Category Archives: Brain Health

High Glucose a Risk Factor for Dementia

September 21st is designated World Alzheimer’s Day. In recognition of this today’s post will review research on the effects of glucose on dementia.

Alzheimer’s disease is the most common form of dementia. Statistics from the CDC indicate as many as 5 million Americans are currently living with Alzheimer’s disease. This number is expected to reach 14 million people by 2060.

It is important to consider that Alzheimer’s disease is not a normal part of aging. There is currently no cure for Alzheimer’s, so recognition of risk factors as a potential strategy for prevention is important.

A research group affiliated with the University of Washington, the Swedish Neuroscience Institute, Harvard Medical School and Harvard School of Public Health and Wake Forest School of Medicine performed a study examining the relationship between glucose levels and risk of dementia.

Enrollees for the study were selected from the Adult Changes in Thought study, which consisted of randomly selected members from Group Health Cooperative in Washington State. These members were all considered to be dementia-free. There were 2067 participants, 839 men and 1228 women, whose mean age was 76 years.

Study subjects were assessed every two years to look for incident cases of dementia. The Cognitive Abilities Screening Instrument was used. Average glucose levels were calculated for each subject at initiation into the study, and then in 5 year rolling periods thereafter. Mean follow-up period was nearly 7 years.

The researchers discovered that among those subjects with diabetes, those with higher levels of glucose had increased risk for dementia. For example, the risk for dementia was 40% higher in those with average glucose of 190 mg/dl compared to 160 mg/dl. 

Even more important, among the subjects without diabetes, those with an average glucose level of 115 mg/dl had an 18% higher risk of dementia compared to those with an average 100 mg/dl glucose level.

The last result bears repeating, in participants WITHOUT diabetes, a 15 mg/dl difference in glucose (115 vs 100) led to an 18% increased risk of dementia. This particular result may indicate that early interventions to lower blood glucose, while one is still in the insulin resistance stage and not advanced into full blown diabetes, may lower the risk of dementia.

At this time there is no cure for dementia. Alzheimer’s disease and dementia in general have a profound impact not only at the individual level, but also on the individual’s caregivers. Perhaps incorporating a low-carb lifestyle may be a strategy to prevent future dementia.

“The power of intuitive understanding will protect you from harm until the end of your days.”–     Lao Tzu

(Source- New England Journal of Medicine, 369.6)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

Brush Your Teeth, It May Help Prevent Dementia

June is Alzheimer’s and Brain Awareness Month, and in recognition of this today’s post will look at the relationship between chronic periodontitis and subsequent development of dementia.

Periodonitis is very common, but may be preventable with proper dental hygiene. It is defined as inflammation of the gums and supporting structures of the teeth. Periodonitis begins with gingivitis, which is inflammation of the gums.

A group of researchers from Korea recently published a study looking at the possible risk chronic periodonitis may play in the development of dementia. This was a retrospective cohort study with a huge number of participants, over 260,000. These subjects were followed from 2005 to 2015. Other health factors were included such as age, alcohol consumption, blood pressure, exercise level, gender, smoking status, among other factors.

At the end of 2015 the study concluded. The researchers found that subjects with chronic periodonitis had a 6% higher risk for dementia, and a 5% higher risk of Alzheimer’s Disease, compared to those without chronic periodonitis.

The authors propose three possible mechanisms by which chronic periodonitis may be related to neurodegenerative processes. First, perhaps bacteria or other pathogens may cross the blood-brain barrier causing an inflammatory response. Second, there may be increased systemic inflammation or thirdly perhaps increased atherosclerotic plaque formation, leading to endothelial damage.

Current medications for dementia only slow progression of the disease, and do not work in all patients. Some patients are unable to tolerate medication side effects. Therefore it is important to identify those risk factors for dementia which are potentially modifiable which in turn could lower one’s risk for development of dementia.

This is a robust study, with a very large number of participants. Also, it may be the first study on this topic to look at concomitant risk factors such as exercise level and smoking status. Given the results, you may want to enlist the help of your dentist and dental hygienist as strategies to prevent dementia.

“Behind every smile there’s teeth.”–  Confucius

(Source- Journal of the American Geriatric Society  00:1-6, 2019)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

Erectile Dysfunction a Risk Factor for Dementia

June 10-16th is designated Men’s Health Week, and in addition June is Alzheimer’s and Brain Awareness Month. Today’s post will look at research regarding dementia and erectile dysfunction (ED).

ED is a common medical problem, particularly in aging males. The Massachusetts Male Aging Study showed about 40% of males are affected at age 40, while nearly 70% are affected by age 70. Data from the National Health and Nutrition Evaluation Survey (NHANES) showed that over 18% of males age 20 and older were afflicted with ED.

A research group based in Taiwan performed a retrospective cohort study on a population of  Asian men. There were two groups, the first group were men who had recently been diagnosed with ED. The second group, or control group, were matched samples, without ED. There were over 4,000 subjects in the ED group, and nearly 21,000 subjects in the control (non-ED) group. Other health issues such as anxiety, chronic kidney disease, coronary heart disease, depression, diabetes mellitus, hyperlipidemia, hypertension, hypothyroidism and stroke were tracked. The subjects were followed over a 7 year period.

After the 7 year follow-up period what the researchers found was astounding- the subjects with ED were 1.68 times more likely to develop dementia than the non-ED (control) group.

The researchers also discovered that the subjects with anxiety, chronic kidney disease, depression, diabetes mellitus, hypertension and stroke were 1.48 times more likely to develop dementia.

This study, published in 2015, was the first population based study to examine the risk of developing dementia among men with ED. While the study population was Asian men, there is reason to believe that the results would similarly apply to non-Asian populations.

There are several possible mechanisms for the association between ED and dementia. One possible factor is damage to the endothelial layer, which lines the blood vessels. Damage to this crucial layer is associated with coronary heart disease, diabetes, and hypertension. A pro-inflammatory state is seen to be a factor in endothelial damage.

This is an important research paper, and should been seen as a distant early warning of sorts. Given the inability of the currently available medicines to reverse dementia, a more preventative strategy should be considered. Men with ED, particularly at younger ages, should consider what health changes they can make to lower their future risk for dementia later in life.

“Lay hold of today’s task, and you will not need to depend so much upon tomorrow’s. While we are postponing, life speeds by.”–  Seneca

(Source- Medicine, Volume 94, Number 24, June 2015)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.

 

 

Acupuncture May Offer Hope for Alzheimer’s

June is Alzheimer’s and Brain Awareness Month. Today’s post will review a study of using acupuncture for mild to moderate Alzheimer’s disease (AD).

Alzheimer’s Disease is the most common form of dementia, and is a degenerative brain disease. It is estimated that nearly 6 million Americans have AD. According to the CDC it is the 5th most common cause of death among adults age 65 and older. Early symptoms of Alzheimer’s Disease include mild memory loss, and may progress to changes in mood and behavior, and difficulty with performing familiar tasks. The annual costs of AD are estimated to be $200 billion. Age is the most important risk factor for AD. Unfortunately, at this time there are no effective medical treatments to stop or reverse AD.

A research group in China performed a randomized trial, comparing the efficacy and safety of acupuncture to the medication donepezil (brand name Aricept) in a group of subjects diagnosed with mild to moderate AD. Subjects were aged 50 to 85 years. 43 individuals were assigned to the acupuncture group, while 44 were assigned to the donezepil group.

The study itself last 28 weeks- a 4 week baseline period, a 12 week treatment period, and a 12 week follow-up period. The acupuncture group received three treatments each week, lasting about 30 minutes each. The treatments were provided by 9 experienced acupuncturists, who individualized treatments to each respective subject.

There were two primary outcome measures, the ADAS-cog and the CIBIC-Plus. The ADAS-cog consists of 11 tasks to measure the symptoms of AD. The CIBIC-Plus on the other hand is a comprehensive global assessment of change in behavior, cognition and function, and requires separate interviews with the caregivers as well as the patients.

The results of the study demonstrated that acupuncture improved the participants score on the ADAS-cog and CIBIC-Plus, indicating improvement in cognitive function and global clinical status.

It is interesting that the study design used a known pharmaceutical treatment (donepezil) as the comparator group to acupuncture, rather than using sham (fake) acupuncture. There is evidence from many studies that sham acupuncture is not a true placebo, and often studies that use sham acupuncture show an elevated placebo response. It is also important to note that no one withdrew from the study due to an adverse side effect from acupuncture, which again points to the safety of this treatment.

A diagnosis of Alzheimer’s Dementia can be devastating to a patient, and in some ways even more so to the patient’s caregivers, which are often family members. Given the results of this study perhaps acupuncture should be given some consideration as a additional treatment for this overwhelming disease.

“I know for certain that we never lose the people we love, even to death. They continue to participate in every act, thought and decision we make. Their love leaves an indelible imprint in our memories. We find comfort in knowing our lives have been enriched by sharing their love.”– Leo Buscaglia

(Source- BMC Complementary and Alternative Medicine (2017) 17:556)

This blog is a review of published medical and scientific literature, and should only be used for informational purposes. It does not constitute medical or health advice, nor does it create a physician-patient relationship with anyone. Discuss any health concerns with your personal physician.