Dementia

NEW EVIDENCE FOR PROTEIN/DEMENTIA LINK

The absence of the protein MK2/3 promotes structural and physiological changes to cells in the nervous system and may be linked to dementia, new research shows. Scientists at the University of Warwick say their findings provide the first evidence that the lack of the naturally occurring protein is linked to early signs of dementia.

Published in Nature Communications, the research showed that these changes have a significant correlation with early signs of dementia, including restricted learning and memory formation capabilities.

An absence of MK2/3, in spite of the brain cells (neurons) having significant structural abnormalities, did not prevent memories being formed, but did prevent these memories from being altered.

“By demonstrating for the first time that the MK2/3 protein, which is essential for neuron communication, is required to fine-tune memory formation this study provides new insight into how molecular mechanisms regulate cognition,” said lead researcher and author Dr. Sonia Corrêa.

MK2/3 regulates the shape of spines in properly functioning postsynaptic neurons, producing wider, shorter spines. With MK2/3’s absence, the spine’s shape restricts the ability of neurons to communicate with each other, leading to alterations in the ability to acquire new memories.

“Deterioration of brain function commonly occurs as we get older but, as result of dementia or other neurodegenerative diseases, it can occur earlier in people’s lives”, said Dr. Corrêa. “For those who develop the early signs of dementia it becomes more difficult for them to adapt to changes in their life, including performing routine tasks.

— Eales et al. The MK2/3 cascade regulates AMPAR trafficking and cognitive flexibility. Nature Communications, 2014; 5: 4701

BY THE NUMBERS

2/3

Proportion of 500 people over age 50 who said they are fearful of developing dementia in a poll from the UK. Just one in 10 said they were scared about getting cancer.

—Saga Group

1 IN 6

A woman’s estimated lifetime risk of developing Alzheimer’s at age 65, compared with nearly 1 in 11 for a man. Women in their 60s are about twice as likely to develop Alzheimer’s during the rest of their lives as they are to develop breast cancer.

— Alzheimer’s Association

$214 BILLION

Estimated total direct costs to American society of caring for those with Alzheimer’s in 2014, including $150 billion in costs to Medicare and Medicaid. Alzheimer’s will cost an estimated $1.2 trillion (in today’s dollars) in 2050.

Nearly one in every five dollars spent by Medicare is on people with Alzheimer’s or another dementia. The average per-person Medicare spending for those with Alzheimer’s and other dementias is three times higher than for those without these conditions. The average per-person Medicaid spending for seniors with Alzheimer’s and other dementias is 19 times higher than average per-person Medicaid spending for all other seniors.

— Alzheimer’s Association

BIOMARKERS IN AD IDENTIFICATION

While core clinical criteria for identification of Alzheimers and Mild Cognitive Impairment remain important, new guidelines incorporate biomarkers. Watch Jeff Burns, MD, MS, of the University of Kansas, explain:

http://practicalneurology.com/series/daily-coverage-philadelphia- 2014/video.asp?f=ifudosopopo

LOW VITAMIN D LINKED TO DEMENTIA

Study authors say they have confirmed a Vitamin D and dementia link.

In the largest study of its kind, researchers suggests that in older people, not getting enough vitamin D may double the risk of developing dementia and Alzheimer’s disease.

“We expected to find an association between low Vitamin D levels and the risk of dementia and Alzheimer’s disease, but the results were surprising—we actually found that the association was twice as strong as we anticipated,” said study author David J. Llewellyn, PhD, of the University of Exeter Medical School in the United Kingdom.

For the study, 1,658 people over the age of 65 who were dementia-free had their vitamin D blood levels tested. After an average of six years, 171 participants developed dementia and 102 had Alzheimer’s disease. The study found that people with low levels of vitamin D had a 53 percent increased risk of developing dementia and those who were severely deficient had a 125 percent increased risk compared to participants with normal levels of vitamin D.

People with lower levels of vitamin D were nearly 70 percent more likely to develop Alzheimer’s disease and those who had severe deficiency were over 120 percent more likely to develop the disease. The results remained the same after researchers adjusted for other factors that could affect risk of dementia, such as education, smoking and alcohol consumption.

—Littlejohns TJ, et al. Vitamin D and the risk of dementia and Alzheimer disease. Neurology. 2014 Aug 6.

ADULT DAY SERVICES PROVIDE STRESS-RELIEVING BENEFITS FOR CAREGIVERS

Use of adult day services for dementia patients appears to reduce stress and could improve long-term health in their caregivers, new research shows.

For the study, researchers measured salivary cortisol awakening response (CAR) and cortisol area under the curve with respect to ground (AUC-G) in 158 family caregivers. They compared levels on days the patient was attending day services to those when the patient was not.

According to the authors, “Caregivers with a ‘burned-out’ or flattened CAR, and associated low AUC-G on non-ADS days displayed a more normative CAR and AUC-G response on ADS days. Restored cortisol regulation was also observed on ADS days among caregivers with the highest CAR and AUC-G levels on non-ADS days.”

Because stress and high cortisol levels are associated with poor long-term health outcomes, the findings suggest possible long-term health outcomes for caregivers who enroll dementia patients in day services.

—The Gerontologist, Online July 2014

ATYPICAL ANTIPSYCHOTICS MAY POSE KIDNEY RISKS

Atypical antipsychotic drug use is associated with an increased risk for acute kidney injury (AKI), according to a new study in the Annals of Internal Medicine that found the rate of AKI was nearly doubled in the group taking the drugs.

The drug class—specifically quetiapine, risperidone, and olanzapine—have been known to cause kidney problems, including hypotension, acute urinary retention, and the neuroleptic malignant syndrome or rhabdomyolysis.

By measuring hospitalization with AKI (assessed by using a hospital diagnosis code and, in a subpopulation, serum creatinine levels) within 90 days of prescription for atypical antipsychotic drugs, researchers found atypical antipsychotic drug use versus nonuse was associated with a higher risk for hospitalization with AKI. This association was consistent when AKI was assessed in a subpopulation for which information on serum creatinine levels was available. Drug use was also associated with hypotension, acute urinary retention, and all-cause mortality.

— Ann Intern Med. 2014;161:242-248.