A 5-minute assessment on an iPad could transform how we screen for dementia—or overwhelm the health care system with worried test-takers. Tap on the right side of the screen whenever they see an animal in one of the pictures, and on the left side when they don’t.
There’s a fair amount of dementia in my relatives, Alzheimer’s on one side and vascular dementia on the other. As I fumble for a word or two that are temporarily not to be found, I worry about going down the paths of parents and grandparents. While filling the word-finding void with reasonable substitutes of that which evades my tongue, I hope it’s just a benign ‘tip of the tongue’ (ToT) missing word task, and, temporarily, just the right word is not to be found. I worry if common dementias can be inherited. I worry if worry increases risk of dementia. Here’s reassurance from The Alzheimer’s Society. I’m sticking with their know-how, but no way, by the way, do I want to take that speed iPad test and become a worried test-taker!
Can dementia be passed down through the family: The majority of dementia is not inherited by children and grandchildren. In rarer types of dementia there may be a strong genetic link, but these are only a tiny proportion of overall cases of dementia.
Can Alzheimer’s be inherited? In the vast majority of cases—99 out of 100—AD is not inherited. The most important risk factor for Alzheimer's disease is age. Because Alzheimer's disease is so common in people in their late 70s and 80s, having a parent or grandparent with Alzheimer's disease at this age does not change your risk compared to the rest of the population.
However, if somebody has developed Alzheimer’s disease at an earlier age (for example, less than 60 years-old) there is a greater chance that it may be a type of Alzheimer’s disease that can be passed on.
But you never know what the future holds, so I was delighted to come across various maneuvers that may decrease the possibilities of geriatic brain collapse whether inherited or not. First, though, a bit of reassurance from JAMA Journal:
In this observational cohort study of more than 21 000 US adults 65 years or older from the nationally representative Health and Retirement Study, dementia prevalence declined significantly, from 11.6% in 2000 to 8.8% in 2012.
Population brain health seemed to improve between 2000 and 2012; increasing educational attainment and better control of cardiovascular risk factors may have contributed to the improvement, but the full set of social, behavioral, and medical factors contributing to the improvement is still uncertain.
The following four suggestions have all proved themselves warriors in the fight against losing your marbles. Strategies I-III were taken from medRXiv, a web-site that posts medical research studies before they are carefully reviewed by their peers. Don’t rush to exhilarating conclusions, therefore, but do hang on for hope that outcomes from these studies may bolster your brain. Viagra awaits human trials, perhaps a bunch of volunteers split into two groups, one provided with placebos while the second group gets the real stuff, and the researchers are ‘blinded’ so that no one knows the truth ‘til it’s all unveiled. Years pass, researchers then check who’s dotty, who’s not. The statistics look good so far, and I would not be reluctant to try all of these methods listed below.
I Varicella Zoster vaccine.
Varicella Zoster virus (VZV) causes chicken pox. Following the disease, this human herpes virus lives on in the ganglia of the nervous system, at times re-emerging as shingles manifesting as a painful rash on some part of the body. Those of us of a certain age have likely had chickenpox caused by VZV, and the older we get, the more likely we’ll get shingles along with the potential complications caused by a resurgence of active human herpes viruses, and we definitely don’t want that.
So you’d think that I, being a physician, would be well-vaccinated by Shingrix, a two shot process with a several month hiatus between first and second. Having heard from my pals about the unpredictable side effects especially after shot 2 (much like those fevers, body aches, and fatigue symptoms from COVID vaccines), I have not yet gotten the Shingrix vaccines, but after reading the following info, I plan to—and perhaps you will too—go to the local pharmacy for shingles shots.
Here’s the first ‘preprint’ (the ‘pending judgment ‘til the experts review’) research study titled “Reduced dementia incidence following VZ vaccination in Wales 2013-2020.” They commenced this study by studying previous studies 20 years prior concerning persons previously vaccinated for diphtheria/tetanus, polio, and influenza. The exposure to these vaccines had a 25%-60% drop in late onset dementia compared to the non-vaccinated. Two more recent studies in 2017 & 2018 demonstrated an increased risk of subsequent senile dementia (SD) development in adult patients with acute varicella zoster (herpes zoster) infections. Another 2018 investigation reported that infection with a different herpes virus, herpes simplex virus type 1 (HSV1), leads to a similarly increased risk of later developing SD. Furthermore, when the authors looked at patients treated aggressively with antiherpetic medications at the time, the relative risk of SD was reduced by a factor of 10. Here, finally, is the Wales study conclusion:
DISCUSSION Our study shows a clear association of shingles vaccination with reduced risk of dementia [25%-30%] compared to those unvaccinated consistent with other observational cohort studies. The association may reflect selection bias with people choosing to be vaccinated having a higher healthy life expectancy. Schnier, et al
I’ve often wondered how many times such strong conclusive findings must be duplicated before they move on to some other wonderful medical discovery!
II Avoid anticholinergics
Our next preprint also comes out of the UK: “Association between anticholinergic burden (ACB) and dementia in UK Biobank”. Previous investigators emphasized the importance of acetylcholine in brain function:
Cholinergic synapses are ubiquitous in the human central nervous system. Their high density [through many parts of the brain] suggest that cholinergic transmission is likely to be critically important for memory, learning, attention and other higher brain functions. Several lines of research suggest additional roles for cholinergic systems in overall brain homeostasis and plasticity. As such, the brain's cholinergic system occupies a central role in ongoing research related to normal cognition and ageing.
As a result, an easy next-step conclusion would be that regular use of anticholinergic drugs is not a good idea as they block acetylcholine nerve receptors which are crucial to the innervation of the brain. Unfortunately, anticholinergic drugs are high on the list of those meds which are regularly prescribed to old people including overactive bladder pills such as oxybutin, anti-anxiety or antidepressants such as amitryptyline diazepam, and citalopram, anti-histamines, decongestants, or Furosemide to name a few. The ACB (this is an accumulation of anticholinergics as opposed to the occasion use of antihistamines for spring allergies as am example) has been linked to cognitive impairment and dementia.
This preprint study, which is now under review, included data from ~170,000 people. There was a definite association between ongoing use of anticholinergics and dementia and death. The anticholinergics highest in scoring were (in order) anti-depressants, antiepileptics. ‘high ceiling’ diuretics such as furosemide, and anti-reflux. But here, in the conclusion, we run into to the ‘need more studies’ on anticholinergics and aging brains. I vote for watch carefully and take a minimum of those drugs that block the cholinergic synapses. And if you’re vegan or vegetarian, consider using choline supplements.
III Live in a large household
This one’s my favorite, and, although a bit confusing, seems to me to be extremely important in keeping our focus and connection as we age.
Large households/families create more positive psychological well-being and human interaction. These researchers set out to prove the more relatives the merrier, increasing protection against development of dementia and the in-home delivery of more comprehensive healthcare to dementia patients.
This particular study focused on dementia mortality which made their research more difficult as the worldwide mortality rate of dementia is only 26.61 per 100,000. This leaves us wondering if decreased dementia mortality rates in large families are coincident instead of causal. Independent of ageing, urban lifestyle and low socio-economic status, the scientists did find that large households had a significant protective role against dementia mortality in this study. There must be more socialization and camaraderie in having the relatives and the cousins amongst the siblings and parents, but this is increasingly rare in wealthier countries.
But, a moment’s rant about the current state of affairs, this damn pandemic is leaving many of us with few people to talk to face to face. I’m assuming my word-finding troubles are do, in part, to a lack of meaningful conversation. The lead investigator wraps it up as follows:
As part of dementia prevention, healthcare practitioners should encourage people to increase their positive interactions with people from their neighborhood or other fields when large household/family size is impossible to achieve. Wenpeng You, Research Fellow at Adelaide Medical School, The University of Adelaide, Australia
So we are left with a bit of confusion, Wenpeng You went looking for—and found—a correlation between large households and dementia morality, yet encourages human interactions, social engagements, outside the home, and in smaller households. No downside to that recommendation!
IV Repurposed Viagra!
There’s a trend now looking at medications already approved by the FDA for certain clinical situations to see if they might benefit other situations. Several have been repurposed for COVID, and two anti-depressants were found to help rebuild cartilage. A strong advantage with repurposed drugs is that their potential side effects are already known. For now, we’re looking at sildenafil, known as Viagra for erectile dysfunction and Revatio which helps exercise endurance in patients with pulmonary hypertension.
Researchers at the Ohio’s Cleveland Clinic identified drugs with potential as therapy for Alzheimer’s Disease (AD). Their analysis of a large insurance-record database of more than seven million American men found that Viagra may reduce the risk of Alzheimer’s dementia by 69 percent. Lead investigator Cheng and his collaborators found that sildenafil users were notably less likely to develop Alzheimer’s disease than non-sildenafil users after six years of follow-up.
Dr. Cheng also noted that sildenafil reduced the likelihood of Alzheimer’s in individuals with comorbidities such as coronary artery disease, hypertension, and type 2 diabetes, all known to increase the potential risk of AD. A strong asset of Viagra is the increase in blood flow not only to the crotch but also the brain.
While examining brain cells from Alzheimer’s patients in a separate study, Cheng and company found that sildenafil increased brain cell growth and decreased the step called hyperphosphorylation of tau proteins which leads to a neurofibrillary tangled mess, a critical step in the onset of AD. These results gave scientists some biological insights into how the drug may protect the brain.
“Sildenafil, which has been shown to significantly improve cognition and memory in preclinical models, presented as the best drug candidate,” said the study team’s leader, Feixiong Cheng, PhD, of Cleveland Clinic’s Genomic Medicine Institute.
So here’s the inevitable conclusion:
While the study established a link between the drug and preventing Alzheimer’s, the authors stressed that this investigation did not prove that sildenafil actually offers protection or benefit in this regard.
Well phooey.
Thank you, thank you! My sister-in-law said for ten years she was going to get Alzheimer's and she did. I had the first shingles shot. Later they came up with the 2-parter, said the one I'd had wasn't any good. I may not have had chicken pox so do I get the two painful shots? haven't decided. All of this is so helpful, though. My second brother used viagra, stayed sharp till he died (kidney failure). Oldest brother is cheerful, two-second memory. etc. This is much more useful than 'don't have a head injury' which usually starts the tv advice. And it gives me plenty to work with. I'm sure staying calm when forgetting things must be helpful; now I will be. when I remember.
Judy, I loved the last two posts.
I did get the 2 shots for Shingles with no problem at all. Be brave!