enrollment. Averaging 81.4 years in age, the study participants also were part of the Rush Memory and Aging Project, a study of residents of more than 40 retirement communities and senior public housing units in the Chicago area.

During the course of the study, they received annual, standardized testing for cognitive ability in five areas - episodic memory, working memory, semantic memory, visuospatial ability, and perceptual speed. The study group also completed annual food frequency questionnaires, allowing the researchers to compare participants' reported adherence to the MIND diet with changes in their cognitive abilities as measured by the tests.

Martha Clare Morris, ScD, a nutritional epidemiologist, and colleagues developed the diet, whose full name is the Mediterranean-DASH Diet Intervention for Neurodegenerative Delay. As the name suggests, the MIND diet is a hybrid of the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. Both diets have been found to reduce the risk of cardiovascular conditions, like hypertension, heart attack and stroke.

"Everyone experiences decline with aging; and Alzheimer's disease is now the sixth leading cause of death in the U.S., which accounts for 60 to 80 percent of dementia cases. Therefore, prevention of cognitive decline, the defining feature of dementia, is now more important than ever," Morris says. "Delaying dementia's onset by just five years can reduce the cost and prevalence by nearly half."

A wine and no cheese party

The MIND diet has 15 dietary components, including 10 "brain-healthy food groups" and five unhealthy groups - red meat, butter and stick margarine, cheese, pastries and sweets, and fried or fast food.

To adhere to and benefit from the MIND diet, a person would need to eat at least three servings of whole grains, a green leafy vegetable and one other vegetable every day—along with a glass of wine—snack most days on nuts, have beans every other day or so, eat poultry and berries at least twice a week and fish at least once a week. In addition, the study found that to have a real shot at avoiding the devastating effects of cognitive decline, he or she must limit intake of the designated unhealthy foods, especially butter (less than 1 tablespoon a day), sweets and pastries, whole fat cheese, and fried or fast food (less than a serving a week for any of the three).

Berries are the only fruit specifically to be included in the MIND diet. "Blueberries are one of the more potent foods in terms of protecting the brain," Morris says, and strawberries also have performed well in past studies of the effect of food on cognitive function.

"The MIND diet modifies the Mediterranean and DASH diets to highlight the foods and nutrients shown through the scientific literature to be associated with dementia prevention." Morris explains. "There is still a great deal of study we need to do in this area, and I expect that we'll make further modifications as the science on diet and the brain advances."

Provided by Rush University Medical Center

Research shows easy-to-walk communities can blunt cognitive decline

Amber Watts of the University of Kansas found that walkable communities help to keep cognition sharp in older adults. Credit: University of Kansas

10 nov 2014--New study results from the University of Kansas to be presented this weekend at the Gerontological Society of America's annual meeting in Washington, D.C., bolster the adage that "heart healthy is brain healthy." The investigation shows neighborhoods that motivate walking can stave off cognitive decline in older adults.

"People can walk either to get somewhere or for leisure," said Amber Watts, assistant professor of clinical psychology, who will share her findings at a symposium Sunday, Nov. 9, in Liberty Salon K at the Washington Marriott Marquis.

"Depending on which type of walking you're interested in, a neighborhood might have different characteristics," she said. "Features of a neighborhood that encourage walking for transportation require having someplace worth walking to, like neighbors' houses, stores and parks."

Watts said neighborhoods that inspire walking for leisure also are full of pleasant things to look at, like walking trails or shade provided by trees. Also, such neighborhoods should make people feel secure on foot.

"For older adults, safety is a key issue in walkability," she said. "That includes things like traffic lights that give ample time to cross, sidewalks that are in good repair, and benches to stop and rest."

The researcher judged walkability using geographic information systems—essentially maps that measure and analyze spatial data.

"GIS data can tell us about roads, sidewalks, elevation, terrain, distances between locations and a variety of other pieces of information," Watts said. "We then use a process called Space Syntax to measure these features, including the number of intersections, distances between places or connections between a person's home and other possible destinations they might walk to. We're also interested in how complicated a route is to get from one place to another. For example, is it a straight line from point A to point B, or does it require a lot of turns to get there?"

Watts said easy-to-walk communities resulted in better outcomes both for physical health—such as lower body mass and blood pressure—and cognition (such as better memory) in the 25 people with mild Alzheimer's disease and 39 older adults without cognitive impairment she tracked. She believes that older adults, health care professionals, caregivers, architects and urban planners could benefit from the findings.

The KU researcher and her colleagues used the space syntax data to estimate a "walkability score" for subjects' home addresses. Then they estimated the relationship between people's neighborhood scores and their performance on cognitive tests over two years, factoring in issues like age, gender, education and wealth, that might influence people's cognitive scores independently of neighborhood characteristics.

Interestingly, she found that intricate community layouts might help to keep cognition sharp, rather than serve as a source of confusion in older adults.

"There seems to be a component of a person's mental representation of the spatial environment, for example, the ability to picture the streets like a mental map," Watts said. "Complex environments may require more complex mental processes to navigate. Our findings suggest that people with neighborhoods that require more mental complexity actually experience less decline in their mental functioning over time."

Watts said that older adults, just like all people, tend to choose the easiest available route or the path of least resistance. "If there is an elevator immediately available, why would we choose the stairs?" she said.

"When the environment presents challenges that are reasonable and within a person's ability level, it keeps our bodies and minds healthy," Watts said. "We need that stimulation. With regard to the complexity of neighborhood street layouts—for example, the number of turns required getting from point A to point B—our results demonstrate that more complex neighborhoods are associated with preserved cognitive performance over time. We think this may be because mental challenges are good for us. They help keep us active and working at that optimal level instead of choosing the path of least resistance."

Watts said cognitive testing of the research subjects fell into three categories: attention, or mentally rearranging patterns of letters and numbers; verbal memory, or recalling words immediately and after a delay; and mental status, a screening test for symptoms of dementia.

The work builds on Watts' longstanding interest in health behaviors, prevention strategies and bio-behavioral processes associated with cognitive decline and dementia.

"I've always been interested in why people choose to engage in healthy behaviors or not," she said. "I had been very focused around issues of the individual until I met and started working with architects who study how the physical world around us influences our choices. I found that fascinating, and I wanted to incorporate that into my work about health behaviors."

More information: www.geron.org/images/gsa/2014a… a2014programbook.pdf

Provided by University of Kansas

Digital literacy reduces cognitive decline in older adults, experts finds

Researchers have found a link between digital literacy and a reduction in cognitive decline, according to a study published in The Journals of Gerontology, Series A: Medical Sciences on July 8th.

13 aug 2014--Led by Andre Junqueira Xavier at the Universidade do Sul de Santa Catarina, this is the first major study to show that digital literacy, or the ability to engage, plan and execute digital actions such as web browsing and exchanging emails, can improve memory. Drawn from the English Longitudinal Study of Ageing, the study followed 6442 participants in the UK between the ages of 50 and 89 for 8 years.

The data measures delayed recall from a 10-word-list learning task across 5 separate measurement points. Higher wealth, education and digital literacy improved delayed recall, while people with functional impairment, diabetes, cardiovascular diseases, depressive symptoms or no digital literacy showed decline.

The researchers' findings suggest that "digital literacy increases brain and cognitive reserve or leads to the employment of more efficient cognitive networks to delay cognitive decline." The authors write, "countries where policy interventions regarding improvement in DL are implemented may expect lower incidence rates for dementia over the coming decades."

More information: The paper, "English Longitidunal Study of Ageing (ELSA): Can internet/email use reduce cognitive decline?," can be accessed here: www.oxfordjournals.org/page/5759/14

Provided by Oxford University Press

Preventing cognitive decline in healthy seniors

Cognitive training exercises—or mental exercise—may help prevent cognitive decline in healthy older adults, while evidence for the benefits of pharmacologic substances and exercise is weak, outlines a review published in CMAJ (Canadian Medical Association Journal).

19 april 2013--Mild cognitive impairment (cognitive decline that is more than normal for someone of a specific age) affects 10%-25% of people over age 70. The annual rate of decline to dementia (which is cognitive decline in several areas along with some functional ability) is about 10%. With anaging population, it is estimated that the prevalence of dementia will double to more than 1 million Canadians over the next 25 years.

The authors reviewed 32 randomized controlled trials to provide the latest evidence for physicians and their patients to help manage cognitive decline.

There is no strong evidence for pharmacologic treatments such as ginkgo, dehydroepiandrosterone (DHEA), vitamins and other substances. Most studies on efficacy show no effect whereas estrogen therapy showed an increase in cognitive decline and dementia. Evidence for the benefits of physical exercise is also weak.

Mental exercise, however, showed benefits in the three clinical trials included in the review. This involved computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning or speed of processing. In one trial, participants had significantly improved memory during 5-year follow-up periods. Another study showed an improvement in auditory memory and attention in a group of seniors who participated in a computerized cognitive training program.

"This review provides some evidence to help clinicians and their patients address what strategies might prevent cognitive decline," writes Dr. Raza Naqvi, Division of Geriatric Medicine, University of Toronto, with coauthors. "Future studies should address the impact of cognitive training on the prevention of cognitive decline, and we encourage researchers to consider easily accessible tools such as crossword puzzles and sudoku that have not been rigorously studied. The studies in this review that assessed cognitive exercises used exercises that were both labour- and resource-intensive, and thus may not be applicable to most patients."

More information: www.cmaj.ca/lookup… /cmaj.121448

Provided by Canadian Medical Association Journal

No evidence drugs, vitamins, supplements help prevent cognitive decline in healthy older adults

A review of published research has found no evidence that drugs, herbal products or vitamin supplements help prevent cognitive decline in healthy older adults.

17 april 2013--The review, conducted at St. Michael's Hospital, found some evidence that mental exercises, such as computerized memory training programs, might help.

"This review provides some evidence to help clinicians and their patients address what strategies might prevent cognitive decline," said Dr. Raza Naqvi, a University of Toronto resident and lead author of the review.

The issue is of particular importance given that mild cognitive impairment affects 10 to 25 per cent of people over age 70. Mild cognitive impairment is characterized by reduced memory, judgment, and decision-making skills compared to someone of a similar age, but not enough to interfere with daily activities.

The annual rate of decline into dementia, such as Alzheimer's disease, is about 10 per cent. Given that rate and the aging population, it's estimated the number of Canadians with dementia will double to more than 1 million in the next 25 years.

Researchers including Dr. Sharon Straus, head of the Knowledge Translation Program at St. Michael's, reviewed 32 randomized clinical trials involving about 25,000 patients.

They found no strong evidence for pharmacologic treatments such as cholinesterase inhibitors that were developed to improve the effectiveness of acetylcholine, a chemical messenger that assists memory, thought and judgment.

Nor was there strong evidence that herbal supplements such as gingko improved cognitive functions or vitamins and fatty acids such as vitamin B6 or omega-3 fatty acids.

Some studies on estrogen actually indicated an increase in cognitive decline and dementia.

Evidence on the value of physical exercise, such as strength-training, was weak.

The strongest evidence was for the value of mental exercises such as computerized training programs or intensive one-on-one personal cognitive training in memory, reasoning, or speed of processing.

Dr. Naqvi said future studies should address the impact of cognitive training on the prevention of cognitive decline.

"We encourage researchers to consider easily accessible tools such as crossword puzzles and sudoko that have not been rigorously studied," he said. "The studies in this review that assessed cognitive exercises used exercises that were both labour- and resource-intensive, and thus may not be applicable to most of our patients."

Provided by St. Michael's Hospital

Older adults with too much salt in diet and too little exercise at greater risk of cognitive decline

Older adults who lead sedentary lifestyles and consume a lot of sodium in their diet may be putting themselves at risk for more than just heart disease.

23 aug 2011--A study led by researchers at Baycrest in Toronto – in collaboration with colleagues at the Institut Universitaire de Gériatrie de Montréal, McGill University and the Université de Sherbrooke – has found evidence that high-salt diets coupled with low physical activity can be detrimental to cognitive health in older adults.

The finding, which appears online today in the journal Neurobiology of Aging, ahead of print publication, may have significant public health implications, emphasizing the importance of addressing multiple lifestyle factors that can impact brain health.

The study followed the sodium consumption and physical activity levels of 1,262 healthy older men and women (ages 67 – 84) residing in Quebec, Canada, over three years. The adults were recruited from a large pool of participants in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge).

While low sodium intake is associated with reduced blood pressure and risk of heart disease, this is believed to be the first study to extend the benefits of a low sodium diet to brain health in healthy older adults.

"We have generated important evidence that sodium intake not only impacts heart health, but brain health as well," said Dr. Alexandra Fiocco, a scientist with Baycrest's Kunin-Lunenfeld Applied and Evaluative Research Unit (KLAERU) and the study's lead investigator.

Health Canada's sodium reduction strategy recommends that people 14 years of age and older consume no more than 2,300 mg of sodium per day in their diet. In the Baycrest study, senior participants were assessed as low, mid or high level sodium consumers based on a food frequency questionnaire they each completed. Low sodium intake was defined as not exceeding 2,263 mg/day; mid sodium intake 3,090 mg/day; and high sodium intake 3,091 and greater (this went as high as 8,098) mg/day.

Researchers used a modified Mini-Mental State Examination to measure cognitive function in participants at year one (baseline) and annually for three additional years. Physical activity levels were measured using the Physical Activity Scale for the Elderly.

"The results of our study showed that a diet high in sodium, combined with little exercise, was especially detrimental to the cognitive performance of older adults," said Dr. Fiocco.

"But the good news is that sedentary older adults showed no cognitive decline over the three years that we followed them if they had low sodium intake."

"These data are especially relevant as we know that munching on high-salt processed snacks when engaged in sedentary activities, such as watching TV or playing in front of the computer, is a frequent pastime for many adults," said Dr. Carol Greenwood, a senior author on the study and internationally-renowned scientist in the field of nutrition and cognitive function in late life.

"This study addresses an additional risk associated with lifestyles that are highly apparent in North American populations."

With brain failure rates expected to rise significantly as Canada's large boomer demographic ages, educating the public about lifestyle changes that can help delay or prevent normal, age-related cognitive decline – including adopting a healthier diet – is a way to give people some control over how their brain health will hold up in later years, said Dr. Greenwood, senior scientist with Baycrest's KLAERU and professor in the Department of Nutritional Sciences at the University of Toronto.

Provided by Baycrest Centre for Geriatric Care

Study predicts risk of memory loss in healthy, older adults

The combined results of a genetic blood test and a five-minute functional MRI successfully classified more than three-quarters of healthy older adults, many of whom were destined to develop cognitive decline within 18 months of testing.

02 feb 2011--John Woodard, Ph.D., associate professor of psychology in the College of Liberal Arts and Sciences and Institute of Gerontology at Wayne State University, is lead author of "Predicting Cognitive Decline in Healthy Older Adults Using fMRI" published in the Journal of Alzheimer's Disease (vol. 21, no. 3).

"No one had studied these combinations of tests in such a large sample," Woodard said. The results have strong implications for determining who is most likely to benefit from preventive Alzheimer's disease treatments.

Woodard and his colleagues performed five tests on 78 healthy elders: a structural MRI (sMRI) that measures the size of the hippocampal region of the brain; a functional MRI (fMRI) that shows how the brain is activated during mental tasks; a blood test that identifies the APOE ε4 allele (a known genetic marker for Alzheimer's disease); and two standard neuropsychological tests that measure mood and ability.

The most effective combination of tests to predict near-term cognitive decline was the fMRI and the APOE ε4 test. The APOE ε4 allele alone correctly classified 61.5 percent of participants, but the combination of the ε4 allele and low activity on the fMRI test correctly classified 78.9 percent of participants, including 35 percent who showed significant cognitive decline 18 months post-testing.

Age, years of education, gender and family history of dementia were not accurate predictors of future cognitive decline. Dr. Woodard and his colleagues also found that persons with larger hippocampal volume, greater functional brain activity and no APOE ε4 allele were less likely to demonstrate cognitive decline over the following 18 months.

The APOE and fMRI tests that combined as the best predictors are readily available, not time-consuming, and don't require special skills or effort on the part of the participant.

"Use of these tests could play a major role in development of medications for prevention of Alzheimer's and other dementias," Woodard said. "If we can intervene before people become symptomatic, we might be able to slow the progression of the disease or eliminate it altogether."

Alzheimer's is age-correlated; the older the person, the greater the likelihood the person will display symptoms.

"If we could delay the onset of Alzheimer's disease by five years, we could cut the number of new cases in half," Dr. Woodard said. "If we could delay the onset of Alzheimer's disease by 10 years, we could potentially eliminate the disease completely."

More information: The complete study is available at http://www.j-alz.c … vol21-3.html

Provided by Wayne State University

Lower biomarker levels, less education associated with greater cognitive decline

Older adults without dementia and with lower levels in plasma of the biomarkers beta-amyloid 42/40 (protein fragments) had an increased rate of cognitive decline over a period of 9 years, according to a study in the January 19 issue of JAMA. The researchers also found that this relationship was stronger among individuals with less education and lower levels of literacy.

19 jan 2011--An estimated 36 million people currently have dementia, with the prevalence expected to double every 20 years, according to background information in the article. "Thus, biomarkers to identify elderly persons at risk of developing dementia could be useful for early prevention, if and when such interventions are available, and treatment," the authors write. "Lower plasma beta-amyloid 42 and 42/40 levels have been associated with incident dementia, but results are conflicting and few have investigated cognitive decline among elders without dementia."

Kristine Yaffe, M.D., of the University of California, San Francisco, and San Francisco Veterans Affairs Medical Center, and colleagues conducted a study to investigate the association between plasma beta-amyloid 42 and 42/40 levels and cognitive decline in a large group of community-dwelling older adults without dementia, and also examined whether measures of cognitive reserve, as indicated by levels of education and literacy attained, modified the association of plasma beta-amyloid level with cognitive decline. The analysis included 997 black and white community-dwelling older adults who were enrolled in the Health ABC Study, a prospective observational study begun in 1997-1998 with 10-year follow-up in 2006-2007. Participant average age was 74 years; 55.2 percent (n = 550) were female; and 54 percent (n = 538) were black. Measures of beta-amyloid 42 and 42/40 and cognitive function (via Modified Mini-Mental State Examination) were obtained.

The researchers found that low beta-amyloid 42/40 level was associated with greater cognitive decline over 9 years. After adjustment for several factors, the results remained statistically significant. There was also a significant association between plasma beta-amyloid 42 levels and cognitive decline. There was no association between plasma beta-amyloid 40 levels and baseline cognitive function or decline.

Also, cognitive reserve measures modified the association between beta-amyloid 42/40 level and cognitive decline. Older adults with low reserve (as measured by less than a high school diploma or sixth-grade or lower literacy) had an even greater association with beta-amyloid 42/40 level, whereas those with high reserve had less association.

"These results are important, as the prevalence of cognitive impairment is increasing exponentially and prevention will be crucial. To identify those at risk of dementia, biomarkers like plasma beta-amyloid level that are relatively easy to obtain and minimally invasive could be useful. In addition, our finding of an interaction of cognitive reserve with the association of plasma beta-amyloid level and cognitive decline could have public health importance because it may suggest pathways for modifying beta-amyloid effects on cognition," such as with cognitive activity or ongoing education, the authors write.

"Future studies should further explore the use of plasma beta-amyloid as a biomarker, assess the mechanisms by which cognitive reserve modifies this association, and determine whether increasing cognitive reserve through interventions can reduce the risk of Alzheimer disease."

More information: JAMA. 2011;305[3]:261-266.

Provided by JAMA and Archives Journals

Silent vascular disease accompanies cognitive decline in healthy aging

Older people who are leading active, healthy lifestyles often have silent vascular disease that can be seen on brain scans that affect their ability to think, according to a new study led by UC Davis researchers and published online today in the Archives of Neurology

12 nov 2010--"This study shows that silent vascular disease is really common as we get older and it influences our thinking abilities," said Charles DeCarli, professor of neurology in the School of Medicine at UC Davis and director of the UC Davis Alzheimer's Disease Center. "We're beginning to realize that vascular disease plays a major role in Alzheimer's disease — they go together."

The study findings are based on data from participants in the Alzheimer's Disease Neuroimaging Initiative. The initiative tracks individuals who are normal, those who have mild cognitive impairment (MCI) and people with Alzheimer's disease using magnetic resonance imaging (MRI), positron emission tomography (PET) imaging and laboratory and cognitive testing to track changes in their cognitive status.

Over 5 million elderly people in the United States have Alzheimer's disease, a progressive, incurable and terminal disease and the most common form of age-related dementia. In its 2009 World Alzheimer Report, Alzheimer's Disease International found that there are more than 35 million people worldwide with Alzheimer's disease or other types of dementia. It also projected that the number should nearly double in the next 20 years.

Cardiovascular disease, including hypertension, high cholesterol and atherosclerosis, is also common in the elderly, and causes "white matter hyperintensities," regions of damaged brain tissue that look like white-hot areas on MRI scans. The purpose of the study was to better understand the relationship between white matter hyperintensities and the extent to which they precede, coincide with or follow short-term changes in cognitive functioning.

For the study, more than 800 participants ages 55 to 90 were recruited from more than 50 research sites throughout the United States and Canada. Some 200 participants were cognitively normal individuals who were followed for three years. Approximately 400 people with mild cognitive impairment also were followed for three years. Two hundred people with Alzheimer's disease were followed for two years. Potential participants with serious brain anomalies, such as brain tumors or prior surgery, were excluded from the study.

All of the participants' baseline cognitive functioning was established using clinical diagnostic evaluation, including the Mini Mental State Exam and the Alzheimer's Disease Assessment Scale-Cognitive Subscale. Criteria for the normal group included no evidence of depression, mild cognitive impairment or dementia. Individuals were included in the MCI category if they had a subjective memory complaint or objective memory loss, among other measures. Participants with Alzheimer's disease met nationally accepted criteria for probable Alzheimer's disease.

Participants whose white matter hyperintensities were significantly above average at the beginning of the study lost more points each year in cognitive testing than those whose white matter hyperintensities were average at baseline. Those with mild cognitive impairment or Alzheimer's disease at baseline had additional declines on their cognitive testing each year, meaning that the presence of white matter hyperintensities and MCI or Alzheimer's disease together added up to even faster and steeper cognitive decline. In addition, participants who were older at baseline saw faster declines over time in their Mini Mental State Exam scores.

The researchers found that, at the outset of the study, the extent of white matter hyperintensities was associated with greater subsequent declines in global cognition over a one-year period.

"In a sample … with frequent evaluations, short-term follow-up and a relatively mild profile of cardiovascular risk, white matter disease may be an important predictor of subsequent short-term global cognitive change," the study found.

"There's a big group of people who have not had major cardiovascular events such as heart attacks. But we see signs that even milder vascular-related insults can contribute to loss of cognitive functioning," said Owen Carmichael, the study's lead author and an assistant professor in the Department of Neurology in the School of Medicine at UC Davis.

Carmichael said that the study suggests that reducing your cardiovascular risk factors to a moderate level may not be enough to avert all forms of brain disease that can lead to cognitive decline in aging.

"Every little bit counts — you have got to squeeze every little bit of healthy lifestyle out of your day" to avoid brain aging, he said.

Provided by University of California - Davis

Walking 6 to 9 Miles a Week May Help Save Memory

17 oct 2010-- Walking about six miles a week appears to protect against brain shrinkage in old age, which in turn helps stem the onset of memory problems and cognitive decline, new research reveals.

"We have always been in search of the drug or the magic pill to help treat brain disorders," noted Kirk I. Erickson, an assistant professor of psychology at the University of Pittsburgh and the study's lead author. "But really what we are after may be, at least partially, even simpler than that. Just by walking regularly, and so maintaining a little bit of moderate physical activity, you can reduce your likelihood of developing Alzheimer's disease and [can] spare brain tissue."

A report on the research, which was supported by the U.S. National Institute on Aging, is published online Oct. 13 in Neurology.

Erickson and his colleagues began tracking the physical activity and cognitive (or thinking) patterns of nearly 300 adults in 1989. At the start, all participants were in good cognitive health, they averaged 78 years old and about two-thirds were women. The researchers charted how many blocks each person walked in a week.

Nine years later, they were given a high-resolution MRI scan to measure brain size. All were deemed to be "cognitively normal."

But four years after that, testing showed that a little more than one-third of the participants had developed mild cognitive impairment or dementia.

By correlating cognitive health, brain scans and walking patterns, the research team found that being more physically active appeared to marginally lower the risk for developing cognitive impairment.

But more specifically, they concluded that the more someone walks, the more gray matter tissue the person will have a decade or more down the road in regions of the brain -- namely the hippocampus, the inferior frontal gyrus and the supplementary motor area -- that are central to cognition.

And among the more physically active participants who had retained more gray matter a decade out, the chances of developing cognitive impairment were cut in half, the study found.

However, the researchers stressed that the relationship between walking and gray matter volume appears to apply only to people who regularly walk relatively long distances that equal about six to nine miles a week.

Walking more than the six- to nine-mile range, however, did not have cognitive benefit, the study found.

"That's because the size of our brain regions can only be so large," Erickson said, adding that the opposite isn't true. "So with no exercise, there can be significant deterioration and decay with age."

However, he added, "what we often tend to think of as an inevitable component or characteristic of aging -- memory decline and brain decay -- is clearly not inevitable. There's plenty of evidence now, and this study is part of that, that shows that we can retain our brain tissue and retain our memories well into late adulthood by maintaining an active and engaged lifestyle."

Dr. Steven V. Pacia, chief of neurology at Lenox Hill Hospital in New York City, described the study's finding as both "intriguing" and an "undoubtedly positive message to send to the public."

"My first reaction to studies like this is that only in America do we have to prove to people that it's good to walk," he said with a chuckle.

"But it stands to reason that being active as we age is going to have a beneficial effect on the brain, just as being inactive is going to have a negative impact," Pacia noted. "Because the brain lives in the environment of the body."

But there may be a catch. "This is just an observational study," Pacia noted. "And while we may assume that the relationship between the brain and activity is a prevention-of-atrophy issue -- just like it is with muscle and bone -- this study doesn't actually prove that. We don't yet know enough about the use-it-or-lose-it notion with respect to brain and exercise. So we do need more research to look at that."

Impaired kidney function linked to cognitive decline in elderly

A new study published in the medical journal Neurology suggests that impaired kidney function is a risk factor for cognitive decline in old age.

29 sept 2009--The study, conducted by researchers at Rush University Medical Center, found that poor kidney function was linked specifically with cognition related to memory functions. Damage to one of these functions, episodic memory, which retrieves memories of time, place, associated emotions and other contextual knowledge, is often the earliest sign of Alzheimer's disease.

"Given the dearth of modifiable risk factors for age-related cognitive decline, these results have important public health implications," said Dr. Aron Buchman, a neuroscientist in the Rush Alzheimer's Disease Center. "Further work to understand the link between kidney function and the brain may provide new strategies for preventing memory loss in elders."

Buchman said the findings suggest that there are common disease processes that affect both the brain and the kidneys in the elderly, and hypothesized that underlying vascular problems, such as diabetes and hypertension, may account for the association between kidney problems and cognitive decline.

The study analyzed data for 886 older adults who participated in the Rush Memory and Aging Project, a group of community-dwelling seniors with a mean age of 81, all of them initially free of dementia. The participants were examined annually for up to six years to track changes in cognition over time. Cognitive assessments included multiple tests that were summarized as a composite measure of overall cognition and of five individual cognitive abilities.

The individual cognitive systems assessed were visuospatial ability; perceptual speed, or the ability to quickly and accurately compare letters, numbers, objects, pictures or patterns; semantic memory, related to meaning, understanding and other concept-based knowledge; working memory, which temporarily stores and manipulates information; and episodic memory.

Ruling out the influence of factors like aging and medications, which can affect cognition, the researchers found that poor kidney function, assessed at the beginning of the study, was linked with a more rapid rate of decline in cognition over the next several years – not in visuospatial ability or perceptual speed, but in three specific areas: episodic, semantic and working memory.

The rate of decline in cognition was equivalent to that of a person seven years older at baseline, Buchman said.

###

The study was supported by funds from the National Institute on Aging, the Illinois Department of Public Health and the Robert C. Borwell Endowment Fund.

About Rush: Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Key Brain Receptors Linked To Learning And Memory Decrease With Age

14 sept 2009--Scientists studying cognitive decline that accompanies aging have been interested in nicotinic receptors, part of a key neural pathway that not only enhances learning and memory skills but reinforces addictions as well. The loss of these receptors has been difficult to study in living subjects, but Yale University researchers using advanced imaging technology have successfully tracked the loss of receptors with age, according to a report in the September issue of the journal Neurobiology of Aging.

"Measurable decline in cognitive abilities is evident by age 50, but our knowledge of the changes in the brain associated with these deficits has been largely confined to post-mortem studies," said Christopher H. van Dyck, senior author of the study and Professor of Psychiatry and Neurobiology and Director of the Alzheimer's Disease Research Unit.

The Yale University researchers used SPECT imaging to track concentrations of nicotinic receptors in eight brain regions of 47 subjects aged 18 to 85. They observed an age-related loss of receptors in seven of eight brain regions, at a rate of about 5 percent per decade of life.

Nicotinic receptors reinforce addictions such as smoking, but also facilitate learning and memory. Autopsies of dementia patients have revealed a significant decline of these receptors.

"Nicotinic receptors are such promising targets that pharmaceutical companies are currently exploring nicotine analogues as potential treatments for Alzheimer's disease and Mild Cognitive Impairment," van Dyck said.

The findings are additional evidence that nicotinic receptors may play a role in the cognitive decline associated with normal aging. "These results may encourage the broadening of therapeutic trials to target the cognitive decline associated with healthy aging," van Dyck said.

Other Yale authors of the paper are Effie M. Mitsis, Kelly P. Cosgrove, Julie K. Staley, Frederic Bois, Erin B. Frohlich, Gilles D. Tamagnan, Kristina M. Estok and John P. Seibyl.

The research was funded by the American Health Assistance Foundation, the Department of Veteran Affairs and the National Institute of Drug Abuse.

Links:
Alan Garen

Source
Yale School of Medicine

ICAD: Antihypertension Diet Linked to Improved Cognition

DASH diet associated with higher cognitive functioning at baseline and over 11 years

15 july 2009-- Eating a diet designed to lower blood pressure may be associated with a reduction in age-related cognitive decline, supporting a link between hypertension and dementia, according to research presented at the 2009 International Conference on Alzheimer's Disease, held July 11 to 16 in Vienna, Austria.

Heidi J. Wengreen, Ph.D., of Utah State University in Logan, and colleagues examined 3831 individuals 65 years of age and older, who participated in the Cache County Study on Memory, Health, and Aging. Participants were evaluated on their adherence to the Dietary Approaches to Stop Hypertension (DASH) diet plan. Individuals were classified into five DASH score groups based on their reported consumption of nine food and nutrient component groups, and followed over 11 years.

The researchers found that, both at the initiation and over the course of the study, higher DASH scores were associated with higher cognitive functioning scores. On a cognitive function test, individuals in the highest DASH score group scored 1.42 and 1.81 points higher at baseline and after 11 years, respectively, compared with individuals in the lowest DASH score group. Of the nine food and nutrient component groups, vegetables, whole grains, low-fat dairy, and nuts and legumes were significantly and independently associated with cognitive functioning scores.

"Our results suggest that including whole grains, vegetables, low-fat dairy foods, and nuts in one's diet may offer benefits for cognition in late life," Wengreen states. "We need more research before we can confidently say how much of these foods to include in your diet to experience some benefit."

Abstract - Page 1
Press Release

Cognitive decline begins in late 20s, study suggests

21 mar 2009--A new study indicates that some aspects of peoples' cognitive skills – such as the ability to make rapid comparisons, remember unrelated information and detect relationships – peak at about the age of 22, and then begin a slow decline starting around age 27.

"This research suggests that some aspects of age-related cognitive decline begin in healthy, educated adults when they are in their 20s and 30s," said Timothy Salthouse, a University of Virginia professor of psychology and the study's lead investigator.

His findings appear in the current issue of the journal Neurobiology of Aging.

Salthouse and his team conducted the study during a seven-year period, working with 2,000 healthy participants between the ages of 18 and 60.

Participants were asked to solve various puzzles, remember words and details from stories, and identify patterns in an assortment of letters and symbols.

Many of the participants in Salthouse's study were tested several times during the course of years, allowing researchers to detect subtle declines in cognitive ability.

Top performances in some of the tests were accomplished at the age of 22. A notable decline in certain measures of abstract reasoning, brain speed and in puzzle-solving became apparent at 27.

Salthouse found that average memory declines can be detected by about age 37. However, accumulated knowledge skills, such as improvement of vocabulary and general knowledge, actually increase at least until the age of 60.

"These patterns suggest that some types of mental flexibility decrease relatively early in adulthood, but that how much knowledge one has, and the effectiveness of integrating it with one's abilities, may increase throughout all of adulthood if there are no pathological diseases," Salthouse said.

However, Salthouse points out that there is a great deal of variance from person to person, and, he added, most people function at a highly effective level well into their final years, even when living a long life.

One of the unique features of this project in the University of Virginia Cognitive Aging Laboratory is that some of the participants return to the laboratory for repeated assessments after intervals of one to seven years.

"By following individuals over time, we gain insight to cognition changes, and may possibly discover ways to alleviate or slow the rate of decline," Salthouse said. "And by better understanding the processes of cognitive impairment, we may become better at predicting the onset of dementias such as Alzheimer's disease."

Salthouse's team also is surveying participants' health and lifestyles to see if certain characteristics, such as social relationships, serve to moderate age-related cognitive changes.

They hope to continue their studies over many more years, with many of the same participants, to gain a long-term understanding of how the brain changes over time.

Common medication associated with cognitive decline in elderly

Study suggests use of certain medications in elderly populations may be associated with cognitive decline

New Haven, Conn., 27 jan 2009- A study published in Journal of the American Geriatrics Society suggested that the use of certain medications in elderly populations may be associated with cognitive decline. The study examined the effects of exposure to anticholinergic medications, a type of drug used to treat a variety of disorders that include respiratory and gastrointestinal problems, on over 500 relatively healthy men aged 65 years or older with high blood pressure.

Older people often take several drugs to treat multiple health conditions. As some of these drugs also have properties that affect neurotransmitters in the brain that are important to overall brain function, the researchers examined the total effects of all medications taken by the patients, both prescription and over-the-counter, that were believed to affect the function of a particular neurotransmitter, acetylcholine.

The findings show that chronic use of medications with anticholinergic properties may have detrimental effects on memory and the ability to perform daily living tasks, such as shopping and managing finances. Participants showed deficits in both memory and daily function when they took these medications over the course of a year. The degree of memory difficulty and impairment in daily living tasks also increased proportionally to the total amount of drug exposure, based on a rating scale the authors developed to assess anticholinergicity of the drugs.

According to study co-author Dr. Ling Han of the Yale University Department of Internal Medicine, elderly patients may be more vulnerable to these types of medications due to neurological and pharmacokinetical changes related to aging..

"This study extends our previous findings on acute cognitive impairment following recent anticholinergic exposure in older medical inpatients," says Han. "Prescribing for older adults who take multiple prescription and over-the-counter medications requires careful attention to minimize the risk of potential harms of the drugs while maximizing their health benefits."

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This study is published in Journal of the American Geriatrics Society. Media wishing to receive a PDF of this article may contact medicalnews@bos.blackwellpublishing.net

Ling Han, M.D., Ph.D., MSc, is a senior epidemiologist and biostatistician at the Program on Aging, Internal Medicine, at Yale University and can be reached for questions at ling.han@yale.edu.

Diabetes linked to cognitive decline in seniors

28 june 2008--Older adults with type 2 diabetes may have a steeper mental decline as they age, a large study suggests.
Diabetes is known to raise the risk of a number of major health problems, including heart disease and kidney failure. More recently, studies have also linked diabetes to speedier mental decline and dementia in older adults.
These latest findings, published in the Journal of the American Geriatric Society, confirm those earlier reports -- and suggest that the longer a person has had diabetes, the more substantial the cognitive decline over time.
For the study, researchers led by Dr. Olivia Okereke, of Harvard Medical School in Boston, examined data from the Physicians' Health Study and the Women's Health Study -- two long-term projects looking at the health of thousands of U.S. men and women.
The researchers looked at the association between diabetes and late-life cognitive impairment in 5,907 men and 6,326 women. Participants were in their early 70s, on average, when they were first assessed for memory, thinking and other cognitive abilities; they were tested again roughly two years later, and women had a third test around the four-year mark.
In general, Okereke and her colleagues found, men and women with diabetes performed more poorly on the initial cognitive tests, then showed a more marked decline on subsequent tests.
In addition, participants with longer-standing diabetes tended to be in worse cognitive shape at the outset, and show a steeper decline over time.
There are several plausible reasons why diabetes might fuel age-related mental decline, according to the researchers.
One is that diabetes can damage the blood vessels that supply the brain, diminishing blood flow and thereby contributing to cognitive problems.
In addition, people with diabetes typically have chronically high levels of the blood-sugar-regulating hormone insulin. And some research suggests that elevated insulin concentrations may boost the body's levels of amyloid-beta protein, which build up to form the "plaques" seen in the brains of people with Alzheimer's disease.
More studies are now needed to find out precisely how diabetes affects older adults' mental function, Okereke and her colleagues conclude.

SOURCE: Journal of the American Geriatrics Society, June 2008.

Caffeine Reduces Cognitive Decline in Women

Susan Jeffrey
August 9, 2007 — Results from a cohort study suggest that caffeine may reduce cognitive decline in women without dementia. French researchers report that women who drank more than 3 cups of coffee per day had less decline during 4 years of follow-up compared with those who drank a cup or less. However, no such effect was seen in men.
The results are published in the August 7 issue of Neurology.
"Caffeine is a psychostimulant which appears to reduce cognitive decline in women," said lead study author Karen Ritchie, PhD, of INSERM, the French National Institute for Health and Medical Research, in Montpellier, France, in a statement from the American Academy of Neurology.
"While we have some ideas as to how this works biologically, we need to have a better understanding of how caffeine affects the brain before we can start promoting caffeine intake as a way to reduce cognitive decline," she noted. "But the results are interesting — caffeine use is already widespread and it has fewer side effects than other treatments for cognitive decline, and it requires a relatively small amount for a beneficial effect."
Reduced Risk With Caffeine
Previous studies have suggested that caffeine, which is known to have positive effects on vigilance, attention, mood, and arousal, may also be neuroprotective, the authors write.
In this study, the researchers used data from the Three City Study, a multisite cohort study of community-dwelling elderly persons in Bordeaux, Dijon, and Montpellier, France, to examine the association between caffeine intake, cognitive decline, and incident dementia, taking into account the potential effects of sex, as well as accounting for any preexisting and current clinical or sociodemographic factors that might contribute to cognitive decline.
Subjects included 4197 women and 2820 men. The researchers assessed cognitive function, any clinical diagnosis of dementia, and caffeine consumption at baseline, and then at 2 and 4 years of follow-up.
They found that caffeine consumption was associated with a wide range of sociodemographic, lifestyle, and clinical variables that might also have an effect on the rate of cognitive decline, such as education level and smoking. Women were higher consumers of caffeine, they note, with 16.4% of women vs 13.2% of men consuming more than 3 units per day.
Multivariate mixed models and multivariate adjusted logistic regression showed that women with high rates of caffeine consumption, more than 3 units per day, had less decline in verbal retrieval and to a lesser extent, visuospatial memory during 4 years, the authors write.
No relation was seen between caffeine intake and cognitive decline among men, they note. "Women may be more sensitive to the effects of caffeine," Dr. Ritchie said in the American Academy of Neurology release. "Their bodies may react differently to the stimulant, or they may metabolize caffeine differently."
However, in these findings at least, there was no effect of caffeine consumption in terms of the development of dementia during 4 years. "Although no impact was observed on dementia incidence, further studies are required to ascertain whether caffeine may nonetheless be of potential use in prolonging the period of mild cognitive impairment in women prior to a diagnosis of dementia," they write.
The Three City Study is conducted under a partnership agreement among INSERM, the Victor Segalen-Bordeaux II University and Sanofi-Synthelabo. The authors have disclosed no relevant financial relationships. Other financial relationships are listed in the original article.
Neurology. 2007;69:536-545.

CABG Not a Contributor to Long-Term Cognitive Decline

Caroline Cassels

October 18, 2007 (Washington, DC) — Contrary to previous findings, a new study suggests that coronary artery bypass graft (CABG) surgery does not contribute to long-term cognitive decline, which rather is related to underlying cerebrovascular disease.
Presented here at the 132nd Annual Meeting of the American Neurological Association, preliminary 6-year results of a prospective, longitudinal study found no significant differences in the degree of late cognitive decline following on-pump CABG surgery compared with other types of coronary artery disease (CAD) treatment.
"We don't think there's any selective long-term decline after CABG surgery that cannot be attributed to significant coronary artery disease or that a risk of late [cognitive] decline should be an issue when it comes to the choice of procedure," principal investigator Guy McKhann, MD, from Johns Hopkins University, in Baltimore, Maryland, told conference attendees.
Investigators conducted the 4-cohort study comparing short- and long-term cognitive outcomes in individuals who had undergone traditional on-pump CABG surgery with those in 3 control groups — off-pump CABG surgery; medical treatment including the use of stents; and heart-healthy controls with no major risk factors for CAD. Subjects were compared at baseline, 3 months, 1 year, 3 years, and 6 years.
At baseline, said Dr. McKhann, individuals with CAD had lower cognitive function than heart-healthy controls, but not across all cognitive domains.
In addition, they found approximately 25% of patients who underwent CABG experienced short-term cognitive problems that generally resolved within 3 months of surgery.
Controversial Area
While baseline memory and language are relatively well preserved in individuals with CAD, they have decreased motor speed, psychomotor speed, and executive function compared with those without CAD, findings that are generally associated with cerebrovascular disease, said Dr. McKhann.
"We didn't see any difference in performance between surgery and nonsurgery patients at 3 months or from there on out. We tell patients there is a risk of cognitive decline and that they are likely to have problems with their memory but that they will get better," he said.
In addition, he said, preliminary 6-year follow-up findings showed no cognitive differences between individuals who underwent on- or off-pump CABG surgery.
According to Dr. McKhann, the long-term cognitive impact of CABG has been a controversial issue. Several research groups have reported cognitive decline between 6 months and 5 years following CABG surgery. However, he said, none of these studies have included appropriate control groups.
A 2001 study reported an association between CABG and a 42% incidence of cognitive decline at 5 years (Newman MF et al. N Engl J Med 2001;344:395-402).
The research, he said, became "a very important paper in the field" and was part of the motivation behind his current study comparing cognitive outcomes in CABG patients with groups with similar cardiovascular risk factors who had not undergone this procedure for treatment of CAD.
Higher Incidence of Watershed Stroke
CABG is associated with higher rates of stroke and encephalopathy, which occur in 3% to 5% and 10% to 15% of patients, respectively. Watershed stroke is particularly common in CABG patients, and Dr. McKhann said preliminary evidence from this study suggests it may be related to fluctuations in blood pressure during the procedure.
However, he pointed out that his team, as well as other research groups, have developed predictive models based on the presence of standard cardiovascular risk factors, including hypertension, diabetes, and previous stroke, to identify potential CABG candidates at high risk for these complications.
The mortality, length of hospital stay, and long-term disability in such patients is high, he said, and may warrant the consideration of preoperative imaging studies and/or possible alternative procedures to on-pump CABG surgery to mitigate their risk.
However, the study's bottom-line is CABG surgery does not appear to contribute to long-term cognitive decline.
"We believe late decline is due to cognitive changes associated with cerebrovascular disease. These patients wouldn't be undergoing surgery or having stents put in if they didn't have significant coronary artery disease. Real attention should be placed on modifying their [CAD] risk factors, because unless something is done to modify their underlying vascular disease they're not going to do well," he said.
The study was supported by the National Institutes of Health.
132nd Annual Meeting of the American Neurological Association. Presented October 10, 2007.

Cognitive Decline May Lead to Sleep Disturbances

Research shows that sleep difficulties contribute to cognitive decline. Now, findings in Neurology suggest the reverse may also be true.
Investigators followed nearly 2500 community-dwelling, nondemented, older women for almost 15 years. Cognitive function was evaluated periodically, and sleep quantity and quality were measured over about four nights at the end of the study.
Women with cognitive decline during follow-up were more likely than those without cognitive decline to have difficulty falling and staying asleep at the end of follow-up (although total sleep time did not differ between the groups). The associations held after adjustment for confounders including age, health status, and use of sleep medications.
The authors conclude: "The association between cognitive decline and sleep disturbances may be bidirectional," emphasizing that cognitive impairment may contribute to sleep difficulties.

VAS-COG: Hypertension Linked to Cognitive Decline in Older Patients

SAN ANTONIO, July 12 -- Uncontrolled hypertension in older patients increases the risk of cognitive impairment, researchers reported here.
Hypertensive patients had a 70% greater risk of non-amnestic mild cognitive impairment compared with nonhypertensive patients (P=0.05), Christiane Reitz, M.D., Ph.D., of Columbia University in New York said at the International Society for Vascular Behavioral and Cognitive Disorders meeting.
Examination of different components of cognitive function showed that hypertension significantly affected the rate of decline in executive performance over time but not memory or language performance, said Dr. Reitz.
"These results suggest that prevention and treatment of hypertension may lower the risk of cognitive impairment in elderly patients," she said.
Studies examining the relationship between hypertension and dementia and Alzheimer's disease have yielded inconsistent data. Most long-term investigations have shown an association between higher blood pressure and an increased risk of dementia, said Dr. Reitz. Cross-sectional and short-term studies have generally shown no association or an inverse association.
Continuing the exploration of hypertension's impact on cognitive function, investigators in the current study sought to determine whether hypertension increased the risk of mild cognitive impairment. They also wanted to see whether hypertension accelerated the decline in cognitive performance over time.
The study involved 918 patients ages 65 and older without cognitive impairment or dementia at baseline. Hypertension was defined as blood pressure at 140/90 mm Hg or greater, current antihypertensive therapy, and a history of hypertension. By those criteria, 626 participants had hypertension at enrollment.
Mild cognitive impairment was defined by four criteria:
Subjective memory complaint
Objective impairment in at least one cognitive domain
Preserved activities of daily living
No diagnosis of dementia
Cognitive impairment was further defined as amnestic or non-amnestic. Amnestic cognitive impairment was characterized by isolated impairment in memory or impairment in memory and one or more other cognitive domains. Patients with non-amnsetic impairment had no impairment in memory but impairment in two or more other cognitive domains.
The study participants were enrolled from 1992 through 1994 and followed at 18-month intervals. Follow-up visits included a battery of neuropsychological tests that assessed memory, abstract reasoning, visuospatial ability, and language skill. Median follow up was about 5 years.
The hypertensive patients differed from the nonhypertensive group in several baseline characteristics. The hypertensive group included more women (73.6% versus 61.0%, P=0.05) and more patients with a history of stroke, diabetes, and heart disease (P=0.05 for each).
At last follow up, 334 patients met one or more criteria for mild cognitive impairment. Overall, hypertensive patients had a 40% greater relative risk of mild cognitive impairment compared with the nonhypertensive patients (RR 1.4, P=0.05). Grouping patients by type of impairment showed that the overall difference in incidence of cognitive impairment owed to a significant difference in non-amnestic impairment in the hypertensive group (RR 1.7, P=0.05).
In a multivariate analysis that controlled for age, sex, education, and ethnic group hypertension significantly (P=0.01) affected the slope of change in executive performance but not memory or language performance. Dr. Reitz said the finding was consistent with hypertension's association with non-amnestic mild cognitive impairment.
Neither study support nor financial conflicts were specified. Primary source: International Society of Vascular Behavioral and Cognitive DisordersSource reference: C Reitz et al. "Hypertension and the risk of mild cognitive impairment." International Society of Vascular Behavioral and Cognitive Disorders meeting, July 11-14, San Antonio. Final program and abstract book. Abstract O-6.