Structural Damage To The Brain From High Blood Pressure Demonstrated Among People As Young As 40

Uncontrolled high blood pressure damages the brain's structure and function as early as young middle-age, and even the brains of middle-aged people who clinically would not be considered to have hypertension have evidence of silent structural brain damage, a study led by researchers at UC Davis has found.

The investigation found accelerated brain aging among hypertensive and prehypertensive individuals in their 40s, including damage to the structural integrity of the brain's white matter and the volume of its gray matter, suggesting that vascular brain injury "develops insidiously over the lifetime with discernible effects."

The study is the first to demonstrate that there is structural damage to the brains of adults in young middle age as a result of high blood pressure, the authors said. Structural damage to the brain's white matter caused by high blood pressure previously has been associated with cognitive decline in older individuals.

Published online in the medical journal The Lancet Neurology, the study will appear in print in the December 2012 issue. It emphasizes the need for lifelong attention to vascular risk factors for brain aging, said study senior author Charles DeCarli, professor of neurology and director of the UC Davis Alzheimer's Disease Center.

"The message here is really clear: People can influence their late-life brain health by knowing and treating their blood pressure at a young age, when you wouldn't necessarily be thinking about it," DeCarli said. "The people in our study were cognitively normal, so a lack of symptoms doesn't mean anything."

Normal blood pressure is considered a systolic blood pressure -- the top number -- below 120 and a diastolic pressure -- the bottom number -- below 80. Prehypertensive blood pressure range is a top number between 120 and 139 and a bottom number between 80 and 89. Blood pressures above 140 over 90 are considered high.

Elevated blood pressure affects approximately 50 million Americans and is associated with a 62 percent risk of cerebrovascular disease, such as ischemic stroke, and a 49 percent risk of cardiovascular disease. It is the single-greatest risk factor for mortality in the United States.

Earlier studies have identified associations between elevated blood pressure and a heightened risk of brain injury and atrophy leading to reduced cognitive performance and a greater likelihood of dementia, making hypertension an important, modifiable risk factor for late-life cognitive decline. There is evidence, the study says, that lowering blood pressure among people in middle age and in the young elderly can help prevent late-life cognitive decline and dementia.

Titled "Effects of Systolic Blood Pressure on White Matter Integrity in Young Adults: From the Framingham Heart Study," the research sought to decipher the age of onset, extent and nature of the effects of elevated systolic blood pressure on cognitive decline among participants in the Framingham study, a longitudinal evaluation begun more than 60 years ago of the cardiovascular health of the residents of Framingham, Mass., that is now in its third generation of participants.

The research included 579 Framingham participants who were, on average, 39 years old when recruited for participation in the study, which launched in 2009. Their blood pressure was measured as the average of two physician-recorded blood pressures. The study subjects were organized into groups with normal blood pressure, those who were prehypertensive and those with high blood pressure. Whether they were receiving treatment for high blood pressure and whether they smoked also was noted.

The meticulously conducted study used magnetic resonance imaging (MRI) to determine the participants' brain health using a variety of measurements of white matter injury and gray matter volume. The MRI exams included diffusion tensor imaging, a particular kind of image that reveals microscopic details of tissue architecture within the white matter of the brain. The white matter includes the axons, the biological "wires" of the brain that carry information from one part of the brain to the other. Measurements from diffusion tensor imaging, such as fractional anisotropy, take on larger values if the axons are more intact. White-matter hyperintensities -- white-matter areas that appear intensely white on another kind of MRI scan -- suggest more severe damage than fractional anistropy does, and gray matter density also were examined. The imaging studies then were combined to create a global measurement of brain health that compared normal and hypertensive subjects.

The results were that, in hypertensive individuals, fractional anisotropy in the frontal lobes was reduced by an average of 6.5 percent. The hypertensives also had 9 percent less gray matter, on average, in their brains' frontal and temporal lobes. Hypertensive individuals' brains were significantly less healthy than those of subjects with normal blood pressure. For example, a typical 33-year-old hypertensive's brain health was similar to that of the typical 40-year-old normotensive subject. So, for those 33-year-olds, high blood pressure had prematurely aged the brain by seven or so years.

The authors did not postulate a mechanism for the damage. However, they noted that high blood pressure causes arteries to stiffen, thus making the blood flowing to the brain pulse more strongly. This stresses the blood vessels of the brain, likely making it more difficult for them to nourish brain tissue such as axons.

"This work suggests that recently described white matter microstructural damage associated with high blood pressure in the elderly may be detectable earlier in the life span, further reinforcing the view that vascular brain injury may develop insidiously over several decades," said Pauline Maillard, the study's lead author and a postdoctoral fellow in the UC Davis Department of Neurology. "These results emphasize the need for early and optimum control of blood pressure, which is neither routinely achieved nor subject to testing in randomised controlled clinical trials."


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Source: http://www.medicalnewstoday.com/

Could Alcohol Be Bad for Your Brain?

VANCOUVER, July 18, 2012 – Light to moderate alcohol consumption has generally been considered to have some health benefits, including possibly reducing risk of cognitive decline. However, two studies reported today at the Alzheimer’s Association International Conference^® 2012 (AAIC^® 2012) in Vancouver suggest that moderate alcohol use in late-life, heavier use earlier in life, and “binge” drinking in late-life increase risk of cognitive decline.

“The many dangers of misuse of alcohol, and some of its possible benefits, have been widely reported, and there needs to be further clarification by the scientific community,” said William Thies, PhD, Alzheimer’s Association^® chief medical and scientific officer. “Certainly no one should start drinking in order to reduce Alzheimer’s risk, as these two new reports attest.”
“We need to know more about what factors actually raise and lower risk for cognitive decline and Alzheimer’s disease. To do that, we need longer term studies in larger and more diverse populations, and we need more research funding to make that happen. We have learned incredible amounts about heart disease and stroke risk from long-term research like the Framingham Study – we have solidly proven lifestyle risk factors that people can act on every day. Alzheimer’s now needs its version of that research,” Thies added.

“In 2050, care for people with Alzheimer’s will cost the U.S. more than $1 trillion, creating an enormous strain on the healthcare system, families, and federal and state budgets. Recognizing this growing crisis, the first-ever U.S. National Plan to Address Alzheimer’s was unveiled in May. Now this plan must be swiftly and effectively implemented. We need Congress to support this implementation with an additional $100 million for Alzheimer’s research, education, outreach and community support,” Thies said.

20-year alcohol consumption patterns and cognitive impairment in older women

Whether moderate alcohol consumption has an impact on cognitive impairment in late-life is unsettled with some studies suggesting a protective effect. To date, few studies have examined patterns of alcohol consumption over time in relation to cognitive status, especially in very late-life.
Tina Hoang, MSPH, of NCIRE/The Veterans Health Research Institute, San Francisco and the University of California, San Francisco, and colleagues followed more than 1,300 women aged 65 and older for 20 years. They measured frequency of current and past alcohol use at the beginning, midpoint (years 6 and 8) and late phases (years 10 and 16) of the study. The researchers assessed participants at the end of the study for mild cognitive impairment and dementia. At baseline, 40.6% were nondrinkers, 50.4% were light drinkers (0 to 7 drinks/week), and 9.0% were moderate drinkers (7 to 14 drinks/week). Heavy drinkers (14 drinks/week) were excluded.
The scientists found that:

• Women who reported drinking more in the past than at the beginning of the study were at 30% increased risk of developing cognitive impairment.
• Moderate drinkers at baseline or at midpoint had similar risk of cognitive impairment to non-drinkers; however, moderate drinkers in the late phase of the study were roughly 60% more likely to develop cognitive impairment.
• Women who changed from nondrinking to drinking over the course of the study had a 200% increased risk of cognitive impairment.

“In this group of older women, moderate alcohol consumption was not protective,” Hoang said. “We found that heavier use earlier in life, moderate use in late-life, and transitioning to drinking in late-life were associated with an increased risk of developing cognitive impairment. These findings suggest that alcohol use in late-life may not be beneficial for cognitive function in older women.”
“It may be that the brains of oldest old adults are more vulnerable to the effects of alcohol, but it is also possible that factors associated with changing alcohol use related to coping or loss could be involved. Clinicians should carefully assess their older patients for both how much they drink and any changes in patterns of alcohol use,” Hoang added.

Binge drinking increases risk of cognitive decline in older adults

Little is known about the cognitive effects of heavy episodic (or “binge”) drinking in older people. Binge drinking is a pattern of alcohol consumption in which someone who is not otherwise a heavy drinker consumes several drinks on one occasion.

“We know that binge drinking can be harmful,” said Dr. Iain Lang of Peninsula College of Medicine and Dentistry, University of Exeter, UK. “For example, it can increase the risk of harm to the cardiovascular system, including the chance of developing heart disease, and it is related to increased risk of both intentional and unintentional injuries.”

According to Lang, it is not clear whether binge drinking in older adults has a damaging effect on cognitive health and whether it increases the risk a person will develop dementia.

Lang and colleagues conducted a secondary analysis of data from 5,075 participants aged 65 and older in the Health and Retirement Study (HRS), a biennial, longitudinal, nationally representative survey of U.S. adults age 50 and older, to assess the effects of binge drinking in older people on cognition and mood. Baseline data were collected in 2002 and participants were followed for eight years. Consumption of four or more drinks on one occasion was considered binge drinking. Cognitive function and memory were assessed using the Telephone Interview for Cognitive Status.

Binge drinking once a month or more was reported by 8.3% of men and 1.5% of women; binge drinking twice a month or more was reported by 4.3% of men and 0.5% of women.
The researchers found that:

• Participants who reported heavy episodic drinking once per month were 62% more likely to be in the group experiencing the highest decline in cognitive function, and were 27% more likely to be in the group experiencing the highest amount of memory decline.
• Participants reporting heavy episodic drinking twice per month or more were 147% more likely to be in the group experiencing the highest decline in cognitive function, and were 149% more likely to be in the group experiencing the highest amount of decline in memory.

Outcomes were similar in men and women when analyzed separately.
“In our group of community-dwelling older adults, binge drinking is associated with an increased risk of cognitive decline,” Lang said. “Those who reported binge drinking at least twice a month were more than twice as likely to have the greatest decline in both cognitive function and memory. These differences were present even when we took into account other factors known to be related to cognitive decline such as age and level of education.”

“This research has a number of implications. First, older people – and their physicians should be aware that binge drinking may increase their risk of experiencing cognitive decline and encouraged to change their drinking behaviors accordingly. Second, policymakers and public health specialists should know that binge drinking is not just a problem among adolescents and younger adults; we have to start thinking about older people when we are planning interventions to reduce binge drinking,” Lang added.

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Source: By Dr. Edgerly, research expert - http://www.alzheimersblog.org/

Finding In Home Care

In-home care includes a wide range of services provided in the home, rather than in a hospital or care facility. It can allow a person with Alzheimer’s or other dementia to stay in his or her own home. It also can be of great assistance to caregivers.
Not all in-home services are the same. Some in-home services provide non-medical help, such as assistance with daily living. Other in-home services involve medical care given by a licensed health professional, such as a nurse or physical therapist. Common types of in-home services include:

• Companion services: Help with supervision, recreational activities or visiting.
• Personal care services: Help with bathing, dressing, toileting, eating, exercising or other personal care.
• Homemaker services: Help with housekeeping, shopping or meal preparation.

Skilled care: Help with wound care, injections, physical therapy and other medical needs by a licensed health professional. Often times, a home health care agency coordinates these types of skilled care services once they have been ordered by a physician.
Determining who will provide home care is an important decision. For some, using a home health agency is the best choice. And for others, an individual care provider is a better fit.

The following steps can be helpful when trying to find the right care:

• Create a list of care needs and your expectations for how they will be met.
• Call home care providers and find out what help they offer and if it meets your needs.
• Meet with a prospective provider in your home for an interview; prepare questions beforehand.
• Check references; some agencies may conduct criminal background checks. Ask if these have been conducted.

Questions to Ask Potential In-Home Providers:

• Are you trained in first aid and CPR?
• Do you have experience working with someone with dementia?
• Are you trained in dementia care?
• Are you with an agency? (If important to you)
• Are you bonded (protects clients from potential losses caused by the employee)?
• Are you able to provide references?
• Are you available at the times needed?
• Are you able to provide back-up, if sick?
• Are you able to manage our specific health and behavioral care needs?

Costs for home care services vary depending on many factors, including what services are being provided, where you live, and whether the expenses qualify for Medicare or private insurance coverage.

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Resource from alzheimersblog.org

How to Respond to "I wanna go home"

“I want to go home.” Many caregivers hear this from their loved one even when their loved one is sitting in the living room of the home they have lived in for many years. It also happens when there’s a change in environment or routine.

It’s upsetting to think your loved one no longer recognizes the environment around them, but this is part of the disease. The person may not believe they are in their home because they truly don’t recognize it. Or that person is likely not speaking literally but searching for the feeling of home – a sense of familiarity, security or comfort. So, what do you do in this situation?

As you so often do, you want to connect to the emotions behind the words instead of reorienting them to their place. In other words, “connect, don’t correct.” Validate their emotions and try to meet the emotional need. A hug or hand holding can soothe. Ask them to tell you about home and they may be able to tell you about the feeling of home.

If it’s not upsetting, you can reminisce about home, possibly using photographs in a photo album. If this upsets the person, distract them with a pleasurable activity – a walk, a favorite snack, or listening to music. You might need to make up an excuse as to why they can’t go home – “the house is being painted; we’ll go later” and distract with an activity.

Reassurance and comfort go a long way; let your loved one know they are safe, taken care of and loved.



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Source: http://www.alzheimersblog.org/

45 Life Lessons, written by a 90 year old

45 Life Lessons, written by a 90 year old

1. Life isn’t fair, but it’s still good.
2. When in doubt, just take the next small step.
3. Life is too short not to enjoy it.
4. Your job won’t take care of you when you are sick. Your friends and family will.
5. Don’t buy stuff you don’t need.
6. You don’t have to win every argument. Stay true to yourself.
7. Cry with someone. It’s more healing than crying alone.
8. It’s OK to get angry with God. He can take it.
9. Save for things that matter.
10. When it comes to chocolate, resistance is futile.
11. Make peace with your past so it won’t screw up the present.
12. It’s OK to let your children see you cry.
13. Don’t compare your life to others. You have no idea what their journey is all about.
14. If a relationship has to be a secret, you shouldn’t be in it.
15. Everything can change in the blink of an eye… But don’t worry; God never blinks.
16. Take a deep breath. It calms the mind.
17. Get rid of anything that isn’t useful. Clutter weighs you down in many ways.
18. Whatever doesn’t kill you really does make you stronger.
19. It’s never too late to be happy. But it’s all up to you and no one else.
20. When it comes to going after what you love in life, don’t take no for an answer.
21. Burn the candles, use the nice sheets, wear the fancy lingerie. Don’t save it for a special occasion. Today is special.
22. Overprepare, then go with the flow.
23. Be eccentric now. Don’t wait for old age to wear purple.
24. The most important sex organ is the brain.
25. No one is in charge of your happiness but you.
26. Frame every so-called disaster with these words, ‘In five years, will this matter?’
27. Always choose Life.
28. Forgive but don’t forget.
29. What other people think of you is none of your business.
30. Time heals almost everything. Give Time time.
31. However good or bad a situation is, it will change.
32. Don’t take yourself so seriously. No one else does.
33. Believe in miracles.
34. God loves you because of who God is, not because of anything you did or didn’t do.
35. Don’t audit life. Show up and make the most of it now.
36. Growing old beats the alternative — dying young.
37. Your children get only one childhood.
38. All that truly matters in the end is that you loved.
39. Get outside every day. Miracles are waiting everywhere.
40. If we all threw our problems in a pile and saw everyone else’s, we’d
grab ours back.
41. Envy is a waste of time. Accept what you already have, not what you think you need.
42. The best is yet to come…
43. No matter how you feel, get up, dress up and show up.
44. Yield.
45. Life isn’t tied with a bow, but it’s still a gift.

The Bias of Medical Care Providers towards Aging

Bias Towards Aging Affects the Medical Treatment Seniors Receive

In many cultures in the world, elderly people are revered and their advice is sought and respected. In our culture, the wisdom, the knowledge and the social skills of the elderly are often overlooked and instead we focus on the mental and physical deficits of our older generation.

 

Because of this prevailing attitude, older people in our society are generally regarded as less valuable than younger people. The younger person has responsibilities of raising a family, maintaining a career and supporting the economy. The older person generally has no responsibilities and in addition is a drag on the economy since a great part of the tax base must go towards the support of older Americans.

 

It is inevitable that many medical care providers will unconsciously have this same attitude towards their older patients. As a result, if an older person has a medical complaint and the cause is not readily apparent, a medical practitioner is more likely to accept the condition as a consequence of old age. This attitude causes practitioners to focus treatment on making the elderly more comfortable in their old age as opposed to finding a cure. In younger people, if the medical complaint is interfering with normal daily function, typically a more concerted effort will be made to identify and correct the problem.

 

A 90 year old man meets with his doctor and complains about pain in his right knee. The doctor tells him,

 

"Well Henry, what do you expect? You're 90 years old."

 

Henry replies,

 

"But doctor my left knee is the same age as my right knee, there's no pain and it feels just fine!"

 

Many in the health-care profession consider old age to be a disease itself. Any medical problems are inappropriately attributed to old age as if it were a medical condition. And since there is no cure for old age, appropriate tests and treatment are never performed. Thus, medical problems that may not be related to age and may just as frequently occur in younger people are often not treated. As an example, a recent survey of physicians involved in the health-care of the elderly reported that 35% of the doctors considered hypertension a result of the aging process and that 25% of them felt that treating an 85-year-old for symptoms of hypertension would cause more harm than the benefits it would produce.

 

Consider This Real-Life Example

(courtesy of the National Care Planning Council, www.longtermcarelink.net)

A 71 year old woman has surgery on her shoulder for a bone spur that is causing her considerable pain. The surgery is successful and she goes through several months of physical therapy to help her recover. But she is not recovering as expected. She continues to experience pain that radiates through her entire back. Her physical therapist does not know how to help her and attributes her failure to recover to old age.

 

She visits her family care doctor at least twice over the next six months, complaining of extreme tiredness and lack of energy. He tells her to exercise patience. He tells her that older people generally don't recover as quickly from major surgery as younger people do. She should expect to be tired as surgery can have a major effect on the elderly.

 

Her skin color is gray and she does not look healthy. Finally she visits her doctor once again and insists he check her for some problem since she is not recovering from the surgery and she feels awful.

 

Based on her insistence, he does blood labs and discovers she is severely anemic. He puts her in outpatient care and gives her four units of red blood cells and puts her on iron supplementation. Within two weeks the pain has disappeared and within a month she has recovered fully from the surgery. Numerous tests are done but there is no explanation for the anemia.

 

Six months later she is healthy and active and her cheeks are ruddy. When she asks her doctor why he did not suspect anemia, he tells her that she has never had anemia and based on her history he would never expect her to develop it. He then tells her, in an obvious contradiction of his previous position, that older people sometimes fail to absorb iron.

 

If this had been a young person, the doctor would have likely suspected that something else was wrong and conducted the tests. Because this was an older person, the doctor assumed failure to recover was due to old age.

 

A Holistic Treatment Approach

Most practitioners who specialize in medical care for the elderly are aware of the above-mentioned problems with older patients and they take a holistic approach with the medical treatment of their patients. An attempt is made, not only to treat the specific condition or conditions, but to make sure there is sufficient physical activity, proper nutrition and family support at home. Practitioners work closely with family members to make sure their loved ones are taking medications properly and are reporting their symptoms.

 

Geriatric-oriented practitioners require caregivers to closely monitor health conditions in their loved ones and report any changes before things get worse. These providers also meet with their patients regularly enough to monitor, on their own, their patient's current health.

 

This broad-based approach results in better health, more functionality and fewer visits to the emergency room because intervention for a worsening condition is achieved at an earlier stage.

Recognizing Symptoms of Dementia

The Brown family reunion has always been an event everyone looks forward to. Family visits, games, stories and everyone’s favorite foods are always on the agenda. On the top of the menu is Grandmas Lemon Coconut Cake. Grandma always makes the traditional cake from her old family recipe. This year, however, the cake tasted a little on the salty side, perhaps a half cup full of salty.

Though the family was disappointed over the cake, of more concern was Grandma’s confusion with the recipe and her similar confusion about the loved ones around her. Could something be wrong with grandma’s mental state?

One might say that for an elder person a little forgetfulness or confusion is normal, but when do you know if there is a serious problem, such as dementia?

An online article from FamilyDoctor.org outlines some common symptoms in recognizing dementia.
“Dementia causes many problems for the person who has it and for the person’s family. Many of the problems are caused by memory loss. Some common symptoms of dementia are listed below. Not everyone who has dementia will experience all of these symptoms.

• Recent memory loss. All of us forget things for a while and then remember them later. People who have dementia often forget things, but they never remember them. They might ask you the same question over and over, each time forgetting that you’ve already given them the answer. They won’t even remember that they already asked the question.
• Difficulty performing familiar tasks. People who have dementia might cook a meal but forget to serve it. They might even forget that they cooked it.
• Problems with language. People who have dementia may forget simple words or use the wrong words. This makes it hard to understand what they want.
• Time and place disorientation. People who have dementia may get lost on their own street. They may forget how they got to a certain place and how to get back home.
• Poor judgment. Even a person who
  doesn’t have dementia might get distracted. But people who have dementia can forget simple things, like forgetting to put on a coat before going out in cold weather.
• Problems with abstract thinking. Anybody might have trouble balancing a checkbook, but people who have dementia may forget what the numbers are and what has to be done with them.
• Misplacing things. People who have dementia may put things in the wrong places. They might put an iron in the freezer or a wristwatch in the sugar bowl. Then they can’t find these things later.
• Changes in mood. Everyone is moody at times, but people who have dementia may have fast mood swings, going from calm to tears to anger in a few minutes.
• Personality changes. People who have dementia may have drastic changes in personality. They might become irritable, suspicious or fearful.
• Loss of initiative. People who have dementia may become passive. They might not want to go places or see other people.”

Dementia is caused by change or destruction of brain cells. Often this change is a result of small strokes or blockage of blood cells, severe hypothyroidism or Alzheimer’s disease. There is a continuous decline in ability to perform normal daily activities. Personal care including dressing, bathing, preparing meals and even eating a meal eventually becomes impossible.

What can family members do if they suspect dementia? An appointment with the doctor or geriatric clinic is the first step to take. Depending on the cause and severity of the problem there are some medications that may help slow the process. Your doctor may recommend a care facility that specializes in dementia and Alzheimer’s. These facilities offer a variety of care options from day care with stimulating activities to part or full-time live-in options. Sometimes if patients tend to wander off, a locked facility is needed.

In the beginning family members find part time caregivers for their loved one. At first, loved ones need only a little help with remembering to do daily activities or prepare meals. As dementia progresses, caregiving demands often progress to 24 hour care. Night and day become confused and normal routines of sleeping, eating and functioning become more difficult for the patient. The demented person feels frustrated and may lash out in anger or fear. It is not uncommon for a child or spouse giving the care to quickly become overwhelmed and discouraged.

Family gatherings provide an excellent opportunity to discuss caregiving plans and whole family support. It is most helpful if everyone in the family is united in supporting a family caregiver in some meaningful way.

“The first step to holding a family meeting, and perhaps the most difficult one, is to get all interested persons together in one place at one time. If it’s a family gathering, perhaps a birthday, an anniversary or another special event could be used as a way to get all to meet. Or maybe even a special dinner might be an incentive.

The end of the meeting should consist of asking everyone present to make his or her commitment to support the plan. This might just simply be moral support and agreement to abide by the provisions or it is hoped that those attending will volunteer to do something constructive. This might mean commitments to providing care, transportation, financial support, making legal arrangements or some other tangible support.” The Four Steps of Long Term Care Planning

Professional home care services are an option to help families in the home. These providers are trained and skilled to help with dementia patients. Don’t forget care facilities as well. It may be the best loving care a family member can give is to place their loved one in a facility where that person is safely monitored and cared for.