1 “helping residents stay mentally sharp” lucie b. arbuthnot, ph.d

1

“Helping Residents Stay Mentally Sharp”

Lucie B. Arbuthnot, Ph.D.

2

Did everyone get a handouts?

Can everyone see?

Can everyone hear?

Is everyone comfortable?

3

Outline

• Can we reduce the risk of memory loss and Alzheimer’s disease?

• What’s the connection between Alzheimer’s and other major chronic diseases, like:

- Heart disease- Stroke- Diabetes- Cancer

• Do daily crossword puzzles help the brain? What about computer games?

4

¿ Questions ?

How many of you serve residents:

• Who show signs of memory loss?

• Who may struggle to find a name or a word?

• Who are worried that it might be something serious, like Alzheimer’s disease?

4

5

¿ Questions ?

How many of you ever:

• Show signs of memory loss ~ like forgetting where you put your keys or your glasses?

• May struggle to find a name or a word?

• Are sometimes worried that it might be more serious, like Alzheimer’s disease?

5

6

The truth is, we’re in this together

MetLife Foundation Alzheimer’s Survey: What America Thinks (May 2006). Used by permission. http://www.metlife.com/WPSAssets/20538296421147208330V1FAlzheimersSurvey.pdf

Adults aged 55+ fear getting Alzheimer’s even more than cancer.

7

MetLife Foundation Alzheimer’s Survey: What America Thinks (May 2006). Used by permission. http://www.metlife.com/WPSAssets/20538296421147208330V1FAlzheimersSurvey.pdf

Is it possible to lower the risk of memory loss and Alzheimer’s disease?

What do we mean by “lower the risk”?

• Non-smokers have a 10-20 times lower risk of getting lung cancer, compared to smokers.

• Still, despite the lower risk, some non-smokers still do get lung cancer (Dana Reeve, Beverly Sills).

• But 10-20 times fewer get lung cancer.

8

Two key strategies lower the risk of memory loss and Alzheimer’s disease

1.Lifestyle strategies

• Keeping mentally active.

• Staying physically active.

• Eating a healthy diet.

9

2. Medical strategiesMaintaining healthy levels of:

• Blood pressure

• Cholesterol

• Blood sugar (reducing diabetes)

• Body weight

10

11

And it must be a two-pronged approach

Both

1. Lifestyle strategies

and

2. Medical strategies

Let’s look at each in turn.

1. Lifestyle strategies

• Keeping mentally active.

• Staying physically active.

• Eating a healthy diet.

12

Keeping mentally active

• Early studies in the 1990’s focused on the role of education.

• They found that people with higher levels of education had lower levels of Alzheimer’s disease.

• Filley CM, Cullum CM. (1997). Education and cognitive function in Alzheimer's disease. Neuropsychiatry Neuropsychol Behav Neurol. Jan;10(1):48-51.

• Evans DA, et al. (1997). Education and other measures of socioeconomic status and risk of incident Alzheimer disease in a defined population of older persons. Arch Neurol. Nov; 54(11):1399-405.

• Cobb JL, et al. (1995). The effect of education on the incidence of dementia and Alzheimer's disease in the Framingham Study. Neurology. Sep;45(9):1707-12.

• Orrell M, Sahakian B. (1995). Education and dementia. BMJ. Apr 15;310(6985):951-2.13

Recent studies confirm this connection

• Why? Researchers hypothesize that people with higher levels of education have developed a lifelong habit of exercising their brains.

• And they usually don’t stop mental activity just because they grow old ~ and perhaps move into our facilities.

• Gatz M et al. (2007). Lifestyle risk and delaying factors. Alzheimer’s Dis Assoc Disord. 20 (3 Suppl 2):S84-8.• McDowell I et al (2007). Mapping the connections between education and dementia. J Clin Exp Neuropsychol

29(2):127-41.

14

15

But it’s not just formal education

• Research studies show that mentally stimulating leisure activities may also cut the risk of Alzheimer’s by as much as half.

• For example, many studies show that leisure activities in middle age reduce the risk of developing Alzheimer’s disease in later years.

• Fratiglioni L et al. (2007). Prevention of Alzheimer's disease and dementia. Major findings from the Kungsholmen Project. Physiol Behav 92(1-2):98-104.

• Fratiglioni L et al. (2004). An active and socially integrated lifestyle in late life might protect against dementia. Lancet Neurology, 3(6):343-53.

• Verghese J et al. (2003). Leisure Activities and the Risk of Dementia in the Elderly. New England Journal of Medicine, 348:2508-16.

• Fabrigoule C (2002). Do leisure activities protect against Alzheimer's disease? Lancet Neurol. 1(1):11.• Scarmeas N et al. (2001). Influence of leisure activity on the incidence of Alzheimer's disease. Neurology, 57(12):2236-42.

15

16

Singing Running a club

Reading Getting involved in politics

Participating in religious activities

Going to movies or restaurants

Listening to music Traveling

Gardening Playing an instrument

Visiting with friends and relatives

Keeping mentally active at work

Going to the theater, museums, concerts

Doing do-it-yourself projects

Walking for pleasure Watching less TV

Playing board / card games Volunteering

Some examples

What about the elderlyA 2007 study found that mentally active seniors, average age 80, were 2.6 times less likely to develop Alzheimer’s than those who were not. Mental activities included:- Reading books, newspapers, magazines- Visiting a library or a museum- Attending a play, concert, musical- Writing letters.

17Wilson RS et al. (2007). The relation of cognitive activity to risk of developing Alzheimer's disease. Neurology [epub ahead of print]

Where are the crossword puzzles and computer games?

As Jeff Victoroff, MD, writes:

“Any kind of active, deliberate learning seems to challenge the nervous system in uniquely fruitful ways.

But it will have this effect only if it is exciting enough, and pleasing enough, to keep us motivated and engaged on an ongoing basis. …

18

19

… The real answer is to live life to its fullest – not merely watch television and wait for cataracts to blur the image.”

Jeff Victoroff, MD. Saving Your Brain. New York: Bantam Books, 2002.

19

What about computer games?Some familiar names (alphabetically):• Brain Age (Nintendo, Japan)• Brain Builder.com (Advanced Brain

Technologies, UT)• Brain Fitness (Posit Science, CA)• Happy Neuron (Quixit , France)• MindFit (CogniFit, Israel)• MyBrainTrainer.comGreene, Kelly (2007). Putting Brain Exercises to the Test. Wall Street Journal Feb. 3, 2007, pg R1.

20

Computer games?

• Computer games may improve specific skills involved in a game.

• But there is little evidence that playing computer games improves other skills, or reduces the risk of memory loss or Alzheimer’s disease.

21

Activities that do show benefitsActivities that have shown cognitive benefits tend to be:– Fun– Failure free–Ongoing.

If your residents love doing crossword puzzles or playing computer games, and do them a lot, they may be beneficial.

22

Otherwise, just remember…

“Any kind of active, deliberate learning seems to challenge the nervous system in uniquely fruitful ways.

But it will have this effect only if it is exciting enough, and pleasing enough, to keep us motivated and engaged on an ongoing basis.”

Jeff Victoroff, MD

23

24

So far we’ve looked at the benefits of

1. Lifestyle strategies

• Keeping mentally active.

• Staying physically active.

• Eating a healthy diet.

24

Next we turn to

1. Lifestyle strategies

• Keeping mentally active.

• Staying physically active.

• Eating a healthy diet.

25

Leisure physical activity• Studies show that leisure physical activity

in middle age reduces the risk of memory loss and Alzheimer’s disease in old age.

• For example, a 2005 study found that middle-aged people who engaged in leisure physical activity at least twice a week were half as likely to develop Alzheimer’s 21 years later.

• Rovio S, Winblad B, Kivipelto M et al. (2005). Leisure-time physical activity at midlife and the risk of dementia and Alzheimer's disease. Lancet Neurology 4(11):705-11.

26

But not work-related physical activity

• When the same research team explored work-related physical activity – commuting to work or at work – there was no decrease in memory loss or Alzheimer’s disease 21 years later.

• Rovio S, Winblad B, Kivipelto M, et al. (2007). Work-related physical activity and the risk of dementia and Alzheimer's disease. Int J Geriatr Psychiatry 22(9):874-82.

27

28

Leisure physical activity in older age

In a 2006 study of seniors over 65:

• Seniors who engaged in 15-minute sessions of low-impact physical activity at least 3 times a week reduced their risk of Alzheimer’s by 40%.

• And they weren’t running marathons.

28

• Walking • Hiking

• Aerobics • Calisthenics

• Swimming • Water aerobics

• Stretching • Weight training

Larson EB (2006). Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Annals of Internal Medicine 144(2):73-81.

Our last lifestyle strategy

1. Lifestyle strategies

• Keeping mentally active.

• Staying physically active.

• Eating a healthy diet.

29

30

Eat a healthy diet

• Studies of individual foods ~ blueberries, green leafy vegetables, fish ~ have shown mixed results.

• But 2006 studies found that a whole diet ~ the so-called “Mediterranean-style” diet ~ could cut the risk of Alzheimer’s disease by more than half.

Scarmeas N et al. (2006). Mediterranean diet and risk for Alzheimer's disease. Ann Neurology, June; 59(6):912-21.Scarmeas N et al. (2006). Mediterranean Diet, Alzheimer Disease, and Vascular Mediation. Arch Neurol. 63(12):1709-17

Oldways Preservation Trust Mediterranean Diet Pyramid. http://www.oldwayspt.org/ Used by permission

30

31

What is a “Mediterranean-style" diet?

High in

Moderateamounts of

Low in

• Fruits and vegetables • Cereals• Legumes and nuts• Olive oil the primary fat

• Fish: 2 - 3 times a week• Poultry, eggs• Wine• Dairy: especially cheese & yogurt

• Meat & meat products31

32

Could it be the wine?• Several studies have shown that moderate

alcohol consumption (1 drink per day for women, 2 for men) lowers the risk of cognitive decline and Alzheimer’s compared to: Abstainers (teetotalers) People drinking more than a moderate

amount.

• There are similar benefits of moderate alcohol consumption for the risk of heart disease and stroke.

• Solfrizzi, V. Alcohol consumption, mild cognitive impairment, and the progression to dementia. Neurology, May 22, 2007; vol 68: pp 1790-1799.

• Stampfer, MJ, Kang JH, Chen J, Cherry R, Grodstein F. (2005). Effects of Moderate Alcohol Consumption on Cognitive Function in Women. New England Journal of Medicine 352:245-53.

32

33

Caveat “If I don’t drink now, should I start?”

• Moderate alcohol consumption may have health benefits for reducing the risk of major chronic diseases such as heart disease and stroke.

• However, more than one drink per day increases both physical and mental health risks.

• “So if you don’t drink now, don’t start,” is the standard advice.

33

34

What about nutritional supplements (ginkgo biloba, vitamins, etc.)?

• Long-term studies in the are on-going, and mostly negative, but the verdict is still out.

• As Dr. Michael K. McCloud, MD, writes: “Spend the money saved [on nutritional

supplements] on fruits and vegetable and walking shoes.”

Northern California Alzheimer’s AssociationFall 2003 Newsletter.

34

Remember, it’s a two-pronged approach

Both

1. Lifestyle strategies

and

2. Medical strategies

2. Medical strategies

We also must maintain healthy levels of:• Blood pressure• Cholesterol• Blood sugar (reducing diabetes)• Body weight

36

37

In a 30-year study of 8,000 HMO patients

These conditions in middle age increased the risk of dementia 30 years later, at age 70-75:

• 75% increase for midlife obesity (BMI over 30).• 46% for midlife diabetes.• 42% for midlife high cholesterol.• 35% for midlife overweight (BMI 25-30).• 26% for those who had ever smoked.• 24% for those with midlife high blood pressure.Whitmer, R. et al. (2005). Midlife cardiovascular risk factors and risk of dementia in late life Neurology, January 2005; vol

64: pp 277-281.

Whitmer, R. et al (2005). Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study. British Medical Journal, 11;330(7504):1360.

38

2006 - 2007 confirmation • In recent studies, patients with the metabolic

syndrome also had 2-3 times the rate of Alzheimer’s disease.

• The metabolic syndrome exists when three or more of these risk factors are present:– High blood pressure – High cholesterol– High blood sugar– Waist circumference greater than 40 inches for men, 35

inches for womenRazay G, Vreugdenhil A, Wilcock G. (2007). The metabolic syndrome and Alzheimer disease. Archives of Neurology,Jan;64(1):93-

6.Vanhanen M et al. (2006). Association of metabolic syndrome with Alzheimer disease: a population-based study. Neurology.

Sep 12;67(5):843-7.

What other major chronic diseases are affected by the metabolic syndrome?

• High blood pressure?

• High cholesterol?

• High blood sugar?

• Large waist circumference?

39

This year’s major news

• “Growing evidence supports a strong and likely causal association between cardiovascular disease and its risk factors [high blood pressure, cholesterol, diabetes, obesity], with incidence of cognitive decline and Alzheimer’s disease.” Meir J. Stampfer, MD

Stampfer MJ (2006). Cardiovascular disease and Alzheimer’s disease: Common links. Journal of Internal Medicine. 260:211-223

40

41

In other words

• By taking steps to reduce memory loss and Alzheimer’s disease, we also reduce our risk of other major killers, including: heart disease stroke diabetes (and some forms of cancer).

41

42

It’s a win-win situation

Reducing the risk of memory loss and Alzheimer’s disease also reduces the risk of other major causes of death and disability.

43

The “David and Goliath” story

43

So why focus on memory loss and Alzheimer’s disease?

44

MetLife Foundation Alzheimer’s Survey: What America Thinks (May 2006). Used by permission. http://www.metlife.com/WPSAssets/20538296421147208330V1FAlzheimersSurvey.pdf

45

Common strategies to tackle major chronic diseases

Alzheimer’s Heart / Stroke Diabetes Cancer / COPD

Keep mentally active

Don’t smoke Don’t smoke Don’t smoke

Stay physically active

Stay physically active

Stay physically active

Stay physically active

Eat a healthy diet

Eat a healthy diet

Eat a healthy diet

Eat a healthy diet

Monitor:

• Diabetes

• Obesity

• Cholesterol

• Hypertension

Monitor:

• Diabetes

• Obesity

• Cholesterol

• Hypertension

Monitor:

• Diabetes

• Obesity

• Cholesterol

• Hypertension

Monitor cancer risks for:

• colon & skin

• breast ♀

• prostate ♂

• others 45

What about residents in Alzheimer's / memory units?

• Are the same strategies relevant to them?

1. Lifestyle strategies

• Keep mentally active.

• Stay physically active.

• Eat a healthy diet.

2. Medical strategies

Maintain healthy levels of:• Blood pressure• Cholesterol• Blood sugar (reduce

diabetes)• Body weight

How can we help our residents stay mentally sharp?

Offer informational talks from:• A local geriatrician or research scientist

• Your regional Alzheimer’s Association (“Maintain Your Brain” program)

• Your local AARP chapter

Share p. 2 of this handout with them.

47

For severely cognitively impaired residents

Provide• fun• failure-free• ongoing activities • that are integrated into activities of daily

living• and are related to their own life stories.

48

Research does not stand still for long

• [Editorial]. Estrogen helps to protect memory into old age. The Lancet, Jan. 3, 1998.

• Larkin, M. Estrogen fails to halt Alzheimer's disease progression, The Lancet, Feb. 26, 2000.

49

TV News Offers Fuzzy Picture on Health

Most local reports left out important information By Robert Preidt

WEDNESDAY, March 8 (HealthDay News) -- Local TV newscasts across the United States present lots of medical stories and health information, but don't always do it well, new research suggests.

• Researchers from the University of Michigan and the University of Wisconsin-Madison concluded that there's room for improvement by both TV stations and health experts who appear in medical/health-related news stories.

• Over a one-month period, health and medical stories comprised 11 percent of the news portion of late-evening newscasts. There were 1,799 medical and health stories carried on 2,795 news broadcasts aired on 122 stations in the top 50 media markets in the United States, the study said.

• The average medical/health story was 33 seconds long. Most of the stories did not provide specifics about the source of information for the report. The study also found that stories about specific diseases often failed to offer viewers recommendations or information about the prevalence of the disease -- something that could help viewers put the item into perspective with other health issues.

• The study, published in the March issue of the American Journal of Managed Care, also found errors that could lead to serious consequences.

• For example, several stations aired items on lemon juice's effect on sperm and speculated on, or presented as fact, the use of lemon as a contraceptive and it's potential to prevent sexual transmission of HIV, the virus that causes AIDS.

• Nearly all the stories failed to mention that this was a laboratory study that had not involved humans. One story misinterpreted the research altogether and reported that lemon juice may be a substitute for "costly" HIV medications.

Copyright © 2006 ScoutNews LLC. All rights reserved.

National Institutes of Health, March 8, 2006

50

51

Keeping abreast of the research

• Alzheimer’s Association alz.org

• AARP aarp.org

• Mayo Clinic MayoClinic.com

• NIH medlineplus.gov/

• National Library of Medicine pubmed.gov • Nelson & Gilbert, Achieving Optimal Memory, NY:

McGraw-Hill, 2005.

52

Outline

• Can we help residents reduce the risk of memory loss and Alzheimer’s disease?

• Is there a connection between Alzheimer’s and other major chronic diseases, like:

- Heart disease?- Stroke?- Diabetes?- Cancer?

• Do daily crossword puzzles help the brain? What about computer games?

53

Thank you!Questions?

Comments?

Lucie B. Arbuthnot, Ph.D.

54

“Helping Residents Stay Mentally Sharp”

1. Lifestyle strategies

• Keep mentally active.

• Stay physically active.

• Eat a healthy diet.

2. Medical strategies

Maintain healthy levels of:• Blood pressure• Cholesterol• Blood sugar (reduce

diabetes)• Body weight

Lucie B. Arbuthnot, Ph.D.