Alzheimer's Disease Archive

Over time, most people with dementia or mild cognitive impairment (a decline in thinking skills) also experience behavioral changes, such as depression and agitation. Which comes first? A study published online by Neurology on Jan. 14, 2015, suggests that psychological and behavioral changes can begin before people develop mild cognitive impairment or dementia. Researchers evaluated the daily functioning, memory and thinking skills, and psychological and behavioral symptoms of about 2,400 people, ages 50 and older, who had no evidence of cognitive decline. The study also suggests that a pattern of depressive symptoms may occur in older adults, unrelated to cognitive decline. The takeaway? "Depressive symptoms can occur in older adults for many reasons. If you are experiencing mood or cognitive changes that last for more than a few weeks, it's a good idea to bring this up with your doctor or consult a mental health specialist to help sort out possible causes," says Dr. Nancy Donovan, an instructor in psychiatry at Harvard Medical School. 

Researchers from the biotechnology company Biogen have reported that a new drug reduced the amount of amyloid plaques—the brain deposits associated with dementia—and slowed cognitive decline in people with early Alzheimer's disease. They presented the report March 20, 2015, at the International Conference on Alzheimer's and Parkinson's Diseases in Nice, France.

The researchers studied 166 people ages 50 to 90 who had been diagnosed with mild Alzheimer's. The participants were randomly assigned to receive either a placebo or one of four different doses of the drug aducanumab—an antibody that attaches to amyloid deposits and turns the immune system on them.

Anticholinergics, a group of medications that includes many over-the-counter and prescription drugs, are well known for causing confusion in older adults. Common medications with anticholinergic properties include medications to treat overactive bladder, such as oxybutynin (Ditropan); medications to treat allergies and sleeping problems, such as diphenhydramine (Benadryl, Sominex, Unisom); and medications used to treat depression, such as amitriptyline (Elavil). It's generally believed that confusion that may develop from anticholinergics clears up when someone stops taking the drugs. But now it appears that the medications are associated with a more permanent effect. A study published online Jan. 26, 2015, in JAMA Internal Medicine linked daily anticholinergic use among older adults for three or more years to an increased risk for developing dementia and Alzheimer's disease.

The study didn't prove that anticholinergics cause dementia; it only found an association between people who take the medications and people who develop dementia. Nevertheless, the researchers suggest that doctors avoid prescribing anticholinergics when possible, or at least limiting the medications to the lowest doses possible. If you're taking an anticholinergic, talk to your doctor about the risks the medication poses, including the risk of falls as a result of confusion.

At middle age, the brain begins to draw on more of its capacity for improved judgment and decision making.

If you forget a name or two, take longer to finish the crossword, or find it hard to manage two tasks at once, you're not on the road to dementia. What you're experiencing is your brain changing the way it works as you get older. And in many ways it's actually working better. Studies have shown that older people have better judgment, are better at making rational decisions, and are better able to screen out negativity than their juniors are.

Medications called anticholinergics are used to treat a host of conditions—overactive bladder, depression, allergies, and Parkinson's disease. They usually aren't recommended for older adults because one of the most common side effects is confusion and difficulty reasoning. Early studies have also indicated that long-term anticholinergic use is associated with an increased risk of dementia, and a recent study by researchers at the University of Washington adds more evidence to support that connection. The results were published online Jan. 26, 2015, by JAMA Internal Medicine.

The researchers tracked almost 3,500 men and women ages 65 and older who were free of dementia. When they matched prescription data for the previous 10 years with the participants' health outcomes, they determined that using anticholinergics was associated with an increased risk of developing dementia. Moreover, dementia risk increased with the dosage of the drugs and the length of time they were used. While people who had taken these drugs daily for the equivalent of three months had no increase in risk, those who had used them for over three years had a 54% greater risk than nonusers.

By Dr. Anne Fabiny, Editor in Chief, Harvard Women's Health Watch

If you have diabetes or prediabetes and you need motivation to get your blood sugar under control, consider this: a study published Dec. 2, 2014, in Annals of Internal Medicine suggests that diabetes in midlife appears to age the mind at a faster rate in later life. Researchers analyzed changes in the thinking skills of more than 15,000 people during a 20-year period. The average age at the start of the study was 57. Twenty years later, among people with a history of diabetes, there was 19% more decline than expected. There were even declines, although smaller, among people with a high blood sugar condition known as prediabetes. "We know that over time, diabetes, like hypertension, will cause mini-strokes in the brain that will impair one's thinking and memory. This study strengthens the claim that addressing cardiovascular risk factors like diabetes early may prevent dementia in the future," says Dr. David Hsu, a psychiatrist in the Center for Alzheimer Research and Treatment at Harvard-affiliated Brigham and Women's Hospital. You can lower your blood sugar—and your risk of diabetes—by exercising, losing weight, and cutting back on refined grains and added sugars.