Sleep Helps Your Brain Repair Itself

At one time or another, everybody has bouts of sleeplessness. House noises, screaming babies, caffeine, or a bed partner who snores, often make it difficult to fall asleep and stay asleep. Eventually, you learn to limit the amount of coffee you drink, the screaming babies grow up, and the snoring bed partner, well ... still snores. Other causes of chronic sleeplessness are sleep apnea, acid reflux, jet lag, swing-shift employment, and ongoing stress that causes sleeplessness. 

Discoveries made by Oregon Health and Science University researchers show that sleep deprivation increases the risk of Dementia later in life and may quicken its progression for those who already have the disease.1 Their data show that insufficient sleep increases the production of beta-amyloid proteins that compose the plaques associated with various kinds of Dementia.1

Taking a different approach, the University of California Berkeley Sleep and Neuroimaging Lab researchers have evidence demonstrating the importance of deep non-REM (rapid eye movement) sleep in preventing memory loss. 2 The deep non-REM sleep phase, among other functions, appears to prevent the buildup of beta-amyloid proteins. Their work shows there is a correlation between the accumulation of beta-amyloid proteins, sleep disorders, and Alzheimer disease. 2
Also, insufficient sleep is a risk factor associated with other health conditions that include obesity, heart disease, and diabetes - all of which increase the likelihood of Dementia later in life.

What to do??
First of all, remember that risk factors do not cause disease but increase the likelihood of having Dementia sometime in the future. Second, and most importantly, modifying behaviors and habits associated with dementia, such as smoking and obesity, can reduce risk.

Sufficient sleep depends on the age of the individual. For adults, seven to 10 hours of sleep per night is considered healthy. 3  However, for adults older than 65-years of age, six to eight hours of sleep per night is both normal and healthy. 3
Many older people, believing less than 8 hours of sleep per night, is abnormal, resort to using sleeping pills. Unfortunately, using medication to assure sleep both increases the risk for dementia and worsens Dementia for those who have the disease.

People acquire habits and behaviors that unknowingly make it difficult to fall asleep and stay asleep. The National Sleep Foundation offers the following tips to get a good night’s sleep.3

⦁ Stick to a sleep schedule – even on the weekends.
⦁ Develop a relaxing routine to prepare your body for sleep. 
⦁ Use your bed only for sleep and sex. 
⦁ If you have trouble sleeping, avoid afternoon and early evening naps.
⦁ Exercise daily.
⦁ Make the room where you sleep comfortable and free from disturbing noise or other distractions. 
⦁ Sleep on a comfortable mattress and pillows. 
⦁ Avoid alcohol, cigarettes, and heavy meals in the evening. 
⦁ Wind down - an hour before bed, choose a calming activity such as reading. 
⦁ If you can't sleep, go into another room and do something relaxing or immensely boring until you feel sleepy. 

Notes:
1. How a lack of sleep can increase YOUR risk of dementia: Lack of rest prevents the brain from clearing out toxins that trigger Alzheimer's', http://www.dailymail.co.uk/health/article-3387246/How-lack-sleep-increase-risk-dementia-Lack-rest-prevents-brain-clearing-toxins-trigger-Alzheimer-s.html (accessed May 17, 2016)
2. Lack of Sleep May Lead to Dementia: New Research Finds It Makes Brain Vulnerable, http://alumni.berkeley.edu/california-magazine/just-in/2015-06-02/lack-sleep-may-lead-dementia-new-research-finds-it-makes (accessed May 17, 2016)
3. Healthy Sleep Tips, https://sleepfoundation.org/sleep-tools-tips/healthy-sleep-tips (accessed May 17, 2016)

Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon. 

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of content within blog posts provided to us with permission or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Risk and Dementia – Genetics

For some types of diseases that cause Dementia to occur, there is a genetic association for having the disease by the time an individual is 60-years of age or older. It’s a subtle distinction, but people who have the altered gene inherit the risk and not the disease itself. In fact, Dementia is not a disease, rather, it is the expression of the cognitive challenges that come about because of the changes in brain tissue, caused by a particular disease.

This post mainly focuses on Alzheimer-caused Dementia but there are many other causes, e.g., Lewy body, Vascular, Frontotemporal, et al.

On the bright side, knowing that you have an inherited risk factor gives you the opportunity to do those things known to reduce risk - maintain a healthy weight, refrain from smoking, engage in socially and intellectually satisfying activities, exercise, and eat a heart-healthy diet.

For the most part, the at-risk genes change how the body processes cholesterol and other blood lipids. Therefore, it’s not surprising to find that having high cholesterol blood-levels is another risk factor associated with having Dementia later-in-life.

Early-onset familial Alzheimer disease (eFAD) is inherited Dementia that affects people as young as 30 years of age. (1) Unlike traits that are observable shortly after birth, such as eye color, symptoms of eFAD do not appear until the individual is 30-years of age or somewhat older. By that time, it is likely he or she has one or more children and may have unknowingly passed the early-onset gene to them.

Fortunately, there are DNA tests that can identify the presence of the increased-risk genes as well as those that cause eFAD. 

Making the decision to undergo testing is difficult. Will knowing make you feel anxious, relieved, or empowered? Will other family members also want testing? How might this information affect family planning for you or your adult children? Will having a positive test for a specific cause of Dementia risk factors or early-onset disease influence your employer, your career, or make it more difficult to receive health insurance? (2)

Often, people find talking with a genetic counselor can make the decision to test--or not--easier. The genetic counselor, by explaining the technical and emotional issues associated with genetic testing, can help you make a personally comfortable decision. Afterward, the genetic counselor can explain the test results to you and guide discussion about any further steps you may want to take. (2)

You can find more information about genetics and genetic counseling on the following webpages: National Association of Genetic Counselors (https://www.nsgc.org/page/find-a-genetic-counselor)and the American Board of Genetic Counselors (https://www.abgc.net/about-genetic-counseling/find-a-certified-counselor.aspx/). Both of these sites may help you find a genetic counselor located near your home.

Notes:
1. What is Early Onset Familial Alzheimer Disease? http://www.alzforum.org/early-onset-familial-ad/overview/what-early-onset-familial-alzheimer-disease-efad (accessed April 26, 2016)
2. Genetic Testing and Counseling for Early Onset Familial Alzheimer Disease, http://www.alzforum.org/early-onset-familial-ad/diagnosisgenetics/genetic-testing-and-counseling-early-onset-familial (accessed, April 26, 2016)

Want to Know Even More?
Alzheimer Disease Genetics Fact Sheet, https://www.nia.nih.gov/alzheimers/publication/alzheimers-disease-genetics-fact-sheet#genetics
(accessed, April 26, 2016)

Contributor: Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Risk for Dementia: Head Trauma

Traumatic brain injury (TBI) describes situations in which an external force, such as a fall or a blow to blow to the head causes extreme pain that is often accompanied by a short or a long period of unconsciousness. People who experience multiple traumatic brain injuries are at high risk of developing dementia later in life. (Note 1)

However, the key phrase “increase risk for” means that TBIs do not cause dementia but do increase the likelihood of having dementia sometime in the future.

In a recent and extensive review of the research literature, Sharan Shively, MD, Ph.D., and colleagues report that a history of moderate and severe TBIs increases the risk of having late-life dementia 2 - to - 4 times that of people who have never experienced a traumatic brain injury. (Note 2) To come to this conclusion, Shively and colleagues reference earlier studies that compare the presence or absence of later-in-life dementia in people who suffered concussions of sufficient severity to cause loss of consciousness to individuals who report never having experienced that degree of head trauma. (Note 2) People who experience multiple traumatic brain injuries are at high risk of developing dementia later in life. (Note 1)

The syndrome, associated with having multiple traumatic brain injuries was originally described in 1928. Called dementia pugilistica or “punch drunk” was first observed in boxers who suffered repeated knock-outs. (Note 3) It took many more years of casual observation before medical researchers linked a history of repeated sports and military-related head injuries, to the onset of dementia symptoms later in life. The condition, chronic traumatic encephalopathy, (CTE) now receives considerable coverage in the public media.

Signs and symptoms of CTE usually begin eight to 10 years after the traumatic brain injuries and include difficulty in thinking, impulsive behavior, memory loss, substance abuse, as well as suicidal thoughts or behavior. (Note 4) Over time, the changes caused by CTE worsen as well as progress to aggressive behaviors, tremor, and speech and language difficulties. (Note 4) More than one-third of people with CTE eventually show signs of other degenerative brain diseases such as dementia and Parkinson disease. (Note 3)

Undoubtedly, ongoing and future research will improve our understanding of traumatic brain injuries and their relationship to later-in-life dementia. In the meantime, you can reduce the likelihood of receiving a head injury by trip-proofing your home, being observant of hazards such as low tree branches and open kitchen cabinet doors, as well as by wearing a helmet to prevent sports-related injuries.

Even if you have experienced multiple head injuries, you may be able to reduce your overall risk of developing dementia by implementing lifestyle changes that include such things as maintaining a healthy weight, eating a heart-healthy diet, as well as participation in an assortment of physical, social and mental activities.

Notes:
1. Alzheimer’s: Can a head injury increase my risk?”, http://www.mayoclinic.org/alzheimers-disease/expert-answers/faq-20057837 (accessed March 21, 2016)
2. Shively et al, “Dementia Resulting from Traumatic Brain Injury” https://www.researchgate.net/publication/229011632_Dementia_Resulting_From_Traumatic_Brain_Injury_What_Is_the_Pathology (accessed March 22, 2016)
3. What Is Chronic Traumatic Encephalopathy?, http://www.brainline.org/content/2010/12/what-is-chronic-traumatic-encephalopathy.html (accessed April 7, 2016)
4. Chronic Traumatic Encephalopathy, http://www.mayoclinic.org/diseases-conditions/chronic-traumatic-encephalopathy/basics/definition/con-20113581 (accessed April 6, 2016)

Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Risks Associated with Dementia: Weight

Body weight and risk for Dementia are both a confusing and complex topic. One can find reports that state obesity increases the risk for dementia as well as ones that indicate the opposite –that being underweight is the risk factor. And to make things even more confusing, there is evidence that indicates being overweight may protect some people from Dementia.*

It’s needless to say, these unexpected findings are difficult to explain and generate considerable discussion and controversy both in the media and between researchers.

However, what these seemingly conflicting findings show is risk – the factors that influence the likelihood of having Dementia is difficult to assess. A too high body mass index (BMI), uses an equation to calculate a numerical rating of your health based on height and weight, is only one of many known risk factors.

Therefore the big challenge is how to determine the combined effects of having multiple risk factors, such as diabetes, insufficient exercise, and smoking. Does having additional factors make having dementia three times more likely than being overweight alone? Or perhaps the risks compound and put people at 10 times the risk for Dementia?

Is it possible that having a high BMI becomes protective when combined with habits and activities known to reduce risk? As you can see, the number of environmental, behavioral, health-related and genetic influences is huge and the combinations of risk factors are infinite.

Another challenge is separating associative risks from those that cause the outcome. For example, obesity is associated with increased risk for diabetes, but in itself does not cause diabetes. What causes diabetes is the inability of the pancreas to produce sufficient insulin. And, as it turns out, having diabetes is a risk factor associated with having dementia later-in-life.

Therefore, based on what we currently know about BMI and risk for Dementia the best answer is, “it depends.” This means, at this time, the best we can to reduce risk is to make a lifelong commitment to what current clinical research shows are health-promoting habits. 

*The Lancet Diabetes and Endocrinology, http://www.thelancet.com/journals/landia/article/PIIS2213-8587(15)00033-9/abstract), Accessed: September 2016.

Contributor: Janet Yagoda Shagam, Ph.D., is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Making Sense! Spotlight On Hearing

Making Sense! Spotlight On Hearing

Hearing connects us to the world, helping us communicate, work, socialize and be alert to potential danger. Hearing impairment, likely affecting over 30% of seniors, touches all aspects of daily living. It contributes to depression, loneliness, poor job performance, and in the long run, may lead to Dementia. It is thought by some, that untreated hearing loss could be responsible for 9% of Dementia worldwide. The good news is that healthy lifestyle choices that include correction of hearing loss, might possibly delay or prevent one-third of Dementia cases.  

Here is a guide to understanding hearing loss and what to do about it:

What causes hearing loss? 

• Age
• Genetics (family history)
• Chronic illness (type-2 diabetes, hypertension, cardiovascular, autoimmune and infectious diseases)
• Medication (diuretics, antibiotics, chemotherapy, others)
• Environment (noise, pollution, industrial chemicals)
• Head trauma
• Smoking
• And more ...

We can’t change our genetics, but we can take steps to affect the other factors. 

What are the types of hearing loss? Peripheral hearing loss occurs in the ear, while central loss involves parts of the brain that process auditory signals. Hearing loss is often a mix of both types.

How does hearing loss cause Dementia? It increases social isolation, reduces stimulation to the brain, and/or it may arise from the same brain changes that cause dementia. 

What does testing involve?  

To be thorough, take three tests:

• Ear testing: wear headphones while identifying short sounds played at different volumes and pitches.
• Central auditory processing (CAP) evaluation: checks speech reception and word recognition using the Staggered Spondaic Word Test (SSW) and the Synthetic Sentence Identification with Ipsilateral Competing Message test (SSI-ICM).
• Cognition: The Montreal Cognitive Assessment (MOCA), available online, for free, in multiple languages and dialects, is one page and takes ten minutes. MOCA detects mild cognitive impairment and early dementia.

What treatment is available? 

• Hearing aids make sounds louder and easier to pick up. 
• Middle or inner (cochlear) ear implants boost signals that go to the brain. 

Treatment slows mental decline and improves cognitive test scores, so sooner is better. 

What lifestyle strategies support hearing? : 

• Moderate alcohol consumption
• Bone-strengthening exercise
• Antioxidant (Mediterranean, DASH) diets
• Stop smoking

Correcting hearing loss improves life enjoyment, daily function, and brain health. Take action today to help counter this modifiable risk for Dementia.

Contributing Blogger: Jennie Ann Freiman, MD, author of The SEEDS Plan.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse or guarantee products, comments, suggestions, links, or other forms of the content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor.

References:
  www.ncbi.nlm.nih.gov/pubmed/29964378    
  www.ncbi.nlm.nih.gov/pubmed/29735277
  www.ncbi.nlm.nih.gov/pubmed/29212633
  www.thelancet.com/commissions/dementia2017?code=lancet-site
  www.ncbi.nlm.nih.gov/pubmed/29937713
  www.ncbi.nlm.nih.gov/pubmed/30011159
  www.ncbi.nlm.nih.gov/pubmed/29430246
  www.ncbi.nlm.nih.gov/pubmed/28894825
  www.ncbi.nlm.nih.gov/pubmed/27806352
  www.ncbi.nlm.nih.gov/pubmed/29937713

Finding Ways to Reduce the Stress of Caregiving

Family caregivers often feel stressed, exhausted, anxious, sad, angry, and sometimes hostile. However, caring for a person who has Dementia does more than affect behavior.

According to psychiatrist Dr. Linda Mah and colleagues, unrelenting stress and anxiety compromises health as well as contributes to increased risk for depression and Dementia. Many of their findings are sobering. Their discovery that unrelenting anxiety and stress damages areas of the brain that regulate emotional responses, thinking, and memory, is particularly relevant. They conclude that some treatments relieving depression may aid in repairing the damage created by caregiving stresses.

But don't let Dr. Mah’s findings be another reason to cause worry in your already stress-filled life. Having risk factors does not mean you are predestined to develop Dementia. Risk factors do not cause the disease; risk factors increase the probability of (someday) having the disease.

There are many reasons why it is important for family caregivers to get relief from the months and years of doing more than their abilities, circumstances, and resources would normally withstand. 

Caregivers have several options available to them in order to reduce their stress. One of them is to look closely at their own behavior. Some family caregivers feel they are the only person who can give their loved-one the proper care. Usually, this is not true. Often family members and friends can step up as good substitute caregivers and will volunteer to help if the primary caregiver appears interested or receptive.

In addition to family and friends, community and faith-based organizations provide affordable respite care. Local nonprofit support groups, as well as the U.S. Administration on Aging, are examples of community resources. The Catholic Charities and Jewish Family Service are examples of faith-based, nonprofit organizations that, regardless of ethnicity or religion, can give the primary caregiver time away from his or her full-time care commitment.

Adult daycare is another possibility. Located in community senior centers, nursing homes, churches, synagogues, hospitals, and schools, adult daycare provides stimulation and companionship for seniors who need medical assistance and other kinds of supervision.  Usually open during business hours, adult daycare centers give the family caregiver time to go to work, to attend to personal business, or to relax while knowing their loved-one is safe.

Family caregivers use respite time in different ways. Some sleep, while others go shopping, spend time with friends, read, walk, or take time to participate in a favorite hobby or sport. Make an effort to set aside time for a daily 15- to 30-minute break for an enjoyable physical activity such as walking. Good times to grab these important moments are when your loved-one is asleep, is in the doctor’s office, or when a friend or relative pays a visit

Schedule longer respite breaks for the same time each week. Plan ahead so you will know how you will spend that precious time. That way, even on a difficult day you will always have something to look forward to doing. But whatever you decide, make respite a priority before feelings of exhaustion, isolation, and resentment take over.  

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.  

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society of America does not provide medical advice. Please consult your doctor.