September 14, 2017

Health Roundup: Alzheimer's Edition

A healthy lifestyle builds brain resilience and really WILL keep dementia at bay

Alzheimer's disease really can be avoided by following a healthy lifestyle - even if you're predisposed to get it, the largest study of its kind has revealed. Exercising, monitoring blood pressure and watching less TV are the three key factors that will help build brain resilience and keep the disease at bay.  

Researchers at the University of California in Irvine began the '90+ Study' in 2003. Tests were carried out on the 1,700 participants every six months to monitor their cognitive ability. Post-mortems were conducted upon their death. Astonishingly half of the dementia-free patients had the hallmark brain plaques - which lead to memory loss and dementia - when they died.  Meanwhile half of the dementia patients did develop symptoms of memory loss - even without having these build-ups in their brain.

Professor Claudia Kawas, lead researcher, suggested the reason for such 'cognitive resilience' in those who should have developed dementia but remained free of it was down to a healthy lifestyle. It follows Cambridge University research three years ago which found just one hour's exercise a week cuts the chance of Alzheimer's by almost half.  And earlier this year a study suggested more than a third of dementia cases could be avoided by exercising more and controlling blood pressure.

Those with a higher level of education were found to have greater protection even if OET scans revealed plaque in the brain typical of Alzheimer's. People with a low level of education had quadruple the risk of contracting dementia, the researchers said. But among those without plaque in the brain, the educational difference was irrelevant....There's currently no evidence of the efficacy of commercial computer-based brain training exercises.

An Alzheimer’s Diagnosis—Before Any Symptoms in the WSJ

An effort is under way that could redefine the way Alzheimer’s is diagnosed, putting the focus on biological changes in the brain rather than on symptoms such as confusion and forgetfulness. Supporters say if their plan moves forward, it could help ensure that experimental therapies are tested on the correct population, accelerating research. Earlier detection also one day could make it easier to target people with more effective therapies.

The diagnosis of Alzheimer’s has long hinged on a doctor’s assessment of a person’s cognitive skills and symptoms. But in a recent report, a committee convened by the National Institute on Aging and the Alzheimer’s Association recommended that researchers instead use tests of the biological markers of disease, such as brain imaging and the measurement of substances in cerebrospinal fluid, when seeking to study participants.

A Case of Rapidly Progressive Dementia--and the Surprisingly Easy Fix

The daughter went into the hall closet and brought out this bag of medicines. There were 21 different bottles of 14 different medications, including multiple antipsychotics and anticholinergics, as can be seen in the handwritten list shown above. I had been unaware that she had been taking any of these. For reference, in the right-hand column, I have included the list that was in her electronic medical record the day I last saw her in clinic. I performed a full medication reconciliation and left her with only three medications, plus insulin, at her home. I took all of the others back to the hospital, called her pharmacy, and stopped those prescriptions.

Three months later, Ms R followed up with me in clinic and reported that she was feeling great. Her daughter said that she is doing wonderfully at home and has returned to her baseline. Both of them felt that she was back to her normal self. We repeated the MoCA, which was a 17 out of 30. She had increased from a 6 to a 17 over the course of 3 months, with the only intervention being a home visit with the removal of medications from her house.

The cost of this? The base Medicare reimbursement for her multiple hospital admissions was more than $30,000. The cost of the home visits, including billing for the visit, gas to and from, and a couple of lattes for my mentor and me: $127. Patient-centered care? Priceless.
Posted by Jill Fallon at September 14, 2017 11:34 AM | Permalink