Breakfast Television, Montreal

CaptureHad a great time with hosts Derick and Joanne. See 5.5-minute video here

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Airing Sunday

…but available as webcast thereafter

Radio program Life Unrehearsed! 4pm Eastern. Funny the last photo of me in a white coat dates back quite some time.

This will be followed by Breakfast Television Montreal Wednesday, May 23rd pretty early in the morning. My homies in California will be fast asleep at that hour but can watch on delay through the website.

…All on the occasion of helping the fabulous Cummings Centre launch its online course about Brain Health behaviors that can build your cognitive reserve. Zut alors!

New App for those with Mild Cognitive Impairment or Mild Stage of Alzheimer’s

Founded by travel-buddy and retired geriatrician Dr. Warren Wong, MemoriesConnect is now in launch mode. The app is intended to act as a personalizable platform for facilitating conversations between the affected person and those around him/her. At this point in history, the app is being tried in Hawai’i before it will be rolled out nationally.

Good luck, team! Interventions to help us connect supportively with loved ones are welcome. For those of you who are not so tech savvy, consider pairing your child/grandchild with the patient to set up the app. The younger generation might be treated to some primo storytelling in the process.

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Diagnoses Confirmed at Autopsy in Early- vs. Late-Onset Frontotemporal Dementia

Very interesting findings by Seo et al.  that might help clinicians raise the right suspicions about causes of illness based on the age at onset of symptoms (before or after age 65):

F1.large

The top row of 2 “pies” in A. have to do with the diagnoses made by clinicians prior to the patients’ deaths. These differed in terms of the top 3. Top 3 diagnoses made for early-onset FTD  patients were:

  1. Behavioural variant FTD
  2. Corticobasal syndrome
  3. Semantic variant primary progressive aphasia

Top 3 for late-onset FTD:

  1. Corticobasal syndrome (CBS)
  2. Behavioral variant FTD
  3. Progressive supranuclear palsy (PSP)

It’s worth keeping in mind that cases that go to autopsy are a self-selected group from all FTD patients. It stands to reason that these findings may not apply to what you see in every clinic where FTD patients are served.

The “pies” in B. do not show the concordance between the clinical diagnoses and the confirmation by autopsies, but since CBS and PSP are tauopathies, such concordance is implied.

Our Mothers’ Fitness

If you’re my age, your mother kind of fits into the demographic studied by Horder et al. My mother is about 16 yrs behind the average gal in this Swedish observational cohort. My editorial comments are in italics interspersed with the Abstract text below

Abstract

Objective To investigate whether greater cardiovascular fitness in midlife is associated with decreased dementia risk in women followed up for 44 years. This is a respectfully long period to evaluate for changes! Given the average age of participants at 50 years, following for 4.5 more decades assures that if these women acquired cognitive deficits, whether due to normal aging or to Alzheimer’s the researchers would have been able to obtain those data.

 

Methods A population-based sample of 1,462 women 38 to 60 years of age was examined in 1968. Of these, a systematic subsample comprising 191 women completed a one-time stepwise-increased maximal ergometer cycling test to evaluate cardiovascular fitness. While this might have put some of us at a disadvantage, at least it was an easily controlled setting to conduct objective, reproducible testing. No self-reporting embellishment allowed!

Subsequent examinations of dementia incidence were done in 1974, 1980, 1992, 2000, 2005, and 2009. Dementia was diagnosed according to DSM-III-R criteria on the basis of information from neuropsychiatric examinations, informant interviews, hospital records, and registry data up to 2012. Cox regressions were performed with adjustment for socioeconomic, lifestyle, and medical confounders. Confounders here refers to those things that could affect fitness level, such as diabetes or cardiac diagnoses, not risk factors for dementia, such as mood disorder or head trauma…

 

Results Compared with medium fitness, the adjusted hazard ratio for all-cause dementia during the 44-year follow-up was 0.12 (95% confidence interval [CI] 0.03–0.54) among those with high fitness and 1.41 (95% CI 0.72–2.79) among those with low fitness. High fitness delayed dementia onset by 9.5 years and time to dementia onset by 5 years compared to medium fitness.  Are you ready to know what the definitions of low, medium and high fitness were?

  1. Low = not able to generate 80W of cycle output, or couldn’t get to a point where the participant said, “I’ve worn myself out!”
  2. Medium = 88–112 W output within about 6 minutes [the equivalent of my energy generated during the first minute and a half of my 2 mile run at 6 mph…and I’m now at the age of the average Swedish gal in the study that started in 1968. See http://bodytransform.co/Blog/Power+output+during+exercise.html for some interesting reading on how our body mass and different activities play out in wattage.]
  3. High fitness = achieved 120 W or more (could power your laptop). 

Of note, the 3 groups had similar average ages at death (80-81 years) despite the increased dementia risk and decreased fitness level in the lowest fitness group.

 

Conclusions Among Swedish women, a high cardiovascular fitness snapshot reading in midlife was associated with a decreased risk of subsequent dementia. Promotion of a high cardiovascular fitness may be included in strategies to mitigate or prevent dementia. Findings are not causal, the other data provided about lifestyle characteristics of the 3 groups indicated to me that the women with high fitness levels were from a higher socioeconomic group. Employment outside the home was fairly rare for all 3 groups.

and future research needs to focus on whether improved fitness could have positive effects on dementia risk and when during the life course a high cardiovascular fitness is most important. I think it’s important to note that the impact of longitudinal fitness levels (whether low fitness started to exercise later in their lives and what impact that might have had on dementia risk) were not reported in this paper. So if anything, my take-home from this paper is that fitness is important, even when looked at in this snapshot grouping design, but low fitness may not condemn a person to dementia unless fitness is NEVER addressed during the lifespan.

Many Faces of Dementia 2018

Learning some great things at this biennial dementia conference at USC today:

  • MAPS Charities provides small one-off grants to pay for elders living at home who might need help installing assistive devices like replacing stairs with a ramp. Please consider donating!

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  • Did you know that if you took the capillaries in the brain alone (not your entire body), and lined them up end-to-end, they’d take you from LA to San Francisco?!? No wonder it’s easy to lose integrity of this system as we age. That’s a lot of plumbing to keep clean
  • Go to this stroke and heart attack risk factor calculator to get a reality check on whether you’re taking adequate care of yourself to avoid these. Disclaimer – you’ll need your lipid panel lab results to use this.
  • Current estimates of prevalence:
    • Frontotemporal dementia causes about 1% of dementia cases
    • Dementia with Lewy bodies causes about 5-10% of dementia cases (changed! We used to attribute this as *20%*). With this reduction, vascular dementia has reclaimed its #2 spot below #1 Alzheimer’s disease.

What’s the Latest in Alzheimer’s Prevention

As I age, gatherings have my friends commenting about how our generation is coming to its less productive phase and laughing about how our bodies are betraying us.

It’s not hard to segue from there into updating folks on recommendations for brain health.

Livingston et al. (a commission struck by the journal The Lancet) summarized the “state of the dementia union” last summer. Below are some excerpts I thought might lend a positive tone to the year ahead. The numbers relate to the paper’s citations, which you can check out here:

Although no disease-modifying treatment for any common dementia is available, a delay in the onset of dementia would benefit even the oldest adults.20  An unexpected decline in age-specific dementia incidence or prevalence has been reported in some countries, such as the USA, the UK, Sweden, the Netherlands, and
Canada.6,7,21–26 Conversely, an increase in the incidence of dementia in China27 and prevalence in Japan28,29 has been reported, while in Nigeria the incidence and prevalence are stable.30 Results of two US studies25,26 showed that the decrease in age-specific prevalence (despite an increase in the absolute number of people with dementia) was associated with an increase in education.

…However, the increasing mid-life rates of obesity and associated illhealth are projected to lead to a 19% increase in dementia in China and a 9% increase in the USA.32

livingston figI’m esp keen on this diagram. The Commission analyzed what percentage of dementia cases might have been delayed, if not prevented, by modifying those things that we can change, and it turned out to be a full third of cases! Here are some things that we CAN do for ourselves:

  • stay in education at least to high school (studies differ on the cutoff, and high school might actually be overkill)
  • in Mid-life, don’t live in denial about your hearing problem! Treat that high blood pressure, and fight obesity.
  • interestingly, there are things about late life that make up the majority of the helpful interventions (so maybe it’s not too late): stop smoking, treat depression and diabetes if you’ve got them, get physically active, and don’t remain socially isolated.

The new part of these findings is the designation of when in life these things can make a difference. I think you’ve heard about various items on this list previously.

New Book on Mindful Caregiving

the-conscious-caregiver-9781440597732_smAuthor Linda Abbit is the Community Outreach Manager for the Mind and Memory Program at the St. Joseph hospital north of me in Mission Viejo.

Her book, The Conscious Caregiver, stands out as a very helpful DIY (Do It Yourself) guide for those who may not have had any prior exposure to meditation or other mindfulness teachings. You’ll like her vignettes that give some very practical ways to implement the suggestions. We all aspire to being mindful but what do you do when you catch yourself being anything BUT mindful? She actually has a subheader entitled “If You’ve Exploded at a Loved One.” I wish they’d thought to index this as Explosion for quick reference.

Other bits I appreciated in her book:

  • role confusion (it’s not simply role reversal, and you knew that, but how many authors acknowledge it?)
  • mindfulness here is explicitly stated in the caregiving in dementia context
  • the R-word (RESENTMENT) is acknowledged and allowed here
  • a section on Accepting Help. Not just saying it’s important but giving you ways to accept help
  • Happiness L.I.S.T. for activating Self Care
  • She recommends Recording Your Conversations because there may come a time that you actually miss the story that’s being repeated endlessly now…but I think maybe you’ll be surprised to hear your own tone. Could allow for a quick reality check on whether you sound the way you want to be heard? just sayin’…