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Don’t forget to floss: the science behind dementia and the four things you should do to prevent it | Science

The idea was simple. Recruit hundreds of people in their 80s and 90s, equip them with fitness trackers, and monitor their physical activity. Then, when the participants died, collect their brains and examine the tissue. Is there evidence, lurking in the tissue, that exercise benefits the brain?

The results, from a 2022 collaboration between the University of California in San Francisco and the University of British Columbia, were striking. Physical exercise, late in life, seemed to protect the ageing connections between brain cells – the synapses where memories are made. The work, if backed up by further studies, could see exercise, and potentially drugs that mimic biochemical aspects of activity – prescribed to help slow the onset of dementia.

“We know there is a 30{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}-80{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} reduced risk of dementia in people who exercise,” says Kaitlin Casaletto, the lead author on the study and an assistant professor in neurology at UCSF. “My question was, wouldn’t it be cool if we could figure out exactly how this is happening? If we could identify some of the mechanisms of exercise for brain health? These are potential therapeutic targets we can bottle.”

A small mountain of work has linked physical exercise to better brain health and lower risk of dementia in older age. One recent study of nearly 80,000 people in the UK found that the risk of dementia was halved in people who reached the goal of 10,000 steps a day. But much is still unclear. Part of the observed benefit could be down to people with healthier brains simply exercising more. While there are definite benefits to be had from exercise – greater blood flow to the brain, better cardiovascular health, lower blood pressure, less obesity and diabetes – there is still plenty to nail down.

Dementia is the number one killer in the UK, with the disorder affecting about 900,000 people. Most cases, about two-thirds, are driven by Alzheimer’s disease, but it is far from the only cause. Other forms, namely vascular dementia, dementia with Lewy bodies, and frontotemporal dementia, arise from other processes. Whatever the cause, the steady destruction of brain cells erodes memory, thinking, movement and personality. In old age, dementia can be several of these conditions at once.

Some of the highest rates of dementia are found in developed countries with older populations. In Germany, Italy and Japan, more than 20 in every 1,000 people have dementia compared with fewer than nine per 1,000 in proportionally younger countries including Mexico, Turkey and South Africa. The UK sits in the middle. Indigenous groups in the Amazon have some of the lowest rates. In one recent study, researchers confirmed only six cases among 604 Bolivian Tsimane and Moseten people aged 60 and over, suggesting that lifelong physical activity and healthier preindustrial diets substantially reduce the risk. Over the next three decades, global dementia is due to rise substantially, particularly in north Africa, the Middle East and eastern sub-Saharan Africa, where population growth and ageing will be among the driving forces.

But dementia is not inevitable, nor is it the reward for dodging other fatal conditions. Take all of the risk factors that we as individuals, or nations through their policies, might improve, and potentially 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of cases could be prevented or delayed. We would not eradicate dementia, and many people who did everything to keep their brains healthy would still succumb to the disease. We could, however, dramatically reduce the risk, meaning more years of sound thinking, intact memories and independent living. “That figure, 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}, is an enormous percentage,” says James Rowe, professor of cognitive neurology at the University of Cambridge. “If we had a drug that could cut dementia by 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}, it would be a phenomenal success.”

Our brains change even with healthy ageing. People vary tremendously, but vocabulary often improves past retirement age, while processing speed, the ease of learning new information, cognitive flexibility, and working memory – for example, how many digits of a phone number you can remember – weaken. Learning more slowly in older age is often framed as a negative, but it has its advantages. Young people know so little that learning everything fast makes sense. But older people weigh new information against a lifetime’s learning. Does it fit with what I know to be true? Is it reliable? Does it deserve to be learned? “When you are born, you are fast but know little. When you are old, you are slower but knowledgeable. Which is better? It depends on the situation,” says Rowe.

Dementia is very different to healthy ageing. It is what happens when brain cells are destroyed by disease. A healthy older person can expect a gradual decline in memory and thinking skills, but people with dementia can develop profound problems with memory, judgment, language, concentration and personality. The sharp decline in performance is mirrored by a pronounced shrinkage of the brain.

Last year, researchers at the universities of Cambridge and Pennsylvania stitched together 125,000 brain scans to reveal how the human brain changes from a 15-week-old foetus to a 100-year-old adult. The work was a tour de force. Ultimately, it should allow doctors to assess how a person’s brain is ageing over their lifetime, much as paediatric growth charts allow them to check whether children are developing normally. For example, a person’s brain might be in the 50th centile at age 45, but if it falls significantly on subsequent scans there may be a problem. The researchers already see stark shifts in scans from people diagnosed with Alzheimer’s. “We see those individuals crashing through the centiles,” says Richard Bethlehem, an assistant professor in neuroinformatics at Cambridge.

Because dementia is seen as a problem of old age, this might seem like the time to act. But ageing is a lifelong process: the better the brain ages, the better it can stave off or withstand dementia. “A lot of the seeds of poor brain health, including dementia, are sown well and truly in childhood and then built on through early adult life and middle age,” says Rowe. “The state of our brain health in late life, when we are conventionally worried about dementia, depends on a whole lifespan of lifestyle and activities.”

In 2020, 28 world leading experts published a major report called the Lancet Commission on dementia. It identifies a dozen “potentially modifiable” factors that affect our risk of developing dementia. Which matters most depends on age. In youth, a good education makes an enormous difference, and benefits brain health for the rest of life. In midlife, not boozing too heavily and controlling blood pressure all come into play. In later life, not smoking, exercising regularly and keeping socially engaged stand out.

How these help to prevent dementia is not always straightforward. A good education doesn’t happen in a vacuum. It can reflect a child’s circumstances: their home environment, household income and expectations all play a part in sculpting the brain. Armed with a good education, people are better equipped to look after themselves. But education seems to act directly on the brain too, creating what researchers call cognitive reserve and resilience. Build up brain capacity early in life and that reserve becomes a shield against future damage. Likewise, education boosts resilience, the brain’s ability to compensate when diseases like Alzheimer’s arise. The impact can be striking. “For people with a very high education, when you look at the brain postmortem, they can have a lot of neuropathology without having had any symptoms,” says Gill Livingston, professor of psychiatry of older people at University College London and lead author of the Lancet report. In short, the disease is there, but the brain can withstand it, at least to the point that obvious symptoms never manifest.

According to the Lancet Commission, poor education accounts for 7{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of dementia worldwide. But the benefits of stretching one’s brain don’t end in youth. People who do cognitively challenging jobs have a lower risk of dementia, too, regardless of their education. As the Lancet report puts it: “The use it or lose it hypothesis suggests that mental activity, in general, might improve cognitive function.” The impact of other brain-stretching activities is far from clear, however. Despite a flurry of brain training programmes being developed to boost cognitive skills, there is no good evidence that people improve at anything apart from the particular task they practise.

One message that runs through all the research on dementia prevention is that a healthy lifestyle helps. Diet is important: you cannot grow a good brain without good nutrition, and a healthy diet helps to maintain it. A recent meta-analysis of studies, involving nearly 35,000 people, found that strict adherence to the Mediterranean diet was associated with a 21{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} lower risk of cognitive disorders and a 40{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} lower risk of Alzheimer’s. Whether specific nutrients and compounds are directly beneficial to the brain is the focus of intensive research, but healthy diets are encouraged regardless, because they reduce risks caused by other disorders, such as high blood pressure, poor vascular health, obesity and diabetes.

Which single intervention could reduce dementia risk the most? The answer is one that even some researchers find surprising: preventing hearing loss. Globally, hearing impairment is believed to account for about 8{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of dementia. Hearing loss means less stimulation for the brain, but also more social isolation for the individual. The brain appears to shrink more rapidly, or at least the temporal lobes, which focus on sound processing, emotions and memories. What’s striking is that the link between hearing loss and dementia is all but absent if people wear hearing aids. Livingston believes this is a huge opportunity. While people with poor eyesight tend to have it corrected, a large proportion of those who cannot hear well either think other people mumble, or are reluctant to wear a hearing aid. Correcting hearing loss as well as we correct poor sight could be a gamechanger, if enacted globally. “I think wearing a hearing aid is still stigmatised,” Livingston says, but she wonders, with more and more people now wearing earbuds, whether that barrier will soon fall too.

The picture emerging from decades of research is that the best protection against dementia comes from building a good brain, keeping it healthy and active, and avoiding too much damage. The latter can happen in seconds or years. Brain injuries, from traffic accidents, military service, falls, or impacts during sports such as boxing, rugby and horse riding, all increase the risk of dementia. So does the sustained damage that comes with smoking, air pollution and excessive alcohol intake – over 21 units a week. Brain injuries are thought to account for about 3{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of dementia, with heavy drinking and smoking making up 1{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} and 5{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} respectively. Air pollution accounts for around 1{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of dementia.

As might be expected, some experts in the field already take steps to reduce their risk. Because it is unclear which exercises are most protective, Dr Casaletto does weekly yoga, but she also jogs and includes high-intensity sprints in her routine. She eats healthily, maximising the vegetables, whole grains, olive oil, fish and legumes of the Mediterranean diet. Then there is the cognitive component. She tries to stay socially and mentally curious – pushing herself at work, broadening her collaborations, and hanging out with people she wouldn’t normally socialise with. “I think novelty is really important,” she says. “If we are doing the same thing over and over, we are not going to be pushing our brains into forming new connections.”

As part of her own risk-reducing lifestyle, Prof Livingston lifts weights and tries to reach 10,000 steps a day, even though she acknowledges it is “not a magic number”. She reads and writes. And she is wary of the impact of giving up work. “I can see that not being retired keeps you so much more active in lots of ways,” she says. “It might make me less likely to retire. Though I do hope that if I get to the stage when I ought to because I can’t function, that my colleagues will tactfully let me know.”

Four changes to make now

Dementia research, like all research, comes with caveats. Most studies cannot prove that doing X instead of Y helps fend off dementia. More commonly, scientists find associations, such as older people who exercise develop less dementia. But there is always the risk of reverse causation. What if people prone to dementia simply exercise less? Whether, and to what extent, exercise protects people’s brains can take some unpicking. The bottom line on whether this or that action keeps dementia at bay is rarely clear cut. Often the picture emerges with time, as evidence builds from different directions. But these are some things that you can do to help reduce the risk.

Get sweaty

Exerciser with a brain — Illustration: Fran Pulido/The Guardian

Keeping physically active matters. By combining the results from multiple studies, scientists find have found time and again that dementia and Alzheimer’s are less common in people who exercise. Sustained exercise in midlife, and possibly later life, appears to protect against dementia. A mix of aerobic exercise and strength training seems most effective. For aerobic exercise, breaking into a sweat at least once a week or doing more than 150 minutes of moderate to vigorous exercise each week have both been shown to be protective. How exercise helps is a focus of ongoing research, but at the least, it can reduce the risk of obesity and diabetes while boosting cardiovascular fitness, all of which lower dementia risk. Other gains can be had from quitting smoking and not drinking too much alcohol.

Use a hearing aid (if you need one)

Woman wearing hearing aid with friend — Illustration: Fran Pulido/The Guardian

Less intuitive than mental and physical fitness is the impact of hearing loss. Poor hearing in middle age is thought to be one of the most significant drivers of dementia that people can act on. The mechanisms are still being teased out, but brain scans have linked poor hearing to faster brain shrinkage, itself a driver of dementia. Hearing loss also drives up social isolation, which compounds the problem, as people withdraw from social gatherings and the conversations they entail. But there is good news emerging: the marked declines seen in people with hearing impairments are not as dramatic in people who wear hearing aids, suggesting that correcting the problem can help keep dementia at bay.

Keep on learning

stimulated brain — Illustration: Fran Pulido/The Guardian

A good chunk of people’s resilience to dementia comes from early life education. But even after school or university, keeping the brain mentally engaged matters. It is important for the brain to be making new connections. This means challenging yourself mentally, setting your brain to work on varied, unfamiliar and cognitively complex issues. A mentally challenging job may help, but so should lifelong learning, engaging hobbies and keeping socially active, especially if you mixing with people you wouldn’t normally hang out with. Being more sociable in your 50s and 60s is linked to better cognitive performance and a lower risk of dementia later in life, perhaps because it gets people using their memory and language skills. Keeping the brain active builds “cognitive reserve”, researchers say, meaning the brain is better able to cope as the pathologies that drive dementia take hold.

Prioritise dental hygiene

Toothbrush — Illustration: Fran Pulido/The Guardian

One of the more speculative ideas on how to reduce dementia risk comes from research into bugs in the mouth. A recent study in the US found that people with gum disease and mouth infections were more likely to develop Alzheimer’s, the most common cause of dementia. Work is now under way to check whether bacteria such as Porphyromonas gingivalis help drive the condition, or simply proliferate in people in the early stages of dementia. If bacteria raise the risk, there will be even more reason to properly brush and floss twice a day.

Seven Healthy Habits To Reduce the Risk of Dementia

New research spanning two decades has found that following seven healthy habits and lifestyle factors, known as the American Heart Association’s Life’s Simple 7, may lower the risk of dementia in women. These factors include being active, eating better, maintaining a healthy weight, not smoking, maintaining healthy blood pressure, controlling cholesterol, and having low blood sugar.

New research that followed female participants for two decades has found that seven healthy habits and lifestyle factors may play a role in lowering the risk of dementia. The preliminary study released on February 27, 2023, will be presented at the American Academy of Neurology’s 75^th Annual Meeting being held in person in Boston and live online from April 22-27, 2023.

The seven cardiovascular and brain health factors, known as the American Heart Association’s Life’s Simple 7, are: being active, eating better, maintaining a healthy weight, not smoking, maintaining a healthy blood pressure, controlling cholesterol, and having low blood sugar.

“Since we now know that dementia can begin in the brain decades before diagnosis, it’s important that we learn more about how your habits in middle age can affect your risk of dementia in old age,” said Pamela Rist, ScD, of Brigham and Women’s Hospital in Boston, Massachusetts, and a member of the American Academy of Neurology. “The good news is that making healthy lifestyle choices in middle age may lead to a decreased risk of dementia later in life.”

The American Heart Association’s Life’s Simple 7 is a set of health goals designed to help people improve their overall health and reduce their risk of heart disease, stroke, and other chronic conditions. These seven goals include:

Manage blood pressure: Keeping your blood pressure within a healthy range can reduce your risk of heart disease and stroke.
Control cholesterol: High levels of cholesterol in the blood can increase your risk of heart disease.
Reduce blood sugar: High blood sugar levels can increase your risk of developing type 2 diabetes and other chronic conditions.
Get active: Regular physical activity can improve your overall health and reduce your risk of chronic conditions.
Eat better: A healthy diet can reduce your risk of chronic conditions and improve your overall health.
Lose weight: Maintaining a healthy weight can reduce your risk of chronic conditions and improve your overall health.
Stop smoking: Quitting smoking can reduce your risk of heart disease, stroke, and other chronic conditions.

By focusing on these seven goals, individuals can make positive lifestyle changes that can lead to better health outcomes and a lower risk of chronic conditions.

The study involved 13,720 female participants with an average age of 54 at the start of the study.

After 20 years of follow-up, researchers looked at Medicare data to identify those who had been diagnosed with dementia.

Of the participants, 1,771, or 13{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}, developed dementia.

For each of the seven health factors, participants were given a score of zero for poor or intermediate health and one point for ideal health, for a total possible score of 7. The average score was 4.3 at the start of the study and 4.2 10 years later.

After adjusting for factors like age and education, researchers found that for every increase of one point in the score, a participant’s risk of dementia decreased by 6{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}.

“It can be empowering for people to know that by taking steps such as exercising for half an hour a day or keeping their blood pressure under control, they can reduce their risk of dementia,” Rist added.

A limitation of the study was that researchers were unable to look at how changes in factors such as quitting smoking influenced the risk of dementia later in life.

The study was supported by the National Institutes of Health.

How ‘Simple 7’ Lifestyle Habits Can Lower Women’s Dementia Risk

Women make up about two-thirds of the people who have dementia.
Researchers say women can lower their risk for the disease by adopting 7 healthy lifestyle habits recommended by the American Heart Association.
The daily habits include being active, having a balanced diet, and maintaining healthy blood pressure.

Women who follow seven healthy habits might lower their risk of developing dementia, according to new research presented at the American Academy of Neurology’s 75^th Annual Meeting this week.

In their study, researchers followed 13,720 women for 20 years to analyze their risk of developing dementia. They examined Medicare claims at the end of the study to determine who received a diagnosis.

The women received a score for seven health factors, with 0 corresponding to “poor” and 7 as “excellent.” The average score at the beginning of the study was 4.3. At the 10-year follow-up, it was 4.2.

At the 20-year follow-up, 1,771 women had been diagnosed with dementia.

After adjusting for factors such as age and education, the researchers found that for every increase of one point in overall score, the participant’s risk of dementia decreased by 6{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f}.

One limitation of the study is that researchers did not receive information that allowed them to see how changes in healthy habits, such as quitting smoking, influenced the risk of dementia.

The findings also have not been published yet in a peer-reviewed journal.

The researchers used the American Heart Association’s “Life’s Simple 7” lifestyle habits for their study.

Those seven factors are:

“The good news is, this isn’t an all-or-nothing situation,” said Dr. Joel Salinas, a behavioral neurologist and researcher at NYU Langone Health and chief medical officer at Isaac Health in New York.

“You don’t need to be the healthiest person. Even if people have a good score in one or two areas, they are receiving some benefit. Any improvements incrementally improve your long-term health,” he told Healthline.

“If you change your habits, you will receive some health benefits. The earlier you make those changes,” Salinas added. “The longer you keep the new habits, the better. The intent is to find an easy way to keep track of your health.”

“Dementia is an overall decline in cognitive ability, usually impacting short-term memory (learning/recall new information) and another cognitive ability (or more), such as decline in executive skills (organization, decision making) or language, or visual-spatial skills,” says Karen Miller PhD, a neuropsychologist and geropsychologist as well as the senior director of the Brain Wellness and Lifestyle Programs at Pacific Neuroscience Institute in California.

“In dementia, these declines typically impact one’s ability to be completely independent (i.e., the person may have difficulty managing finances or medications, difficulty/impairment in driving, etc.),” she told Healthline.

Women make up about two-thirds of people with dementia, including Alzheimer’s disease, according to a 2021 report.

One reason is that women live longer than men and dementia typically appears after age 80. Other possible explanations, according to Cognitive Vitality, a program of the Alzheimer’s Drug Discovery Foundation, include:

Higher education is associated with lower rates of dementia. Many older women today were not afforded the same educational opportunities as men.
Dementia is linked to depression, and more women have depression than men
People who exercise are less likely to develop dementia and women exercise less than men

When women develop dementia, they decline faster than men do. Therefore, they can have a more severe illness.

Dementia occurs when neurons in the brain stop working or interacting with other brain cells, according to the National Institute of Aging.

Everyone loses some neurons as they age, but people with dementia have a more significant loss.

While many people over 85 have dementia, it is not considered a normal part of aging.

Alzheimer’s disease is the most common form of dementia, but it is not the only one.

A few other types of dementia include the following:

Some people can have a combination of two or more types of dementia.

Signs and symptoms of dementia include:

Experiencing memory loss, poor judgment, and confusion.
Difficulty speaking, understanding, and expressing thoughts, or reading and writing.
Wandering and getting lost in a familiar neighborhood.
Trouble handling money responsibly and paying bills.
Repeating questions.
Using unusual words to refer to everyday objects.
Taking longer to complete routine daily tasks.
Losing interest in normal daily activities or events.
Hallucinating or experiencing delusions or paranoia.
Acting impulsively.
Losing balance and problems with movement

It is important to note when symptoms are worsening, experts say.

“When people start noticing these symptoms, in themselves or a loved one, it may be time to see a doctor. The same is true for new changes, new symptoms, or a worsening of previous symptoms. There are some treatments – that can’t cure or reverse the damage. Still, they can possibly slow the progression of the disease, such as aducanumab and lecanemab,” Salinas said. “New treatments are another reason to see a doctor.”

How eye tests could help detect diabetes, MS, and dementia

The eyes have long been called the “windows to the soul,” and increasingly, evidence is suggesting that they might be also windows to both the brain and body. Several health conditions can be detected by examination of the eyes, among them diabetes, multiple sclerosis, and even Alzheimer’s disease. Medical News Today spoke to experts in the field to discover how the eye can reveal the body’s secrets.

Most of us have our eyes tested regularly, but few may be aware that an eye test is not just for checking vision and correcting sight problems.

Because it has a “window” at the front, the eye is the only part of the body where doctors can, non-invasively, examine the inside of an organ. At the back of the eye is the retina, where blood vessels and the optic nerve can be clearly seen.

Thanks to this, optometrists and ophthalmologists could diagnose not only disorders of the eye, but also systemic diseases — those that affect other organs in the body or the whole body.

If a routine eye test raises concerns, the optometrist can refer a person to a medical ophthalmologist who will investigate by carrying out further eye examinations. If their investigations reveal a systemic disease, they can then refer the person to the relevant specialist.

Dr. Hagar Ibrahim, senior specialist trainee (ST6) in medical ophthalmology at St. Paul’s Eye Unit, Liverpool University Hospitals NHS Trust, in the United Kingdom, told Medical News Today that “a routine eye examination in which the pupils are dilated using eye drops can provide a full and clear view of the optic nerve, which connects to the brain, the retina, […] and all the blood vessels supplying the retina.”

“Therefore, pathology in the eye can be clearly seen during [an] eye examination, both in localized eye conditions and in systemic disease, truly making the eye a window into the rest of the body,” she added.

“People are often surprised when an eye doctor diagnoses them with a systemic illness but they shouldn’t be. Many people with systemic illnesses are first diagnosed by their eye doctor, which is just one reason why all adults should have regular eye examinations at least every 2 years.”

– Dr. Philip Storey, a board-certified ophthalmologist and fellowship-trained retina specialist at Austin Retina Health

As well as identifying problems with vision, such as nearsightedness, farsightedness, and astigmatism, a routine eye test will detect other eye disorders, such as glaucoma, and age-related macular degeneration.

By examining the blood vessels in the retina and the optic nerve, the optometrist can also discover a lot about a person’s general health.

This non-invasive process can detect many other health conditions that may seem unconnected to the eyes, among them hypertension, diabetes, thyroid disorders, and neurodegenerative diseases such as Alzheimer’s disease, and multiple sclerosis (MS).

“Ocular inflammation can affect many parts of the eye, and can often be the first sign of a systemic disease. The key to diagnosing the cause is in focused history taking followed by [a] guided investigation of the relevant body systems, including blood tests,” explained Dr. Ibrahim.

Changes in the blood vessels in the retina can be early indicators of both diabetes and hypertension.

Dr. Storey told MNT that “[d]iabetes is the most commonly diagnosed disease given the frequency of the illness as well as the classic findings on retina exam, which can include bleeding, leakage of fluid, and areas of poor blood flow.”

Although a firm diagnosis of diabetes can only be made with a blood glucose test, changes in the blood vessels of the retina can give a strong indication that a person may have diabetes. They can then be referred for further testing.

According to the American Academy of Ophthalmology, the signs of diabetic retinopathy can sometimes be detected by eye examination even before a person suspects they may have diabetes.

Once diagnosed, provided the diabetes is well controlled, the person can then minimize the risk of further eye damage, as Dr. Ibrahim explained: “In addition to localized eye therapies such as laser treatment or intravitreal eye injections, improving blood sugar levels by sticking to the proper pharmacological treatment, restricting sugar intake and making necessary lifestyle changes, can result in regression of diabetic retinopathy.”

However, for those with diabetes, the most important eye tests take place after diagnosis, to monitor changes in the eyes and take steps to prevent further damage, as Dr. Howard R. Krauss, surgical neuro-ophthalmologist and director of Pacific Neuroscience Institute’s Eye, Ear & Skull Base Center at Providence Saint John’s Health Center in Santa Monica, CA, noted:

“In most cases, diabetes is diagnosed before changes become evident in the retina, but the retinal examination is a vital part of routine diabetic evaluations, so as to aid in the management of the disease, and to intervene when indicated, with any of a variety of treatments to reduce the risk of blindness from diabetic retinopathy.”

Studies have shown that signs of hypertension, or high blood pressure, are found in the eyes of around 10{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of the adult, diabetes-free population.

On examination, an eye doctor might see traces of narrowing of arterioles in the retina, arteriovenous nicking, retinal hemorrhages, and, as in diabetic retinopathy, microaneurysms. All these are indicators of hypertensive retinopathy.

“Hypertension also presents with classic signs within the eye. The earliest signs of hypertension are narrowing of the vessels, often referred to as ‘silver wiring’ because of their appearance.”

– Dr. Philip Storey

The good news is that if the hypertension is controlled, the damage can be halted, as Dr. Ibrahim explained.

“Early detection means that appropriate precautions are taken and necessary lifestyle changes are made, such as eating a healthy diet and exercising regularly, in addition to starting the proper medical treatment thereby reducing the risk of heart disease,” she told us.

During a routine eye test, the eye doctor will also examine the optic nerve to look for any abnormalities or changes.

Dr. Ibrahim explained why: “The optic nerve connects the eye to the brain and is therefore an extension of the central nervous system. It is the only part of the brain that can be clearly visualized by examining the back of the eye.”

“Optic nerve swelling or inflammation can be detrimental to vision and color vision, and can diagnose MS, [which is] an autoimmune demyelinating disease of the brain and spinal cord, [as well as] neuroinflammatory disorders such as neuromyelitis optica or brain tumor,” she added.

Vision problems in MS, which tend to flare up then resolve within a few weeks, are usually a result of optic neuritis, an acute inflammatory demyelinating disorder of the optic nerve.

Optic neuritis is the first symptom in up to 20{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of people who are subsequently diagnosed with MS, although it can indicate other disorders, or even be the result of a viral infection or vitamin deficiency.

If an optometrist suspects optic neuritis in a routine eye examination, they will refer a person for further testing to confirm the diagnosis and identify the cause.

“Retinal screening of Alzheimer’s disease is an exciting prospect at the forefront of current medical research. The retina […] is made up of multiple layers of specialized neural cells and there is strong evidence that the same changes in the brain can occur in the retina, potentially allowing screening patients for early signs of Alzheimer’s disease.”

– Dr. Hagar Ibrahim

Current methods of diagnosing Alzheimer’s are often lengthy, invasive and expensive, so being able to diagnose the condition from the retina would be a huge advance.

Although this is not yet a disease that can be diagnosed from a routine eye examination, recent research has suggested that doctors could, in the future, diagnose Alzheimer’s through retinal scans.

The new technique, so far tested only in mice, combines the results of two scans to assess the condition of the retina. Those with Alzheimer’s disease have a much rougher retinal surface than those without.

Other research has identified beta-amyloid plaques on the retina as an indication of Alzheimer’s disease, and also in the lens of the eye, both of which can be detected by non-invasive methods.

Dr. Ibrahim explained some of the new developments:

“There are several areas under research. Firstly, looking for the presence of beta-amyloid fragments in the retina, which may be detected by specialist retinal imaging modalities, before symptom onset. […] Secondly, looking at biomarkers detectable on retinal OCT-A images in the form of differences of retinal microvasculature in patients with Alzheimer’s disease and mild cognitive impairment compared to healthy controls.”

Perhaps these findings may lead to easier, earlier diagnosis of Alzheimer’s disease enabling treatment to begin before symptoms become severe.

As well as allowing an optometrist to detect diseases elsewhere in the body, changes in the eyes can tell a physician how a systemic disease is progressing.

So regular eye tests are important, particularly as we get older, as Dr. Benjamin Bert, an ophthalmologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA, told MNT:

“While eye exams are mostly to check the health of the eyes, they do help to screen for systemic diseases. For adults, if you don’t have any need for glasses or contact lenses, it is still recommended to get an annual exam at least once in your 20s, twice in your 30s, and more regularly after 40. After 40 is when eye-specific ailments can start to become more common — including presbyopia, glaucoma, cataract, and changes to the retina from diabetes or high blood pressure.”

Dr. Krauss reiterated the same advice.

But it is also important to remember that eye examinations are only one tool in monitoring health conditions.

“An examination of the retina often reflects the severity of a disease throughout the body. […] However, patients should not rely on an eye examination to assess how well their systemic disease is controlled,” Dr. Storey cautioned.

“The damage that we see in the eye can take years to occur. Even when a patient’s eye examination is normal, their systemic disease — hypertension or diabetes for example — could be poorly controlled,” he explained.

So, make sure a regular eye test is part of your overall health care, particularly as you get older — it may just detect a condition that you were unaware of, helping you to take control of your health.

Dementia, stem cell, and mental health research

2022 has been an eventful year when it comes to medical research, but what are some of the most intriguing findings and trends? Our editors, Maria Cohut, Yasemin Nicola Sakay, and James McIntosh reflect on this year’s highlights in our December “In Conversation” episode.

While 2020 and 2021 may have stuck in the collective memory as two intense pandemic years, 2022 has also been an eventful one.

Google’s Year in Search report pinpoints some of people’s most pressing concerns at a global scale throughout 2022. One of these is the monkeypox epidemic, which the World Health Organization (WHO) declared a “public health emergency of international concern” in August.

The death of Queen Elizabeth II of Great Britain in September, after a record 70-year reign, garnered global interest, as did the impact of the ongoing conflict in Ukraine.

And the overturning of Roe v. Wade in the United States sparked concern among medical communities worldwide.

But 2022 has also seen a wealth of advances in medical research, from a new way of assessing potential dementia symptoms that may help to diagnose it up to 9 years sooner than the current standard to the discovery of an insulin-mimicking molecule that may, in the future, help treat diabetes.

This December, three of our editors — myself, the Feature Editor, Yasemin Nicola Sakay, the Global News Editor, and Managing Editor James McIntosh — joined the “In Conversation” podcast to talk about some of 2022’s research highlights.

These include the twists and turns dementia research has taken this year, why scientists are increasingly interested in the potential of psychedelics in mental health treatments, and how stem cell research is advancing at a steady pace.

Listen to this month’s installment of our podcast below, or on your preferred streaming platform.

This year has been a very charged one for dementia research. As many as 55 million people around the world live with a form of dementia, the most common form of which is Alzheimer’s disease.

While there are some treatments that target symptoms of dementia, such as memory loss and anxiety, there is currently no cure for Alzheimer’s disease and related neurodegenerative conditions.

One thing that would help researchers find better treatments to prevent or slow down the progression of dementia symptoms would be finding out its true cause and the mechanisms that drive it.

The ‘amyloid hypothesis’ controversy

In 2006, a study that appeared in the journal Nature lent credibility to what is now known as the “amyloid hypothesis,” which holds that an overaccumulation of beta-amyloid protein in the brain — forming sticky amyloid plaques — disrupts the communication between neurons, thus being largely responsible for the main symptoms of dementia, such as memory and thinking problems.

Since its publication, the Nature paper has been cited in over 2,200 other studies, and the amyloid hypothesis has informed the vast majority of the dementia research conducted until now.

Yet in July 2022, an assistant professor of neurology at Vanderbilt University called into question claimed that some of the images in the seminal study had been manipulated, which may affect the credibility of the amyloid theory.

While the 2006 Nature paper has not, at the time of writing, been retracted, the recent claims of scientific misconduct have caused an uproar among dementia experts, and given rise to many questions.

One question is: If the paper truly does build on inaccuracies, will this invalidate some of the findings in dementia research reported until now? Not so, some experts say.

Speaking to Medical News Today, Dr. Sara Imarisio, head of research at Alzheimer’s Research UK, explained that “the findings from the [Nature] paper were very specific and, contrary to some reports, have not significantly affected the progress or direction of research into Alzheimer’s.”

“Even for research groups who work in this particular area, findings that can’t be reproduced will be identified as controversial and lose credibility, while genuine findings will come to predominate and guide the direction of future studies.”

– Dr. Sara Imarisio

Indeed, some findings about amyloid plaques seem to hold true, as a recently developed drug, lecanemab, which attacks the accumulation of beta-amyloid in the brain, has shown clear promise in recent clinical trials, and its developers hope that the drug will be approved for use in people aged 65 years and older in the U.S. as soon as next year.

New research avenues

But scientists were already aware that beta-amyloid plaques are not the be-all and end-all of dementia research. How so? In our June 2022 podcast, we spoke with Dr. Kamar Ameen-Ali, a lecturer in biomedical science at Teesside University in the United Kingdom.

Dr. Ameen-Ali explained that the crux of the matter is this: Beta-amyloid accumulates in the brains of healthy people just as it does in those of people with dementia symptoms. What makes this protein disruptive in some cases but not others remains unclear.

This is one of the reasons why dementia research does not, and has never stopped at the amyloid hypothesis, influential as it may be.

The controversy has also meant that more and more researchers are looking into alternative or additional pathologies in Alzheimer’s disease and other forms of dementia, including the role of tau, another protein implicated in dementia, which, some experts say, may be a better indicator of Alzheimer’s disease progression.

In September, an animal study whose results appeared in PLOS Biology suggested that brain inflammation caused by a dysfunction in the blood-brain barrier may be a likely cause of Alzheimer’s disease.

“These findings may have a significant global impact on the millions of people living with Alzheimer’s disease,” Prof. Warren Harding, chair of Alzheimer’s WA, told MNT about the study.

And in November 2022, a study published in Nature argued that disruptive swelling along axons, which form the link between neurons, may be the true cause of Alzheimer’s symptoms.

One emerging treatment for dementia is stem cell therapy, thanks to the potential of stem cells — which are a kind of “blank slate” cells — to differentiate and “specialize” into cells with different functions, thus providing healthy cells to replace those that have experienced some degree of “damage.”

Stem cell research has made great strides this year, with scientists looking at the potential of stem cell treatment in many incurable or difficult-to-treat diseases.

In April 2022, for instance, a study whose findings appeared in npj Regenerative Medicine showed how implanting induced pluripotent stem cells in rats with Parkinson’s disease-like motor symptoms helped reverse those symptoms by replacing damaged neurons.

Speaking to MNT about the study results, Dr. Jeffrey Kordower, director of the ASU-Banner Neurodegenerative Disease Research Center at Arizona State University, said that they gave him “great confidence” about the treatment’s applicability in human patients in the future.

Another stem cell therapy highlight made the press in summer 2022, when the fourth, and oldest patient yet with HIV and leukemia achieved remission after receiving a stem cell transplant.

The patient, a 66-year-old man, achieved long-term remission of HIV 3 years after receiving a stem cell transplant for leukemia, which is a blood and bone marrow cancer.

“When I was diagnosed with HIV in 1988, like many others, I thought it was a death sentence. I never thought I would live to see the day that I no longer have HIV,” the patient declares in a statement for the press.

Creating embryo and brain models from stem cells

Stem cell research has also reached other intriguing and much-debated heights this year. In August 2022, two different research teams reported having successfully created embryo models in the laboratory, using not sperm and egg cells, but stem cells to do so.

The embryo models managed to develop rudimentary structures, including a beating heart, blood stem cell circulation, a head region with folds, and the beginnings of a gut tube.

They are also viable enough to allow researchers to delve deeper into the study of embryonic development. Models like these can also help researchers steer free of experiments with potential ethical implications.

Other researchers managed to create brain organoids — models of brain tissue — from stem cells in the lab. Such models can help scientists learn more about rare neurological conditions, such as microcephaly, where the size of the brain is reduced compared to that of a healthy brain.

More widely, researchers could use models of brain tissue to better understand the way in which viruses, such as SARS-CoV-2, might attack and affect the brain, and to further dementia research.

The importance of stem cell donation

Our own Managing Editor, James McIntosh, donated stem cells earlier this year to help further research on better treatments for people with blood cancers and blood disorders. James talks about his experience at length in a “Through My Eyes” personal perspective article.

When a person donates blood, they can also choose to donate stem cells, which are separated through a process called “apheresis.” It may seem like an unsettling experience, but, James wrote, it was nowhere near as scary as a first-time stem cell donor might think.

In his article, he explains how apheresis works:

“All the heavy lifting was going to be done by a cell-separating machine. The nurse inserted a needle into a vein in my left arm from which my blood was drawn into the machine. The machine then separated the blood into its separate components: red blood cells, white blood cells, plasma, and platelets. Once the blood was separated, the parts containing my precious stem cells were taken away, leaving the rest of the blood to return to me. The nurse inserted another needle into a vein in my right arm, and the blood was able to rejoin my bloodstream here from the machine.”

James encourages everyone who can to donate stem cells for treatment and research: “Stem cells are a vital part of treatment for several serious conditions while also showing a lot of potential in the development of new therapies for currently untreatable diseases. As a result, it is very important for there to be people willing to donate their stem cells. Many will be able to save lives by joining a donation register.”

Our January 2022 podcast on blood donations and transfusions further explains how blood donation works, how to prepare, what the different types of blood donation are, and why this is such a vital part of medical treatment and research.

Another research avenue that has been gaining ground in 2022 is the use of psychedelics in the treatment of anxiety and depression.

Around the world, hundreds of millions of people live with anxiety or depression, which can severely affect their quality of life.

The standard treatments for these mental health conditions include psychotherapy and cognitive behavioral therapy (CBT), as well as medications such as serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) — also known as “antidepressants” — which are meant to help rebalance the levels of key chemicals in the brain.

However, according to some estimates, up to 30{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of adults living with major depressive disorder have treatment-resistant depression, which does not respond to standard lines of treatment.

And around 50{bf0515afdcaddba073662ceb89fbb62b6b1bf123143c0e06b788e1946e8c353f} of adults with generalized anxiety disorder do not respond to first-line treatments, such as antidepressants.

In a bid to find more effective ways of addressing the symptoms of hard-to-treat depression and anxiety, researchers have turned to a sometimes-controversial line of inquiry, namely psychedelics, particularly ketamine, LSD, and psilocybin, the psychoactive compound in magic mushrooms.

What do psychedelics do?

These drugs are, for the most part, illegal in the U.S. and elsewhere, at least for personal use, but researchers can study their effects in humans under closely supervised, clinical trial conditions, and the results of some of these studies have been intriguing.

In our May 2022 podcast, we spoke to Dr. Adrian Jacques Ambrose, medical director of the Columbia Psychiatry Practice Office.

“For anxiety disorder, as well as panic disorder, there’s hyperactivation of what we call the fear network. [By this] I mean specific parts of the brain that includes the thalamus, the amygdala, the hippocampus, and the striatum,” Dr. Ambrose explained.

And since the human brain has a negativity bias — meaning it tends to hold onto negative memories and emotions — this may exacerbate the negative thinking that occurs in anxiety and depression.

Dr. Ambrose believes that standard treatments such as antidepressants may not always work “because of their lack of specificity.” In contrast, psychopharmacological treatments may be able to “rewire” the parts of the brain involved in this vicious cycle of negative thoughts.

Indeed, a study whose results appeared in JAMA Psychiatry in October 2022 concluded that ketamine can ease depression symptoms in as little as 4 hours by “updating” negative beliefs that people with severe depression hold about themselves and the future.

“We observed each patient before and after ketamine and found an early cognitive effect on beliefs about the future. Notably, patients started to show an optimism bias in belief updating 4 hours after [the] first, single infusion. At one week of treatment, the optimist bias in belief updating correlated to the clinical antidepressant effect,” says study author Dr. Liane Schmidt.

And in November, a study from NEJM found that a single, 25-milligram dose of a synthesized formulation of psilocybin also relieved the symptoms of treatment-resistant depression, although the exact way in which psilocybin acts on the brain remains unclear.

The catch

While studies such as the ones mentioned above seem to indicate that psychedelics may indeed be the way to go when it comes to severe anxiety and depression, they all come with a series of caveats.

In the JAMA Psychiatry study, the participants received ketamine infusions, which is a very specific method of administration. They also received their regular antidepressant treatment throughout the study period.

Speaking to MNT, Dr. Guochuan Emil Tsai, neuropsychiatry expert and CEO of the company SyneuRx, not involved in the study, pointed out that:

“Ketamine infusion is available but not commonly used. It’s usually reserved only for treatment-resistant depression and can only be done in facilities that offer IV infusion and can monitor patients. It would be similar to a dialysis center. Ketamine is also a Schedule III controlled substance with inherent risks.”

The NEJM study came with an even greater caveat: Although psylocibin did help reduce depression symptoms in most of the participants, about a week after the treatment, the most commonly reported side effects were suicidal ideation and intentional self-injury.

“It’s not a recreational process — it”s not like do-it-yourself self-help,” Dr. David A. Merrill, psychiatrist, and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, CA, not involved in the study, told MNT in an interview.

“It really needs to be done with professionally trained, licensed, or certified practitioners who understand the power of these drugs to create a mind-altered state. Dissociation, even at times hallucinations, [are] part of the journey of psychedelics to open the mind to new possibilities, but that journey needs to be supported with professional help,” stressed Dr. Merrill.

So in the course of studying psychopharmacological treatments, a few questions remain: What are the safest doses and delivery methods? Do the benefits outweigh the risks? And who would most benefit from these interventions?

Our editorial team hopes that, in 2023, we may be one step closer to finding the answers to these and other questions that could transform healthcare practices for the better, and that our audience will continue to join us in our exploration of medical innovations.

Why a Healthy Lifestyle Is Not Enough to Prevent Dementia

Summary: The alternatives for a healthful way of life are unequally dispersed and being socially deprived with a larger danger of producing Alzheimer’s illness.

Supply: University of Leipzig

Dementia is on the rise in Germany. In the absence of therapy possibilities, the focus is shifting to protecting against dementia. In particular, a healthful lifestyle is regarded as beneficial for brain health and fitness.

A examine by the College of Medication now shows that possibilities for a healthy lifestyle are unequally dispersed: being socially disadvantaged is associated with a greater risk of dementia. The present findings have been published in the Journal of Alzheimers Sickness.

As the population ages, dementia is on the rise. Currently, about 1.8 million individuals in Germany suffer from dementia. Inhabitants studies forecast an raise to about 3 million by 2050. Global investigation demonstrates terrific opportunity for dementia avoidance primarily based on modifiable health and way of life elements, these types of as hypertension, being overweight, physical and mental activity, and eating plan. In other text: a wholesome life-style is superior for mind health.

“But the alternatives are unequally distributed,” states Dr. Susanne Röhr, head of the recent research and a researcher at the Institute of Social Drugs, Occupational Medication and Community Well being (ISAP) at Leipzig College. “Socially disadvantaged individuals, these kinds of as individuals on very low incomes, have a tendency to have a better risk of dementia.”

The scientists used facts from much more than 6,200 participants in the Existence Adult review at the Leipzig Study Middle for Civilization Ailments. The proportion of females and adult males was the similar. The topics had been concerning 40 and 79 many years aged and ended up not affected by dementia.

The significant knowledge foundation of the populace-dependent cohort examine permits the Leipzig researchers to map a advanced life-style index with twelve modifiable hazard factors for dementia.

These contain hypertension, actual physical activity, smoking, obesity, and nutritional behavior. Subsequently, the impact of the index on the partnership involving socio-economic factors such as training, occupational position, and family cash flow, and psychological general performance and benefits of neuropsychological checks, is examined.

Why a Healthy Lifestyle Is Not Enough to Prevent Dementia — The effects of the present-day review demonstrate that dissimilarities in psychological efficiency thanks to social inequalities are associated to modifiable wellbeing and life style elements for dementia. Graphic is in the community domain

The final results of the current examine present that variances in psychological performance because of to social inequalities are linked to modifiable wellness and life style aspects for dementia.

“This implies that way of life interventions could mitigate social inequalities in cognitive general performance,” adds Professor Steffi Riedel-Heller, director at ISAP.

According to the researchers, on the other hand, wellness and lifestyle factors only make clear dissimilarities in mental efficiency thanks to socio-economic variables to a smaller extent. The examine findings hence also recommend that the greater emphasis may possibly be on the social circumstances them selves.

“Political steps aimed at reducing social inequalities could thus contribute noticeably to minimizing the chance of dementia,” states Dr. Röhr.

About this way of life and dementia research news

Writer: Press Office environment
Source: University of Leipzig
Speak to: Push Business – University of Leipzig
Image: The impression is in the public domain