Midlife Changes in Blood Pressure Linked to Poor Brain Health Later

Changes in blood pressure in those as young as 36 are linked to poorer brain health later in life, according to new research.

Data for the new study came from the MRC National Survey of Health and Development (NSHD), the longest running birth cohort in the U.K. Called Insight 46, the new study is designed to follow more than 500 birth cohort members to look for early signs and risk factors for dementia as they reach their 70s.

Blood pressure in midlife has previously been linked to a higher risk of dementia, but the mechanism by which this happens, and the time when blood pressure is most important, remain to be fully understood, researchers noted.

To answer these questions, the research team followed 502 individuals who were all born in the same week in 1946.

The participants were free from dementia at the start of the study, with 465 undergoing brain scans to assess their brain health. The researchers were able to measure their blood pressure at ages 36, 43, 53, 60-64 and 69 years.

The brain scans looked for levels of a key Alzheimer’s protein, amyloid, in the brain, according to the researchers. The scans also assessed the size of the brain — an indicator of brain health — and the presence of blood vessel damage in the brain.

The results showed that higher blood pressure at the age of 53 and faster rises in blood pressure between 43 and 53 were associated with more signs of blood vessel damage or “mini strokes” in the brain when a person was in their early 70s.

Additionally, higher blood pressure at the age of 43 and greater increases in blood pressure between the ages of 36 and 43 were associated with smaller brain volumes, according to the study’s findings.

Researchers report that blood pressure was not associated with the amount of amyloid protein in the brain and did not appear to predict memory and thinking problems.

“This unique group of individuals, who have contributed to research their entire lives, has already shaped our understanding of the factors influencing health throughout life,” said Professor Jonathan Schott of the University College London Queen Square Institute of Neurology.

“The Insight 46 study has allowed us to reveal more about the complex relationship between blood pressure and brain health. The findings suggest that blood pressure even in our 30s could have a knock-on effect on brain health four decades later.”

“We now know that damage caused by high blood pressure is unlikely to be driven through the hallmark Alzheimer’s protein amyloid, but through changes in blood vessels and the brain’s architecture,” he continued. “The findings show that blood pressure monitoring and interventions aimed at maximizing brain health later in life need to be targeted at least by early midlife.”

“High blood pressure in midlife is one of the strongest lifestyle risk factors for dementia, and one that is in our control to easily monitor and manage,” added Dr. Carol Routledge, Director of Research at Alzheimer’s Research UK.

“Research is already suggesting that more aggressive treatment of high blood pressure in recent years could be improving the brain health of today’s older generations. We must continue to build on this insight by detecting and managing high blood pressure even for those in early midlife.”

The Insight 46 study will continue to monitor these people in the years to come to explore whether those with worse brain health are more prone to cognitive decline and dementia.

The study was published in The Lancet Neurology.

Source: University College London

Regular Exercise May Avert Physical Markers For Those at Risk for Alzehimer’s

Regular moderate exercise is not only good for memory as people age, it also appears to help prevent the development of physical signs of Alzheimer’s, known as biomarkers, in those who are at risk for the disease, according to new research.

“Our research shows that, in a late-middle-age population at risk for Alzheimer’s disease, physically active individuals experience fewer age-related alterations in biomarkers associated with the disease, as well as memory and cognitive functioning,” said Ozioma Okonkwo, Ph.D., an assistant professor of medicine at the University of Wisconsin School of Medicine and Public Health. Okonkwo presented findings from multiple studies at the 2019 annual convention of the American Psychological Association.

For their research, Okonkwo and his colleagues examined 317 participants enrolled in the Wisconsin Registry for Alzheimer’s Prevention, an ongoing observational study of more than 1,500 people with a history of parents with probable Alzheimer’s dementia. The participants were between the ages of 40 and 65 years at the time of enrollment and cognitively healthy.

Participation in the registry included an initial assessment of biological, health, and lifestyle factors associated with the disease and follow-up assessments every two to four years, according to the researchers.

All participants completed a questionnaire about their physical activity and underwent neuropsychological testing and brain scans to measure several biomarkers associated with Alzheimer’s disease.

The researchers compared data from individuals younger than 60 years with older adults and found a decrease in cognitive abilities, as well as an increase in biomarkers associated with the disease, in the older individuals. However, the effects were significantly weaker in older adults who reported engaging in the equivalent of at least 30 minutes of moderate exercise five days a week.

“The most interesting part of our research is that we now show evidence that lifestyle habits — in this case regular, moderate exercise — can modify the effect of what is commonly considered a non-modifiable risk factor for Alzheimer’s, in this case aging,” said Okonkwo.

In another study, also presented by Okonkwo, researchers studied 95 people, also from the registry, who were given scores called polygenic risk scores, based on whether they possessed certain genes associated with Alzheimer’s.

Similar to the previous research, the researchers also looked at how biomarkers changed with genetic risk and what role, if any, aerobic fitness might play.

Not surprisingly, people with higher risk scores also showed increased biomarkers for the disease, the researchers reported.

Again, the researchers found that the effect was weaker in people with greater aerobic fitness, a score incorporating age, sex, body mass index, resting heart rate, and self-reported physical activity.

A third study examined MRIs from 107 individuals from the registry who were asked to run on a treadmill to determine their oxygen uptake efficiency slope, a measure of aerobic fitness. In line with the previous studies, the researchers again found an indicator of Alzheimer’s, known as white matter hyperintensities, significantly increased in the brain with age, but not so much in participants with high levels of aerobic fitness.

“Overall, these studies suggest that the negative effect of aging and genetic risk on Alzheimer’s’ disease biomarkers and cognition can be lessened in physically active, older adults at risk for the disease compared with their less active peers,” said Okonkwo.

“If these findings are supported by more prospective, controlled studies, it would provide compelling evidence for physical activity as an effective approach to prevention, particularly in at-risk populations.”

Source: The American Psychological Association

Depression Symptoms, Protein Buildup in Brain Tied to Later Cognitive Decline

Depression symptoms in cognitively healthy older adults together with brain amyloid — protein deposits which are a biological marker of Alzheimer’s disease (AD) — could trigger changes in memory and thinking over time, according to a new study published in the journal JAMA Network Open.

“Our research found that even modest levels of brain amyloid deposition can impact the relationship between depression symptoms and cognitive abilities,” said Jennifer Gatchel, M.D., Ph.D., of the Massachusetts General Hospital (MGH) Division of Geriatric Psychiatry, and lead author of the study.

“This raises the possibility that depression symptoms could be targets in clinical trials aimed at delaying the progression of Alzheimer’s disease. Further research is needed in this area”

Increasingly, Alzheimer’s research has focused on the preclinical stage, when people have biological evidence of AD but no or minimal obvious symptoms, and when interventions might have the potential to prevent future decline of older adults.

Although previous studies have shown a link between depression and cognitive deficits in older adults, the new study is among the first to reveal that this association is influenced by the presence of cortical amyloid in unimpaired older adults, even when depression symptoms are mild to moderate.

Data were collected by researchers over a seven-year period from 276 community-dwelling older adults, all participants in the landmark Harvard Aging Brain Study (HABS).

They discovered a significant link between worsening depression symptoms and declining cognition over two to seven years that was influenced by AD pathology, as measured by PET imaging of brain amyloid.

“Our findings offer evidence that in healthy older adults, depression symptoms together with brain amyloid may be associated with early changes in memory and in thinking,” Gatchel said.

“Depression symptoms themselves may be among the early changes in the preclinical stages of dementia syndromes. Just as importantly, these stages represent a clinical window of opportunity for closely monitoring at-risk individuals, and for potentially introducing interventions to prevent or slow cognitive decline.”

The team also learned from their extensive work that not all older adults with depression symptoms and cortical amyloid will experience cognitive decline. Other risk factors that could affect the link between depression and cognition include brain metabolism and volume of the hippocampus, the part of the brain associated with learning and the forming of new memories.

The authors also note that other mechanisms may be involved and need to be investigated.

“These findings underscore the fact that depression symptoms are multi-factorial and may actually work synergistically with amyloid and related processes to affect cognition over time in older adults,” Gatchel said. “This is an area we will continue to actively study.”

Source: Massachusetts General Hospital


Apathy: A Common but Understudied Symptom of Dementia

In a new U.K. study of 4,320 people with Alzheimer’s disease, researchers found that 45% of study participants had apathy — the absence of emotion, interest, concern or passion — and that the condition was often distinct from depression.

Apathy is the most common neuropsychiatric symptom of dementia and is often associated with more severe cases and worse clinical symptoms. In fact, apathy tends to have an even bigger impact on function than does memory loss.

“Apathy is an under-researched and often ignored symptom of dementia,” said Miguel de Silva Vasconcelos, PhD student at the University of Exeter and King’s College London.

“It can be overlooked because people with apathy seem less disruptive and less engaging, but it has a huge impact on the quality of life for people living with dementia, and their families.”

“Where people withdraw from activities, it can accelerate cognitive decline, and we know that there are higher mortality rates in people with apathy. It’s now time this symptom was recognised and prioritised in research and understanding.”

In the study, a research team led by the University of Exeter analyzed 4,320 people with Alzheimer’s disease from 20 group studies, to look at the prevalence of apathy over time.

The researchers found that 45% of study participants presented with apathy at the beginning of the study and 20% had persistent apathy over time. In addition, a proportion of the subjects had apathy without depression, which suggests that the symptom might have its own unique clinical and biological profile when compared to apathy with depression and depression only.

“Apathy is the forgotten symptom of dementia, yet it can have devastating consequences,” said Professor Clive Ballard, of the University of Exeter Medical School. “Our research shows just how common apathy is in people with dementia, and we now need to understand it better so we can find effective new treatments.”

Ballard also noted that in his team’s previous study, they found that exercise helped improve apathy among care home residents. This suggests that action can be taken to minimize the condition. “This is a real opportunity for interventions that could significantly benefit thousands of people with dementia,” he said.

The presentation, entitled “The Course of Apathy in People with Dementia,” was delivered at the Alzheimer’s Association International Conference in Los Angeles, California.

Source: University of Exeter

Study Finds Link Between Liver Dysfunction and Alzheimer’s

A new study has discovered novel connections between liver dysfunction and Alzheimer’s disease (AD).

The findings, published in the journal JAMA Network Open, may lead to earlier detection of Alzheimer’s disease and ultimately better prevention.

With increasing evidence linking Alzheimer’s disease to diabetes or high cholesterol and other systemic illnesses, the research team uncovered a link between liver function and Alzheimer’s, which adds to the understanding of metabolic dysfunction in the disease.

“This is a new paradigm for Alzheimer’s research,” said study leader Kwangsik Nho, Ph.D., radiology professor at Indiana University (IU) School of Medicine.

“Until now, we only focused on the brain. Our research shows that by using blood biomarkers, we can still focus on the brain but also find evidence of Alzheimer’s and improve our understanding of the body’s internal signaling.”

The researchers evaluated more than 1,500 participants from the National Institute of Aging (NIA)-sponsored Alzheimer’s Disease Neuroimaging Initiative (ADNI) for more than two years. They looked at five serum-based liver function assessments, which measure enzymes predominantly found in the liver.

By using biochemical markers, the team was able to uncover evidence of metabolic disturbance and gain a new perspective on altered liver enzymes in association with both cognitive impairment and AD pathophysiology.

The study’s focus outside the brain aligns with known risk factors for Alzheimer’s disease, including metabolic disorders. According to Nho, looking elsewhere in the body for signals correlated with the disease can provide important clues toward detection and ultimately prevention.

“While we have focused for too long on studying the brain in isolation, we now have to study the brain as an organ that is communicating with and connected to other organs that support its function and that can contribute to its dysfunction,” said Rima Kaddurah-Daouk, Ph.D., of Duke University.

“The concept emerges that Alzheimer’s disease might be a systemic disease that affects several organs including the liver.”

The study was a combined effort of the ADNI, a 60-site study, and the Alzheimer’s Disease Metabolomics Consortium (ADMC). Overall, the findings shed new light on the link between the liver and brain. This line of research is expected to ultimately enable physicians to provide more personalized patient care.

“No stone can be left unturned in our attempt to understand the disease and to identify viable therapeutic targets,” said Andrew J. Saykin, Psy.D., director of the Indiana Alzheimer Disease Center at IU School of Medicine and site principal investigator for the Alzheimer’s Disease Metabolomics Consortium.

Source: Indiana University School of Medicine

Being Socially Active Linked to Lower Risk of Dementia

Being more socially active in your 50s and 60s predicts a lower risk of developing dementia later on, according to a new study.

“Dementia is a major global health challenge, with 1 million people expected to have dementia in the UK by 2021, but we also know that one in three cases are potentially preventable,” said the study’s lead author, Dr. Andrew Sommerlad of University College London.

“Here we’ve found that social contact, in middle age and late life, appears to lower the risk of dementia,” he continued. “This finding could feed into strategies to reduce everyone’s risk of developing dementia, adding yet another reason to promote connected communities and find ways to reduce isolation and loneliness.”

For the study, researchers used data from the Whitehall II study, tracking 10,228 participants who had been asked on six occasions between 1985 and 2013 about their frequency of social contact with friends and relatives. The same participants also completed cognitive testing from 1997 onwards. Researchers referred to the participants’ electronic health records up until 2017 to see if they were ever diagnosed with dementia.

The researchers report they focused on the relationships between social contact at age 50, 60, and 70, and the subsequent incidence of dementia. They noted they also looked at whether social contact was linked to cognitive decline, after accounting for other factors, such as education, employment, marital status, and socioeconomic status.

The researchers found that increased social contact at age 60 is associated with a significantly lower risk of developing dementia later in life. The analysis showed that someone who saw friends almost daily at age 60 was 12 percent  less likely to develop dementia than someone who only saw one or two friends every few months.

They also found similarly strong associations between social contact at ages 50 and 70 and subsequent dementia. Those associations did not reach statistical significance, but the researchers say that social contact at any age may well have a similar impact on reducing dementia risk.

According to the researchers, there are a few explanations for how social contact could reduce dementia risk.

“People who are socially engaged are exercising cognitive skills, such as memory and language, which may help them to develop cognitive reserve. While it may not stop their brains from changing, cognitive reserve could help people cope better with the effects of age and delay any symptoms of dementia,” said senior author Professor Gill Livingston.

“Spending more time with friends could also be good for mental wellbeing, and may correlate with being physically active, both of which can also reduce the risk of developing dementia,” he added.

The study was published in PLOS Medicine.

Source: University College London