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Butler Hospital and Brown Medical School, Providence, RI, USA [Abstract: National Institutes of Health - Entrez PubMed]

Buying time: management of mild cognitive impairment and early dementia
This paper provides an overview of the relationship between mild cognitive impairment and Alzheimer?s disease and the clinical evidence in favour of using donepezil for these patients in terms of effects on memory and cognition...Full Story

Early initiation of Alzheimer's disease (AD) treatment is advantageous because it can potentially keep patients in milder stages of the disease longer than delayed treatment. Early initiation of cholinesterase inhibitor therapy is an effective intervention for mild AD. Therefore, it is critical to identify and monitor patients who are at risk for AD and to initiate treatment once AD is diagnosed. A new diagnostic category, mild cognitive impairment (MCI), has been evolving to identify patients who demonstrate objective memory impairment but have essentially intact function or only limited functional impairment and do not meet diagnostic criteria for dementia. The amnestic subtype of this condition is associated with a high risk of AD - 16% of amnestic MCI patients convert to AD each year compared with 1% to 3% of normal elders. A recent three-year study found that patients with amnestic MCI who were treated with donepezil had a significantly reduced likelihood of progression to dementia in the first 12 months of treatment. ....

Johns Hopkins Medicine:

Study among elderly women shows seniors especially may be at risk

ANEMIA AFFECTS BODY -- AND MAYBE THE MIND

For older adults, anemia's trademark loss of oxygen-toting red blood cells has long been linked to fatigue, muscle weakness and other physical ailments. Now researchers at Johns Hopkins have found a relationship between anemia and impaired thinking, too.

"Our work supports the notion that mild anemia may be an independent risk factor for so-called executive-function impairment in older adults," says Paulo Chaves, M.D., Ph.D., an assistant professor at The Johns Hopkins University School of Medicine and the lead author of the study. "If further studies confirm that's true, this could mean that correction of anemia in these patients might offer a chance to prevent such a cognitive decline."

Reporting on the research in the September issue of The Journal of the American Geriatrics Society, the Johns Hopkins investigators went looking for such an effect because previous studies showed that age-related declines in the brain's so-called executive function -- problem solving, planning, assessing dangers, following up on important activities -- lead to declines in self-sufficiency.

"Executive function impairment, which happens often before memory loss occurs, may happen early on in the process of becoming unable to carry on with instrumental day-to-day living activities, such as shopping, cooking, taking medications, paying bills, walking, etc.," says Chaves.

Chaves and his team gave three psychological tests commonly used to evaluate executive function to 364 women, all between 70 and 80 years old, who were living in Baltimore, Md. Approximately 10 percent had anemia, which was of mild intensity.

Some 15 percent of those with the worst results on all three of the tests were anemic, compared to only 3 percent who scored best. Those with anemia were four to five times more likely to perform worst on the executive function tests, compared to those with normal blood hemoglobin, after taking into account the effect of other factors that affect cognition, such as age, education and existing diseases.

"These preliminary results don't prove that anemia causes impaired executive function, nor indicate that treatment of anemia would necessarily lead to better executive function," says Chaves. "However, they are compelling enough to serve as a roadmap for continued research."

How anemia could affect thinking remains to be determined. It could be that it chronically diminishes the supply of oxygen to the brain. Another view proposes that the fatigue accompanying anemia leads to inactivity and the loss of aerobic-fitness benefits to the prefrontal cortex.

The study was funded by the National Institute on Aging and grants from the Claude D. Pepper Older Americans Independence Center at The Johns Hopkins University; General Clinical Research Center, National Institutes of Health; and Ortho Biotech Products L.P., which produces a medication that stimulates the production of red blood cells. Chaves has served as a paid consultant for Ortho Biotech Products L.P. The terms of the latter arrangement were managed by The Johns Hopkins University in accordance with its conflict of interest policies.

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CLICK TO READ MOREis having a new medicine clinically-tested on two subjects in Russia for leader Kim Jong-Il who is suffering from diabetes and heart disease, a news report says.

An unnamed lawmaker from South Korea's ruling party was quoted as telling the Yonhap news agency that he had been briefed on the drug tests by Kim Seung-Kyu, the director of South Korea's main spy agnecy.

"I heard about it from director Kim at a recent intelligence committee plenary session at parliament," he was quoted as saying.

"His agency believes the two (test subjects), who are same in physique and age as Kim Jong-Il, are receiving the new medicine for diabetes and heart diseases at a hospital in Russia.".....

- Focus On Fiber: How Much is Enough?KPLC-TV: "The average American only gets about half the amount of fiber they need everyday for their body to function optimally. According to the American Heart Association (AHA), fiber helps lower cholesterol and is important for the health of our digestive system. Both the AHA and the National Cancer Institute recommend that we consume 25 to 30 grams of fiber daily. Dietary fiber is a transparent solid complex carbohydrate that is the main part of the cell walls of plants. It has two forms: soluble and insoluble. Soluble fiber may help lower blood cholesterol and reduce the risk of heart disease and stroke. Insoluble fiber provides the bulk needed for proper functioning of the stomach and intestines. It promotes healthy intestinal action and prevents constipation by moving bodily waste through the digestive tract faster, so harmful substances don't have as much contact with the intestinal walls. Unfortunately, many people are not eating this much fiber, which is causing serious cardio-vascular health concerns. Recently the AHA and the FDA (Food and Drug Administration) confirmed that coronary heart disease is the leading cause of death in the United States, killing more people than any other disease. It causes heart attack and angina (chest pain). A blood clot that goes to the heart is considered a heart attack, but if it goes to the brain it is a stroke. The AHA ranks stoke as the third most fatal disease in America, causing paralysis and brain damage. Eating a high-fiber diet can significantly lower our risk of heart attack, stroke and colon cancer. A 19-year follow-up study reported...."

Memory loss: When to seek help: Mayo Clinic...CLICK HERE FOR MORE:
"Alzheimer's symptoms follow a pattern distinct from that of normal memory loss.

"Everyone forgets things. How many times have you lost your car keys or forgotten the name of a person you just met? Forgetfulness tends to increase with age, but there's a big difference between normal absent-mindedness and the type of memory loss associated with Alzheimer's disease.

What's normal?
Normal age-related memory loss doesn't prevent you from living a full and productive life. You just need more time to remember a name or the task you had set out to do. You're aware that you're forgetful and may even joke about it.

People with memory loss due to something other than normal aging, such as Alzheimer's disease, may feel that something's not quite right, but they're unable to pinpoint what's bothering them. Rather than call attention to a memory lapse, they may behave as if everything is fine.

Additional symptoms
Memory loss associated with Alzheimer's gets worse over time, but it certainly is not the only symptom of the disease.

Some of the earliest signs and symptoms of Alzheimer's disease include:

Asking the same questions repeatedly
Difficulty finding words or use of inappropriate words
Not being able to complete familiar tasks, such as following a recipe
Misplacing items in inappropriate places, such as putting a wallet in the refrigerator
Becoming lost while driving on familiar streets
Undergoing sudden changes in mood or behavior for no apparent reason

Reversible conditions
Many other medical problems cause symptoms similar to Alzheimer's. That's why it's so important to consult a doctor if you've noticed memory lapses or uncharacteristic mood swings in yourself or in someone close to you. The problem may be a potentially reversible illness, such as depression, a metabolic disorder such as hypothyroidism, a reaction to a drug, or a vitamin deficiency.

Ask your doctor
To help rule out some of these other problems, here's a list of questions you may want to ask your doctor:

Could some of my medications be interacting? If you take more than one medication a day, there is a chance that these drugs could interact in your body, producing such symptoms as dizziness and memory loss. Give your doctor a list of all the medicines you use, including herbal remedies and over-the-counter items such as arthritis cream.

Have I lost or gained any weight? Your weight is a factor in the dosage for some types of drugs. Losing or gaining even 10 pounds could make you have too much or too little medicine in your body, which might result in symptoms that mimic Alzheimer's disease.

Could I be dehydrated? Older people are at higher risk of dehydration because the ability to feel thirst decreases with age. While dehydration itself can cause confusion, it can also increase the concentration of medicine in your blood, which can affect your mental processes.

Might I have a concussion? Some people can lose consciousness after a fall and not realize it. Ask your doctor to check you over if you find an unexplained, tender lump on your head. Also talk to your doctor if you start to feel mentally fuzzy after what seems like a minor fall.

Could I be depressed? Sometimes, family members and even health professionals suspect Alzheimer's disease in older adults who are really just depressed. Your doctor can use neurological and psychological evaluations to test you for depression.

Could I be drinking too much? Alcohol is really just another drug, which can cause memory loss all on its own or by interacting with your medicines.....MORE

When daughters become mothers:
"There comes a time when our parents get older and they need to be cared for. In a high percentage of cases, this responsibility falls to the daughter. In some cases, the son takes care of his elder parent. No matter who is doing the duty, it can become a 24-hour and seven day per week commitment.

Children become parents to the very folks who raised them. Whether the elder is physically or mentally affected -or both - the responsibility of care is enormous. It can eat up a person%u2019s life savings. It can eat up work and leisure time for their children. Hard-working folks can end up spending thousands every month to send their parents to a 'nursing home' or long-term care facility. Some end up broke......"

Aspirin, Ibuprofen Don't Mix: FDA: Timing Of Doses Key To Keeping Aspirin's Heart Protection - CBS News Interactive: Healthwatch: "A new report says the heart-related benefits of taking aspirin can be offset if you take it too closely to when you take ibuprofen.

The Food and Drug Administration paper says people taking a low dose of aspirin each day for long-term protection against heart attacks and strokes can wipe out that protection if they take ibuprofen less than a half-hour after taking aspirin. It says the desired effect from aspirin also won't happen if you take it less than eight hours after taking ibuprofen.

On The Early Show Tuesday, medical correspondent Dr. Emily Senay pointed out that ibuprofen is the main ingredient in such over-the-counter pain relievers as Advil and Motrin.

It's been estimated by the manufacturer of Bayer aspirin that 28 million Americans take a small dose of aspirin every day, because it's been shown to help reduce a person's risk of heart attack and stroke.

The main way aspirin does it, Senay explained, is by limiting the blood's ability to form dangerous clots. But the FDA paper says aspirin's clot-fighting abilities can be cancelled out when aspirin and ibuprofen are taken too closely together.

But that, Senay noted, applies to when people take immediate-release aspirin.

Many people use a slower-release form of aspirin with what's called an enteric coating, because that form is considered less likely to irritate the stomach. There isn't enough research yet to know how ibuprofen interacts with the slower-release aspirin, Senay observed.

She adds this is yet another reminder that medications can interact badly, whether they're OTC, prescribed by doctors, or so-called natural remedies.

You should discuss whatever you take, from any or all of those categories, with your doctor, Senay stressed. You also should carefully read product labels and package inserts. In some cases, such as with aspirin and ibuprofen, one product can cancel out an important benefit you hope to get from the other. In other cases, two products that may help you separately could cause serious harm if you take them together.

If you take aspirin regularly to help protect your heart and are wondering, after reading this, whether there's any alternative to ibuprofen, Senay says that's unclear at the moment.....MORE"

Accelerated Weight Loss May Signal Imminent Dementia Onset
"An early warning sign for Alzheimer's disease could be accelerated weight loss, researchers here suggested. Among more than 400 healthy older adults ages 65 to 95, followed as part of a longitudinal study of Alzheimer's, those who had a sudden doubling of the rate of weight loss developed dementia about a year later, found David K. Johnson, Ph.D., of Washington University, and colleagues.

'Specific factors contributing to weight loss are unknown, but these data suggest they operate before the development of dementia of Alzheimer's type,' the authors reported in the Sept. 11 issue of Archives of Neurology. 'Hence, weight loss may be a preclinical indicator of Alzheimer disease.'

Other studies have shown that weight loss is associated with development of dementia and with nursing home placement, but the timing and rate of the weight loss in relationship to the first signs of dementia are unknown, the authors noted...."

Enzyme May Help Fight Alzheimer's - Forbes.com:
"Researchers Researchers think they may have found a way to target neurofibrillary tangles, the jumbled bits of protein inside brain cells that might contribute to Alzheimer's disease.

In tests with mice and fruit flies, an enzyme appeared to both eliminate the tangles and reduce the brain's decline.

The research is in an early stage. However, the approach is both unique and promising, said study co-author Dr. Daniel Geschwind, professor of neurology, psychiatry and human genetics at the University of California, Los Angeles.

"We've shown in animals that this is working," Geschwind said. "I think it's very viable, but one needs to prove that."

Much of Alzheimer's research has focused on so-called amyloid plaques, a buildup of proteins inside the brain between cells that appears to contribute to dementia. But Geschwind and his colleagues looked at tangles, another part of the puzzle. These tangles of protein, called tau, are associated with cognitive decline in Alzheimer's and similar "tauopathy" diseases.

Neurofibrillary tangles are "a kind of compressed bunch of filaments that are just like a tangled bit of twine inside the [brain] cell," Geschwind said.

It's not clear if tangles hurt brain cells or are just a symptom of a dementia problem. "The point is that they're totally correlated with neurodegeneration in Alzheimer's disease, and in a number of other dementias," he said.

In some forms of dementia, tangles are "the whole story" because amyloid plaques aren't present, said Dr. Sam Gandy, director of the Farber Institute for Neurosciences at Thomas Jefferson University in Philadelphia.

Geschwind and his colleagues suspected that an enzyme known as puromycin-sensitive aminopeptidase plays a role in degenerating brains. They tried to see if the enzyme would affect brain cells in mice that had been genetically engineered to suffer from neural degeneration that was similar to Alzheimer's in humans.

The scientists launched a similar effort in fruit flies. While fruit flies may not seem like the brainiest of species, the researchers simulated Alzheimer's by causing degeneration in the cells of their eyes, Geschwind said.

The researchers found that the enzyme appeared to prevent both the decline of brain cells and snip apart tangles. Research on brain cells taken from humans suggested that the scientists are on the right track.

The findings are published in the Sept. 7 issue of the journal Neuron...."

Learning to live with aging -- gracefully