Alzheimer’s Disease

Posted Posted in Brain Science, Continuing Education, Elder Care, Seminars

constant-63613_640By Dr. Mary O’Brien, MD

Alzheimer’s disease is one of the most dreaded health conditions of our time. There is no cure, and current treatments don’t slow down the disease; they can only alleviate symptoms. As well as avoiding Alzheimer’s disease and age-related cognitive decline, many people want to stay as sharp as possible as they age, and, if possible, delay age-related cognitive decline. Yet are there truly preventive strategies to stave off of Alzheimer’s disease or cognitive problems associated with aging?

While there’s no definitive evidence about what can prevent or reduce the risk of Alzheimer’s disease or dementia, scientific studies have offered clues about strategies that might slow down or prevent cognitive decline. The good news is that research on the prevention and treatment of Alzheimer’s disease—which currently affect about 5.3 million Americans—is now a high priority.

In late 2015, the U.S. Congress approved the largest increase to date in federal spending for Alzheimer’s disease research and care-giver support in the 2016 federal budget—a $350 million increase over 2015. The increase in federal spending came in response to reports and studies documenting the needs and opportunities that lie ahead for Alzheimer’s disease research. By 2050, Medicare spending on Alzheimer’s disease is expected to quadruple to $589 billion annually, but one treatment delaying the onset of the disease could save Medicare $345 billion in the first 10 years of its use, according to a report from the Alzheimer’s Association.

Over the past 30 years, many advances have been made in understanding Alzheimer’s disease and dementia. We now understand the biology of Alzheimer’s disease as never before. The brains of people with Alzheimer’s disease are filled with amyloid plaques—composed of deposits of a toxic protein fragment called beta-amyloid. The brains of Alzheimer’s disease patients also have an abundance of neurofibrillary tangles or abnormal collections of twisted protein threads found inside nerve cells, composed chiefly of a protein called tau.  In Alzheimer’s disease, the amyloid plaques and neurofibrillary tangles damage the brain’s neurons, interfering with their ability to function and communicate with one another. As a result, Alzheimer’s disease causes the brain to shrink and atrophy.

Scientists are now emphasizing research on the development of Alzheimer’s disease and on the symptoms and signs of early Alzheimer’s disease, which is termed mild cognitive impairment. The hope is that learning more about mild cognitive impairment can help identify patients at increased risk for the disease and for disease progression.

The symptoms of mild Alzheimer’s disease include:

  • Memory loss and confusion about once familiar things or places.
  • Difficulty accomplishing daily tasks, especially handling money and paying bills.
  • Poor judgment that leads to bad decisions.
  • Mood and personality changes, such as increased anxiety and aggression.

The symptoms of moderate Alzheimer’s are more serious, and include:

  • Increasing memory loss and confusion, and shortened attention span.
  • Irritability and Inappropriate outbursts of anger.
  • Difficulty with language (in reading and writing) and difficulty in working with numbers.
  • Trouble recognizing friends and family members.
  • Difficulty organizing, planning, and thinking logically.
  • Restlessness, agitation, anxiety, tearfulness, and wandering.
  • Repetitive movements and statements and sometimes muscle twitches.
  • Paranoia, delusions, and hallucinations.
  • Loss of control over impulses.

Age and genetics are the strongest risk factors for dementia and Alzheimer’s disease. However, other risk factors have been linked to Alzheimer’s disease. Research has shown that people with heart disease, stroke, and high blood pressure may be more likely to develop Alzheimer’s disease and to have more severe diseases.  Studies also show that patients with metabolic syndrome, Type 2 diabetes, and sleep apnea are at increased risk for mild cognitive impairment and Alzheimer’s disease. Whether or not successful treatment of hypertension, heart disease, diabetes and sleep apnea can affect cognitive decline is open to question, but is under study. One large trial funded by the National Institutes of Health (NIH) has compared intensive glucose-lowering treatment with standard treatment for Type 2 diabetes, but there were no significant differences between the two groups.

Hormones such as estrogen and progesterone also have effects on the brain. Yet studies on whether menopausal hormone therapy is protective against cognitive decline or Alzheimer’s disease have been conflicting.  Research is continuing on estrogen and progesterone as well as other hormonal therapies that could be preventive, including testosterone, growth hormone-releasing hormone and DHEA (dehydroepiandrosterone).

Many studies have also investigated whether vitamins and dietary supplements can protect against cognitive decline and Alzheimer’s disease. Epidemiological and laboratory studies have suggested that antioxidants from food and supplements can lower the risk of Alzheimer’s disease by preventing oxidative damage from free radicals. Vitamin E, vitamin C, B vitamins, and coenzyme Q10 have been tested as treatments to slow down or prevent Alzheimer’s disease, but none have proved effective. Researchers are also investigating the effect of resveratrol—a compound found in red grapes and red wine.

Research has also revealed that healthy habits can have an important influence on the risk for Alzheimer’s disease and cognitive decline. Studies show that exercise can stimulate the brain and help to make new neuronal connections within the brain that are vital to healthy cognition. Daily aerobic exercise, for instance, can enhance recall and executive function. Research has also found that a diet rich in vegetables is associated with a reduced risk for cognitive decline, and a Mediterranean diet significantly lowers the risk for mild cognitive impairment and Alzheimer’s disease.

Keeping your mind active throughout life may also reduce the risk of Alzheimer’s disease. Large observational and epidemiological studies have associated cognitive health with the maintenance of social relationships at work, volunteering or by living with someone. Mentally stimulating activities such as reading books and magazines, playing game and going to lectures may also keep the mind sharp. Recent large studies have found that people who spend a lot of time in intellectually stimulating activities are significantly less likely to be diagnosed with Alzheimer’s disease.

For healthy people, formal cognitive training sessions also seems to have benefits for the brain. Studies on memory, reasoning, and processing speed training—all aimed at improving mental skills—show that this training can improve cognitive skills for up to 10 years. Other studies are now investigating whether the combination of exercise and cognitive training can delay or prevent age-related cognitive problems.

  1. National Institute on Aging. Alzheimer’s Disease: Unraveling the mystery.
  2. National Institute on Aging. Alzheimer’s Disease Progress Report: Intensifying the Research Effort.
  3. Preventing Alzheimer’s Disease: What Do We Know?
  4. Alzheimer’s Association. Historic Alzheimer’s funding increase signed into law, answering Alzheimer’s Association call for action.


Is the Paleo Diet Healthy? Arguments For The Paleo Diet

Posted Posted in Continuing Education, Homestudy, Nutrition, Seminars

breakfast-1058726_640More than one-third of U.S. adults are obese—and at high risk for obesity-related diseases such as metabolic syndrome, diabetes, cardiovascular disease, and some cancers. Yet is the Paleo Diet, one of the newest weight-loss trends, the most healthful way to reduce the risk of obesity-related diseases?

The Paleo diet—which relies on eating like our hunter-gatherer ancestors — is one of today’s most controversial diets. It is based on the nutrition of our ancestors living in the Paleolithic period between 2.5 million and 10,000 years ago. The Paleo nutrition plan is a low-carb diet based on meat, non-starchy vegetables, and fats such as coconut oil. It eliminates many of the products of modern agriculture—such as grains, dairy products, beans, and soy products.

Since the 1990s, researchers have known that lifestyle factors, such as diet, can lead to obesity-related health risks, morbidity, and mortality. Yet whether the Paleo diet really plays an important role in avoiding these risks is hotly debated among leading nutritionists.

Arguments for the Paleo Diet: A Good Bet for Reducing Health Risks

The Paleo diet is not only helpful for losing weight—it also has the potential to reduce the incidence of diabetes, high cholesterol, metabolic syndrome, and hypertension, according to some nutritionists. Paleo diet proponents even claim that the Paleo nutrition plan can decrease the risk for cancers and inflammatory diseases.

Some studies do show that a Paleo diet can be beneficial for those with metabolic syndrome, and it can also lead to lower HbA1c levels, lower triglycerides, and lower blood pressure levels, according to Kellyann Petrucci, a naturopathic physician, who wrote an editorial for the Wall Street Journal in March 2015.

Dr. Petrucci argued that some studies suggest that the Paleo diet can be as healthful as the Mediterranean diet for reducing risk for cardiovascular disease and some cancers. She argued that studies have suggested that the Paleo diet in patients with ischemic heart disease may lead to better glucose tolerance and a larger drop in abdominal fat than the Mediterranean diet. She also maintains that diets high in carbohydrates increase risk for colon cancer, while the Paleo diet may reduce this risk.

Some scientific studies have found no evidence that diets high in saturated fats and low in carbohydrates increase risk for heart disease, according to Paleo diet proponents. The criticism that the Paleo diet leads to nutritional deficiencies is also unfounded, according to nutritionists who favor the Paleo diet. Paleo diet foods such as salmon, kale, and broccoli, for instance, are high in calcium. Necessary dietary fiber and nutrients can also be found in the vegetables and fruits, seafood, eggs, and meat found in the Paleo eating plan.

  1. Petrucci K. and Nestle M. Is a Paleo Diet Healthy? The Wall Street Journal. March 23, 2015.
  2. Jabr F. How to Really Eat like a hunger-gatherer: Why the Paleo Diet is Half-Baked. Scientific American. June 3, 2013.
  3. Hamblin J. Science Compared Every Diet, and the Winner Is Real Food. The Atlantic. March 24, 2014.


Sleep: Crucial for Good Health

Posted Posted in Continuing Education, Homestudy, Psychology, Seminars, Webinars

baby-22194_640By Michael Howard, PhD

Regular and restful sleep helps keep immune systems strong.  Such sleep also helps keep blood pressure and blood sugar at low levels.

This kind of sleep can help resist weight gain and obesity, assist in emotional stability and forming new memories, and reduce pain perception.

Many older people in their 70s and 80s get only about six hours of sleep per night. Centenarians typically have regular sleep patterns and get plenty of restful, restorative sleep—usually seven to eight hours.

One of the major characteristics of 100-year-olds in an area of Costa Rica is sleeping about eight hours per day on a regular basis. While sleep times can vary from person to person, getting regular rest is the key.  Centenarians have established sleep routines, tending to go to bed and wake up at the same time each day. In general, they go to sleep when the sun goes down and wake up when it comes up. In the Japanese Centenarian Study, spontaneously waking up at regular times in the morning was a major characteristic of those who were living independently.

Taking a nap during the day may be a healthy sleeping pattern for older people. While sleeping continuously throughout the night is often touted as the most recommended way to sleep, midday napping appears to be a common characteristic of the healthiest older people. In the MEDIS study of long-lived people in the Mediterranean islands, all of the people in the study older than 90 years were found to engage in naps around noontime.

Unfortunately, as many as 40 percent of the elderly have some type of sleep disorder that can result in physical and cognitive problems. “Short-sleepers” getting less than six hours of sleep a night have been found to have poor insulin control of blood sugar, more diabetes and obesity, stronger appetites, more heart attacks, and shorter life spans. These risks are even more pronounced for those getting five or fewer hours of sleep per night.  Obesity and sleep deprivation are strongly connected. Studies show that, compared with those getting about eight hours of sleep per night, those who sleep only five hours have a 50 percent higher chance of becoming obese. Those who sleep only four hours have a 73 percent higher chance of obesity. It also appears that getting too much sleep—hypersomnia—of nine or more hours nightly may be even worse for health and longevity than sleep deprivation.

Increasing age increases the chance of developing several sleep disorders. Sleep disorders are associated with many health problems and are major risk factors for heart disease, stroke, depression, and even Alzheimer’s disease.

Common age-related sleep disorders include insomnia, obstructive sleep disorder, restless legs, periodic limb movement disorder, and REM (rapid eye movement) behavior disorder. Insomnia is the biggest culprit, because it is the most common sleep disorder. Other less-common sleep disorders may be even more dangerous. Obstructive sleep apnea, for example, dramatically raises the risk of heart attack and stroke. According to a study in the American Journal of Respiratory and Critical Care, even mild obstructive sleep apnea raises cardiovascular disease risk because of increased arterial stiffness. It seems clear that getting a good night’s sleep is crucial to health and longevity.

If there are problems sleeping, there are techniques you can try at home to help, called “sleep hygiene.”  Techniques of improving sleep with easily-implemented sleep hygiene strategies can be found on the internet, and many people can help themselves to a better night’s sleep by using them. Centenarians practice many of these techniques. If sleep hygiene techniques do not work and sleep problems continue, the best recommendation is to see a sleep disorders specialist or go to a sleep disorders clinic for thorough evaluation, diagnosis, and treatment.  Bottom line: to live long, sleep well.


Music As Medicine

Posted Posted in Brain Science, Continuing Education, Elder Care, Psychology, Seminars, Webinars

By Barbara Sternberg, Ph.D.

Music has long been recognized as an effective therapy for emotional disorders. But the idea of using music to treat physical ailments is relatively new. The past several years have seen an explosion of research on the uses and benefits of music for both mental and physical health. In a meta-analysis of 400 studies, it was found that music improves the body’s immune-system function and reduces stress. In reducing anxiety prior to surgery, listening to music was also found to be more effective than prescription drugs. In addition, listening to and playing music increased the body’s production of the antibody immunoglobulin-A and natural killer cells. Music also reduced levels of the stress hormone cortisol.

ukulele-516503_640A recent study on the link between music and stress found that music can help calm pediatric emergency-room patients. In a trial with children ages three to 11, University of Alberta researchers found that young patients who listened to relaxing music while having an IV inserted reported significantly less pain, and some showed less distress compared to patients who did not listen to music. Also, for the music-listening group, more than two-thirds of the healthcare providers reported that the IVs were very easy to administer.

Music is also helpful in reducing pain among adult patients as well. In one study, patients in palliative care who participated in live-music therapy sessions reported relief from persistent pain. Music therapists worked closely with the patients to tailor the intervention. Patients sang, played instruments, discussed lyrics, and wrote songs.
Another study evaluated the analgesic effects of music in patients with fibromyalgia pain. Fibromyalgia patients were exposed either to relaxing, pleasant music which they had chosen, or to a control auditory condition (white noise). They rated their pain level, and their functional mobility was evaluated using a standardized measure.
Functional mobility was found to be superior in the patients exposed to music compared to the controls.

In addition, music has been shown to enhance certain quality of life aspects among older adults. A study evaluated the impact of piano training on cognitive function, mood, and quality of life in older adults. Thirteen participants received piano lessons and practiced daily for four months and were compared to an age-matched control group of 16 who participated in other forms of leisure activities such as physical exercise, computer lessons, or painting lessons. In terms of executive function, inhibitory control, and divided attention, significant differences were found for the group that received piano-training. Piano lessons also decreased depression, induced positive mood states, and improved the psychological and physical quality of life of the elderly participants. The researchers concluded that playing piano and learning to read music can be a useful intervention in older adults to promote cognitive reserve and improve subjective well-being.

There is growing evidence that music may be useful in medicine – in areas including reducing stress and pain and improving mood and cognitive function. On word fluency, working memory, and recognition memory, other studies have examined the effects of listening to music. These studies also showed enhanced performance in these cognitive abilities in older adults.


The Mystery of Pain: Acute vs Chronic Pain

Posted Posted in Brain Science, Continuing Education, Pain, Psychology, Seminars, Webinars

By Michael Howard, Ph.D.

Early humans explained the mystery of pain by associating it with evil, magic, or demons. Relief was the responsibility of sorcerers, shamans, priests, and priestesses, who treated their clients with herbs and rituals.

Ancient civilizations recorded on stone tablets accounts of pain and the treatments used, including pressure, heat, water, and sun. The Greeks and Romans were the first to advance a theory of sensation, the idea that the brain and nervous system were involved in the perception of pain.pain

During the Middle Ages and into the Renaissance, evidence began to accumulate supporting these theories. Leonardo da Vinci and his contemporaries came to see the brain as the central organ responsible for sensation, with the spinal cord transmitting sensations to the brain.

In the 19th century, pain came to dwell under a new domain—science—which paved the way for advances in pain therapy. Physician-scientists discovered that opium, morphine, codeine, and cocaine could be used to treat pain. In the late 1800s, research led to the development of aspirin, to this day the most commonly-used pain reliever. Before long, anesthesia—both general and regional—was refined and applied during surgery.

Pain is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. There are two basic categories of pain, acute and chronic, and they differ greatly.

Acute pain usually results from disease, inflammation, or injury to tissues. This type of pain generally comes on suddenly—for example, after trauma or surgery—and may be accompanied by anxiety or emotional distress. The cause of acute pain can generally be diagnosed and treated, and the pain is self-limiting—confined to a given period of time and severity. In some instances, it can become chronic.

Chronic pain is widely believed to represent a disease in and of itself. It persists over a longer period of time than acute pain and is resistant to most medical treatments. Chronic pain often persists longer than three months, or longer than expected for normal healing. It can be made much worse by environmental and psychological factors. It can—and often does—cause severe problems for patients, as pain signals keep firing in the nervous system for weeks, months, or years. There may have been an initial mishap such as a sprained back or serious infection, or there may be an ongoing cause of pain such as arthritis, cancer, or infection. However, some people suffer chronic pain in the absence of any past injury or evidence of illness.


Review of INR Seminar, “Understanding Depression and Bipolar Disorder”

Posted Posted in Brain Science, Continuing Education, Homestudy, Psychology, Seminars, Webinars

understanding-depressionRecently, I attended a continuing-education online seminar (Webinar) and was asked to write a blog post about my experience. The seminar’s title was “Understanding Depression and Bipolar Disorder.” The seminar’s sponsor was INR (Institute for Natural Resources). The presenter was Dr. David Longo (Ph.D.). The Webinar was six hours long. There were two breaks and time for lunch.

If you are a health-care professions (registered nurse, licensed practical nurse, pharmacist, registered dietitian, psychologist, social worker occupational therapist, physical therapist, case manager, nursing home administrator, counselor, or care-giver), this course is for you.

My first impression of the Webinar is that it was very well organized. My Webinar code worked correctly the first time. It appeared that no one else taking the Webinar had any technical issues. The Webinar platform was very simple and easy to understand. Dr. Longo, the presenter, had a pleasant voice and spoke at the right pace — not too fast and not too slowly. Dr. Longo kept my interest. He relied on case studies and his extensive knowledge.
The first hour examined the Three Brains of humans: The Brain Stem (Archaic Brain); Limbic System (Old Brain); and the Cerebral Cortex (New Brain). Dr. Longo discussed, in-depth, how changes in brain chemistry and structure occur in depression and bipolar disorder. Then, he covered how stress becomes a pathway for the development of major depressive disorders.

Dr. Longo discussed the new DSM-V (Diagnostic Statistics Manual, Version Five) criteria for the diagnosis of major depressive disorders and bipolar disorder.

I work in the marine industry, and I learned a fascinating fact: marine engineers have, by occupation, the highest suicide rates. Next in line are physicians and dentists.

Dr. Longo mentioned that there are many significant changes in the new Diagnostics and Statistical Manual of Mental Disorders. I was pleased to have an instructor who showed a working knowledge of such mental disorders.

The afternoon session focused on drugs used in the treatment of bipolar disorder, cyclothymia, and other disorders. Dr. Longo had experience with these medications and covered them thoroughly. He also focused on various forms of psychotherapy used to treat depression.

Overall, the Webinar provided superb information. Dr, Longo and INR did a superb job. I look forward to being part of future INR programs.


Probiotics: The Good Bacteria

Posted Posted in Continuing Education, Homestudy, Nutrition, Seminars, Webinars

girl-791563_640By Barbara Sternberg, Ph.D. and Clare Fleishman, M.S., R.D.

Probiotics are live, nonpathogenic microorganisms that are typically bacteria or yeasts. The term “probiotics,” also called “good bacteria,” has its root in the Greek pro, meaning “promoting” and biotic, meaning “life.” The term includes some types of beneficial microbes that can be found in probiotic supplements as well as certain microbes added to food. The term also refers to the trillions of friendly microbes that typically live in our digestive tracts and other organs.  Probiotics are naturally found in fermented foods such as yogurt, aged cheese, and kimchi. Thus far, the FDA (Food and Drug Administration) has not approved any health claims for probiotics.

People usually associate bacteria with infection and illness. However, most bacteria are not pathogenic for humans, and many play a very important role in supporting good health. Trillions of bacteria live on or in the human body, collectively known as microbiota, microbiome, or microflora.

Probiotics are found on the skin, in the respiratory system, and in the urinary tract, but most of them are in the gastrointestinal tract—some 100 trillion of them. These so-called gut bacteria greatly outnumber our body cells. Gut microflora get their nutrients from our bodies and create a healthy environment that protects us from illness and helps in disease control and the digestion of food.  Probiotics and humans have a symbiotic relationship.

Considerable research has been done and continues to be done on the relationship between these bacteria and various aspects of overall human physical and mental health, including obesity, celiac disease, inflammatory bowel disease, fatty liver disease, atherosclerosis, autoimmune disorders, and depression.

The gastrointestinal tract is an amazing metabolic machine. The surface area of the human gut is huge—about the size of a tennis court. Along this surface are nearly 1,000 different species of bacteria doing their important work — work that supports normal digestion. The numbers and balance of these bacteria vary. The numbers and balance are affected by diet, aging, geographical location, and environmental factors such as infections and the use of antibiotics.

How do gut bacteria facilitate health? They produce several B vitamins, vitamin K, and certain key fatty acids. The byproducts of bacterial interactions supply up to 10 percent of the body’s daily energy needs. In addition, gut bacteria play an important role in normal immune-system development. Their efficacy generally depends on a balance between the numbers and species of bacteria present. Disruptions of this balance can lead to significant problems with illness and disease.

Probiotics are vital for the immune system. They send signals to the immune system that reduce destructive overreactions, including inflammation. Insufficiency of probiotics affects immune responses and, hence, affect every aspect of our health.

Probiotics is a continuing education course available from the INR bookstore.  Check it out… and more.