The Long Island Chapter of the Alzheimer’s Association will be holding an in-person event called “10 Warning Signs of Alzheimer’s” at the Middle Country Public Library, 101 Eastwood Blvd., Centereach on Thursday, Mar. 9 from 6:30 to 7:45 p.m.
This will be an overview of how to recognize the common signs of Alzheimer’s disease; how to approach someone about memory concerns; the importance of early detection and benefits of a diagnosis; possible tests and assessments for the diagnostic process, and Alzheimer’s Association resources
“It is important to recognize the warning signs of Alzheimer’s disease and other dementia,” said Taryn Kutujian, LMSW, Senior Community Education Manager for the Alzheimer’s Association Long Island Chapter. “We are here to provide the Long Island community the resources that you need to learn more about Alzheimer’s disease and other dementia.”
To learn more about the Long Island Chapter of the Alzheimer’s Association, visit its website here or call the 24/7 Helpline at 800.272.3900
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Alzheimer’s Association®
The Alzheimer’s Association is a worldwide voluntary health organization dedicated to Alzheimer’s care, support and research. Our mission is to lead the way to end Alzheimer’s and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. Their vision is a world without Alzheimer’s and all other dementia®.
The Alzheimer’s Foundation of America (AFA) has awarded the Long Island Museum a $6,000 grant to support the Museum’s “In the Moment” program, a free program designed to creatively engage those living with dementia-related illnesses and their care partners.
Created in 2011, this innovative program takes individuals living with dementia and their care partners on guided tours of the museum’s collection of art, historical objects, and seasonal exhibits. Additionally, the program offers hands-on art workshops which afford opportunities for creative expression, with all needed materials provided for free.
All programs are led by museum educators and designed to be cognitively stimulating. Programming is currently offered virtually through Zoom and as a hybrid, in-person/virtual option. Since its inception, the program served more than 3,200 individuals, according to the Museum.
“This AFA grant has allowed us to purchase a 75” Vibe Smartboard Pro to use as we return to in-person programming,” said Lisa Unander, Director of Education at the Long Island Museum. “We are building upon the lessons we learned through remote engagement and bringing the most successful aspects of these virtual programs to enhance our gallery sessions. Specifically, we have seen how powerful short video clips are as a way to engage and bring themes to life. With this grant, we won’t have to lose techniques we now heavily rely on, but instead will be able to incorporate these tools to create even more memorable multi-sensory moments together.
“Art can be a powerful tool to enhance quality of life for individuals living with a dementia-related illness and their caregivers. It stimulates the mind and creates opportunities for self-expression and socialization,” said Charles J. Fuschillo, Jr., AFA’s president and chief executive officer.“We are proud to support the Long Island Museum in delivering this impactful program to Long Islanders affected by Alzheimer’s disease and other dementias.”
Nikhil Palekar, MD. Photo by Jeanne Neville/Stony Brook Medicine
StonyBrook Center of Excellence for Alzheimer’s Disease selected as the only recipient on Long Island, and one of only 10 NYSDOH-supported, hospital-based centers of its kind in New York State
StonyBrook Center of Excellence for Alzheimer’s Disease (CEAD) was awarded a new $2.35 million, state-funded grant over five years (2022-27 grant cycle) by the New York State Department of Health (NYSDOH) and renews on June 1. Of the 10 NYSDOH-supported, hospital-based centers in the state, StonyBrookMedicine is the only recipient of this competitive grant on Long Island and will continue to serve the growing needs of communities in both Nassau and Suffolk counties.
To qualify as a Center of Excellence for Alzheimer’s Disease, a hospital-based center must meet rigorous standards which are measured and reviewed annually. These include: high quality diagnostic and assessment services for people with Alzheimer’s or another type of dementia; patient management and care; referral of patients and their caregivers to community services; training and continuing education to medical professionals and students on the detection, diagnosis and treatment of Alzheimer’s and other forms of dementia.
With scientific strides being made in identifying potential new ways to diagnose, treat and prevent Alzheimer’s and other dementias, StonyBrook’s efforts during this five-year grant cycle will also include a continued focus on research.
“The renewal of this important NYSDOH grant comes at a time when there are a growing number of people with Alzheimer’s disease in our state, many of whom reside in underserved communities right here on Long Island,” said Harold Paz, MD, MS, Executive Vice President Health Sciences, StonyBrook University, and Chief Executive Officer, StonyBrook University Medicine. “It reinforces the strong reputation StonyBrook has built over the years, as an expert in diagnosis, care, training and resources, and as an institution committed to being at the forefront of research and clinical trials seeking effective treatments and a cure.”
A Growing Population of 65+
According to the DOH, 410,000 New Yorkers age 65 and older live with Alzheimer’s disease. By 2025, this number is expected to increase to 460,000 New Yorkers needing care for Alzheimer’s disease. Long Island has the second-highest age 65+ population in New York State after New York City. On Long Island’s East End, approximately 36 percent of homes have at least one person in the household who is over 65 years of age.
“We are honored once again to be recognized for all that our team and community partners have accomplished as we continue to serve this vulnerable population,” said Nikhil Palekar, MD, Director, StonyBrook Center of Excellence for Alzheimer’s Disease. Dr. Palekar, who joined StonyBrook in 2017, has been instrumental in developing the Center’s mission and services.
An expert in the treatment and research of cognitive and mood disorders in older adults with grant funding from National Institutes of Health (NIH), the Alzheimer’s Association and Alzheimer’s Foundation of America, Dr. Palekar encourages people who are having trouble remembering, learning new things, concentrating, or making decisions to get screened and diagnosed — the sooner the better. “When the brain is unable to function well, your entire health starts to suffer. If you’re having memory issues, you’re probably forgetting to take your medications for blood pressure, diabetes, high cholesterol, causing a worsening of chronic medical conditions,” he noted.
Cognitive Screenings, Clinical Trials, Federally Qualified Health Center Partnerships
The StonyBrook Center of Excellence for Alzheimer’s Disease, part of the StonyBrook Neurosciences Institute, now offers free cognitive screening clinics to the community at CEAD’s offices at Putnam Hall on the campus of StonyBrook University, as well as at StonyBrook’s Advanced Specialty Care location in Commack. The StonyBrook CEAD staff is also available to conduct free screenings in communities on Long Island upon request. Each individual screened will receive the screening results on the spot so that they can bring the results to their primary care physician for further assessment and treatment if needed.
The StonyBrook Center of Excellence for Alzheimer’s Disease also offers a variety of clinical trials in support of groundbreaking research studies on aging, memory, and dementia. StonyBrook has been selected as a study site for several clinical trials, including monoclonal antibody therapy trials that target amyloid plaque for the treatment of mild Alzheimer’s disease.
Another new initiative of the StonyBrook CEAD is the establishment of partnerships with several federally qualified health centers (FQHCs) on Long Island to help meet the needs of unserved and underserved people spanning communities from the east end to those bordering Queens. StonyBrook CEAD will provide free cognitive screening assessments, educational resources, training for physicians, and opportunities to participate in research studies and clinical trials, which will help improve early diagnosis and quality of life for people in these communities living with Alzheimer’s or other forms of dementia.
For more information about the StonyBrook Center of Excellence for Alzheimer’s Disease, visit ceadlongisland.org.
About the StonyBrook Neurosciences Institute:
StonyBrook Neurosciences Institute is the regional leader in diagnosing and treating a full range of brain, neurological and psychiatric disorders in adults and children. As a tertiary care center, we also serve as the “go-to” medical facility for community physicians and other specialists in the region who have complicated cases and seek advanced care for their patients. We bring the expertise of renowned specialists together with the use of sophisticated technology to deliver high-quality, disease-specific, comprehensive care for patients, while providing peace of mind to their families. This care includes access to various resources and therapies to assist with rehabilitation and reintegration into everyday living during and after treatment. The Institute features more than 15 specialty centers and programs — several that are unique to our region — and more than 70 research laboratories dedicated to the study of various neurological and psychiatric disorders and diseases. The Institute also provides challenging yet supportive educational experiences that prepare graduates to practice in a variety of clinical and academic settings. To learn more, visit www.neuro.stonybrookmedicine.edu.
About 5 percent of people who suffer from Alzheimer’s disease have a genetic mutation that likely contributed to a condition that causes cognitive declines.
That means the vast majority of people with Alzheimer’s have other risk factors.
Donghui Zhu, an associate professor of biomedical engineering in the Institute for Engineering-Driven Medicine who joined Stony Brook University this summer, believes that age-related decline in the presence of the element magnesium in the brain may exacerbate or contribute to Alzheimer’s.
Donghui Zhu
The National Institutes of Health believes the former associate professor at the University of North Texas may be on the right track, awarding Zhu $3.5 million in funding. Zhu believes magnesium helps prevent the loss of neurons, in part because of the connection between this element, inflammation and the development of Alzheimer’s.
Numerous other factors may also contribute to the development of Alzheimer’s. Diabetes, lifestyle, a specific sleep cycle and low exercise levels may all play a role in leading to cognitive declines associated with Alzheimer’s, Zhu said.
According to some prior research, people with Alzheimer’s have a lower level of free magnesium in their body and in their serum levels than people who don’t suffer from this disease, he added.
In the short term, he aspires to try to link the magnesium deficiency to neuronal inflammation and Alzheimer’s disease.
Zhu plans to use some of the funds from the grant, which will run for the next five years, on animal models of Alzheimer’s. If his study shows that a lower level of magnesium contributes to inflammation and the condition, he would like to add magnesium back to their systems. Magnesium acts as an antioxidant and an anti-inflammatory agent.
“If we supply a sufficient amount of magnesium, can we slow down or reverse the process of this disease?” Zhu asked. “We hope it would.”
Any potential cognitive improvement in animal models might offer a promising alternative to current treatments, which often only have limited to moderate effects on patient symptoms.
In the longer term, Zhu would like to contribute to an understanding of why Alzheimer’s disease develops in the first place. Knowing that would lead to other alternative treatments as well.
“I don’t think my group or we alone can solve this puzzle,” he said. “We are all trying to chip in so the scientific community can have an answer or solution for the public.”
Like people with many other diseases or disorders, any two people with an Alzheimer’s diagnosis don’t necessarily have the same causes or type of the progressive disorder.
Women represent two-thirds of the Alzheimer’s population. Zhu said this isn’t linked to the longer life span for women, but may be more of a by-product of the change in female hormones over time.
In his research, he plans to study female and male animal models separately, as he looks to understand how the causes and progression of the disease may differ by gender.
In the human population, scientists have linked drug addiction or alcoholism with a higher risk of developing Alzheimer’s. He plans to perform additional studies of this connection as well.
“It’s the consensus in the community that alcohol addiction will increase the risk of developing Alzheimer’s disease,” Zhu said. People who consume considerable alcohol have reduced blood flow to the brain that can endanger or threaten the survival of blood vessels.
“This is another topic of interest to us,” he added.
Zhu is collaborating with other experts in drug addiction studies to explore the link with Alzheimer’s.
In his research, he hopes to link his background in biology and engineering to tackle a range of translational problems.
Stefan Judex, a professor and interim chair in the Department of Biomedical Engineering at Stony Brook, is excited about the potential for Zhu’s work.
Zhu is “a fast rising star in the field of biomaterials and fills a gap in our department and the university,” Judex explained in an email. “He is well-equipped to apply his unique research skills to a number of diseases, ultimately aiding in preventing and treating those conditions.”
In addition to his work on Alzheimer’s, Zhu also pursues studies in several other areas, including nano-biomaterials, biodegradable or bio-resorbable materials, regenerative medicine for cardiovascular and orthopedic applications, and drug delivery device and platforms
During his doctoral studies and training at the University of Missouri in Columbia, he focused on dementia and neuron science, while his postdoctoral research at the University of Rochester involved engineering, where he did considerable work on tissue engineering and biomaterials.
Zhu decided he had the right training and experience to do both, which is how he picked up on tissue engineering, regenerative medicine and neuroscience.
“They are not totally exclusive to each other,” he said. “There are many common theories or technologies, methods and models we can share.”
Adults don’t generate or create new neurons. He hopes in the future that an engineering approach may help to reconnect neurons that may have lost their interaction with their neighbors, in part through small magnesium wires that can “help guide their reconnection,” which is, he said, a typical example of how to use biomaterials to promote neuro-regeneration.
In his lab, he works on the intersection between engineering and medicine. The interdisciplinary and translational nature of the research attracted him to the new Institute for Engineering-Driven Medicine at Stony Brook.
He described Stony Brook as the “total package for me” because it has a medical school and hospital, as well as an engineering department and entrepreneurial support.
He has already filed numerous patents and would like to form start-up companies to apply his research.
Judex wrote that he is “incredibly pleased and proud that Dr. Zhu joined” Stony Brook and that it is “incredible that he received this large grant within the first few months since his start.”
In his career, Zhu would like to contribute to new treatments.
“Some day,” he said, he hopes to “put a real product on the market.”
Above, a transmitter and wristband that can be obtained at the Suffolk County Sheriff’s Department. Photo courtesy of S.C. Sheriff's Dept.
When someone goes missing, it can be a terrifying experience for the person as well as family, friends and neighbors, especially when the individual has an impairment.
The Suffolk County Sheriff’s Department is reminding the public of its Project Lifesaver initiative after John Wile, a Stony Brook man with Alzheimer’s, was found dead Aug. 8 on the Research and Development Park property, also in Stony Brook, after leaving his home to jog two days earlier. The 10-year-old rapid-response program aids clients who may wander due to cognitive impairments or other afflictions, such as Alzheimer’s, dementia and autism.
Deputy Sheriff Sgt. Brian Weinfeld said those enrolled in the sheriff’s program wear a wristband with a transmitter that can be used on the wrist, ankle or as a necklace. The radio frequency transmitter and wristband come with a case, tester and battery. The battery and wristband have to be changed or charged every 30 to 60 days depending on the type.
He said caretakers are informed to call a special line with the Sheriff’s Department and 911 as soon as it’s discovered that someone with the transmitter is missing. The calls are received at the sheriff’s communication bureau and a text message is sent out to all Project Lifesaver responders, which is approximately 15 people within the department who are spread out from Montauk to Amityville. While all may not be working when an emergency occurs, Weinfeld said sometimes a responder will join the search on his or her day off.
Once the responders get a message that someone is missing they turn on their equipment and will receive a signal every one second transmitted from the person’s location device, Weinfeld said. The range of the signal depends on the terrain, and a responder’s antennae can pick up a signal approximately 3 miles on land and 5 in the air. The signal can be picked up by the antenna on a car or from a handheld antenna when searching on the ground. Using radio frequencies has its benefits.
“It’s not susceptible to satellites going down, cloudy weather or being in a basement,” he said. “That signal is going to be strong no matter what. Whereas with a GPS-type of device, you’re going to be relying on satellites and a clear path to the sky and that type of stuff.”
Weinfeld said responders start from where the person went missing and have an estimated range of how far the person could have wandered, which can be about 4 miles an hour. When a man in Brentwood went missing recently, a responder was near the Sagtikos State Parkway and the man was found within three minutes, according to the deputy sheriff sergeant. He said it’s critical when looking for someone who is lost that a caretaker calls the second he or she realizes, even before he or she searches for the person.
“Thankfully most of our searches end before we even get there,” he said. “Which is great. I tell all the clients, ‘Please, don’t hesitate to call us because we’re working, we’re on the road, we’re there. If you think your person is missing, just call us. We can start by sending someone to your area. Five minutes later we’re just pulling in and you found them, no big deal, we’ll just go back to work.’ I don’t want people to think they’re burdening us.”
Weinfeld said there are approximately 108 clients enrolled in the program, with roughly 50 percent being seniors with Alzheimer’s or dementia. The other 50 percent are children and adults with autism. He said there has been a 100 percent success rate out of the 3,000 reported searches in North America.
Those interested in the program can fill out a form with the Sheriff’s Department, and after a home visit and approval, can purchase the kit for approximately $300. Weinfeld said health insurance may cover the expense in some cases and others may be eligible to receive it for free.
According to the Alzheimer’s Association, a voluntary health organization in Alzheimer’s care, support and research, one in three seniors die with Alzheimer’s or other dementias, and it’s the sixth leading cause of death in the U.S. The association states 5.7 million Americans are currently living with the disease, and it’s projected that number will rise to about 14 million by 2050.
“The use of electronic tracking devices may be an appropriate part of a comprehensive safety plan which offers peace of mind for individuals with the disease and their caregivers,” said Douglas Davidson, executive director of the Alzheimer’s Association,Long Island Chapter.”It should never be used as a replacement for needed supervision, and families should prepare for safety issues throughout the course of the disease.”
For more information on Project Lifesaver, visit www.suffolkcountysheriffsoffice.com/project-lifesaver. Also visit www.alz.org/longisland, for more information about Alzheimer’s and free programs and support available for patients in Suffolk and Nassau counties.
In Hawaii, numerous small earthquakes caused parts of Big Island to shake. Geologists, who monitor the islands regularly, warned of a pending volcanic eruption. They were right, clearing people away from lava flows.
How did they know?
It’s a combination of history and science. Researchers in the area point to specific signs that are reflections of patterns that have developed in past years. The small earthquakes, like the feel of the ground trembling as a herd of elephants is approaching in the Serengeti, suggest the movement of magma underneath the ground.
Higher volumes of lava flows could come later on, as in 1955 and 1960, say USGS scientists in the archipelago.
The science involves regular monitoring of events, looking for evidence of what’s going on below the surface. “Hopefully we’ll get smart enough that we can see [tremors] coming or at least be able to use that as a proxy for having people on the ground watching these things,” Tina Neal, scientist-in-charge at USGS Hawaiian Volcano Observatory, explained to KHON2 News in Honolulu.
People look for signs in everything they do, hoping to learn from history and to use whatever evidence is
available to make predictions and react accordingly.
Your doctor does it during your annual physical, monitoring your blood chemistry, checking your heart and lungs, and asking basic questions about your lifestyle.
Scientists around Long Island are involved in a broad range of studies. Geneticists, for example, try to see what the sequence of base pairs might mean for you. Their information, like the data the geologists gather in Hawaii, doesn’t indicate exactly what will happen and when, but it can suggest developments that might affect you.
Cancer researchers at Cold Spring Harbor Laboratory and Stony Brook University are using tools like the gene editing system called CRISPR to see how changing the genetic code affects the course of development or the pathway for a disease. Gene editing can help localize the regions responsible for the equivalent of destructive events in our own bodies, showing where they are and what sequences cause progression.
Scientists, often working six or seven days a week, push the frontiers of our ability to make sense of
whatever signs they collect. Once they gather that information, they can use it to help create more accurate diagnoses and to develop therapies that have individualized benefits.
Indeed, not all breast cancers are the same, which means that not all treatments will have the same effect. Some cancers will respond to one type of therapy, while others will barely react to the same treatment.
Fundamental, or basic, research is critical to the understanding of translational challenges like treating
Alzheimer’s patients or curing potentially deadly fungal infections.
Indeed, most scientists who “discover” a treatment will recognize the seminal studies that helped them finish a job started years — and in some cases decades — before they developed cures. Treatments often start long before the clinical stages, when scientists want to know how or why something happens. The pursuit of knowledge for its own sake can lead to unexpected and important benefits.
Outside the realm of medicine, researchers on Long Island are working on areas like understanding the climate and weather, and the effect on energy production.
Numerous scientists at SBU and Brookhaven National Laboratory study the climate, hoping to understand how one of the most problematic parts of predicting the weather — clouds — affects what could happen tomorrow or in the next decade.
The research all these scientists do helps us live longer and better lives, offering us early warnings of
developing possibilities.
Scientists not only interpret what the signs tell us, but can also help us figure out the right signs to study.
In Europe, lipoic acid is classified as a drug, unlike in the United States, where it is a supplement.
Lipoic acid may have a significant effect on multiple chronic diseases
By David Dunaief, M.D.
Lipoic acid, also known as alpha lipoic acid and thioctic acid, is a noteworthy supplement. I am not a big believer in lots of supplements for several reasons: Diet contributes thousands more nutrients that work symbiotically; in the United States, supplements are not regulated by the FDA, thus there is no official oversight; and research tends to be scant and not well-controlled.
Dr. David Dunaief
So why would I write about lipoic acid? It is a supplement that has scientific data available from randomized controlled trials, which are the gold standard of studies. In Europe, lipoic acid is classified as a drug, unlike the United States, where it is a supplement (1).
Lipoic acid is an antioxidant, helping to prevent free radical damage to cells and tissues, but also is a chelating agent, potentially removing heavy metals from the body. Lipoic acid is involved in generating energy for cells; it is an important cofactor for the mitochondria, the cell’s powerhouse. It may also boost glutathione production, a powerful antioxidant in the liver (1). We produce small amounts of lipoic acid in our bodies naturally. Lipoic acid may be important in chronic diseases, including Alzheimer’s, multiple sclerosis and diabetic peripheral neuropathy. Let’s look at the evidence.
Diabetic peripheral neuropathy
Diabetic peripheral neuropathy, or diabetic neuropathy, involves oxidative stress and occurs in up to half the population with diabetes. One in five patients, when diagnosed, will already have peripheral neuropathy. The most common type is distal symmetric polyneuropathy — damage to nerves on both sides of the body in similar locations. It causes burning pain, numbness, weakness and pins and needles in the extremities (2).
The best studies with lipoic acid focus on peripheral neuropathy with diabetes. In a double-blinded, randomized controlled trial (SYDNEY I), results showed that the total treatment score had improved significantly more for those receiving 600 mg lipoic acid by intravenous therapy compared to the placebo group (3). Also, individual symptoms of numbness, burning pain and prickling significantly improved in the group treated with lipoic acid compared to placebo.
The study involved 120 diabetes patients with stage 2 neuropathy. Its weakness was its duration; it was a very short trial, about three weeks. The author concluded that this therapy would be a good adjunct for those suffering diabetic neuropathy.
In a follow-up to this study (SYDNEY II), the design and the results were the same (4). In other words, in a second double-blinded, placebo-controlled trial, the lipoic acid treatment group showed significantly better results than the placebo group. There were 180 patients with a similarly short duration of five weeks.
Why include this study? There were several important differences. One was that lipoic acid was given in oral supplements, rather than intravenously. Thus, this is a more practical approach. Another difference is that there were three doses tested for lipoic acid: 600, 1,200 and 1,800 mg. Interestingly, all of them had similar efficacy. However, the higher doses had more side effects of nausea, vomiting and vertigo, again without increased effectiveness. This suggests that an oral dose of 600 mg lipoic acid may help treat diabetic peripheral neuropathy.
Dementia and Alzheimer’s
In a recent randomized, placebo-controlled trial involving Alzheimer’s patients, results were significantly better for lipoic acid (600-mg oral dose) in combination with fish oil, compared to fish oil alone or to placebo (5). The amount of fish oil used was 3 grams daily containing 675 mg docosahexaenoic acid and 975 mg eicosapentaenoic acid of the triglyceride formulation.
The duration of this pilot study was 12 months with 39 patients, and the primary end point was a change in an oxidative stress biomarker, which did not show statistical significance. However, and very importantly, the secondary end point was significant: slowing the progression of cognitive and functional decline with the combination of fish oil and lipoic acid. Minimental status and instrumental activities of daily living declined less in the combination treatment group. This was encouraging, although we need larger trials.
However, another study showed 900 mg lipoic acid in combination with 800 IU daily of vitamin E (alpha tocopherol strain) and 500 mg vitamin C actually mildly reduced an oxidative stress biomarker but had a negative impact on Alzheimer’s disease by increasing cognitive decline on a minimental status exam (6). What we don’t know is whether the combination of supplements in this study produced the disappointing effects or if an individual supplement was the cause. It is unclear since the supplements were tested in combination. The study duration was 16 weeks and involved 78 moderate to severe Alzheimer’s patients.
Multiple sclerosis
In a study involving rats, giving them high doses of lipoic acid resulted in slowing of the progression of multiple sclerosis-type disease (7). The mechanism by which this may have occurred involved blocking the number of inflammatory white blood cells allowed to enter the cerebrospinal fluid in the brain and spinal cord by reducing the enzymatic activity of factors such as matrix metalloproteinases.
I know this sounds confusing, but the important point is that this may relate to a human trial with 30 patients that showed reduction in the enzyme MMP (8). Thus, it could potentially slow the progression of multiple sclerosis. This is purely connecting the dots. We need a large-scale trial that looks at clinical outcomes of progression in MS, not just enzyme levels. The oral dose used in this study was 1,200 to 2,400 mg lipoic acid per day.
Interestingly, the 1,200-mg dose used in the human trial was comparable to the high dose that showed slowed progression in the rat study (9). This only whets the appetite and suggests potential. So, we have lots of data. What do we know? In diabetic neuropathy, 600 mg oral lipoic acid may be beneficial. However, in Alzheimer’s the jury is still out, although 600 mg lipoic acid in combination with fish oil has potential to slow the cognitive decline in Alzheimer’s disease. It also may have a role in multiple sclerosis with an oral dose of 1,200 mg, though this is early data.
Always discuss the options with your physician before taking a supplement; in the wrong combinations and doses, supplements potentially may be harmful. The good news is that it has a relatively clean safety profile. If you do take lipoic acid, know that food interferes with its absorption, so it should be taken on an empty stomach (1).
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
Dementia symptoms include impairments in thinking, communicating, and memory. Stock photo
By David Dunaief, M.D.
When you hear the word dementia, what is your reaction? Is it fear, anxiety or an association with a family member or friend? The majority of dementia is Alzheimer’s, which comprises about 60 to 80 percent of dementia incidence (1). There is also vascular dementia and Parkinson’s-induced dementia, as well as others. Then there are precursors to dementia, such as mild cognitive impairment, that have a high risk of leading to this disorder.
Dr. David Dunaief
Encouraging data
There is good news! A recent study, the Health and Retirement Study (HRS), a prospective (forward-looking) observational study, suggested that dementia incidence has declined (2). This was a big surprise, since predictions were for significant growth. Dementia declined by 24 percent from 2000 to 2012. There were over 10,000 participants 65 years old and older at both the 2000 and 2012 comparison surveys. There was also a decrease in mild cognitive impairment that was statistically significant. However, the reason for the decline is not clear. The researchers can only point to more education as the predominant factor. They surmise that more treatment and prevention of risk factors for cardiovascular disease may have played a role.
So how is dementia defined?
According to the American Psychiatric Association’s DSM-5 (“Diagnostic and Statistical Manual of Mental Disorders,” Fifth Edition), dementia is a decline in cognition involving one or more cognitive domains. In addition to memory, these domains can include learning, executive function, language, social cognition, perceptual-motor and complex attention (3).
What can be done to further reduce dementia’s prevalence?
Knowing some of the factors that may increase and decrease dementia risk is a good start. Those that raise the risk of dementia include higher blood pressure (hypertension), higher heart rate, depression, calcium supplements in stroke patients and prostate cancer treatment with androgen deprivation therapy (ADT).
What abates risk?
This includes lifestyle modifications with diet and exercise. A diet shown to be effective in prevention and treatment of dementia is referred to as the MIND (Mediterranean–DASH intervention for neurodegenerative delay) diet, which is a combination of the Mediterranean-type and Dietary Approaches to Stop Hypertension (DASH) diets. Surprisingly, there is also a cocktail of supplements that may have beneficial effects.
How does medication to treat dementia, specifically Alzheimer’s, fit into this paradigm?
It is not that I was ignoring this issue. Our present medications are not effective enough to slow the disease progression by clinically significant outcomes. But what about the medications in the pipeline? The two hottest areas are focusing on tau tangles and amyloid plaques. Recently, drugs targeting tau tangles from TauRx Therapeutics and amyloid plaques from Eli Lilly failed to achieve their primary clinical end points during trials. There may be hope for these different classes of drugs, but don’t hold your breath. The plaques and tangles may be signs of Alzheimer’s dementia rather than causes. Several experts in the field are not surprised by the results.
Let’s look at the evidence.
The quandary that is blood pressure
If ever you needed a reason to control high blood pressure, the fact that it may contribute to dementia should be a motivator. In the recent Framingham Heart Study, Offspring Cohort, a prospective observational study, results showed that high blood pressure in midlife — looking specifically at systolic (top number) blood pressure (SBP) — increased the risk for dementia by 70 percent (4). Even worse, those who were controlled with blood pressure medications in midlife also had significant risk for dementia.
There were 1,440 patients involved in the study over a 16-year period with an examination every four years. Then, those patients who were free of dementia were examined for another eight years. Results showed a 107-patient incidence of dementia, of which half were on blood pressure medications. And when there was a rapid drop in SBP from midlife to late in life, there was a 62 percent increased risk, to boot. Thus, the moral of the story is that lifestyle changes to either prevent high blood pressure or to get off medications may be the most appropriate route to reducing this risk factor.
Prostate cancer inflates dementia risk
Actually, the title above does not do justice to prostate cancer. It is not the prostate cancer, but the treatment for prostate cancer, androgen deprivation therapy (ADT), that may increase the risk of dementia by greater than twofold (5). Treatment duration played a role: those who had a year or more of ADT were at higher risk. ADT suppresses production of the male hormones testosterone and dihydrotestosterone. The study involved over 9,000 men with a 3.4-year mean duration; however, it was a retrospective (backward-looking) analysis and requires a more rigorous prospective study design to confirm the results. Thus, though the results are only suggestive, they are intriguing.
Calcium supplements — not so good
In terms of dementia, the Prospective Population Study of Women and H70 Birth Cohort trial has shown that calcium supplements, especially when given to patients who have a history of stroke, increase the risk of dementia by greater than sixfold (6). Those who had white matter lesions in the brain also had an increased risk. The population involved 700 elderly women, with 98 given calcium supplements. How do we reduce this risk? Easy: Don’t give calcium supplements to those who have had a stroke. This brings more controversy to taking calcium supplements, especially for women. You are better off getting calcium from foods, especially plant-based foods.
The MIND diet to the rescue
In a recent study, results showed that the MIND diet reduced the risk of Alzheimer’s dementia by 53 percent in those who were adherent. It also showed a greater than one-third reduction in dementia risk in those who only partially followed the diet (7). There were over 900 participants between the ages of 58 and 98 in the study, which had a 4.5-year duration. When we talk about lifestyle modifications, the problem is that sometimes patients find diets too difficult to follow. The MIND diet was ranked one of the easiest to follow. It involves a very modest amount of predominantly plant-based foods, such as two servings of vegetables daily — one green leafy. If that is not enough, the MIND diet has shown the ability to slow the progression of cognitive decline in those individuals who do not have full-blown dementia (8).
Supplement cocktail
To whet your appetite, a recent study involving transgenic growth hormone mice (which have accelerated aging and demonstrate cognitive decline) showed a cocktail of supplements helped decrease the risk of brain deterioration and function usually seen with aging and in severe Alzheimer’s dementia (9). The cocktail contained vitamins, minerals and nutraceuticals, such as bioflavonoids, garlic, cod liver oil, beta carotene, green tea extract and flax seed. Each compound by itself is not considered to be significant, but taken together they seem to have beneficial effects for dementia prevention in mice.
The reasons for dementia may involve mitochondrial dysfunction, oxidative stress and inflammation that are potentially being modified by these supplements. Hopefully, there will be more to come on this subject. It comes down to the fact that lifestyle modifications, whether in terms of reducing risk or slowing the progression of the disease, trump current medications and those furthest along in the drug pipeline. There may also be a role for a supplement cocktail, though it’s too early to tell. The MIND diet has shown some impressive results that suggest powerful effects.
Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.
Update, 4.27.16, 9:42 a.m.: Police reported that Reynaldo Macadaeg has been found, unharmed.
An elderly man told his wife he wanted to go to the Philippines before disappearing on Monday, the Suffolk County Police Department said.
Reynaldo Macadaeg, a 77-year-old man with Alzheimer’s disease, was last seen at his home on Centereach’s Strathmore Village Drive around 3 p.m., according to police.
Authorities issued a Silver Alert for the missing man, who also has heart problems and did not bring any medication with him.
Macadaeg is described as Filipino, 5 feet 4 inches tall and about 160 pounds, police said. He has brown eyes and thinning white hair.
At the time he was last seen, when he told his wife about how he wanted to go to the Philippines, he was wearing navy blue slacks, a dark blue coat and black shoes.
Anyone with information on his whereabouts is asked to call detectivesat 631-854-8652 or 911.
Annual Asharoken swim to benefit Alzheimer's disease research raises more than $6,000
By Talia Amorosano
On Tuesday morning, more than 20 kayakers and swimmers gathered for the 12th Annual Distant Memories Swim, an event created and organized by Bryan Proctor, a Harborfields physical education teacher, to raise awareness for Alzheimer’s disease, the most common form of dementia. Participants traveled two nautical miles from Asharoken Beach in Northport to Knollwood Beach in Huntington and were cheered on by family members and supporters who waited and watched the event from shore. This year’s event has raised more than $6,000 for the Alzheimer’s Disease Resource Center so far, and over the course of its existence, has raised over $100,000. Organizers hope that the money will eventually help researchers find a cure for this increasingly prevalent disease.
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Bryan Proctor comes ashore after a long swim at Knollwood Beach in Huntington. Photo by Talia Amorosano
Bryan Proctor’s family members complete the event at Knollwood Beach in Huntington. Photo by Talia Amorosano
A swimmer emerges from the water at Knollwood Beach in Huntington. Photo by Talia Amorosano
The group of volunteers, organizers, and supporters gather at Knollwood Beach in Huntington. Photo by Talia Amorosano
Supporters wait near the water for swimmers and kayakers to return at Knollwood Beach in Huntington. Photo by Talia Amorosano
A kayaker makes it ashore at Knollwood Beach in Huntington. Photo by Talia Amorosano
First swimmers ashore, Andrea O’Brien and Jennifer Howard are interviewed by News 12 Long Island at Knollwood Beach in Huntington. Photo by Talia Amorosano
Swimmer Jennifer Howard is all smiles and the second person ashore at Knollwood Beach in Huntington. Photo by Talia Amorosano
Swimmer Andrea O’Brien has her name and time recorded at Knollwood Beach in Huntington. Photo by Talia Amorosano
Swimmer Andrea O’Brien is the first person ashore at Knollwood Beach in Huntington. Photo by Talia Amorosano
Swimmers and kayakers get together for a group picture prior to the event at Asharoken Beach in Northport. Photo by Talia Amorosano
