Dementia

Neurodegenerative Copathology

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About 20 years ago, neuropathologists began to report an inconvenient finding in the autopsied brains of people with dementia: Most have evidence of more than one disease. Studies since have shown the brains of up to half of people diagnosed with Alzheimer’s disease also have a key feature of Parkinson’s disease—deposits of the protein alpha synuclein. At the same time, up to half of Parkinson’s patients who develop dementia have elevated levels of beta amyloid and tau proteins, hallmarks of Alzheimer’s. Most dementia patients have multiple brain diseases – https://www.science.org/content/article/most-dementia-patients-have-multiple-brain-diseases-how-should-they-be-treated

Yikes.

Eat More Eggs

Antidepressant Use Associated With Cognitive decline in Patients with Dementia

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In this cohort study, use of antidepressants was associated with faster cognitive decline in patients with dementia, in particular SSRIs (i.e., citalopram, sertraline and escitalopram) and mirtazapine. These effects appeared to be more pronounced in patients with more severe dementia. Compared with sertraline, escitalopram presented faster cognitive decline, while citalopram was linked to a slower cognitive decline. Additionally, higher dispensed doses of SSRIs were associated with greater cognitive decline, as well as increased risks of severe dementia, all-cause mortality, and fracture. Our study cannot distinguish whether these findings are due to the antidepressants or the underlying psychiatric indication. Mo, M., Abzhandadze, T., Hoang, M.T. et al. Antidepressant use and cognitive decline in patients with dementia: a national cohort study. BMC Med 23, 82 (2025). https://doi.org/10.1186/s12916-025-03851-3

If I develop dementia no SSRI’s for me please.

Food for Thought (and memories)

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Favorite Meals May Trigger Memories in People with Dementia

Mealtime can provide opportunities to connect with someone experiencing memory loss and tap into deeply rooted memories. “If you’re going to make your father’s favorite meal, think about how you can delve into it as an experience,” Aguirre says. Dr. Kramer notes that several senses associated with cooking and eating dishes, including smell and taste, are closely related to memory. Both the olfactory bulb, the main receiving center for smell, and the insular cortex and frontal operculum (also called the gustatory cortex), responsible for perception of taste, are closely connected to the amygdala, an area involved in emotional learning. The olfactory nerve, which conveys the sense of smell to the brain, is also close to the hippocampus, one of the most important brain structures for memory. And the combined effect of smell and taste—what neuroscientists who study this field call “flavor”—can be especially powerful at conjuring long-held memories charged with emotion, says Joel Salinas, MD, MBA, FAAN, assistant professor of neurology at NYU Langone Health and chief medical officer at Isaac Health, a clinic in New York City for brain health and memory problems.Favorite Meals May Trigger Memories in People with Dementia – https://www.brainandlife.org/articles/food-may-trigger-memories-in-people-with-dementia

Another Reason to Exercise (your brain)

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Group-based trajectory modeling identified four groups of distinct occupational cognitive demands according to the degree of routine tasks in the participants occupations during their 30s, 40s, 50s and 60s. The researchers analyzed the link between these trajectory groups and clinically diagnosed MCI and dementia in participants in the HUNT4 70+ Study (2017-19). Additionally, the researchers accounted for important dementia risk factors such as age, gender, educational level, income, overall health, and lifestyle habits from assessments made in 1984-86 and 1995-97.  Within age groupings the researchers looked at such occupations as primary school teacher, salesperson, nurse and caregiver, office cleaner, civil engineer, and mechanic, among others.

After adjusting for age, sex, and education, the group with low occupational cognitive demands (the high RTI group) had a 37 percent higher risk of dementia compared to the group with high occupational cognitive demands. Occupations That Are Cognitively Stimulating May Be Protective Against Later-life Dementia — https://www.publichealth.columbia.edu/news/occupations-are-cognitively-stimulating-may-be-protective-against-later-life-dementia

Link to the study abstract – https://www.neurology.org/doi/10.1212/WNL.0000000000209353

I hope my spouse doesn’t read this or she’ll never let me retire.

Undiagnosed Cirrhosis and Hepatic Encephalopathy in Dementia

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The findings of this cohort study suggest that, in a national veterans cohort of patients with dementia, 5% to 10% of the patients have laboratory values suggestive of possible undiagnosed cirrhosis that could implicate HE as a contributor to overall cognitive impairment. Patients in this study with possibly undiagnosed cirrhosis were more likely to be of races other than White, Hispanic, and urban-dwelling, and more likely to have AUD and viral hepatitis. These percentages of affected patients were corroborated with medical records review of 2 separate validation cohorts. In conclusion, FIB-4 should be considered as a screening tool to detect cirrhosis and potential HE in older veterans with dementia. Those with high scores (eg, >2.67) should be considered for further evaluation and treatment.

Undiagnosed Cirrhosis and Hepatic Encephalopathy in a National Cohort of Veterans With Dementia — JAMA Netw Open. 2024;7(1):e2353965. doi:10.1001/jamanetworkopen.2023.53965 — https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2814346

Sedentary Behavior and Incident Dementia Among Older Adults

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Conclusions and Relevance  Among older adults, more time spent in sedentary behaviors was significantly associated with higher incidence of all-cause dementia. Future research is needed to determine whether the association between sedentary behavior and risk of dementia is causal.

Sedentary Behavior and Incident Dementia Among Older Adults — https://jamanetwork.com/journals/jama/article-abstract/2809418

I’m screwed.

Vitamin D and Dementia

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Researchers at the University of Calgary’s Hotchkiss Brain Institute in Canada and the University of Exeter in the UK explored the relationship between vitamin D supplementation and dementia in more than 12,388 participants of the US National Alzheimer’s Coordinating Center, who had a mean age of 71 and were dementia-free when they signed up. Of the group, 37 per cent (4,637) took vitamin D supplements.

In the study, published in Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, the team found that taking vitamin D was associated with living dementia-free for longer, and they also found 40 per cent fewer dementia diagnoses in the group who took supplements.

University of Exeter. “Taking vitamin D could help prevent dementia: Taking vitamin D supplements may help ward off dementia, according to a new, large-scale study..” ScienceDaily. http://www.sciencedaily.com/releases/2023/03/230301101511.htm (accessed March 1, 2023) — https://www.sciencedaily.com/releases/2023/03/230301101511.htm

Journal Reference:

Maryam Ghahremani, Eric E. Smith, Hung‐Yu Chen, Byron Creese, Zahra Goodarzi, Zahinoor Ismail. Vitamin D supplementation and incident dementia: Effects of sex, APOE , and baseline cognitive status. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 2023; 15 (1) DOI: 10.1002/dad2.12404

Social Isolation and Dementia Risk

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A study by Huang and colleagues is the first nationally representative cohort study examining the association between social isolation and incident dementia for older adults in community dwelling settings. A cohort of 5,022 older adults participating in the National Health and Aging Trends Study was followed from 2011 to 2020. When adjusting for demographic and health factors, including race, level of education, and number of chronic health conditions, socially isolated adults had a greater risk of developing dementia, compared with adults who were not socially isolated (hazard ratio, 1.27; 95% CI, 1.08 – 1.49). Potential mechanisms to explain this association include the increased risk of cardiovascular disease and depression in older adults who are socially isolated, thereby increasing dementia risk.

Mengru Wang. Geriatrician Advises on Use of Vitamin D Supplementation, Lecanemab, and Social Media for Her Patients – Medscape – Jan 20, 2023 — https://www.medscape.com/viewarticle/987285?src=rss#vp_2

One week ago we had our older adult friends over for dinner. Midweek my wife went out with her friends while I gathered with my friends. Last night was date night and we got out of the house. This evening we’re having dinner at a friend’s house.

Dementia risk reduction activities!

Heavy Drinking ‘Strongest’ Modifiable Risk Factor for Dementia

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The retrospective analysis involving 30 million people in France shows that those with a history of alcohol use disorders had a threefold increased risk for dementia and that over half those with early-onset dementia had a history of alcohol problems. “This study used a phenomenally large database, and the result showing that half the cases of early-onset dementia were associated with alcohol use disorders is truly staggering,” Ballard told Medscape Medical News.

The researchers used diagnostic codes on hospital records to identify patients with dementia and those who had a history of alcohol use disorders. They found over a million cases of dementia, after excluding people with diseases that can lead to rare types of dementia and those with early-life mental disorders that can increase or confound dementia diagnosis. There were also 945,000 people with alcohol use disorders.

Results showed a strong association between a history of alcohol problems and dementia. This was especially noticeable in early-onset dementia, with 57% of the 57,000 patients who had developed dementia under the age of 65 years having a history of alcohol use disorders (66% of men and 37% of women).

In an analysis of just those patients in whom the first record of dementia occurred in 2011-2013 and adjusted for other risk factors found in the medical records, the risk for dementia was three times greater if the patient had a history of alcohol use disorders. The hazard ratio was 3.36 for men and 3.34 for women.

Read the Medscape article here.  Or get down and dirty with the full study here.

Be careful with interpreting these results.

France.  I’m not joking.  Here’s  a Global Consumption Map.

 

 

Anosognosia

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Remember this – if you can’t remember you’ve forgotten you have a problem.

Source article here. 

And while we’re on the topic don’t forget to exercise.

Or did you forget?

A follow up two years later showed that patients who were unaware of their memory problems were more likely to have developed dementia, even when taking into account other factors like genetic risk, age, gender and education. The increased progression to dementia was mirrored by increased brain metabolic dysfunction in regions vulnerable to Alzheimer’s disease.