Us Old People need our Sleep Too ! Not TOO Much Not TOO Little

  Researchers in Japan followed 1,517 adults without dementia for 10 years.
  Incident rates of dementia and all-cause mortality were significantly greater in subjects who slept less than 5 hours per day or 10 or more hours per day.
  Therefore, short AND long daily sleep duration are risk factors for dementia and death in adults age 60 and older.
J Am Geriatr Soc. 2018 June 6

Decrease Risk of Alzheimer's with Frequent Sauna Bathing

  2,000 men from Finland in a 20 year follow-up as a part of the Kuopio Ischemic Heart Disease Risk Factor Study (KIHD) that took a sauna 4-7 times per week were found to have a 66% decreased risk of dementia than those that took a sauna once a week.
Age Aging. 2016 Dec 7

Copper - A Suggested Relationship to Alzheimer's Disease

  From researchers at the U of Rochester, when studying aging mice that were fed drinking water (with only low levels of copper) found a four fold increase in copper in brain capillaries and a two-fold decrease in in LRP1 (lipoprotein receptor-related protein 1). LRP1 facilitates the transport of amyloid beta across the blood-brain barrier and into the bloodstream for removal. If the level of LRP1 is reduced then Abeta transport is reduced and its accumulation results in the production of plaques and deposits seen in the brains of patients with AD.
  It might be that as we get older our brains may be more sensitive to to copper in our diet and water.
  Because copper is a vital nutrient to cell function altering it will be a complicated task. Currently there is a study in phase II trials employing PBT2 , a chaperone molecule to escort copper from the brain.
  The fact that copper prevents the pleating of amyloid-beta has been known for many years. But in the lab, at least, copper decelerates the deposition of amyloid- beta in plaques.
Proc Natl Acad Sci USA 2013;E-pub2013 aug 19

Alzheimer's Disease Short Course Treatment

  This is a follow-up to a previous blog entry related to IVIG treatment of patients with Alzheimer's disease from the Mayo Clinic, Rochester,MN.
 Patients with early Alzheimer's disease receiving five doses of intravenous immunoglobulin (IVIG) over an eight week period  showed significantly less brain atrophy after 1 year than a placebo group.
  The problem is that IVIG is derived from human donor plasma and is extremely scarce supply. It's primary neurologic application to date has been in the treatment of patients with Guillain-Baré syndrome. Production capabilities for all current suppliers could not begin to provide enough for all patients with mild to moderate Alzheimer's disease, let alone the even larger population with mild cognitive impairment.
  Therefore, if a short-term dosing regimen is as effective as continuing therapy, it would extend current supplies that may be provided to a larger number of patients.

Kile S, et al "Initial findings of a randomized double-blinded placebo-controlled study of intravenous immunoglobulin in mild cognitive impairment due to Alzheimer disease" AAN 2013; Abstract P01.013.

Dementia Update Cliffnotes

DEMENTIA
Dementia with Lewy body DLB=Decreased CSF alpha- synuclein
AD=Decreased CSF amyloid-beta 42 (earlier bio-mkr) ⬆total-tau and phospho-tau
Increased soluble amyloid precursor protein beta (sAPP) (Neuro 77;1:7/11)
DLB and AD = 80 % Diagnostic sensitivity
AD with Lewy body pathology 35-40% Diagnostic sensitivity

Brain 2010 Sept 7 2011.......
P300 < 323ms ,>5.0 mV = nml
E. Braverman, Cornell/Harvard

DRUG Treatment of Psychiatric consequences of DementingIllness
1. Impulsive Tx (stealing, sexual) : (Zoloft) sertraline 200mg/d, lamictal, VPA,divalproex,Inderal
2. Agitation /Paranoia : trazodone
3. Delusional : risperidone (ie. delusion of theft)

Mild Cognitive Impairment Treatment
MCI (Neurology 1/10/12 Vanderbilt nicotine patch 15 mg/d...cotinine is the active ingredient (from tobaccoJrnlAD) 2/14/11

CDR ( Clin. Dementia rating scale ) www.wustl.edu Wash U. St. Louis
CDR 3=severe,CDR2=mod, 1=mild,0.5 very mild

PET in diff dementia PLoS One 2011;6(3):e18111

DBS of entorhinal cortex enhances memory in MCI --( NEJM 2012;366:502-510)

✳FTD ( frontotemporal degeneration )
1. Progranulin Blood Test (A@G Pharma) ⬇Progranulin in blood dt Progranulin gene (PGRN) mutation ( Nature 2006)
2.C9ORF72 mutation(Neuron2011;72:245-56;257-68)(Lancet Neurol.3/9/12)

Alzheimer's Disease ⬆plasma Adiponectin (ArchNeurol2012Jan1)