Postponing Retirement Might Help Keep Dementia at Bay

Amy Norton wrote . . . . . . . . .

Early retirement may sound appealing, but a recent study hints that putting it off a few years might help older adults retain more of their mental sharpness.

Using data on more than 20,000 older Americans, researchers estimated that if all of those people waited until age 67 to retire, their collective cognitive health would benefit.

“Cognition” refers to a person’s ability to think, reason, plan and remember, among other vital brain functions. Research suggests that various factors over a lifetime — from education level to exercise habits to heart health — can affect a person’s rate of cognitive decline, and risk of dementia, later in life.

For the new study, researchers wanted to estimate the possible impact of later retirement on people’s cognitive functioning.

In theory, spending more years on the job would be protective — in a “use it or lose it” kind of way, explained lead researcher Jo Mhairi Hale of the University of St. Andrews, in Scotland.

“Those who keep working are ‘forced,’ let’s say, to stay cognitively engaged, while those who retire may choose to be involved in cognitively engaging activities, but not necessarily,” Hale said.

Her team started with data on more than 20,000 Americans aged 55 to 75 who took part in a long-running health survey called the Health and Retirement Study. It included standard questions that gauge memory and other brain functions.

Many respondents were still working, at least part-time, while about 45% were retired.

The researchers used statistical methods to estimate what would happen if all study participants were “forced” to delay retirement until at least age 67.

In real life, there is a whole host of factors that could sway both a person’s cognitive health and retirement age. And some people might retire earlier because their mental acuity is declining.

Hale said the Health and Retirement Study examined a “plethora of life-course factors,” so that allowed her team to account for some of that complexity.

The investigators weighed factors like people’s education levels; childhood family income and current wealth; health conditions such as diabetes and heart disease; depression symptoms; and whether their longest-held job was professional or “non-professional” (such as manual labor).

In the end, the researchers calculated that delaying retirement until age 67 or older would help people retain some mental sharpness. On average, the group lost about 1 point on their cognitive scores between the ages of 61 and 67; delaying retirement, the researchers estimated, could reduce that by one-third.

The team also found that the benefit could persist for at least five years beyond retirement.

That was not because the extra work years offered bonus brain power. It was because earlier retirement was linked to a faster cognitive decline, the researchers said.

So should older adults keep punching the clock in order to protect their brain health?

The study does not answer that question, according to Claire Sexton, director of scientific programs and outreach for the Alzheimer’s Association.

“It’s definitely a tricky thing to examine the effect of just one event, like retirement age,” said Sexton, who was not involved in the study.

For one, she noted, many factors affect people’s retirement decisions — including whether they enjoy their work and find it stimulating, and whether their job is stressful or physically taxing.

Similarly, Sexton said, a range of factors sway dementia risk, from genes to health conditions like high blood pressure, diabetes and heart disease to obesity and lack of exercise.

That caveat made, Sexton agreed that staying on the job might be beneficial — if it provides people with mental stimulation and social interaction. A body of research suggests those things may help protect the aging brain.

Of course, jobs are not the only way to stay mentally and socially engaged.

Retirement could be used as a “springboard,” Sexton said, freeing up time to take a class, start a new exercise routine, or join a club or volunteer group.

Hale agreed that retirees “would be well-served to regularly participate in cognitively engaging activities.”

A next research step, she said, “would be to explore the extent to which alternative activities that promote cognitive engagement — such as grandparenting or volunteering — are protective against cognitive decline.”

The findings were recently published online in the journal SSM Population Health.

Source: HealthDay

What Are Researchers Doing to Stop Dementia?

Laura Williamson wrote . . . . . . . . .

They are words nobody wants to hear: Alzheimer’s disease and dementia. As the population ages, a growing number of older adults gradually lose cherished memories and the ability to think and, ultimately, to perform even the most basic functions of daily living.

Researchers say dementias are so varied and complex, there remain more questions than answers when it comes to how to thwart them.

“This is a condition with multiple pathologies,” said Cynthia Lemere, immediate past chair of the medical and scientific advisory group of the Alzheimer’s Association. “There’s a lot of research going on right now.”

While there are many causes of dementias, much of the research revolves around Alzheimer’s, which accounts for 60%-70% of all cases. According to the Alzheimer’s Association, more than 6.2 million people are living with Alzheimer’s disease, a number expected to double by 2050.

The federal government spends about $3.1 billion annually on Alzheimer’s research. Another $250 million comes from the Alzheimer’s Association, and last year the American Heart Association announced a joint brain health research project with Bill Gates, as well as support for a global networking effort among research centers to accelerate early detection and treatment of Alzheimer’s and related dementias.

Many drugs are being tested. Some work by going after what is considered one of the hallmarks of the disease – beta-amyloid protein. When this protein builds up in the brain, it clumps together to form plaques that stick in between nerve cells, interfering with the cells’ ability to communicate.

Lemere, an associate professor of neurology in the Ann Romney Center for Neurologic Diseases at Brigham and Women’s Hospital and Harvard Medical School in Boston, has spent the past two decades working on an Alzheimer’s vaccine and antibodies that would attack amyloid plaques.

While trials have shown some potential, it has been difficult to get sufficient amounts of antibodies to cross the blood-brain barrier, she said. Nonetheless, “there are three or four drugs in this class coming down the pipeline that look promising.” A drug that targets amyloid plaque received conditional approval from the Food and Drug Administration this summer and requires further testing to verify its benefits.

A newer area of investigation focuses on drugs to stop the spread of a protein called tau, needed to stabilize the structure of nerve cells. In the brains of people with Alzheimer’s disease, tau changes its structure and aggregates inside the cells, causing tangles to form. The tangles block nutrients and any communication from moving through the cells, which eventually die. That’s when symptoms appear.

“Alzheimer’s disease doesn’t start when you begin to see memory loss. It starts 15-25 years earlier, when these plaques and tangles are forming,” Lemere said. “When you have them both for a long period of time, neurodegeneration starts.”

So far, researchers have seen the best results with patients who are in the earliest stages of Alzheimer’s, Lemere said. “Previous clinical trials have shown that these drugs do not work well for people with moderate to severe Alzheimer’s disease. If someone has already lost 40% of their hippocampal neurons, clearing plaque won’t bring those back. That’s why we still need to continue to find ways to help those in later stages of the disease.”

What’s causing beta-amyloid to accumulate in the first place remains unclear. Some believe it may be an immune system response to viral infections, such as herpes, and may even be linked to the bacteria in gum disease.

“It turns out that amyloid plays a role in protecting the brain from infection,” said Dr. Mitchell Elkind, immediate past president of the American Heart Association. He is a professor of neurology and epidemiology at Columbia University Irving Medical Center in New York City.

When an infection attacks the brain, beta-amyloid may be overproduced as part of an immune response, he said. One avenue of investigation hypothesizes that anti-viral agents could therefore prevent Alzheimer’s or slow progression of the disease based on the theory that “if we eliminate the inciting insult of the infection, perhaps we can decrease the amount of amyloid. That’s an exciting possibility.”

Studying COVID-19 may help, Elkind said. “For those of us interested in the concept that infections may worsen dementia, COVID provides a great model because there is so much of it around. It can help us answer the question of whether a virus can cause long-term cognitive decline. We don’t know yet.”

When viruses and bacteria activate the immune system, they also produce inflammation, which researchers believe contributes to plaque development.

“Inflammation is a hot button now for Alzheimer’s disease research,” Elkind said. Investigators are exploring whether anti-inflammatory agents can be used to ward off symptoms.

Lemere said she believes the most promising approach may be combinations of drugs that help the immune cells in the brain do their job while tamping down inflammation.

“That is going to be the wave of the future,” she said. “Maybe an anti-inflammatory agent with a tau antibody to prevent the downstream neurodegeneration.”

But even if researchers succeed in developing drugs that clear the brain of amyloid plaques and tau tangles, it won’t stop other forms of dementia, said Dr. Mary Sano, director of the Alzheimer’s Disease Research Center at Mount Sinai Health System in New York City.

About 10% of dementias are vascular – they’re linked to strokes or issues with poor blood flow to the brain. Others have mixed dementia, which can be a combination of Alzheimer’s, vascular and other less common types of dementia.

Sano’s center works with people who often develop dementias related to Type 2 diabetes and heart disease risk factors, such as high blood pressure, and these “have a very different profile of cognitive deficits.” For example, people with diabetes begin with greater problems with executive functions, such as the ability to plan and organize. Memory may be less impaired.

Lifestyle behaviors remain an important avenue for preventing vascular dementia, she said. Controlling blood pressure, cholesterol and blood sugar levels and making other lifestyle changes, such as quitting smoking, exercising, eating a nutritious diet and losing weight – metrics the AHA has dubbed Life’s Simple 7 – all have been shown to help maintain good brain health as people age.

This has to start early, Elkind said. “It’s not your blood pressure in your 70s and 80s that causes dementia, but what it was in your 40s and 50s.”

One of the best things people can do is exercise, Lemere said. “It promotes cardiovascular health, which is related to brain health. It’s anti-inflammatory and it promotes better sleep. Lack of sleep is a risk factor for Alzheimer’s disease, and exercise is one of the biggest ways people can stave off or reduce their risk for dementia.”

Source: American Heart Association

Want to Avoid Dementia? Add Some Color to Your Plate

See large image . . . . .

Cara Murez wrote . . . . . . . . .

Something as simple as having a glass of orange juice in the morning or an apple at lunch could be one of the keys to protecting your brain health.

People who consumed just a half serving a day of foods high in a naturally occurring compound called flavonoids had a 20% lower risk of mental decline, according to a new study.

“We think it may have important public health implications because based on what you’re seeing in the current study, it could be that just by making some simple changes to your diet, that is, by adding these flavonoid-rich foods into your diet, you could potentially help prevent cognitive decline,” said study co-author Dr. Tian-Shin Yeh, a research fellow at Harvard T.H. Chan School of Public Health.

Besides bananas, apples, pears and sweet peppers, the list of flavonoid-rich foods includes celery, citrus fruits, cherries and berries. Flavonoids are a type of antioxidant, the researchers said.

In the absence of effective treatments for dementia, the impact of risk factors that people can control, such as changing their diets and building in regular exercise, is getting more attention. Cognitive, or mental, decline is caused by a combination of genetic, lifestyle and environmental factors, Yeh said.

Researchers examined the diets and perception of subjective cognitive decline in about 77,000 U.S. adults enrolled in the Nurses’ Health Study or the Health Professionals Follow-up Study. The women had an average age of 48 and the men an average age of 51 at the start.

Participants completed several questionnaires over 20 years of follow-up that asked how often they ate certain foods. Researchers calculated their flavonoid intake.

Those who ate the most flavonoids had an average of 600 milligrams (mg) daily. Those who ate the least had 150 mg on average. To put that in context, an apple has about 113 mg of flavonoids, while there are roughly 180 mg in about two-thirds of a cup of strawberries.

Flavones, a particular flavonoid found in some spices and yellow or orange fruits and veggies, had the strongest protective qualities, researchers said. They were associated with a 38% reduction in risk of cognitive decline.

Another type of flavonoid, called anthocyanins, was associated with a 24% reduced risk of cognitive decline. This is found in darker fruits such as cherries, blueberries and blackberries.

Twice during the study, participants also assessed their own cognitive abilities, answering questions such as, “Do you have more trouble than usual remembering recent events?” and “Do you have more trouble than usual remembering a short list of items?”

Researchers said these types of questions can catch early memory problems, at the point that a person notices them and before they can be detected on a screening test.

Exactly why these foods might make a difference in brain health remains an open research question, said Dr. Darren Gitelman, a neurologist and senior medical director for the Advocate Memory Center in Chicago. Gitelman was not involved in the study.

Some theories suggest antioxidant foods reduce amyloid deposition, which is a factor in the start of Alzheimer’s disease, or neuroinflammation.

“There are a lot of hypothesized effects on the neuronal environment that may be beneficial with these foods,” Gitelman said. “I will say it’s also possible, and it’s not mentioned, that it may be that if you eat these foods, you may generally have a healthier approach to diet and to your physical being than if you don’t eat these foods.”

Yeh said a colorful diet rich in flavonoids is a good bet for promoting long-term brain health — and that it’s never too late to start. Even study participants who began eating more flavonoids later saw benefits.

A healthy lifestyle is important for overall health and for brain health, Yeh said. “And the combination of diet and exercise appears to offer a more comprehensive benefit than either one of them alone,” she noted.

The study adjusted for many dietary and non-dietary factors, include socioeconomic factors, physical activity and other nutrients. The findings on flavonoids were independent of these other factors, but future studies are still needed to confirm the findings, Yeh said.

The results appear in the online issue of Neurology. Study limitations include that people were recalling their own diets. Also, the study doesn’t establish a direct cause-and-effect relationship, merely an association between diet and lower risk of dementia.

Gitelman added, “This study was important in showing the potential advantages of these types of foods on our brain health, but it must be extended to other populations before we know its true impact.”

Source: HealthDay

Diabetes and Dementia Risk: Another Good Reason to Keep Blood Sugar in Check

Laura Williamson wrote . . . . . . . . .

There are many reasons to avoid getting diabetes, or to keep it controlled if you already have it: Higher risks for heart disease, stroke and for having a foot or leg amputation. But here’s another one: It’s a major risk factor for dementia.

While researchers are still investigating what causes that increased risk, one thing they do know is it’s linked to highs – and lows – in the body’s blood sugar levels.

“Whether it’s Type 1 or Type 2 diabetes, glycemic control is very important” for maintaining good brain health, said Rachel Whitmer, chief of the division of epidemiology at University of California, Davis and associate director of the school’s Alzheimer’s Disease Research Center. “This is another motivation to have good control.”

Good management of blood glucose levels is one of seven lifestyle changes people can make to support better heart and brain health, called Life’s Simple 7 by the American Heart Association. It’s a step that could potentially help more than 34.2 million people in the U.S. living with diabetes.

According to the Centers for Disease Control and Prevention, the vast majority of people with diabetes have Type 2, which becomes more prevalent as people get older, as does dementia. It happens when the body can’t properly use the insulin it makes to control blood sugar levels. It develops over many years and is often associated with being overweight or obese. Type 1 diabetes is an autoimmune disease in which the body stops making insulin.

Most of the research on the diabetes-dementia link involves Type 2 diabetes, which studies show roughly doubles the dementia risk and may cause it to develop a few years earlier. For people with Type 1 diabetes, treatment advances have led to longer lifespans, allowing researchers to begin delving into how the disease affects their cognitive abilities as they age.

“They are now living to ages to be at risk for diseases that happen later in life,”

said Whitmer, who is also an adjunct investigator at the Division of Research for Kaiser Permanente Northern California.

Whitmer led a study for Kaiser that showed older adults with Type 1 diabetes who were hospitalized for just one blood sugar extreme were at higher risk for dementia – and those who were hospitalized for both highs and lows were six times more likely to later develop dementia.

Shannon Macauley, an assistant professor of gerontology and geriatric medicine at Wake Forest School of Medicine, studies the relationship between Type 2 diabetes and Alzheimer’s disease in her lab in Winston-Salem, North Carolina.

“Glucose is unbelievably important for the brain,” Macauley said. Though it makes up just 2% of the body’s weight, the brain uses 20%-30% of circulating blood glucose. “People don’t appreciate how much the brain sucks glucose out of the blood; it’s a big user of your glucose supply.”

Unlike other organs, the brain can’t store excess glucose, she said. That makes it vulnerable to highs and lows. “It needs it on demand in a rapid fashion but that puts the brain at excess risk when glucose levels hit one extreme or another.”

Macauley’s research in mice suggests too much glucose may be causing rapid production of beta-amyloid, proteins that clump together to form amyloid plaques in the brain. Beta-amyloid has been implicated in the development of Alzheimer’s disease.

When the brain suddenly produces excess beta-amyloid, it’s “like throwing a Jersey barrier out onto I-95,” Macauley said. “All the cars have to figure out how to get around it. The cells can’t get to where they need to go, they can’t communicate properly with other cells and lose their efficiency.”

Conversely, too little glucose in the brain robs it of the energy it needs to perform tasks, she said. “You need energy on hand for every task – to talk, think, button your shirt. Energy also goes to keeping the cells and brain alive. If you go low, you are starving the brain, and it can’t do what it needs to do.”

Preventing dementia isn’t the only way good blood glucose control helps the brain, Whitmer said.

“It also helps to prevent stroke,” she said. “There are lots of blood vessels in the brain. Good glycemic control equates with good blood vessel health. What’s good for your heart is good for your brain.”

Whether a person has Type 1 or Type 2 diabetes, there are many steps they can take to keep blood sugar levels on an even keel.

First, it’s important to know your numbers. Even blood sugar levels slightly higher than normal – a condition known as prediabetes – can start to do damage, Macauley said. To be in the healthy range, levels should be lower than 100 mg/dl, with measurements from 100-125 mg/dl considered prediabetes.

“If you are in that realm, there are clues you are becoming unhealthy,” Macauley said. A person may be overweight, eating an unhealthy diet, smoking or not getting enough sleep or physical exercise. “Exercise causes you to use that extra glucose.”

If diet and exercise don’t help enough, medication may be needed, she said.

People with Type 1 diabetes need to check blood sugar levels throughout the day because what they eat and how much physical activity they get can cause levels to rise or fall. Health experts recommend they keep supplies such as hard candy, fruit juice or glucose tablets with them to boost levels should they get too low.

As people with Type 1 live longer, Whitmer said, researchers need to focus on other ways to ensure their years are healthy ones. “We really need to step back and think about how we can increase this patient population’s chances of successful aging.”

Source: American Heart Association

Missing Teeth, Higher Odds for Dementia?

Brushing and flossing is good not only for your teeth: It might also benefit your brain, a new study suggests.

The findings showed that tooth loss is tied to an increased risk of dementia, though getting dentures may help reduce that risk.

For the study, New York University researchers analyzed 14 studies that included more than 34,000 older adults and nearly 4,700 with diminished thinking (“cognitive function”) skills.

The investigators found that adults with more tooth loss had 1.48 times the risk of developing impaired thinking and a 1.28 times increased risk of dementia.

“Our findings underscore the importance of maintaining good oral health and its role in helping to preserve cognitive function,” said senior author Bei Wu, co-director of the Aging Incubator at New York University in New York City.

The more teeth lost, the greater the risk, her team found.

Each additional tooth lost was associated with a 1.4% higher risk of thinking impairment and 1.1% higher risk of being diagnosed with dementia.

But timely treatment with dentures may help, the findings suggest.

People who were missing teeth were less likely to have impaired thinking if they had dentures (nearly 17%) than if they did not (24%), according to the report published in

JAMDA: The Journal of Post-Acute and Long-Term Care Medicine

.

About one in six U.S. seniors have lost all of their teeth, according to the U.S. Centers for Disease Control and Prevention.

The new study did not prove a cause-and-effect relationship. However, previous research has found a link between tooth loss and cognitive decline and suggested a number of possible reasons.

Missing teeth make it difficult to chew, which may lead to nutritional deficiencies or trigger brain changes. There’s also increasing evidence of a connection between gum disease (a leading cause of tooth loss) and thinking decline.

Also, tooth loss may be caused by lifelong socioeconomic disadvantages that are also risk factors for cognitive decline.

“Given the staggering number of people diagnosed with Alzheimer’s disease and dementia each year, and the opportunity to improve oral health across the lifespan, it’s important to gain a deeper understanding of the connection between poor oral health and cognitive decline,” Wu said in a university news release.

Source: HealthDay