Some people with markers of Alzheimer’s don’t develop the disease

A new study from The University of Texas Medical Branch at Galveston, published in the Journal of Alzheimer’s Disease  has uncovered why some people that have brain markers of Alzheimer’s never develop the classic dementia that others do.

Alzheimer’s is the most common form of dementia and affects more than 5 million Americans. People suffering from Alzheimer’s develop a buildup of two proteins that impair communications between nerve cells in the brain, plaques made of amyloid beta proteins and neurofibrillary tangles made of tau proteins.

Curiously, researchers were at a loss to explain why not all people with those signs of Alzheimer’s ever develop any cognitive decline.  The question then became, what sets these people apart from those with the same plaques and tangles that develop dementia?

Giulio Taglialatela, director of the Mitchell Center for Neurodegenerative Diseases said

“In previous studies, we found that while the non-demented people with Alzheimer’s neuropathology had amyloid plaques and neurofibrillary tangles just like the demented people did, the toxic amyloid beta and tau proteins did not accumulate at synapses, the point of communication between nerve cells. When nerve cells can’t communicate because of the buildup of these toxic proteins that disrupt synapse, thought and memory become impaired. The next key question was then what makes the synapse of these resilient individuals capable of rejecting the dysfunctional binding of amyloid beta and tau?”

To answer this question, researchers used high-throughput electrophoresis and mass spectrometry to analyze the protein composition of synapses isolated from frozen brain tissue donated by people who had participated in brain aging studies and received annual neurological and neuropsychological evaluations during their lifetime. The participants were divided into three groups, those with Alzheimer’s dementia, those with Alzheimer’s brain features but no signs of dementia and those without any evidence of Alzheimer’s.

Results showed that resilient individuals had a unique synaptic protein signature that set them apart from both demented AD patients and normal subjects with no AD pathology. Taglialatela said this unique protein make-up may underscore the synaptic resistance to amyloid beta and tau, thus enabling these fortunate people to remain cognitively intact despite having Alzheimer’s-like pathologies.

Taglialatela sai they still didn’t understand the mechanisms responsible for this protection,” but “understanding such protective biological processes could reveal new targets for developing effective Alzheimer’s treatments.”

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Dementia and alcohol

In the United States alone, 5.7 million Americans are thought to have Alzheimer’s disease. Experts estimate that by 2050, this number will have reached 14 million. According to recent estimates, almost 50 million people worldwide currently have dementia and this number is expected to double every 2 decades, reaching over 130 million by 2050.

Research has found that dementia has various risk factors such as high blood pressure, lack of sleep and lack of physical exercise. Now research has found alcohol may play a role. A new study followed  9,000 people over a 23-year period to draw conclusions on the link between alcohol consumption and dementia risk.

The researchers assessed their alcohol consumption and potential dependence regularly using standard questionnaires and by looking at alcohol-related hospital admissions.

The combination of French and English  reasearchers also examined hospital records for cases of dementia, as well as for any diagnoses of conditions, such as heart disease or diabetes.

In the UK anything over 14 standard U.K. alcohol units per week counted as heavy drinking. In the U.K., a standard glass of wine counts as 1 unit of alcohol, and 14 weekly units is the maximum threshold for what is considered harmful drinking.

In the U.S., the Dietary Guidelines for Americans recommend that men should not drink more than two drinks per day and women should not exceed one drink per day.

The average follow-up period for the study was 23 years. During that time, 397 people developed dementia. The researchers team took into account for various sociodemographic factors that may have influenced the results.

The study was published in the BMJ (Britsish Medical Journal) and in an  editorial comment, Sevil Yasar, from the Johns Hopkins School of Medicine in Baltimore, MD, weighed in on the findings.

[A]lcohol consumption of 1-14 units/week may benefit brain health; however, alcohol choices must take into account all associated risks, including liver disease and cancer.”

 

 

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Choosing a healthcare proxy

Choosing a healthcare proxy helps to ensure you receive the care you want at the end of life. Your healthcare proxy, or agent, should be someone you trust, a family member or close friend. Your agent makes medical decisions for you when you no longer can. You can ask your proxy to make all your healthcare decisions or only certain ones. Your proxy can also decide how your wishes apply as your condition changes. Appointing a proxy ensures that providers follow your wishes.

Everyone over age 18 should have a healthcare proxy. Situations that may require a proxy:

  • You are in a coma from an accident or illness.
  • You are terminally ill and not expected to recover.
  • You have Alzheimer’s or another form of dementia.
  • You are under general anesthesia, when something unexpected occurs.
  • You are in a persistent vegetative state.

Appointing the right person to be your healthcare proxy can be difficult. Here are some steps to guide you:

Clarify your values and beliefs.

Consider what’s important to you. What contributes to the quality of life you want? How do you want to spend your final years, weeks or days? What activities are essential to having a quality life? What role does your faith play in making these decisions?

Frame your medical wishes around these values and priorities. Determine which treatments you are willing to accept. Figure out which treatments you would never want. How much medical care are you willing to have to stay alive? What kind of medical risks are you willing to take? When would you want to shift from treatment to comfort care?

Have an honest conversation.

Talk to family members and friends about what you want. During those conversations, look for someone who is most likely to represent your wishes.

Once you choose a proxy, continue to share your wishes, thoughts and opinions with that person. It’s impossible to predict every scenario that may present itself. But explaining your views will give your agent the information to make decisions on your behalf.

Discuss your wishes with providers.

It’s important to share your wishes with your providers, particularly your primary care provider. This information will enable them to care for you in a manner that is consistent with your wishes. You should also let them know you have a healthcare proxy.

Once you have a healthcare proxy, complete the New York Health Care Proxy form. Instructions are available in several languages:

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What you should know about strokes

Even though strokes are the leading cause of preventable deaths, very few people know much about them. So, the American Stroke Association has published a list of things you didn’t know about strokes for its 20th anniversary. Here are the top 10.

  1. There are three different types of strokes: Ischemic, Hemorrhagic, and TIA (Transient Ischemic Attack). Ischemic occurs as a result of an obstruction within a blood vessel supplying blood to the brain. It accounts for 87 percent of all stroke cases. Hemorrhagic occurs when a weakened blood vessel ruptures. Two types of weakened blood vessels usually cause hemorrhagic stroke: aneurysms and arteriovenous malformations(AVMs). But the most common cause of hemorrhagic stroke is uncontrolled hypertension (high blood pressure). TIA is caused by a temporary clot. Often called a “mini stroke”, these warning strokes should be taken very seriously.
  2. During a stroke, nearly 120 million brain cells die every hour. Compared with the normal rate of cell loss in brain aging, the brain ages 3.6 years each hour without treatment. The sooner the patient gets medical care, the better their chances of recovery.
  3. About 66 percent of the time, someone other than the patient makes the decision to seek treatment – recognizing the warning signs and sudden symptoms of stroke to receive treatment fast, could help save a life.
  4. F.A.S.T. is an acronym used to teach the most common warning signs and sudden symptoms of stroke. F.A.S.T. stands for (F) face drooping, (A) arm weakness, (S) speech difficulty, (T) time to call 9-1-1. Less than half of the population is aware of the signs.
  5. Stroke symptoms can also include sudden numbness, sudden trouble seeing in one or both eyes, sudden severe headache with no known cause and sudden trouble walk
  6. Calling 9-1-1 and arriving at the hospital in an ambulance is the fastest way to get treated quickly during a stroke emergency. Driving to the hospital is a common mistake people make, that can result in longer wait times before the patient receives medical care.
  7. Patients who have an ischemic stroke, may have a treatment window for mechanical clot removal within six hours to up to 24 hours in certain patients with clots in large vessels.
  8. Alteplase (also known as tPA) is a drug used to dissolve a blood clot that causes stroke. Stroke patients who arrive at a hospital within 90 minutes of symptom onset and qualify to receive tPA are almost 3 times more likely to recover with little or no disability.
  9.  Nearly half of all adults in the U.S. (an estimated 103 million) have high blood pressure.
  10.  High blood pressure is the most common controllable cause of stroke. Recent guidelines redefined high blood pressure as a reading of 130/80 mm Hg or higher. A normal reading would be any blood pressure below 120/80 mm Hg and above 90/60 mm Hg in an adult.

To read more about strokes please visit National Stroke Association

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Nursing homes dosing patients with anti-psychotic drugs

According to a Human Rights Watch report, nursing homes are doping tens of thousands residents with anti-psychotic drugs that don’t have diagnoses that require them. Not only that they are doing it without the patients’ consent.

In the report called, “They Want Docile,” the group claims 179,000 residents of long-term nursing homes across the country are given anti-psychotic drugs each week that are not appropriate for their condition. They claim the drugs are used for their sedating side effects, which make patients with dementia and Alzheimer’s disease easier to manage.

Hannah Flamm, an NYU law school fellow at Human Rights Watch told the Guardian, “People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse.”

The report is based on publicly available data and visits  to 109 nursing facilities from October 2016 to March 2017 in California, Florida, Illinois, Kansas, New York and Texas. They also interviewed 323 people living in nursing homes, nursing facility staff and long-term care and disability experts.

An attorney for AARP, Kelly Bagby, which has been involved in several court cases challenging nursing home medication practices, told Fox News  “given the dire consequences” of antipsychotics, the number of elderly people with dementia taking the drugs “should be zero.”

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