Although I left home long ago, I have kept in touch with the fantastic service providers in Los Angeles, who are doing so much for diverse populations around the city.
Please support my journey to help individuals and families facing Alzheimer’s! I am making a difference in the lives of over 166,000 individuals in Los Angeles county currently living with Alzheimer’s or another form of dementia. Each year approximately 1.6 million California caregivers provide 1.8 billion hours of unpaid care valued at $24.2 billion.
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You may have seen trials in the past that have tested non-steroidal anti-inflammatory agents for Alzheimer’s disease. None of those trials showed positive efficacy, but the inflammatory system is still a target of interest. Researchers at Monash University in Australia through the ASPREE study group, checked out the possibility that aspirin might have an effect. They followed 19,114 participants living in the US and Australia for conversion to mild cognitive impairment or to Alzheimer’s disease and had to stop the trial early out of futility. The curves for the placebo and aspirin arms of the study almost perfectly overlapped!
Dhana et al. from Rush (see prior post re Rush’s Dr. Wilson’s work on early-life enrichment) reported in a late July issue of Neurology that their Chicago participants had lower risk of dementia due to Alzheimer’s disease if they were currently adhering to at least 2, and optimally 5 of the following:
at least 150 minutes per week of moderate or vigorous physical activity
light-to-moderate alcohol consumption (some of us can’t tolerate moderate levels of alcohol!)
the Mediterranean diet (see graphic below for reminder)
late-life cognitive activities (reading, crossword puzzles — yes, this could include Sudoku. I think many kinds of volunteering and participation in the arts could count too)
Risk reduction ranged from 40-60%. Putting this into perspective: If you already were at low risk for Alzheimer’s disease, then your low risk gets lower but that may not be a significant difference. If you at a higher risk for AD due to unmodifiable factors, such as repetitive head traumas, recurring depression, crebrovascular disease, or family history, these modifiable risk factors may be worth paying attention to!
I know I haven’t mentioned Parkinson’s disease much – favoring frontotemporal dementia and Alzheimer’s disease on this blog– but I am inspired to share a new podcast out of Australia with you, featuring my friend’s brother, the dynamic and brilliant neuroscientist Dr. Dom Rowe as the expert commentator. He likens dopamine therapy for Parkinson’s disease to an oil that is necessary for your car’s engine to function right. The podcast is one creative product from a group called “It’s Not Funny.”
In their own words: “It’s Not Funny” is a community of people living with Parkinson’s Disease. Sharing their stories through photography, film and words. We inform the general public that Parkinson’s disease is not just an old person’s disease, more people in the prime of their lives are being diagnosed and then go into hiding uncertain and even fearful of how they will be perceive. We help them feel at ease with the disease with dignity and in a positive, light hearted way. You’re constantly hearing the bad news about Parkinson’s disease. We think it’s time to hear about the brighter side of living with the condition.
Along the same lines, JAMA Neurology recently ran a great review of what’s new in the image of PD by Armstrong and Okun. The good news is that a good number of patients have mild symptoms for a long time (B below). The better reporting is that there are more women and non-Caucasian populations involved than formerly stated. I really liked this graphic from that article:
The U.S. Congress is seen on Tuesday, April 23, 2019, Washington, D.C. (Photo by Aurora Samperio/NurPhoto via Getty Images)
There’s a quick link for you to pop messages to your congressmember here. The auto-generated message asks, “Please cosponsor and pass the Promoting Alzheimer’s Awareness to Prevent Elder Abuse Act (H.R.6813/S.3703), which would require the Department of Justice to develop training materials to assist professionals who support victims of abuse living with Alzheimer’s and other dementia in order to improve the quality of their interactions with this vulnerable population, and help protect them from elder abuse,” but you CAN personalize the note!!
This is the dark side of dementia care and needs to be addressed.
In keeping with the prior post, the STAR study also looked at obesity in early adulthood and found correlations with late-life dementia risk:
Obesity during young adulthood (i.e. 20s and 30s) increases dementia risk.
Being overweight during one’s 30s also increases dementia risk, such that sustained or consistent obesity during young adulthood can more than double that risk.
This finding was echoed across races by research at Columbia University by Dr. Adina Zeki Al Hazzouri’s group, quantifying by body mass index (BMI). For the Cardiovascular Health Study (CHS) and Health, Aging and Body Composition study (Health ABC), early adulthood was extended to age 49.
For women with higher early adulthood BMI equivalent to what is diagnosed as obese, , dementia risk increased 2.5 times more than for women with BMI within what is considered the normal range. [caveat: BMI doesn’t work for a lot of Asian bodies.]
Midlife BMI did not have an impact on dementia risk among women.
Among men, dementia risk was similarly 2.5 times higher among those who were obese in early adulthood, AND there was an effect of high BMI in mid-life.
Not stopping the inquiry at mid-life measures, for both sexes, dementia risk was decreased with higher BMI in late-life. [I would not say this means it’s ok to gain a lot of weight in late-life, but there has been literature over the years showing that late-life BMI is complicated. People with cognitive impairment tend to lose weight in late-life, especially if Alzheimer’s dementia is moderate to severe, and this can confound studies attempting to correlate BMI and dementia risk.]
This year’s AAIC was made available online free of charge [kudos to the Alzheimer’s Association for making this work]. To view these presentations, you would have to register for the conference, but I’m not sure how long it will be available online…lectures are still available as the date of this posting, August 11, 2020.
Drs. Rachel Whitmer, Kristen George and Rachel Peterson of UC Davis reported on behalf of the Study of Healthy Aging in African Americans (STAR) study: when adolescents (12-20 yrs old) have high blood pressure and diabetes, they have worse late-life cognitive outcomes. The same risk applies if either hypertension or diabetes or both are present in young adulthood (considered age 21-34) or midlife (age 35-56). These conditions are more prevalent among African Americans than Caucasians within these age groups.
While many of us think of preventing head injury and substance abuse as brain health practices or, as the NFL has termed it, HEAD health, these findings make it clear that we need to screen young people for conditions that are often assumed to pop up in middle-age. Not to do so among African Americans creates a health disparity.
In a March 19 article in Neurology Today, writer Gina Shaw laid out great tips for when healthcare professionals have to break bad news to people from more diverse backgrounds – several neurologists discussed their lessons learned when having to deliver diagnoses of brain tumor or brain death. The situation is not so different when we have to face a patient or family surprised by the diagnosis of dementia. I appreciated how the tips were broken down so operationally. This is hard to do around such an emotional event, but it’s important to remain aware of these facets to allow space for a meaningful exchange of information and management of expectations:
Make listening a priority. Dr. Nicte Mejia advised, “Challenging conversations require ‘cultural humility’: opening up your ears, eyes and heart to listen with curiosity and learn about people’s value system, belief, and preferences.”
Prepare for the conversation in advance [I always did better if I could use the chart to remind myself what I’d said before about differential diagnosis, who was present at the prior appointment and whether there were any obviously sensitive topics for either the patient or someone else in his inner circle.]
Avoid making assumptions [Really! There’s no quicker way to lose trust! Lay out the options so they can make choices, even if they ask for your help to come to a conclusion]
Acknowledge historical realities. [yes, they do mean Tuskegee and Henrietta Lacks’ stories]
Don’t hide behind technical terms [If you have any written materials that also address the subject written at a lay person’s reading level, bring them along]
Take time [people perceive that you’re spending more time when you sit down in the room/at the table, even if the actual time elapsed is the same!Body language is universal and important; don’t fold your arms across your chest. Bring your team in with you and make clear what their roles are – who should be the family’s point person for further questions, who does what. Bring business cards so the patient and family don’t have to distract themselves writing down names and contact info]
Remember that it’s not about you [the physician]. [Indeed, sometimes the patient or family needs to have us hear them venting. Keep breathing, listen, and that rush of emotional heat willpass.]