Category Archives: Diagnosis & Tests

Catch Up I: Dementia Signs, Microbiome & Brain, Processed Foods & More

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Here we set out five brief posts concerning links which either bring up to date earlier posts on Strong Brain, or which are simply of interest in and of themselves.

Signs: Onset of Dementia

Our recent post Distilled: Signs of the Onset of Dementia listed 18 possible signs of the onset of dementia. The excellent article Recognizing Alzheimer’s Disease adds to that by providing a discussion of early warning signs and a view of diagnosis.

Category: Diagnosis & Tests

Microbiome & Brain

Quite recently, it has become apparent that the microbiome (all the microbes resident in an organism) can affect the brain, including the amount of amyloid beta clumps and exhibition of autistic behaviors. Much of the work has been done with mice (surprise!), but some also on humans. This is a quite interesting article on these investigations:
Germs in Your Gut Are Talking to Your Brain. Scientists Want to Know What They’re Saying.

Category: Neuro-Psych

☞ More on Processed Foods

Recently we published a somewhat lengthy post Best To Avoid Over-Processed Foods. The article below adds to that post:
What’s so bad about processed foods? Scientists offer clues.

Category: Diet

Cancer Treatment and Dementia

A very large U.S. study of prostate cancer patients in their 70’s demonstrates a notable increased risk of Alzheimer’s among patients who received Androgen Deprivation Therapy.
Dementia tied to hormone-blocking prostate cancer treatment
Hormone Therapy for Prostate Cancer Tied to Dementia
Original research:
Association Between Androgen Deprivation Therapy Use and Diagnosis of Dementia in Men With Prostate Cancer

Category: Risk Factors

Dementia Screening During Wellness Exams

The article Alzheimer’s Screenings Often Left Out Of Seniors’ Wellness Exams discusses the situation vis-a-vie dementia screening during annual wellness exams for seniors. The number of seniors experiencing them, and the number of physicians administering them, are relatively low, for a variety of reasons discussed in the article. Most likely, large-scale routine screening won’t be happening until a moderately inexpensive blood test is widely available.

Category: Diagnosis & Tests

Each group of links has been added to the indicated category.

Napping: Alzheimer’s Disease Destroys Alertness Neurons

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For some time, excessive daytime drowsiness and napping has been regarded as one of the earliest signs of Alzheimer’s. It was argued that daytime naps were a consequence of poor night’s sleep (common for Alzheimer’s patients). However, new research shows that the tau tangles characteristic of Alzheimer’s directly attack the brain regions responsible for maintaining daytime alertness. Hence, excessive daytime napping can indeed be seen as an early warning sign of the onset of Alzheimer’s.

Here are three media articles and a university post:
Alzheimer’s disease destroys neurons that keep us awake
Alzheimer’s Appears to Attack The Neurons That Keep Us Awake
Alzheimer’s disease destroys neurons that keep us awake
Alzheimer’s Disease Destroys Neurons that Keep Us Awake
Here is the research publication [paywall]:
Profound degeneration of wake-promoting neurons in Alzheimer’s disease

All links have been added to Neuro-Psych.

Closer To A Blood Test For Alzheimer’s

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Clumps of amyloid beta can begin building up in the brains of Alzheimer’s sufferers nearly 20 years before the individuals exhibit the memory loss and confusion characteristic of Alzheimer’s disease. Currently, the most reliable method of detecting amyloid beta buildup before exhibition of behavioral symptoms is using a PET scan (Positron emission tomography) (Brain Scans Prevent Alzheimer’s Misdiagnosis and Lead to Better Treatment—But They’re Not Covered By Medicare), but these are expensive, not covered by insurance, and take time and a visit to a site with the right scanning machinery. Because of this, few people have the scans done on a routine annual basis, and it is very difficult for drug researchers to recruit participants who might develop Alzheimer’s in the future, but don’t current exhibit memory loss and confusion.

These are all reasons why a blood test which could detect buildup of amyloid beta as early as PET scans would be highly desirable. A recent research publication reports on work coming very close to such a test. A certain amount of amyloid beta is naturally present in both brain and blood. The test first chops up the amyloid obtained from a blood sample with enzymes. The amounts of two fragments, called a-beta 42 and a-beta 40, are obtained by mass spectrometry, and their ratio is computed. As amyloid beta starts building up in the brain, less of the fragment a-beta 42 is available for circulation in the blood, and so the computed ratio goes down. Utilizing this ratio, together with an individual’s age and genetic risk, the test was able to match PET scan performance on 94% of the study participants.

Although at present there are no reliable methods of treating Alzheimer’s, a positive result on a blood test such as this would enable one to take steps to defer the onset of the disease, using:

And, sensibly, one could ensure that one’s will and healthcare advance directive were up to date, and one could consider creating an Advance Directive for Dementia.

Here are three media articles on the blood test work:
Blood test can identify Alzheimer’s 2 decades before symptoms
Blood test is 94% accurate at identifying early Alzheimer’s disease
New Alzheimer’s Blood Test Proved 94% Accurate in Finding Brain Changes Related to the Disease

Here is the published research article:
High-precision plasma β-amyloid 42/40 predicts current and future brain amyloidosis

All links have been added to Alzheimers > Diagnosis & Tests

Distilled: Signs of the Onset of Dementia

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We’ve collected a number of web pages offering lists of symptoms of the onset of demetia, and have distilled out 18 of the signs. Keep in mind that the occasional and not long lasting appearance of one of these is most likely a sign of aging. However, regular occurrence of one or more of these signs is an indication that a visit to a physician or clinincal psychologist specializing in cognition is warrented.
The web links contributing to this list are collected at the bottom of this post.
Here are the 18 distilled signs:

1. Memory loss that disrupts daily life fairly often — not the occasional forgetting of a name or date that comes back later.
2. Challenges in planning or solving problems, or following recipes or keeping track of monthly bills.
3. Difficulty with numbers and/or handling money in shops.
4. Difficulty making familiar trips (walking or driving).
5. A failing sense of direction and spatial orientation, including wandering and getting lost.
6. Confusion about time or place.
7. Repeating questions after a short interval.
8. Vision problems, including difficulty reading, judging distance and determining color or contrast — not due to cataracts or other eye problems.
9. Problems with words in conversations or writing, including repeating themselves or stopping mid-conversation unable to continue; also failure to find the right word.
10. Difficulty following storylines.
11. Misplacing things (often in very unusal places) and losing the ability to retrace steps to find them.
12. Decreased or poor judgment, including mishandling money, and decreased attention to grooming and keeping clean.
13. Notable weight changes.
14. Withdrawal from work or social activities.
15. Apathy, or loss of spontaneity and sense of initiative.
16. Changes in mood and personality, including becoming confused, suspicious, depressed, fearful or anxious, or aggressive.
17. Lessening of ability to focus and concentrate.
18. Failure to recognize people they know.

Here are links to the web pages contributing:

10 Early Signs and Symptoms of Alzheimer’s
What are the early signs of dementia?
10 Early Symptoms of Dementia
Dementia – early signs
What Are the Signs of Alzheimer’s Disease?
Symptoms of dementia
Symptoms
Well, that was a weird moment’ and other signs of dementia family members should watch for [Possible paywall]
Dementia’s Signs May Come Early [Possible paywall]

All links have been added to Alzheimer’s > Diagnosis & Tests

Sniffing For Alzheimer’s

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The idea of being able to utilize an inexpensive “scratch & sniff” test such as described in Smelling Alzheimer’s & Brain Injury? to obtain early warnings of possible Alzheimer’s onset is certainly intriguing, and work is ongoing. Most recently, a study reported a correlation between development of poor sense of smell and a notably higher incidence of death within 10 years. The mechanism(s) and meaning(s) remain unclear.

Here are two media articles on the work:
Routine sense of smell tests could be used to spot signs of dementia
Poor sense of smell associated with nearly 50 percent higher risk for death in 10 years

Here is the research publication Summary for Patients:
Poor Sense of Smell and Risk for Death in Older Adults

Here are interesting overviews from 2017 and 2018:
Smell Test May Sniff Out Oncoming Parkinson’s and Alzheimer’s
Can a Smell Test Sniff Out Alzheimer’s Disease?

Here are media articles on several smell-related research reports from 2017:
Sniffing out dementia with a simple smell test
Alzheimer’s could be diagnosed early with sniff tests
Sniffing out dementia with a simple smell test

All links have been added to Alzheimer’s > Diagnosis & Tests.

Another Route To Alzheimer’s Diagnosis Thru The Eyes

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Because the retina at the back of the eye is essentially a part of the brain, it is an intriguing target for diagnosis of Alzheimer’s. Earlier, we reported on work (The Eyes May Know About Alzheimer’s) developing a scanning machine for determining the amount of plaque present in the retina. Recent work, using 39 people with Alzheimer’s and 133 healthy people, takes the same route through the eyes, but instead examines the density of the microscopic network of blood vessels in the retina. The network in healthy people was notably denser than that in people with Alzheimer’s.

Here are two media articles on the work:
Alzheimer’s and brain health could soon be detected using an eye exam
Could an eye doctor diagnose Alzheimer’s before you have symptoms?

Here is the research report:
Retinal Microvascular and Neurodegenerative Changes in Alzheimer’s Disease and Mild Cognitive Impairment Compared with Control Participants

All links have been added to Alzheimers > Diagnosis & Tests.

Promising Non-Invasive Tests For Predicting Possible Dementia

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Two promising non-invasive tests for predicting possible future dementia have been reported.

The first test used an ultrasound scanner to examine the pulses in the neck arteries of nearly 3200 people in 2002. The study then monitored their cognitive functions until 2016, and found that those people with the most intense pulses and irregular blood flow in the neck arteries were up to 50% more likely to experience cognitive decline, which is a strong sign of oncoming dementia. If the results can be replicated in larger studies, this test could become routine and widespread in doctors’ offices.

Here are links to two media articles on the work, together with a link to the abstract of the study:

Dementia risk: Five-minute scan ‘can predict cognitive decline’
Five-minute neck scan can spot dementia 10 years earlier, say scientists
Meeting-presented abstract:
Abstract 13364: Carotid Artery Wave Intensity Measured in Mid- to Late-Life Predicts Future Cognitive Decline: The Whitehall II Study

The second test can be carried out by an optician during routine annual examinations of patients’ eyes. During such routine annual exams, the optician examines the state of the patient’s retinas. This study showed that the thinness of the retina is correlated with the likelihood of cognitive decline: Healthy patients with the thinnest retinal layers were seen to be twice as likely to later experience cognitive decline. Such thinness of the retinal layer could be routinely checked by opticians.

Below are links to two media articles about the study, together with the study abstract:

Optician’s eye test ‘could spot early dementia signs’
Retinal Thinning Tied to Cognitive Decline
Research abstract:
Association of Retinal Nerve Fiber Layer Thinning With Current and Future Cognitive Decline

All links have been added to Alzheimer’s > Diagnosis & Tests

New Biological Definition Of Alzheimer’s Advances

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Historically, Alzheimer’s Dementia (AD) has been defined by visible symptoms, simply because that was all that was available. Around the mid 1990’s, various researchers began pushing for the development of a biologically-based specification of the disease, separate from the manifested symptoms. Among other things, this allows reasoning about the onset of AD before manifestation of symptoms, much like cancer or heart disease. It is believed that the AD process may begin decades before any outward sign of memory loss or other decline.

In 2007, leading AD clinicians formed an international working group (IWG) and proposed using amyloid PET scans, MRI, CSF (cerebrospinal fluid) levels of Aβ and tau, genetic testing, brain structural changes, and subtle cognitive changes to diagnose AD at an earlier stage than before. The NIA/AA (National Institute of Aging, and the Alzheimer’s Association) set up a separate leadership group, and in 2011 it proposed a related set of diagnostic guidelines for AD research that utilized separate criteria for three stages of disease: preclinical AD, mild cognitive impairment, and dementia. The current NIA/AA research framework draws on these two efforts and their personnel.

The workers stress, both in the framework publication and in an associated editorial, that this work is directed at research, and will only slowly begin appearing in the clinical context. But it is expected that the new framework will markedly improve research communication and advances.

Links to media articles on the new framework:
New biological research framework for Alzheimer’s seeks to spur discovery
Alzheimer’s disease redefined: New research framework defines Alzheimer’s by brain changes, not symptoms
New Definition of Alzheimer’s Hinges on Biology, Not Symptoms

Links to two different publications of the framework:
NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease
NIA-AA Research Framework: Toward a biological definition of Alzheimer’s disease

All the links have been added to Neuro-Psych and to Alzheimers > Neurology & Neuroplasticity

Diagnosing Dementia & MCI Using Computers

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The first two bodies of work below use computer-based games to research the decline of 3D navigational skills (one of the first symptoms exhibited by the onset of dementia of all kinds), and the diagnosis of mild cognitive impairment (MCI), respectively. The third study reports on the correlation that “Less Daily Computer Use is Related to Smaller Hippocampal Volumes in Cognitively Intact Elderly”.

Sea Hero Quest

Sea Hero Quest is a collaboration between Alzheimer’s Research UK, Deutsche Telekom, the game designers Glitchers and scientists at 7 British universities. Recognizing that one of the first symptoms of dementia is loss of navigational skills, Sea Hero Quest mobile was designed to help researchers to understand the mental processes involved in 3D navigation, while at the same time providing a sea journey quest taken by a son attempting to recover the memories his father has lost to dementia. There are three sections to the game: navigation, shooting flares to test orientation, and chasing creatures. Each section is scientifically valid as well as fun and exciting. The game was launched in 2016 and, according to its website (below), nearly 3 million people have played the game up to now,. This amount of play has generated effectively 80 years worth of data, in turn equivalent to about 12,000 years of typical lab-based dementia research.

Here are three links to media articles about the game:
Sea Hero Quest: the mobile phone game helping fight dementia
Game shows that ability to navigate declines at young age
https://blog.strong-brain.com/wp-admin/post.php?post=2135&action=edit
Here is the Wikipedia entry for the game:
Sea Hero Quest [Wikipedia]
And here is the actual game site on the web, where you can download the Mobile and/or VR versions of the game:
Sea Hero Quest [Site]

Virtual Super Market (VSM)

The study reported here uses as “Virtual Super Market” Virtual Reality (VR) brain-training-style program to assess mild cognitive impairment on the part of the player. It is of definite interest since the testing game and assessment can be carried out without an administrator. Here is a link to a media article about the work:
Mild cognitive impairment (MCI) detected with brain training game

Here are a link to the original study together with an earlier prototype work:
A Preliminary Study on the Feasibility of Using a Virtual Reality Cognitive Training Application for Remote Detection of Mild Cognitive Impairment
Can a Virtual Reality Cognitive Training Application Fulfill a Dual Role? Using the Virtual Supermarket Cognitive Training Application as a Screening Tool for Mild Cognitive Impairment

Computer Use Time Can Correlate With Cognitive Decline

The study followed 27 ‘cognitively-healthy’, dementia-free adults aged 65 or older over 9 years in Portland. On the one hand, the study used MRI scans to measure the volume of the volunteers’ hippocampus, and on the other hand, data on computer use among participants was collected via mouse movement detection software. Embedded sensor technology monitored their mobility, sleep, socialisation, digital activities and medication intake. The research results showed that an additional hour of computer use each day was linked to a 0.025% larger hippocampal volume, leading to the conclusion that lower computer usage could be used to predict cognitive decline.

Here is a link to a media article about the study:
Computer use could help predict early-stage Alzheimer’s

Here is the original research study:
Less Daily Computer Use is Related to Smaller Hippocampal Volumes in Cognitively Intact Elderly

Here is the Wikipedia entry for Hippocampus:
Hippocampus [Wikipedia]

All the links have been added to Diagnosis & Tests.

The Eyes May Know About Alzheimer’s

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Finding inexpensive non-invasive tests to detect early Alzheimer’s is a major goal for many research groups. A very promising route is to use eye scans since the retina, exposed at the back of eye, is actually part of the central nervous system. Researchers at Cedars-Sinai Hospital in Los Angeles have taken that route, and have developed a scanning mechanism, similar to standard ophthalmic instruments, which can examine the retina and determine the amount of retinal plaque — similar to brain plaque seemingly involved in Alzheimer’s — present in the retina. Promising trials correlating the amount of retinal plaque present with the amount of brain plaque present are underway, where the amount of brain plaque is estimated by means of (expensive and difficult) PET scans.

Here are links to three media articles about the work:

Can this eye scan detect Alzheimer’s years in advance?
Clinical study shows that retinal imaging may detect signs of Alzheimer’s disease
Cedars-Sinai Device May Provide Early Detection of Alzheimer’s Disease

And here is a link to the main research article:
Retinal amyloid pathology and proof-of-concept imaging trial in Alzheimer’s disease

It’s interesting to note that a similar approach has been developed for early diagnosis of Parkinson’s disease:
Eye test may detect Parkinson’s before symptoms appear

All links are contained in Alzheimer’s > Diagnosis & Tests

Category: Diagnosis & Tests