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Can Fruits and Veggies Keep Your Memory Strong?
Can Staying Lean Keep You Mentally Sharp?
The Future of Preventing Alzheimer's Moves Closer to Reality
Adjust Your Attitude to Boost Your Memory
Normal Forgetfulness or Alzheimer's?

Can Fruits and Veggies Keep Your Memory Strong? By: Karen Barrow
Filling your plate with fruits and vegetables may not only be a good way to keep your body healthy, it can keep your brain going strong, too.  From Utah State University have found that elderly men and women who consume high amounts of these foods have better memories than those who skimp on the broccoli, spinach, apples and pears.

Dr. Heidi Wengreen, a lead investigator of the study, said that this research is the first of its kind to look at diet as a means to prevent dementia. The findings were presented at the Alzheimer's Association International Conference on Prevention of Dementia.

For the study, researchers tested the memory of over 5,000 seniors up to four times over an eight-year period. At the beginning, the participants also answered questions about their eating habits. The group of seniors with the highest intake of fruits and vegetables, five or more servings a day, scored higher on the test than the rest of the participants. Moreover, those who nibbled on plenty of veggies and fruit were able to maintain their memory over time.

"It appears that higher intake of fruits and vegetables may protect against memory loss in older adults," said Wengreen.

Previously, the same research group also found that taking daily vitamin E and C supplements also cuts the risk of Alzheimer's. However, since the data was based on the dietary information given at the beginning of the study, Wengreen said that she is unable to say if the seniors who consumed a lot of fruits and vegetables continued to do so as the years passed.

Additionally, Wengreen also noted that the current guidelines recommend that adults eat five-and-a-half cups of fruits and vegetables every day, which is far from the amount that most American adults eat.

"Many Americans fall short of the current recommendations…even though we know they are good for us," said Wengreen, "Eating more fruits and vegetables in your later years offers benefits to both body and mind."

Can Staying Lean Keep You Mentally Sharp? By: Karen Barrow
Doing your best to keep the extra pounds off during middle age may not only keep your body healthy, but your mind fit, too. A new study shows that being severely overweight well before your senior years may have a deteriorating impact on your mind.
While the health consequences of excess weight in terms of vascular disease and joint pain are well documented, for the first time, researchers appear to have found a direct link between obesity, dementia and Alzheimer's disease.

"Obesity at midlife may increase the risk of dementia and Alzheimer's disease later in life," noted the study authors.

Moreover, if one's obesity is coupled with high blood pressure and elevated cholesterol, as it often is, the risk for Alzheimer's is six times greater than that of a healthy individual.
For the study, published in October 2005 in the Archives of Neurology, researchers from the Karolinska Institute in Sweden recruited 1,449 middle-aged men and women and measured the participants' body mass index (BMI), blood pressure and cholesterol levels. Approximately 20 years later, a follow-up exam was given in which the participants' cognitive abilities were measured.

The researchers found that almost 17 percent of those who were obese at middle age—defined by a BMI greater than 30—developed either Alzheimer's disease or dementia, compared to 5 percent who were of normal weight for their height. After taking other risk factors like high blood pressure and high cholesterol into account, the risk of future mental decline was still twice as high from being overweight alone. There was no notable difference in risk between men and women.

The researchers explain that while the mechanism is not entirely understood, the vascular problems associated with high blood pressure and cholesterol may affect the brain's ability to function. So, controlling these factors may help.

"Elimination of even one risk factor can decrease this risk [for dementia]," writes lead study author, Dr. Miia Kivipelto of the Aging Research Center at the Karolinska Institute.

More research is needed to determine why obesity alone increases the risk of mental decline, but in the meantime, the researchers suggest that shedding excess pounds and maintaining a healthy weight may allow you to keep your mind going strong late into life.

The Future of Preventing Alzheimer's Moves Closer to Reality  By: Eric Sabo
As researchers scramble to find new treatments for the growing number of Americans with Alzheimer's disease, some of the most dramatic developments are happening in the area of prevention and early detection.

Studies increasingly show how certain lifestyles, such as keeping mentally engaged, eating a heart-healthy diet and staying physically active may protect against Alzheimer's. In addition, new research shows that the first signs of decline may begin years before someone is diagnosed with the memory-robbing disease, offering a chance for doctors to intervene early.

Dr. Ronald Petersen, director of the Alzheimer's Disease Research Center at the Mayo Clinic in Minnesota, discovered a type of pre-dementia stage, known as mild cognitive impairment (MCI). People who develop this early, more severe type of memory problem have a higher chance of progressing to Alzheimer's. Other teams have since found that the signs of Alzheimer's may start even earlier, prompting researchers to search for tests that may help predict who is at risk. Dr. Petersen discusses the latest findings and the steps people can take to prevent the disease.

When do people first begin to show signs that may indicate a greater risk of Alzheimer's?
If you look at the development of Alzheimer's on a continuum, those individuals who are going to develop it start out with normal memory. Then, they go through this transitional phase that we've called mild cognitive impairment, where people are slightly impaired, usually in memory.

And then as things progress even beyond that, they develop the full-blown signs of Alzheimer's disease. A recent study from Sweden indicated that even when people are normal—before the MCI stage—there may be some subtle features of cognitive decline that warn of greater changes in the future. In fact, some of the symptoms of Alzheimer's disease really begin as much as a decade or more before the clinical diagnosis is made.

There are some subtle features, such as memory impairment, trouble with processing multiple pieces of information and difficulty concentrating on what's going around us. These changes may indicate that a person is more likely to develop Alzheimer's disease in the future.

Is there a way to test whether someone is at risk for Alzheimer's?
I think that there are some hints now that we may be able to pick up the very earliest signs of the disease. There may be some measurement of performance—such as memory and thinking—that will indicate a person who might be susceptible to developing Alzheimer's disease. We may need to augment that with brain imaging techniques to measure the size of certain structures in the brain that are critical for learning and remembering.

The most recent work, which is still in its formative stages with regard to imaging, has to do with detection of the actual amyloid protein that is thought to be a major player in the development of Alzheimer's disease. [These proteins, or plaques, gradually clump together in the brains of Alzheimer's patients. It is still unclear if this build up causes the disease or is the result of it.] This is very preliminary, and it's not a diagnostic test by any means at this stage.
But down the road, it may be a combination of measures; perhaps memory, perhaps a structural brain measurement, perhaps measurement of proteins in the brain and perhaps a genetic component. You put all of these together, and we may be able to develop a prediction as to who is more likely to develop Alzheimer's disease in the future.

Can we prevent memory loss if we treat the disease sooner?
That's the presumption. The thought would be that if you identify the disease earlier, hopefully we'll be able to intervene and do something about it; stop it before the damage is done in the brain.

Now, that's a promissory note at this point, since we don't have the preventive treatments, yet. But that's what a lot of people are working on in the basic science laboratory, and I think that we will get there. But before we can use those prevention strategies early, we have to identify people who might be at greater risk for developing this disease.

 Your recent study found that patients with mild cognitive impairment could delay more serious memory problems by taking the Alzheimer's treatment, Aricept, but ultimately the drug did not prevent the disease. Is preventing Alzheimer's a matter of finding the disease earlier, a matter of stronger drugs or both?

Both. Our study on mild cognitive impairment indicated that you can intervene at an earlier stage than has previously been recognized. This was the first study demonstrating that you could have any effect at delaying the diagnosis of Alzheimer's. That had not been shown before.

Now, this is not a huge effect, and we didn't stop the disease by any means, but we did indicate that at least this one type of intervention can slow down the progression of Alzheimer's disease by up to 12 months. So, I think if we have better therapeutic interventions and preferably an intervention that would actually have an effect on the underlying disease process, that we can intervene at least at this MCI stage. We'd like to intervene even earlier by getting to those people who have the risk profile of developing Alzheimer's disease before they even become symptomatic.

What other interventions are being tested?
There are several strategies to try to stop the abnormal processing of this amyloid protein in the brain.

Staying physically active and eating a heart-healthy diet may be good for the heart, but it may also be good for the brain, and in addition, this intellectual activity, staying socially engaged in your various social spheres, might also be helpful in preventing the disease.

Can anyone prevent memory loss by remaining mentally engaged?
Well, I think there's a certain amount of genetic endowment that comes along with this. That is, we're born with a certain genetic deck of cards, and we probably can't change that to a great extent.
But given our own genetic endowment, we can enhance our functional ability by staying intellectually active. People who have been better educated and more intellectually active over their lifespan tend to have a lower risk of developing the disease.

Now, that research is a little bit difficult to interpret at times, because without a so-called biological marker or a black-and-white diagnostic test for Alzheimer's disease, we still must rely on our clinical judgment. Clearly, those individuals who are better educated perform better on tests, so we always have to be concerned that we're not just biasing people with lower education toward performing worse on tests and then concluding that they are in fact at greater risk of developing Alzheimer's disease. But there are some biological measures that indicate that those with higher education may in fact have a lesser chance of Alzheimer's.

Why might exercise help prevent Alzheimer's?
There was a very interesting study reported earlier this year where mice who were genetically predisposed to develop this amyloid protein in the brain were actually encouraged to be more physically active in their cage setting, such as running on wheels and things like that, versus mice who had a less active lifestyle. When the animals ultimately died, and their brains were looked at for the amyloid protein, those mice who had been more physically active over their lifespan had less of this protein in the brain, which is related to Alzheimer's disease.

So, there may be a real connection between physical activity and reduced deposition or development of this protein in the brain. I think this is one of the first hard studies to imply that there may actually be a mechanism of physical exercise and reduced Alzheimer's protein in the brain.

What is your advice for people who are concerned about developing Alzheimer's?
I think that the best, safest measure is to engage in intellectually stimulating activities, physical activity, eating a heart-healthy diet, staying socially involved. I think that these are going to be more promising and probably safer for you than going out and taking a dietary supplement or nutraceuticals [natural food supplements], which have been touted to stimulate the brain and ward off Alzheimer's disease. I think there's very little data for any of those being effective, whereas there's accumulating data that these other lifestyle measures may in fact be important.

Adjust Your Attitude to Boost Your Memory  By: Eric Sabo
If you often find yourself calling people "what's his name", or the thing in your hand a "whatchamacallit", you may want to change your attitude. In a series of new experiments, researchers are finding that your preconceived views about learning can affect what it is you hope to remember. Memories, in part, seem to grow stronger or fade away based on where you stand in the nature versus nurture debate: Do you feel smart people are born that way, or can anyone become the next Albert Einstein under the right conditions?

Those who consider intelligence a natural gift—or the lack thereof the fault of bad genes—may have trouble recalling a fact they have just learned. On the other hand, those who believe that intelligence is something that can be acquired through dedication and hard work demonstrate more vibrant memories of things past. Jennifer Mangels, PhD, assistant professor of psychology at Columbia University in New York, says that such flexible thinkers have better memories because they are less concerned about forgetting. "They look at a mistake at a more meaning based level, rather than superficially," she says.

As a result, explains Mangels, the brains of flexible thinkers process information in greater depth, increasing the likelihood of memorization. These latest revelations stem from research done on college students, but Mangels says that the right attitude may help at any age. Citing a study that compared senior university professors to elderly retirees, Mangels says that academics retain better memory skills—no surprises there.

"But it's not that professors are brilliant," says Mangels. "It's that they are engaged in the process of learning."
Flexible thinkers appear well suited for the "use it or lose it" philosophy of healthy aging, adds Mangels. Whether it's teaching, reading a book or doing a crossword puzzle, keeping mentally engaged is thought to be one step you can take to prevent Alzheimer's disease.

For those worried about school performance, a flexible view of learning is also linked to better grades. Studies led by Mangels' colleague at Columbia University, Carol Dweck, show that flexible thinkers are more motivated, can better cope with and achieve higher goals in the face of academic adversity compared to those who have a set belief of intelligence. Picking up on this theme, Mangels recently tested some fiftycollege students to see if such attitudes might influence long-term memory.

As part of the study, which has yet to be published, about half of the students identified themselves as flexible learners; they believed that anyone could do well in school by working hard. The other half, who researchers dubbed the "entity theorists", said that being smart is essentially the luck of the draw.

Mangels' team measured brain activity in students as they asked various questions dealing with humanities, science and geography. To ensure that both groups started on the same emotional playing field, Mangels rigged the test so that all the students would flunk. "We made sure that everyone experienced the same miserable sense of failure," she says.

Afterwards, the researchers told the students the correct answers, and then surprised them by giving them same test over again. The flexible learners remembered 8 percent more of the right answers than the students who believed intelligence is fixed.

According to brain imaging scans, the flexible learners also showed more sustained activity in the frontal and left posterior regions of the brain, a sign that they might remember the information for a longer time.

"It's like preparing for work by doing some of it ahead of time," says Mangles, adding that a flexible mentality is good to pick up at any age. To improve your memory, don't be afraid to admit that you may not know everything. And if you still call someone "what's his name," keep motivated to get it right the next time. "Even when the chips are down, you can still learn," Mangels says.

Normal Forgetfulness or Alzheimer's? By Christine Haran

While many people over 60 say they have "senior moments" when they forget a neighbor's name or spend 10 minutes looking for eyeglasses that are perched on top of their head, most age-related forgetfulness doesn't significantly interfere with one's day-to-day life. Memory loss and confusion due to Alzheimer's disease, however, can wreak havoc on the lives of the people it affects and their loved ones.

But how can one distinguish between age-related forgetfulness and the early signs of Alzheimer's disease, a progressive form of dementia that affects an estimated 4.5 million older Americans? Below, Ronald Petersen, MD, director of the Mayo Alzheimer's Disease Research Center in Rochester, Minn., discusses the signs and symptoms of Alzheimer's disease and how doctors, patients and their families can work together to ensure an early and accurate diagnosis.

Is memory loss a part of normal aging?
Some forgetfulness is common and felt to be a part of normal aging. If people forget incidental items—information that one doesn't spend a lot of attention trying to remember—that's probably normal. That includes things like "Where did I put my checkbook?" and "Where are my reading glasses?"

 Another common forgetfulness of aging is having trouble coming up with names of people such as acquaintances you run into unexpectedly. You may struggle for their name for a few minutes and then say, "Oh, of course, that was Bill."

However, when people start to indicate that they are forgetting information that is important to them, that's a concern. This applies to something that they actually have spent some effort trying to remember such as a doctor's appointment.

Forgetting an appointment, as an isolated event, is not necessarily abnormal. But if you look back and see that you also forgot to meet your friends for lunch or to go to a committee meeting, you might have a pattern. And if people who know you well are starting to notice that you're forgetting information that you formerly would not have forgotten, then this matter deserves further attention.

What about people who were always forgetful?
Some of us are characterized by our spouses as being absentminded, and, if that's been a lifelong pattern, then that's not too worrisome. However, if a spouse or adult child or good friend notices a change in your thinking ability and your forgetfulness, then that may warrant attention.

What are symptoms of Alzheimer's disease other than memory loss?
Outside of the memory domain, you may have changes in the ability to carry out your daily functions. So if you formerly handled the finances for the family—you took care of the checkbook, you paid the monthly bills, you did the taxes or prepared the material for your tax preparer—and now you're starting to have difficulty, that might be significant.

Loss of navigational skills is another symptom. We all take it for granted that we can get around town, we know how to get to the grocery store, to the golf course or the restaurants. But if you're starting to get a little disoriented and getting lost in previously familiar environments, that would be a sign there are cognitive difficulties associated with Alzheimer's.

People may also have a change in their ability to concentrate on events. So, formerly, you could sit through a two-hour movie without a problem or watch television programs, or read a novel. And you just don't do that anymore.

How do doctors make the assessment?
There's a fairly standard approach to evaluating somebody for a cognitive impairment that might lead to a diagnosis of dementia or Alzheimer's disease. Generally, we start out with the history. That is, we interview the person and ask questions about their behavior and forgetfulness and ask them to give examples.

We ask how long has this been going on. "Have you been noticing this for days, weeks, months or maybe even years? Has it changed? Has it actually changed your functional activities now? Are you now altering your daily routines or your behaviors because of these cognitive changes?"

Equally important to the patient's history is that of a collaborative source who can also reflect on that person's cognition and behavioral changes. So interviewing a spouse, adult child or good friend is invaluable and you pretty much ask the same kinds of questions.

What does the medical evaluation involve?
Once the doctors have established a feeling as to whether this might be a serious problem or not, they conduct an examination. A medical examination is done to make sure the heart and lungs are OK. A neurologic examination is performed to make sure that there's nothing else in the nervous system going on like a stroke or Parkinson's disease or evidence for a brain tumor.

Physicians will also do a mental status exam. I'll do a little brief exercise in the office where I'll say, "What's the date? Where are we? Try to remember these numbers. Here are a few words to remember." I'll have them do some calculations.

After that, we might launch into laboratory testing, looking for medical causes of the change in thinking. So we'll do blood counts, thyroid function, vitamin B12 level, which can have an impact on thinking and memory. We may do an imaging study such as a CT scan or an MRI scan of the brain to see if there's any evidence of a stroke, tumor, blood clots. Or we will see if is there more shrinkage in the brain than we would like to see for their age, implying that there might be a degenerative process.

There are a variety of other tests that we might pursue, depending on the medical history of the person. Then we put all this information together and we come up with a judgment as to whether this person is, in fact, experiencing a change in daily activities as a result of cognitive problems. We then determine how severe it is and try to sort out what kind of dementia it is.

How does one distinguish between Alzheimer's and other forms of dementia?
In people in their late 60s, 70s and 80s, dementias are usually degenerative; they come on slowly and insidiously. And anywhere from 50 percent to 75 percent of all dementias of aging are due to Alzheimer's disease.

But there are some degenerative dementias other than Alzheimer's disease. One is called dementia with Lewy bodies, which is seen in the brains of people with Parkinson's disease. People with this condition may have daytime visual hallucinations and a particular type of sleep disturbance where they act out dreams in the middle of the night. Although their information-processing speed is slow and their ability to navigate in the environment is impaired early, memory is relatively spared. In contrast, memory is the hallmark of the early onset of Alzheimer's disease.

The next most common form of dementia is so-called frontotemporal dementia. The frontal and the temporal lobes of the brain are involved in somewhat different behaviors in cognitive function than the parts of the brain that Alzheimer's affects. So people with this dementia may engage in inappropriate behavior that they never would have done earlier in life had their brain not been affected. For example, they might say inappropriate things in social settings, like comment on the appearance of someone.

There is also the more rare, abrupt onset of so-called vascular dementia. So if you said "Oh, my cognitive problems started last Wednesday at 3 pm," that would imply there was a stroke or blood clot or other event that caused the problem. That would not be consistent with the degenerative picture of most dementias.

Is there a test for Alzheimer's?
While there is no definitive test for Alzheimer's disease while the patient is alive—an autopsy is the final way we get the answer—doctors usually get the diagnosis correct.

There is a blood test called apolipoprotein E that has been touted as being useful in helping sort out the underlying cause of the dementia. [This test looks for proteins produced by the ApoE gene, which has been linked to Alzheimer's.] But some rather large studies have shown that this only augments the clinician's opinion a few percentage points. And those tests are imperfect because they don't necessarily pinpoint this as being Alzheimer's disease or not; they just alter the probability that it's Alzheimer's disease.

Are there any early warning signs?
We've been doing a lot of research on the notion of mild cognitive impairment. I think the broadest way to understand this concept is to say that this is the earliest form of any type of dementia. It's about moving the threshold for detection back to try to pick up a condition before it evolves.

We've developed criteria for this mild cognitive impairment condition. Usually, people are aware their memory's not as good as it used to be. Number two, when we actually measure their memory performance, they are, in fact, performing lower than other people of their same age and education. Yet, when we measure their other cognitive functions and daily activities, they're normal.

So if you use these criteria, you can define a group of people who do have features of mild cognitive impairment. And then, if you follow them over subsequent years, they tend to progress to meet the criteria for Alzheimer's disease at a rate of maybe 10 to 15 percent per year. And that's in contrast to people of the same age who will become demented or meet criteria for Alzheimer's disease at a rate of only 1 to 2 percent per year.

Do you think people who have a little forgetfulness should get checked out?
I think so. I'm not trying to alarm everybody because if you ask a group of 65-year-old-plus individuals, how many of you are having difficulties with your memory, three-quarters of the room will raise their hand. So you don't want to frighten everybody and say, "Oh, my gosh, you've got this mild cognitive impairment, so you're going to develop Alzheimer's disease in three to five years."

But, at the same time, if you think about the worrisome types of forgetfulness versus the more benign types of forgetfulness, I think you can sort out who should be evaluated.

What is your advice to someone who's concerned that they or someone in their life has Alzheimer's disease?
If you are concerned about yourself or about your loved one, you should probably pursue an evaluation with your local doctor and start the ball rolling because sometimes there are treatable reasons for the problems they are experiencing.

For example, depression can alter our ability to think and concentrate, so it can affect memory function and that's a treatable entity. Sometimes there are medical conditions that may cause a worsening of thinking and those may be treatable or have treatable components. Maybe it's a side effect of medications that you've been taking for other health problems. It might be due to a medical illness or some physical aging factor such as vision loss. I think it's the job of the clinician to try to tease those apart.

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