A poor sense of smell may be one of the earliest signs of Alzheimer's. Now, researchers have shown that the offending culprit may be beta-amyloid, a protein that builds up in a toxic form in the brains of those with the disease.

Working with laboratory mice that had been bred to develop a disease that resembles Alzheimer's in people, the scientists from Case Western Reserve University School of Medicine showed that removing the plaque-forming protein restores the animals' sense of smell.  Researchers believe that the smell centers of the brain may be among the first areas affected by toxic beta-amyloid, followed by brain areas critical for memory and thinking.

“Understanding smell loss, we think, will hold some clues about how to slow down this disease,” said Daniel Wesson, assistant professor of neuroscience at Case Western Reserve and lead investigator for the study, which was published in The Journal of Neuroscience.

Loss of the sense of smell can be caused by many conditions other than Alzheimer’s, including medications, viral illnesses or injuries to the olfactory systems. But a poor sense of smell has also long been recognized as an early sign of Alzheimer's. It may also be an early sign of mild cognitive impairment, a form of memory loss that sometimes precedes Alzheimer's. Not all people with Alzheimer’s lose their sense of smell.

The new research shows how and where in the brain this happens, and that the impairment is likely to be treatable.

Mice exposed to a very minute amount of beta-amyloid lost their ability to detect odors. Plaques made up of the toxic proteins appeared in the rodents' brain areas responsible for smell long before they showed up in areas important for memory. The mice spent more time sniffing than usual but became incapable of remembering smells or telling the differences among odors in lab experiments.

The research team then sought to reverse the effects. The mice were given a drug that clears beta-amyloid from the brain. After two weeks on the drug, the mice could process smells normally. After withdrawal of the drug for one week, impairments returned.

Like the mice in the study, people with Alzheimer's may have a poor sense of smell and be unable to detect common odors like natural gas or roses. But no drugs are currently available that clear beta-amyloid from the brain, though scientists continue to test new candidates.

“The evidence indicates we can use the sense of smell to determine if someone may get Alzheimer’s disease, and use changes in sense of smell to begin treatments, instead of waiting until someone has issues learning and remembering,” Dr. Wesson said. “We can also use smell to see if therapies are working.”

The researchers are continuing their research to determine how beta-amyloid spreads through the brain, and to find new ways to slow its spread and stop the progression of disease.

By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer’s Disease Research at The Rockefeller University.

Source: The Journal of Neuroscience, Nov. 2, 2011. Case Western Reserve Medical School.

Scientists have long sought to develop a vaccine that may prevent the onset or progression of Alzheimer’s disease. But so far, vaccines have had limited benefit and proved potentially dangerous, sometimes triggering life-threatening inflammation in the brain. Now, researchers say that giving a vaccine at an early stage, before symptoms and brain damage have become prominent, may be critical for getting a vaccine to work.

The researchers, from Georgetown University Medical Center in Washington, worked with lab rats that had been bred to develop a disease that resembles Alzheimer’s in humans. They found that the rodents with a large brain buildup of toxic amyloid protein, similar to the beta-amyloid protein that builds up in the brains of people with Alzheimer’s, were more likely to develop brain inflammation after receiving the vaccine than those with little buildup of the toxic protein. The animals with the least amyloid in the brain were also most likely to benefit from the vaccine, showing a slowing of symptoms suggestive of Alzheimer’s disease.

The results mean that people in the earliest stages of Alzheimer’s, who have little buildup of toxic beta-amyloid in the brain, may be the best candidates for an Alzheimer’s vaccine, since they may be least likely to suffer from toxic side effects of vaccine-induced inflammation. The findings were presented at the 2011 annual meeting of the Society for Neuroscience.

The results also call attention to the need for improved techniques to diagnose Alzheimer’s early, before buildup of beta-amyloid has extensively damaged the brain.

Several Alzheimer’s vaccines are currently being tested. Most target beta-amyloid, and some have shown limited success in preventing the buildup of the toxic protein in the brain. But in early experiments, some have had to be withdrawn from testing because they caused inflammation and brain swelling, both potentially dangerous, in a few patients.

The study is important, said Dr. R. Scott Turner, director of the Georgetown University Memory Disorders Program, because it shows that excessive inflammation occurs in brains that have a high burden of amyloid. The results suggest that benefits from the vaccine will most likely be found in those with less amyloid buildup, or so-called amyloid burden. The study also provides clues as to how and why the inflammation occurs, Dr. Turner says.

The researchers note that the vaccines now being tested in patients with Alzheimer's may work better in patients with mild cognitive impairment, or MCI, a form of memory loss that sometimes precedes Alzheimer’s. They are currently recruiting patients for a trial of a vaccine in people with MCI.

"We may find that in the future, we will have to tailor immunization therapies based on amyloid burden in individual patients," Dr. Turner said. People with more advanced disease, for example, may be given a vaccine tailored to minimize the risk of excessive inflammation in the brain.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Georgetown University Medical Center. Society for Neuroscience Annual Meeting.

A new type of brain scan may help to detect Alzheimer's early, using no radiation and at less cost than other techniques, researchers report. Doctors at the University of Pennsylvania's Perelman School of Medicine have developed a form of magnetic resonance imaging, or MRI, that detects brain changes that signal Alzheimer's disease. The doctors have developed a modification to the technique called arterial spin labeling, or ASL-MRI. Small studies show, this may be a useful way to diagnose probable early dementia.

MRI scans are routinely used in hospitals to check for tumors and other issues, and seniors with memory problems may undergo the procedure to rule out brain tumors, strokes or other problems that may be causing the deficits. If Alzheimer's is suspected, they may then undergo another scanning procedure, such as a PET scan.

The advantage of the new ASL-MRI technique is that someone could undergo brain scanning in a single session to help determine whether Alzheimer's may be present. The technique looks for changes in blood flow and the uptake of blood sugar, or glucose, in the memory centers of the brain. It requires about an additional 20 minutes compared to standard MRI scans.

"Increases or decreases in brain function are accompanied by changes in both blood flow and glucose metabolism," explained Dr. John Detre, professor of Neurology and Radiology at Penn, who has worked on ASL-MRI for the past 20 years. "We designed ASL-MRI to allow cerebral blood flow to be imaged noninvasively and quantitatively using a routine MRI scanner."

Studies show that the MRI method is similar in effectiveness to current PET scans that inject a radioactive dye to measure these brain changes. However, the ASL-MRI method uses no radiation and costs one-fourth as much.

"If ASL-MRI were included in the initial diagnostic work-up routinely, it would save the time for obtaining an additional PET scan, which we often will order when there is diagnostic uncertainty, and would potentially speed up diagnosis," said Dr. David Wolk, Assistant Director of the Penn Memory Center and a collaborator on the research.

The studies compared the MRI technique and the specialized PET scan results using flurodeoxyglucose, or FDG, a radioactive tracer. In one, published in the journal Alzheimer's and Dementia, doctors compared images from 13 patients diagnosed with Alzheimer's and 18 age-matched controls. Both methods proved equally effective in detecting signs of early Alzheimer's.  In the second study, published in the journal Neurology, data from 15 AD patients were compared to 19 age-matched healthy adults. The patterns of reduction in cerebral blood flow were nearly identical to the patterns of reduced glucose metabolism by the PET scan and showed reductions in brain gray matter typical of Alzheimer's disease.

"Given that ASL-MRI is entirely noninvasive, has no radiation exposure, is widely available and easily incorporated into standard MRI routines, it is potentially more suitable for screening and longitudinal disease tracking than FDG-PET," said the Neurology study authors.

Early diagnosis of Alzheimer's in the doctor's office has long been a goal for those who treat dementia. Increasingly, experts believe that Alzheimer's is a disease that begins many years before symptoms like memory loss and personality changes become apparent. Treatment of the disease may be most effective in these early stages, before damage to the brain has become extensive. In addition, a simple test to measure brain function would be useful for researchers to test and monitor new treatments.

Additional studies of this new MRI technique will focus on larger sample sizes, including patients with mild cognitive impairment and other kinds of brain problems.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: American Academy of Neurology. Musiek ES, Chen Y, Korczykowski M, et al: "Direct Comparison of Flurodeoxyglucose Positron Emission Tomography and Arterial Spin Labeling Magentic Resonance Imaging in Alzheimer's Disease." Alzheimer's and Dementia, Oct. 20, 2011, epub ahead of print. 

When we began creating short stories for people living with dementia to read aloud, we were surprised by the journey that this simple exercise created. As people began reading our prepared stories, they started telling us stories from their own lives. These stories really grabbed us, and we began writing them down. It is often said that everyone has at least one good story in them, and we have found this to be true.

We are not talking about autobiography and we are not discussing life histories, but rather we are talking about incidents, fleeting moments from a person’s life that they share with us. For example, there was Virginia’s story about how she met her husband. He was the brother of a girl that Virginia worked with in a factory during WWII. He was in the Navy and was home on leave when Virginia went to her friend’s house for dinner. Virginia told us,

“We took one look at each other and it was ‘bif, bam boom!” They were married before his leave was over and he had to go back to the Navy and to the war. He survived the war and they were married until his death, some forty years later. This was just a brief moment in Virginia’s long life, but of course, a seminal one for her and for her husband.

We asked Virginia if she would like to film her story about how she met her husband. She agreed and we made a very short film of Virginia telling us this story. Then, as we always do, we showed Virginia her movie. At first, we were alarmed because when Virginia saw herself on the television screen, she asked us,

“Who is that old woman? How does she know all that stuff about my life?” Virginia began to grow agitated and we thought that perhaps this was a mistake. But then, as she began to listen to the old woman talking on the TV, Virginia became engrossed in the story. She began to agree with the old woman, and shake her head yes, that was right. She laughed out loud when the old woman on the TV said that it was ‘bif, bam boom,’ when Virginia met her husband.

She clapped heartily when the film ended and was very much awake when she went to lunch that day. We were not sure if Virginia understood that the old woman talking on TV was actually her, but then we overheard her talking to her lunch companions and saying, “You are not going to believe this, but I was on TV today. I had my own show on TV!”

When we realized that some people who have dementia can still tell stories from their lives, we began documenting these stories in print and on film. We learned that it was very important to first give people something to hold in their hands in order to prime the pump of memory. For Virginia, we happened to be visiting on Veteran’s Day and we just happened to give her a little flag that had the Navy insignia on it. She recognized the flag and that was the prompt that opened the gates to her story of how she met her husband. Now, we deliberately bring in meaningful objects or photographs from people’s lives to help give them some context for sharing stories from their lives.

Finally, there was the love story that was told to us by a highly regarded scientist. He had taught in a major university and conducted important research that had an impact on world wide crop development. Knowing his life work, we brought in small galvanized buckets of different types of grains for him to put his hands into, to feel the grain again, to prime his memory of the years that he researched and worked with arable crops.

As often happens to us in this work, Philip completely surprised us by his response to this grain exercise. He happily plunged his hands into the buckets, letting the showers of grain slide through his fingers. His eyes took on a dreamy look as the grain fell from his fingers back into the bucket. Then, to our amazement, Philip, the scientist, began to tell us about his one great love, the girl who got away, the reason he never married.

Philip met her when he was working for the government in Washington D.C. When he began to describe Sherry, his whole physical being changed. His face turned bright pink, his eyes brightened and his breathing came in rapid breaths, as though he had been running. He never told us why they did not make a match of it, he only told us of his great love for her and of her personal loveliness.

We thought that by bringing in buckets of grain, Philip would tell us a story about his work in agricultural research, but instead we learned of his great love, Sherry. He said her name over and over again, with a dreamy smile on his face. It was a wonderful experience to see this great man of science talk about his one and only love, Sherry, the girl who got away.

There have been books and articles written about “the storied memory.” Stories are how we frame the scenes from our lives; it is how we remember our lives. People living with dementia obviously cannot remember their lives chapter and verse; they may be confused as to what era they are presently living in, or they may not remember events in the correct sequence, but there are scenes, moments from their lives that can be brought back to life. We know that the people telling us these amazing stories may not remember us for long, nor remember the stories they have told us; but we will never forget them or their stories. These stories bolster our belief that people who are living with dementia have so much to teach us, so much to share with us of wisdom and joy and heartache and fortitude. When we help people who are living with dementia bring their stories back to life, we give them the opportunity to be generative again, to give these stories from their lives back to their immediate communities, to their families and to the larger world.

When it’s maelstrom season in your Alzheimer’s world, you might not have much time or appetite for keeping the Captain’s log. Such has been my stormy situation this Spring. I mentioned in my last post that circumstances had funneled us into moving Jeff into a nearby assisted living unit. Those circumstances, it turns out, were but the edge of the storm system. 

Sometimes you just don’t understand what’s happening until you can look at it in the rear-view mirror, and then you say, “oh yeah...I see where this was going.” Take one part delusion, one part agitation, and one part paranoia, and you have mixed yourself a volatile concoction called Alzheimer’s aggression. It’s a powerful little potion which can turn a lifelong gentle soul into someone who would threaten to put furniture through the window of his ALF, or perceive everyone in view, wife included, as the enemy.

And so it happened that one otherwise fine morning, a few weeks ago, Jeff left the ALF under the escort of a posse of paramedics. After a useless weekend at a local “regular” hospital, I pulled the strings needed to get him checked into a Baltimore area geriatric-psych unit for a longer-term medication adjustment.

After three eruptions of “behavior,” I was confident that the medical professionals in charge at least now had a good idea what they were dealing with. We’ve just crossed the three week mark at his current digs. It is difficult to trust the process while your loved one’s metabolism is learning how to deal with drugs that ease anxiety and paranoia. Fall-down dopiness may not always precede a return to something resembling calm “normalcy,” but it did in our case. I have passed many days despairing that there might exist a compromise between raging bull and near-catatonic. Over the past three days, the evidence has gradually begun to suggest that maybe there is.

Yesterday, when I got to the hospital at my typical late morning time, he seemed so bright and chipper that I almost wondered why we weren’t back to old normal and living at home. Almost. It was bit of an illusion, easily dashed when we took a stroll down the corridor and I noted that he still needed help turning left, needed help aiming for a chair, could not get a spoon loaded with lunch (let alone aim for his mouth,) and refused to use the toilet because of “those construction workers” looking in the window. (Note to all dementia units: try not to have large mirrors in the bathroom or anywhere else. I had no idea I look so much like a construction worker.)

According to his psychiatrist, we may now be on the path to control. Also according to her, control now is no guarantee of control later. And so, when it is decreed by both the psychiatrist and the staff at his ALF that I may do so, I will take Jeff back and cross my fingers that he can exist there in relative peace and harmony. But it may be tough to ever lose the niggling fear that craziness may again erupt.

Meanwhile, I will imagine an alternative–a place of tender loving care, where crack shots with pea shooters stand ready to deliver a kindly and necessary dose of fast-acting tranquilizer when and if the need arises.

Can what you eat help to protect the brain, and possibly help ward off Alzheimer’s disease? A growing body of evidence suggests nutritional factors can influence brain health, including a new report linking certain nutrients to good cognitive health.

Researchers measured blood levels of 30 key vitamins and nutrients in a sample of elderly men and women, all of whom also underwent memory tests. Some also underwent brain scans to measure their brain volumes and look for signs of Alzheimer’s disease.

Five nutrients were linked to good memory and thinking skills: omega-3 fatty acids, the kinds of fats found in fish, and vitamins B, C, D, and E. People who had high blood levels of these nutrients scored better on thinking tests than those who had low blood levels of these nutrients. Their brains also showed less shrinkage, a sign of brain health. People with Alzheimer’s typically have smaller brains than those without the disease.

The study also found that people with high levels of trans fats, an unhealthy type of fat found in packaged baked goods as well as fast, fried and frozen foods, scored lower on thinking and memory tests than those with low trans fat levels. Trans fats are also found in some types of margarine and have been banned in some locales. The findings appeared in Neurology, a journal from the American Academy of Neurology.

The study, part of the Oregon Brain Aging Study, involved 104 people whose average age was 87. Other than advanced age, they had few risk factors for Alzheimer’s disease or other forms of dementia. Over all, the participants were nutritionally sound, though 7 percent were low in vitamin B12, and 25 percent were deficient in vitamin D.

“These results need to be confirmed, but obviously it is very exciting to think that people could potentially stop their brains from shrinking and keep them sharp by adjusting their diet,” said study author Gene Bowman of Oregon Health and Science University in Portland.

Other studies have shown that deficiencies in individual nutrients, like vitamin B12, can lead to memory problems. And anyone with memory problems should be tested for that and other vitamin levels.

This study was the first to use nutrient levels in the blood to analyze the effect of diet on memory and thinking skills and brain volume. Blood measurements are considered more reliable than questionnaires to assess people’s diet, since people often forget exactly what they ate. Food surveys also do not account for how much of the nutrients are absorbed by the body, and poor absorption of certain vitamins and nutrients is often a problem in the elderly.

While dietary factors are complex and foods contain a balance of hundreds of nutrients, the study suggests these five may be especially important for brain health.

Omega-3 fatty acids: Other studies have shown that the oils found in fish are good not just for the heart, but for the brain as well. Oily fish like salmon, tuna, mackerel and trout are particularly high in omega-3s.

Vitamin B: There are many types of B vitamins, and all are important for nerve and brain health. B12 in particular has been shown to be protective against memory problems. After age 50, some people lose the ability to absorb B12 from foods, so supplements may be recommended. B12 is found in meats and other animal foods like fish, eggs and cheese. Some cereals are fortified with B vitamins as well.

Vitamin C: Most people know vitamin C from orange juice, but it’s also found in broccoli, red peppers, dark green vegetables, strawberries and kiwifruits.

Vitamin D: Called the sunshine vitamin because people make it through the skin on exposure to sunlight, vitamin D levels also tend to be low in older people. Milk has added vitamin D, but it’s also found in fatty fish.

Vitamin E: Since vitamin E is stored in fat, you don’t want to overload on it. But it is found in vegetable oils, nuts and seeds, leafy greens and whole grains. Wheat germ is also an excellent source of vitamin E.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Sources: Christy C. Tangney, Nikolaos Scarmeas: “The Good, Bad, and Ugly? How Blood Nutrient Concentrations May Reflect Cognitive Performance.” Neurology Vol 78 No 1, 2012.

G. L. Bowman, L.C. Silbert, D. Howieson, et al: “Nutrient Biomarker Patterns, Cognitive Funciton, and MRI Measures of Brain Aging.” Neurology Vol 78, No. 1, 2012.

The activity and festivities during Passover and Easter pose special challenges for families coping with Alzheimer’s disease. The hurried pace can be trying at times for just about anyone, but for someone coping with Alzheimer’s disease, the change in routine can be especially disruptive. That’s why it’s important to take steps to minimize disruptions and simplify the gatherings. A few steps can help to assure that anyone with Alzheimer’s, and those who care for and love them, can have fun and be safe.

• Simplify. The change in routine can be disconcerting and upsetting. An Easter egg hunt, or taking up their former role in a large dinner such as the Passover Seder, can be disorienting for someone with memory loss and confusion. Click here for tips on how to reduce the risk of wandering. Rethink your family traditions, and simplify. Pick and choose those traditions that are most important to you. Simplify the decorations, and avoid large crowds and raucous noise. For safety’s sake, avoid candles and artificial fruits and vegetables, which may be mistaken for the real thing.

• Engage the person with Alzheimer’s—but keep things at their usual pace. Someone with Alzheimer’s might enjoy simple tasks, such as decorating eggs. Or, reading a beloved scripture or story at home may be a meaningful alternative to visiting a place of worship. Do not, however, force the person with Alzheimer’s to participate if they resist. Stick to the same daily routine and schedule as much as possible.

• If a loved one with Alzheimer’s lives in a nursing home or assisted-living facility, test the waters by bringing him or her home for a short visit beforehand. For many with Alzheimer’s, being removed from familiar surroundings can be disorienting and upsetting. Even being around family members a person doesn’t see often can make someone with dementia anxious or fearful. If a home visit seems too stressful, arrange for visits by small groups to the nursing home to minimize confusion and upset.

• Apprise family members and relatives who are coming from out of town about the status of a parent, sibling or loved one with Alzheimer’s ahead of time. That way, everyone will be better prepared during family gatherings.

• Delegate. Let family members and friends help with the chores, such as baking. Let others watch a loved one if you need to take time for yourself.

Alzheimer’s is characterized by the buildup of beta-amyloid, a protein that accumulates in the brains of those with the disease. But at least 20 percent of elderly men and women also have evidence of beta-amyloid buildup in the brain on autopsy, despite having normal memory and thinking skills while alive.

Now researchers have demonstrated that plaque buildup occurs in many well-functioning people beginning in middle age or even earlier, and are correlated with subtle disturbances in memory. The findings, published in the journal Neurology, provide further evidence that Alzheimer’s is a long process that begins well before the telltale memory loss and other symptoms of the disease become apparent.

For the study, researchers at the University of Texas at Dallas and UT Southwestern Medical Center recruited 137 healthy men and women ranging in age from 30 to 89. All were free of obvious memory problems.

The study participants underwent brain scans using special dyes to look for signs of beta-amyloid buildup. They also were given tests to look for subtle signs of memory and thinking problems, even though their memory showed no obvious signs of failing.

The researchers found that the older someone was, the more beta-amyloid they tended to have. "In our study, we observed that even in adults with apparently good cognitive health, increasing amounts of beta-amyloid in the brain are related to subtle changes in memory and mental function," said study author Denise C. Park of the Center for Vital Longevity at the University of Texas at Dallas.

Plaque buildup was notably elevated in about one in five of those over 60, more commonly in those who carried a gene called APOE-E4 that raises the risk of developing Alzheimer’s disease. Those with more plaque tended to score worse on memory tests than their peers with less plaque; they did not process thoughts as quickly and were less able to think logically and solve problems requiring reasoning skills.

"We found that this high-amyloid group showed deficits in cognitive performance, even though the individuals were well educated and scored normally on our standard tests of cognition," said Dr. Karen Rodriguez, lead author of the study.

"Our findings suggest that subtle effects on cognition occur early," Dr. Park said. "These are important findings, because imaging patients when they first show signs of very mild cognitive impairment could be essential to determining their risk of future disease."

Determining who will ultimately develop Alzheimer’s is important, since many researchers believe that the best strategy to treat the disease may be to develop new drugs that can be given during middle age, before brain deterioration from the disease becomes irreparable. Currently available drugs do nothing to stop progression of Alzheimer’s.

"Just as many adults take aspirin to lower their risk of heart disease or stroke, one day we may be able to help protect our brains and cognitive health by starting a treatment in our 40s or 50s," Dr. Park said.

The authors also found that some people in their 60s, 70s and 80s seemed to defy the brain deterioration of old age. Levels of beta-amyloid buildup in some of these men and women were as low, or lower, than some others in their 30s, 40s or 50s.

"Another avenue of our future work will be to investigate what factors enable these individuals to maintain cognitive health well into old age, whether they be genetic factors, lifestyle factors or environmental issues," said Dr. Park. "Understanding how the brain and mind stay healthy and vital over the long term will help guide our efforts to delay or even prevent the devastation caused by diseases like Alzheimer's."

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

K.M. Rodrigue, PhD K.M. Kennedy, PhD M.D. Devous, Sr., PhD, et al: “Beta-Amyloid Burden in Healthy Aging: Regional Distribution and Cognitive Consequences.” Neurology Vol. 78, 2012, pages 387-395.

A daily walk or jog may help to ward off the memory loss of Alzheimer’s, a new study suggests, particularly in people at increased risk of the disease.

The study, which appeared in the Archives of Neurology, was among the first to look at people’s activity levels and whether they carried a gene called APOE-E4, which increases the risk of developing Alzheimer’s in old age. People who have the gene are at up to 15 times increased risk of getting Alzheimer’s, though carrying the gene only heightens risk and does not mean you will get the disease.

Researchers found that people with APOE-E4, which may be carried by around 20 percent of the population, who were physically active had fewer plaques in their brains compared to less active carriers of APOE-4. The buildup of plaque, composed of a toxic protein called beta-amyloid, is linked to the memory loss of Alzheimer’s. People with Alzheimer’s tend to have lots of beta-amyloid buildup in their brains, and the more beta-amyloid, the worse memory and thinking skills tend to be.

For the study, researchers at Washington University in St. Louis looked at 210 men and women, ages 45 to 88, none of whom had serious memory problems. They were tested to see whether they carried the APOE-E4 gene, and most also underwent spinal taps and specialized brain scans to look for signs of beta-amyloid. They were also asked about their regular exercise habits during the previous 10 years.

The researchers found that those adults who tended to be active and get plenty of exercise had less buildup of beta-amyloid than those who were sedentary, particularly in parts of the brain important for memory and thinking. They also found that people who carried the APOE-E4 gene had more beta-amyloid accumulation than those without the gene.

The combination of carrying the APOE-E4 gene and being sedentary was a particularly destructive combination. People without the gene who did not exercise had some beta-amyloid buildup in their brains, but far less than those who carried the gene. The relationship held even after considering factors like advancing age, obesity, or having diabetes or depression, all of which increase the risk of developing Alzheimer’s.

Exercise, though, appeared to benefit those who carried the APOE-E4 gene. Carriers who walked or jogged regularly had less plaque buildup in the brain. The authors note that, “In summary, our findings suggest that exercise at levels recommended by the American Heart Association may be particularly beneficial in reducing the risk of brain amyloid deposition in cognitively normal APOE-E4-positive individuals.”

The American Heart Association recommends that all adults, including older ones, strive for an “active lifestyle.” That means getting at least 150 minutes per week of moderate exercise, or 75 minutes per week of vigorous exercise, or a combination of both moderate and vigorous activity. That translates to 30 minutes a day, five times a week, though they also note that getting short bursts of activity – say 10 to 15 minutes a few times a day – is also effective. Climbing stairs, playing a sport, walking, jogging, swimming or biking all count. The group also recommends strength and stretching exercises that build overall stamina and flexibility.

Walking, the American Heart Association notes, may be especially apt choice for beginners or older adults. Several studies have shown that people who walk regularly have a lower Alzheimer’s risk, and may have brain changes that promote cognitive health. See, for example, the ALZinfo.org story, “Walk to Keep the Memory Sharp” at http://www.alzinfo.org/12/articles/prevention-and-wellness/walk-memory-sharp.

By ALZinfo.org, The Alzheimer's Information Site. Reviewed by William J. Netzer, Ph.D., Fisher Center for Alzheimer's Research Foundation at The Rockefeller University.

Source: Head D, Bugg JM, Goate AM, et al: Exercise Engagement as a Moderator of the Effects of APOE Genotype on Amyloid Deposition. Archives of Neurology.
Published online January 9, 2012. doi:10.1001/archneurol.2011.845.

Whether it's relatives, friends or nursing staff, anyone who is caring for those afflicted with Alzheimer’s or dementia has heard or will inevitably hear the patients say, “I want to go home!”

Patients may even pack their bags, piling them at the front door, waiting to leave. This may happen even though they are still living in their own residence of thirty-some years.

My father would constantly ask me, “Why can’t I go home? My mother is going to be awfully worried about me.” This is a perfect example of a need for redirection. This will be a caregiver’s best tool of defense. For example: I would assure my dad that everything was going to be okay. “I just talked to your mother an hour ago. She knows that you’ll be spending the night here so why don’t you play some cards until dinner is ready?”

Just go with the flow. Obviously, they’re already confused. Try to avoid making matters any worse.

Hearing the statement, “I want to go home” should be taken as a potential forewarning that wandering may be in the near future. Nonchalantly pay close attention to your loved one until you feel confident that he or she has moved on to fresh and pleasant thoughts.

I’m directing this advice to everyone who is involved in the care of the memory-impaired. This includes nursing home employees, family members, etc. This is a situation where patients can easily become lost and possibly seriously hurt.

Some may find this a bit comical, but there is a nursing home in Germany which built an exact replica of a bus stop in front of their facility. Their average patients suffers from having no short-term memory. But the long-term memory may still recall the colors of the bus sign and that waiting there means they’re soon going home.     

The staff then gently approaches the confused patients, informing them that the bus won’t be along until later in the day and then invites them inside for a cup of coffee while waiting. Usually, by the time the cup’s empty, the patients have completely forgotten what they were waiting for. If this keeps them from running off and getting hurt, I would call their well-intended ruse a success.

The fact that patients are unable to recognize their own surroundings makes things extremely frightening for them. They will wish they were back in the comfort of their own home, even if they already are.

Once again, casual redirection of an Alzheimer patients thoughts is something every caregiver needs to master.