Early Dementia Often Caused by Autoimmune Disorders

Dementia in patients who are younger than 45 years of age is often caused by degenerative, metabolic or autoimmune diseases, Dr. Brendan Kelley, of the Mayo Clinic in Rochester, Minnesota, told attendees at the 60th annual meeting of the American Academy of Neurology, being held this week in Chicago.

Kelley and colleagues searched the Mayo Clinic database for patients who began to develop dementia between 17 and 45 years that was not related to trauma, brain infections or mental retardation. They identified 235 such patients receiving care between 1996 and 2006. The average age at dementia onset was 34.7 years.

Neurodegenerative causes accounted for dementia in 29.8 percent of the group, frontotemporal dementia occurred in 13.2 percent and Alzheimer's disease was seen in less than 1 percent," data presented by Kelley showed.

Autoimmune-inflammatory causes, including multiple sclerosis, accounted for 21.2 percent. Inborn errors of metabolism were identified in 10.6 percent.

At the last evaluation, the cause of dementia was still unknown in 44 patients (18.7 percent) despite exhaustive evaluations, Kelley reported.

Inborn errors of metabolism were more common in individuals with symptoms appearing before age 30. Neurodegenerative causes were more common in dementias occurring after age 35.

"Some of the important causes, such as lupus, metabolic disorders, Huntington chorea, among others, can occur in very young children," Kelley told Reuters Health. "Only 4 of the 235 cases in our series resembled Alzheimer's type dementia."

"It is important to increase awareness that dementia can and does occur in young patients," Kelley continued. "This is important for social services and other aid-giving organizations to know."

"Symptoms in younger patients have more of a neuropsychiatric focus, with a lot of psychiatric features," he said. These patients can be misdiagnosed with psychiatric disorders, such as schizophrenia.

The causes of young-onset dementia are more often hereditary or genetic than they are in older patients with dementia.

"We are now looking to determine which clinical features are more classic...which clinical features to focus on," Kelley said. "This is a single disorder with multiple underlying causes. Treating the causes may correct to some extent the disorder."

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Hypertension Drugs May Prevent and Treat Alzheimer’s, Study Finds

Drugs commonly used to treat hypertension, may be successful in preventing Alzheimer’s disease, according to a new study published in The Journal of Clinical Investigation.

In the study, researchers at the Mount Sinai School of Medicine found that geriatric patients who are being treated for high blood pressure with hypertenstion drugs may cut their risks of developing Alzheimer’s disease.

The researchers studied more than 1,500 drugs currently available to treat other disorders to determine the effectiveness of the drugs in preventing Alzheimer’s. They found that of the 55 drugs studied, seven drugs used to treat hypertension were the most effective.

Researchers found that the drugs prevented beta-amyloid production, a fragment of protein in the brain that is usually eliminated but forms a kind of plaque, or blockage, in the brain of Alzheimer’s patients.

The drugs may also prevent further deterioration in those who are already afflicted with Alzheimer's, according to the study. One drug, Valsartan, was given to Alzheimer’s diseased mice, at a three or four times lower than the normal dosage for humans, and the drug still prevented further production of this blockage in the brain.

The effectiveness of hypertension drugs in preventing this blockage in the brain may help identify future treatments that can prevent cognitive deterioration and dementia in Alzheimer’s patients, according to researchers. However, studies on human patients is necessary.

"The use of these drugs for their potential anti-Alzheimer’s disease role is still highly experimental, and at this stage we have no clinical data beyond phenomenological observation in humans" said Dr. Pasinetti, director of the Center of Excellence for Research in Complementary and Alternative Medicine in Alzheimer's disease at Mount Sinai. "We need to complete preventive and therapeutic clinical trials in the near future if we are to identify certain anti-hypertensive drugs with anti beta-amyloid antioligomeric activities, which will need to be prescribed at dosages that do not interfere with blood pressure in normotensive Alzheimer’s disease patients."

Self-discipline may reduce Alzheimer's risk

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People who are meticulous and "finish what they start" may have a reduced risk of developing Alzheimer's disease, according to a study involving Catholic nuns and priests.

The most conscientious and self-disciplined individuals were found to be 89% less likely to develop this form of dementia than their peers over the course of the 12-year study.

Robert Wilson at Rush University Medical Center in Chicago, Illinois, US, and colleagues followed 997 healthy Catholic nuns, priests and Christian brothers between 1994 and 2006. Early on in the study, participants completed a personality test to determine how conscientious they were.

Based on answers to 12 questions such as "I am a productive person who always gets the job done", they received a score ranging from 0 to 48. On average, volunteers scored 34 points in the test.

Controlled impulses

Volunteers also underwent regular neurological examinations and cognitive tests. Over the lifetime of the study, 176 of the 997 participants developed Alzheimer's disease. However, those with the highest score on the personality test – 40 points or above – had an 89% lower chance of developing the debilitating condition than participants who received 28 points or lower.

"These are people who control impulses, and tend to follow norms and rules," Wilson told New Scientist.

Previous studies suggest that exercise and intellectual stimulation can decrease the risk of Alzheimer's disease. But the link between self-discipline and a reduced risk of the illness remained strong even after researchers discounted these factors from their study. Subjects still had a 54% lower chance of developing the condition.

Exactly why conscientiousness should have an impact on Alzheimer's risk remains unclear, says Wilson. He notes that brain autopsies conducted on 324 of the study's participants failed to resolve the mystery.

Alzheimer's test?

Earlier work has linked the presence of plaques and protein tangles within the brain to Alzheimer. Yet, in general, the brains of those who scored highly on the conscientiousness test had as many plaques and protein tangles as those of subjects who scored lower.

Wilson suggests that more meticulous and conscientious individuals may have more active frontal brain regions, an area that is responsible for decision-making and planning. Increased activity in this region may perhaps compensate for a decline in function in other brain regions, he speculates.

Based on the new findings, doctors could perhaps consider certain patients at greater risk of dementia, says Ross Andel at the University of South Florida, US. "This is a study about identifying people at risk," he says.

Conscientious People Less Prone to Alzheimer's

Alzheimer's linked to behaviour study suggests

Forget the smokes

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Here's another reason to quit smoking - the habit can contribute to dementia or Alzheimer's disease. Smokers are 50% more likely to develop these conditions than former smokers or people who have never smoked, a Dutch researcher has found. Dr. Monique Breteler of Erasmus Medical Centre in Rotterdam studied 7,000 smokers, non-smokers and former smokers over the age of 55 for seven years. Her study, published in the journal Neurology, found that 706 people developed dementia, the majority of them smokers. Smoking increases the risk of diseases of blood vessels in the brain, which is tied to dementia, Breteler said.

Med diet found to have further Alzheimer's benefits

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By Lorraine Heller

Adhering to a Mediterranean diet could allow sufferers of Alzheimer's disease to live longer than patients who eat a more traditional Western diet, according to new research published today.

The findings are the latest in a string of health benefits linked to the eating plan of the people of southern Europe, which has in the past also been associated with the prevention of Alzheimer's disease.

Published in today's issue of Neurology, the medical journal of the American Academy of Neurology, the new findings were based on researchers' observations of 192 Alzheimer sufferers for four and a half years.

During that time, 85 of the people died. Researchers found that those patients who most closely followed a Mediterranean diet were 76 percent less likely to die during the study period than those who followed the diet the least.

"The more closely people followed the Mediterranean diet, the more they reduced their mortality," said study author Nikos Scarmeas of Columbia University Medical Center in New York, and member of the American Academy of Neurology.

"For example, Alzheimer's patients who adhered to the diet to a moderate degree lived an average 1.3 years longer than those people who least adhered to the diet. And those Alzheimer's patients who followed the diet very religiously lived an average four years longer."

Previous research by Scarmeas published last year found that greater adherence to a Mediterranean-style diet could cut the risk of healthy people developing Alzheimer's disease by 68 percent.

The Med diet is rich in cereals, wine, fruits, nuts, legumes and whole grains, fish and olive oil. Its main nutritional components include beta-carotene, vitamin C, tocopherols, polyphenols, and essential minerals. It is these antioxidants and polyphenols that appear to offer protection, suggested the researchers.

Another study by the same researchers, published earlier last year in the Annals of Neurology (Vol. 59, pp. 912 - 921), reported that elderly individuals whose diet closely resembled the Med diet had a 40 per cent lower risk of Alzheimer's than those who adhered the least to the diet.

"New benefits of this diet keep coming out," wrote Scarmeas today.

"We need to do more research to determine whether eating a Mediterranean diet also helps Alzheimer's patients have slower rates of cognitive decline, maintain their daily living skills, and have a better quality of life."

Alzheimer's disease is the most common form of dementia and currently affects over 13 million people worldwide. The direct and indirect cost of Alzheimer care is over $100 bn (ˆ 81 bn) in the US alone. The direct cost of Alzheimer care in the UK was estimated at ?15 bn (ˆ 22 bn, $30bn).

The Mediterranean diet has also been linked to longer life, less heart disease, and protection against some cancers - and the flow of scientific back-up for its healthfulness has started to trickle into consumer consciousness, with more and more people seeking out products that meet the diet's criteria.

Common foods of the eating plan include bread, pasta, rice, couscous and potatoes; olives, avocados and grapes; eggplant, tomatoes, peppers, nuts and beans; and cheese and yogurt. Moderate consumption of fish and poultry is also encouraged, whereas consumption of red meat is advised only a few times a month.

In the US, a nutrition group recently launched a Med Mark symbol to allow manufacturers to flag up Mediterranean diet foods. Introduced three months ago by Oldways, the packaging symbol already appears on 50 products.

Mediterranean Diet May Help Alzheimer's Patients Live Longer