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Another study showing big problems with anticholinergics, which are in many popular medicines - both non-prescription and prescription (e.g., Chlor-Trimeton, Benadryl, Tavist, Dimetapp). An earlier study with older adults found a dose-response link with dementia, but the current study explored this issue further. They followed 2 groups of  "cognitively normal older adults" in their early 70s for several years: those who took anticholinergic medicines and those who did not take anticholinergic medicines. They found that those who took anticholinergic medicines had reduced brain volume (brain shrinking) and cognitive decline (when compared to those who did not take anticholinergic medicines). The researchers summarized their findings as the "use of anticholinergic medication was associated with increased brain atrophy and dysfunction and clinical decline". This finding was greatest for those taking drugs with the most anticholinergic activity.

See a list of anticholinergic medicines  from the Aging Brain Program of the Indiana University Center for Aging Research. Definitely try to avoid medicines with a score of 2 (medium effect) or 3 (high effect), but I would even be cautious about score 1 (low effect) medicines - use all medicines only as long as absolutely needed. My one very important question is: If these effects are found in older adults, what do anticholinergics do to younger brains, especially the developing brains of children? From Medical Xpress:

Brain scans link physical changes to cognitive risks of widely used class of drugs

Older adults might want to avoid a using class of drugs commonly used in over-the-counter products such as nighttime cold medicines due to their links to cognitive impairment, a research team led by scientists at Indiana University School of Medicine has recommended. Using brain imaging techniques, the researchers found lower metabolism and reduced brain sizes among study participants taking the drugs known to have an anticholinergic effect, meaning they block acetylcholine, a nervous system neurotransmitter.

Previous research found a link between between the anticholinergic drugs and cognitive impairment and increased risk of dementia.....Drugs with anticholinergic effects are sold over the counter and by prescription as sleep aids and for many chronic diseases including hypertension, cardiovascular disease, and chronic obstructive pulmonary disease. A list of anticholinergic drugs and their potential impact is at http://www.agingbraincare.org/uploads/products/ACB_scale_-_legal_size.pdf.

Scientists have linked anticholinergic drugs and cognitive problems among older adults for at least 10 years. A 2013 study by scientists at the IU Center for Aging Research and the Regenstrief Institute found that drugs with a strong anticholinergic effect cause cognitive problems when taken continuously for as few as 60 days. Drugs with a weaker effect could cause impairment within 90 days.

The current research project involved 451 participants, 60 of whom were taking at least one medication with medium or high anticholinergic activity. The participants were drawn from a national Alzheimer's research project....and the Indiana Memory and Aging Study. To identify possible physical and physiological changes that could be associated with the reported effects, researchers assessed the results of memory and other cognitive tests, positron emission tests (PET) measuring brain metabolism, and magnetic resonance imaging (MRI) scans for brain structure.

The cognitive tests revealed that patients taking anticholinergic drugs performed worse than older adults not taking the drugs on short-term memory and some tests of executive function, which cover a range of activities such as verbal reasoning, planning, and problem solving. Anticholinergic drug users also showed lower levels of glucose metabolism—a biomarker for brain activity—in both the overall brain and in the hippocampus, a region of the brain associated with memory and which has been identified as affected early by Alzheimer's disease. The researchers also found significant links between brain structure revealed by the MRI scans and anticholinergic drug use, with the participants using anticholinergic drugs having reduced brain volume and larger ventricles, the cavities inside the brain.

A new study has confirmed an association between proton pump inhibitors (PPIs) — drugs that treat heartburn, peptic ulcers, and other acid-related disorders of the upper gastrointestinal tract — and increased risk for dementia in older patients. An earlier study by the same researchers found the same link between PPI use and dementia risk. The drugs work by lowering the amount of acid produced by the stomach. PPIs are among the most frequently prescribed drugs, and include omeprazole (Losec), esomeprazole (Nexium), lansoprazole (Prevacid), and the over-the-counter medication Olex.

The U.S. Food and Drug Administration have warned people to take them for the shortest period possible, namely a few weeks, and only for serious acid reflux, ulcers, or stomach bleeding. Other problems linked to long-term use are: fractures, pneumonia, increased rates of C. difficile, low magnesium levels, and chronic kidney disease. From Science Daily:

Proton pump inhibitors may be associated with increased risk of Dementia

The use of proton pump inhibitors, the popular medications used to treat gastroesophageal reflux and peptic ulcers, may be associated with an increased risk of dementia in a study using data from a large German health insurer, according to an article published online by JAMA Neurology.  The use of proton pump inhibitors (PPIs) has increased among older patients and PPIs are among the most frequently used classes of drugs.

Britta Haenisch, Ph.D., of the German Center for Neurodegenerative Diseases, Bonn, Germany, and coauthors examined the association between the use of PPIs and the risk of dementia using data from 2004 to 2011 on inpatient and outpatient diagnoses and drug prescriptions. Regular PPI use was at least one PPI prescription in each quarter of an 18-month interval.

The study population included 218,493 individuals 75 or older before 144,814 individuals were excluded, leaving 73,679 individuals included in the final analysis. The authors identified 29,510 patients who developed dementia during the study period. Regular users of PPIs (2,950 patients, mostly female and average age nearly 84) had a 44 percent increased risk of dementia compared with those (70,729 patients, mostly female and average age 83) not receiving PPI medication, according to the results.

"The present study can only provide a statistical association between PPI use and risk of dementia. The possible underlying causal biological mechanism has to be explored in future studies. 

New research has found that low vitamin D levels among older adults is associated with accelerated cognitive decline and impaired performance (particularly in areas of memory and executive function). The next research in this area will have to look at whether vitamin D supplementation will change (slow down) the decline. Please note that it is widely accepted that an average daily intake of 1000 IU  of D3 daily is safe. The best source of  vitamin D is sunlight. From Science Daily:

Low vitamin D among elderly associated with decline in cognition, dementia

Vitamin D insufficiency among the elderly is highly correlated with accelerated cognitive decline and impaired performance, particularly in domains such as memory loss that are associated with Alzheimer's disease and dementia, researchers with the UC Davis Alzheimer's Disease Center and Rutgers University have found. The effect is "substantial," with individuals with low vitamin D declining at a rate three times faster than those with adequate vitamin D levels

The researchers said their findings amplify the importance of identifying vitamin D insufficiency among the elderly, particularly high-risk groups such as African-Americans and Hispanics, who are less able to absorb the nutrient from its most plentiful source: sunshine. Among those groups and other darker-skinned individuals, low vitamin D should be considered a risk factor for dementia, they said. "Independent of race or ethnicity, baseline cognitive abilities and a host of other risk factors, vitamin D insufficiency was associated with significantly faster declines in both episodic memory and executive function performance," said Joshua Miller...

The large, longitudinal study was conducted in nearly 400 racially and ethnically diverse men and women in Northern California participating in longitudinal research at the Alzheimer's Disease Center in Sacramento, Calif. Fifty percent of participants were Caucasian and 50 percent were African-American or Hispanic. The participants had a mean age of 76 and were either cognitively normal, had mild cognitive impairment, or dementia.The participants' serum vitamin D status was measured at the beginning of the study.... Overall, 26 percent were deficient and 35 percent were insufficient. Among Caucasians, 54 percent had low vitamin D, compared with 70 percent of African-Americans and Hispanics.

Over five years of follow-up, vitamin D deficient individuals experienced cognitive declines that were two-to-three times faster than those with adequate serum vitamin D levels. In other words it took only two years for the deficient individuals to decline as much as their counterparts with adequate Vitamin D declined during the five-year follow-up period.

Exposing the skin to sunlight is the major source of vitamin D. Racial and some ethnic minorities are at greater risk of low vitamin D because the higher concentration of melanin that makes their skin darker -- and protects against skin cancer in sunny climates -- also inhibits synthesis of vitamin D. Diet is the other major source of vitamin D. Dietary vitamin D is obtained particularly through dairy consumption. The intake of dairy products is especially low among minority groups, with only 6.5 percent of African-Americans and 11 percent of Mexican-Americans nationwide consuming the recommended three daily servings of dairy products, the study says.

People fear dementia and Alzheimer's disease, because they are progressive diseases that nothing treats successfully. However, in the past year there have been some studies showing improvements with lifestyle changes (not cures, but for some the progression was slowed or showing some improvements). The latest studies found that exercise (especially aerobic execise) had some beneficial effects on those with mild cognitive impairment (MCI), Alzheimer's disease, and vascular cognitive  impairment (VCI): neuropsychiatric improvements, improvements in biomarkers for the disease, and improved blood flow to the brain. From Medscape:

Physical Activity May Help Treat Dementia

New research shows that being physically active not only reduces cognitive decline and improves neuropsychiatric symptoms in patients with dementia but may actually reduce Alzheimer's disease (AD) biomarkers, including amyloid and tau protein in the brain. Exercise could also benefit patients with types of dementia other than AD, another study suggests.Some of this promising new research on exercise was presented at the Alzheimer's Association International Conference (AAIC) 2015. 

Danish researchers had already presented cognition-related results of the multicenter ADEX study ...The intervention consisted of 1 hour of aerobic exercise three times a week for 16 weeks. The control group received usual care..... The analysis found that these [neuropsychiatric] symptoms improved in the 66 patients in the "high exercise"group... The NI is a 12-item questionnaire that rates, among other things, depression, apathy, agitation, hallucinations, irritability, weight loss, and sleep."We saw that the control group got worse; there was a small decline in this group, which you would expect because this is progressive disease," said Steen Hasselbalch, MD, Danish Dementia Research Centre, Copenhagen, Denmark. "But the intervention group remained at the same level and even got a little better, so at end of the intervention there was a significant difference."

The question arises of whether exercise could not just delay worsening of symptoms but actually change brain pathology.The answer, suggests other research, is yes. In a separate study presented at the AAIC 2015, researchers found decreased phosphorylated tau (P tau) in older, previously sedentary persons completing a 6-month regimen of moderate- to high-intensity aerobic exercise.

The study enrolled 70 patients aged 55 to 89 years with prediabetes as well as amnestic mild cognitive impairment (MCI)....We think they are at high, high risk for developing dementia of the Alzheimer's type." These patients were randomly assigned to the aerobic exercise group or to the stretching group. Those in the aerobic group started slowly — 10 minutes of exercise a week — and gradually built the time and intensity up over 6 weeks to the point where they were exercising 45 minutes a day, 4 days a week, at 75% to 85% of their maximum heart rate...."This group had a choice of exercises: treadmill, stationary cycling, elliptical trainer, or preapproved group classes.

The stretching group, whose members could do balance exercises, gentle yoga, and other approved classes in addition to stretching, maintained a maximum heart rate of below 35%. All exercises were adapted to the needs and limitations of individual patients and were done at a local YMCA.

The researchers looked at biomarkers in cerebrospinal fluid (CSF), including P tau protein and amyloid β 42....Most intervention trials don't show such changes in P tau. "But we saw it with exercise and no medications," said Dr. Baker. "Exercise was enough to move a biomarker that indicates the severity of the disease."  It wasn't surprising, she added, that this was true only for older patients. "It may be that before age 70, you have a lot of compensatory mechanisms that help to maintain brain health, and after 70, those start breaking down."

The study also showed that the aerobic activity increased blood flow to the brain...The researchers demonstrated that the increased blood flow was in regions characteristically affected by aging and AD (ie, memory and processing).Cognitive benefits were particularly noteworthy for executive function..."Our brain imaging results are just fantastic; they show some really nice increases in blood flow in the areas of brain that support executive function and areas of the brain that normally show decreased flow for people with MCI, so it's reversing the blood flow detriment in MCI."

AD may not be the only dementia potentially treatable through exercise. Another study discussed at the meeting showed that this intervention may help those with vascular cognitive impairment (VCI)It's the first intervention trial to suggest that exercise can improve cognition in patients with confirmed VCI, said Teresa Liu- Ambrose, PhD, Canada Research Chair, University of British Columbia, Vancouver, Canada, who reported the results.The 6-month study included 71 patients aged 56 to 96 years with mild VCI of varying physical capacities. They were assigned to usual care that included a nutrition component or to an intervention of moderate-intensity walking, 3 times a week for an hour....In a subset of patients who had neuroimaging, there was "evidence of efficiency" in the brain of those who exercised, Dr Liu-Ambrose told Medscape Medical News.

Big question: will vitamin D supplementation prevent cognitive decline? And what should be a daily supplement dose for adults? An earlier post cited a Medscape article suggesting that taking 1000 IU of vitamin D3 daily would be a good daily level of supplementation. From Medscape:

Vitamin D Deficiency Predicts Cognitive Decline

A new study supports a link between low levels of vitamin D and increased risk for cognitive decline, prompting calls for clinical trials to test whether vitamin D supplementation may delay or prevent dementia. In a group of cognitively intact older adults, serum 25-hydroxyvitamin D (25OHD) levels below 75 nmol/L at the outset predicted cognitive decline over roughly the next 4 years, independent of other factors.

For this analysis, the researchers looked at data on 1927 community-dwelling elderly individuals (mean age, 73.9 years) participating in the Italian population-based cohort study, Progetto Veneto Anziani (Pro.V.A.).

Dr Toffanello and colleagues say studies are needed to evaluate whether vitamin D supplementation might help to delay the cognitive decline, especially in patients who already have cognitive impairment.

David J. Llewellyn, PhD, from the University of Exeter Medical School in the United Kingdom, who has studied vitamin D and cognitive function but wasn't involved in this study, agrees. He told Medscape Medical News that this new study "effectively replicates" a 2010 study by his group showing a link between low vitamin D levels and an increased risk for cognitive decline. He said the Pro.V.A . study results are also consistent with a study his group published just this year inNeurology. That study suggested older patients with vitamin D levels below 50 nmol/L have about a 122% increased risk for dementia compared with those with higher levels.

Excerpts from an article by Jane Brody in the NY Times:

Beating Back the Risk of Diabetes

This year, nearly two million American adults and more than 5,000 children and adolescents will learn they have a potentially devastating, life-shortening, yet largely preventable disease: Type 2 diabetes. They will join 29.1 million Americans who already have diabetes.

Diabetes and its complications are responsible for nearly 200,000 deaths a year; the fatality rate among affected adults is 50 percent higher than among similar people without diabetes. Alarmingly, recent studies even have linked diabetes to an increased risk of dementia and Alzheimer's disease. Even people with above-average blood glucose levels, but not diabetes, have an elevated risk.

The Diabetes Prevention Program study, conducted among about 3,800 people who had pre-diabetes, found that moderate weight loss — an average of 12 pounds —  reduced the odds of progression to diabetes by nearly 50 percent.

An excellent discussion of what is known about the effect on diabetes of various foods and supplements appeared recently in Nutrition Action Healthletter at cspinet.org/iceberg.pdf. Some highlights:

Carbohydrates - breads, grains, cereals, sugary drinks and sweets of all kinds — are most problematic for people with diabetes or at risk of developing it. Carbohydrates are eventually metabolized to glucose, which raises the body’s demand for insulin. Consume less of them in general, and choose whole-grain versions whenever possible.

If you must have sweet drinks, select artificially sweetened ones. In two huge studies of nurses and other health professionals who were followed for 22 years, those who drank one or more sugary soft drinks a day had about a 30 percent higher risk of developing diabetes than those who rarely drank them, even after their weight was taken into account.

But there’s good news about coffee. Two or three cups of coffee (but not tea) a day, with or without caffeine, have been consistently linked to a lower risk of Type 2 diabetes. 

For protein, limit consumption of red meat, especially processed meats like sausages, hot dogs and luncheon meats, which are linked to a higher diabetes risk. Instead, choose fish, lean poultry (skinless and not fried), beans and nuts. Low-fat dairy products, including yogurt, and even fatty ones may lower the risk of diabetes; the reason is unclear.

Most protective are green, leafy vegetables — spinach, chard, kale, collards, mustard greens and even lettuce — as well as cruciferous vegetables like cabbage, broccoli and cauliflower. But all vegetables are good and should fill at least two-thirds of your dinner plate.

The nutrients magnesium and vitamin D are also potentially protective. In fact, the preventive value of leafy greens, whole grains, beans and nuts may lie in their high magnesium content. In a well-designed clinical trial of 32 overweight people with insulin resistance, the prelude to diabetes, blood glucose levels and insulin sensitivity improved in those who took a daily magnesium supplement for six months. Don’t go overboard: More than 350 milligrams of magnesium daily can cause diarrhea. 

Vitamin D, long known to be crucial to healthy bones, may also be helpful. In one study of 92 overweight or obese adults with prediabetes, those who took a supplement of 2,000 international units of vitamin D daily had better function of the pancreatic cells that produce insulin..

Of course, how much you weigh and what you eat are not the only concerns. Regular, preferably daily, physical exercise is a vital component of any prevention and treatment program for Type 2 diabetes, or most any chronic ailment. Weight loss can reduce diabetes risk by about 50 percent, but adding exercise to that can lower the odds by 70 percent, compared with people who remain overweight and inactive, according to a study that followed nearly 85,000 female nurses for 16 years. Women who were active for seven or more hours weekly had half the risk of developing diabetes as did women who exercised only a half-hour a week.

Yes, going out in the sunshine for a while is a good way to get vitamin D. From Science Daily:

Link between vitamin D, dementia risk confirmed

Vitamin D deficiency is associated with a substantially increased risk of dementia and Alzheimer's disease in older people, according to the most robust study of its kind ever conducted. An international team found that study participants who were severely vitamin D deficient were more than twice as likely to develop dementia and Alzheimer's disease.

The team studied elderly Americans who took part in the Cardiovascular Health Study. They discovered that adults in the study who were moderately deficient in vitamin D had a 53 per cent increased risk of developing dementia of any kind, and the risk increased to 125 per cent in those who were severely deficient.

Similar results were recorded for Alzheimer's disease, with the moderately deficient group 69 per cent more likely to develop this type of dementia, jumping to a 122 per cent increased risk for those severely deficient.

The study was part-funded by the Alzheimer's Association, and is published in Neurology, the medical journal of the American Academy of Neurology. It looked at 1,658 adults aged 65 and over, who were able to walk unaided and were free from dementia, cardiovascular disease and stroke at the start of the study. The participants were then followed for six years to investigate who went on to develop Alzheimer's disease and other forms of dementia.... Previous research established that people with low vitamin D levels are more likely to go on to experience cognitive problems, but this study confirms that this translates into a substantial increase in the risk of Alzheimer's disease and dementia.

Vitamin D comes from three main sources -- exposure of skin to sunlight, foods such as oily fish, and supplements. Older people's skin can be less efficient at converting sunlight into virVitamin D, making them more likely to be deficient and reliant on other sources. In many countries the amount of UVB radiation in winter is too low to allow vitamin D production.

The study also found evidence that there is a threshold level of Vitamin D circulating in the bloodstream below which the risk of developing dementia and Alzheimer's disease increases. The team had previously hypothesized that this might lie in the region of 25-50 nmol/L, and their new findings confirm that vitamin D levels above 50 nmol/L are most strongly associated with good brain health....During this hottest of summers, hitting the beach for just 15 minutes of sunshine is enough to boost your vitamin D levels. 

This is Part 3 on how lifestyle influences aging. Many recent research reports tell of a link between our lifestyle and how we'll age - whether we'll be active and healthy well into our 80s or in terrible shape and dying young. Mind you, these are not "definites" because nothing can give you a guarantee, but they are ways we can improve our odds in living a long and healthy life. From Medical Xpress:

Having a sense of purpose may add years to your life, study finds

Feeling that you have a sense of purpose in life may help you live longer, no matter what your age, according to new research. The research has clear implications for promoting positive aging and adult development, says the lead researcher.

The researchers looked at data from over 6000 participants, focusing on their self-reported purpose in life (e.g., "Some people wander aimlessly through life, but I am not one of them") and other psychosocial variables that gauged their positive relations with others and their experience of positive and negative emotions.

Greater purpose in life consistently predicted lower  across the lifespan, showing the same benefit for younger, middle-aged, and older participants across the follow-up period. "To show that purpose predicts longer lives for younger and older adults alike is pretty interesting, and underscores the power of the construct," he explains.

From Science Daily:

Education boosts brain function long after school, study shows

Education significantly improves mental functioning in seniors even four decades after finishing school, shows a new study. The study shows that people who attended school for longer periods performed better in terms of cognitive functioning than those who did not. Using data from individuals aged around 60, the researchers found a positive impact of schooling on memory scores. The fact that young people or their parents did not choose whether to go longer to school strongly suggests that schooling is the cause rather than personal characteristics that would affect this choice and could also explain the differences in cognitive function.

From Medscape:

Lifetime of Intellectual Enrichment Keeps Aging Brain Sharp

A lifetime of intellectual enrichment helps delay onset of cognitive decline in older individuals, new data from the Mayo Clinic Study on Aging show.

In this longitudinal study, researchers found ties between higher levels of education and working in mentally stimulating jobs in early- to mid-life, as well as higher levels of mid- to late-life cognitive activity, such as using a computer, reading, and participating in social activities, and better cognition with age..."We also found that an individual with low education/occupation benefited more by engaging in high mid-/late-life cognitive activity than an individual with high education/occupation," Dr. Vemuri noted.

A number of research results were reported at the Alzheimer's Association International Conference 2014.  From Science Daily:

Potential Alzheimer's disease risk factor and risk reduction strategies become clearer

Participation in activities that promote mental activity, and moderate physical activity in middle age, may help protect against the development of Alzheimer's disease and dementia in later life, according to new research.

From Science Daily:

Physical activity is beneficial for late-life cognition

Physical activity in midlife seems to protect from dementia in old age, according to a study. Those who engaged in physical activity at least twice a week had a lower risk of dementia than those who were less active. The protective effects were particularly strong among overweight individuals. In addition, the results showed that becoming more physically active after midlife may also contribute to lowering dementia risk.

The importance of 5 healthy behaviors in having the best chance of leading a disease free life. The 5 behaviors are: taking regular exercise, non-smoking, a low body weight, a healthy diet and a low alcohol intake. And as the researchers point out: "healthy behaviors have a far more beneficial effect than any medical treatment or preventative procedure".From Science Daily:

35 Year Study Finds Exercise Reduces Risk of Dementia

The study identifies five healthy behaviors as being integral to having the best chance of leading a disease-free lifestyle: taking regular exercise, non-smoking, a low body weight, a healthy diet and a low alcohol intake.

The people who consistently followed four or five of these behaviors experienced a 60 per cent decline in dementia and cognitive decline -- with exercise being the strongest mitigating factor -- as well as 70 per cent fewer instances of diabetes, heart disease and stroke, compared with people who followed none.

"The size of reduction in the instance of disease owing to these simple healthy steps has really amazed us and is of enormous importance in an aging population," said Principle Investigator Professor Peter Elwood from Cardiff University's School of Medicine. "What the research shows is that following a healthy lifestyle confers surprisingly large benefits to health -- healthy behaviors have a far more beneficial effect than any medical treatment or preventative procedure.

The Caerphilly Cohort Study recorded the healthy behaviors of 2,235 men aged 45-59 in Caerphilly, South Wales.