Tangents on the topic of longevity

Advancing age is the number one risk factor for Alzheimer’s disease. Today, the Alzheimer’s Association estimates that 1 in 9 people over 65 have this progressive neurodegenerative disease and about 1 in 3 over 85 have AD. [That number is actually down from a 2011 annual report that concluded that 43% of those over 85 have AD]. There is also a higher incidence of AD in women than men, largely due to the fact that women tend to live longer than men.

Flashback to the early 1900’s and the average life span was 47. Higher infant mortality rates played a role in this number that is significantly lower than today (American women live an average of 81 years while men live 76 years on average). But medical advances have also made it possible for more people to live longer – treatment improvements for cardiovascular disease and the cessation of tobacco usage are two huge contributing factors here.

Longevity around the world
America actually ranks 37th in average lifespan. Japan has the highest average for a woman (87) while Iceland has the highest life expectancy for a man (81.2 years). Women in developed countries tend to live 19 years longer than those in poorer countries. Men live 16 years longer in this comparison. So ultimately, Alzheimer’s is more prevalent in developed countries where people are steadily exceeding the average age of 65.

Villagers in India have some of the lowest incidences of Alzheimer’s. Many researchers are coming to conclude that the high levels of turmeric in Indian diets may play a role there. In China, where vegetarian diets are much more common, AD was also found at a lower rate – in 2010 China had 5.7 million cases compared to 5.3 million in America (which is only one third China’s population). But the cases in China have almost doubled from just a few decades earlier…

Longevity has been increasing in China, and likewise the cases of dementia. Photo by Miriam (CC).

Since 1990, the average lifespan in China has increased from 70 to 76. Coincidentally, the prevalence of dementia in general there is now twice as high as reported previously by the international health community. Rapid industrialization (leading to changes in diet and lifestyle) seems to be another reason for these increasing dementia cases.

And back to Japan – here the general population consumes fish more so than meat. The incidence of dementia has been lower in comparison to Japanese-Americans (by about 4-6%). But 1 in 4 native Japanese are now over 65 and those numbers are growing. Studies have shown that Alzheimer’s has steadily been replacing vascular dementia as the critical heath issue there.

Longevity in Down Syndrome
In another unique population, people with Down Syndrome are also living longer. DS is a form of premature aging. Researchers have known for a while now that 75-100% of people with DS have the elevated pathology of Alzheimer’s disease by age 40. Early onset dementia is often observable. And yet, not all of these people go on to develop the symptoms of dementia…

People with Down Syndrome are living longer – nearly 100% exhibit the Alzheimer’s pathology by age 50.

Studies at the University of Wisconsin, Madison, have shown that about one third of the DS participants showed no cognitive impairment, despite having elevated levels of amyloid-beta on MRI’s and PET scans. And studies in Australia have shown that DS participants have been developing the symptoms of AD at a later age (50-60 years old), possibly due to education, early intervention, better nutrition and healthcare.

Longevity with TBI’s
Over the past few decades, significant success has been achieved in keeping people alive after traumatic brain injuries (TBI’s). While each case of TBI is unique in damage, there are some items worth noting here as well.

The symptoms of many TBI’s already overlap dementia dramatically: memory loss, impaired judgment, inappropriate behavior, attention deficits, and sometimes communication problems. Some studies have shown that moderate to severe head injuries can lead to the development of the Alzheimer’s pathology. A specific study of veterans at the University of CA, S.F. suggests that TBI’s may even be a trigger for earlier onset dementia.

The recent flurry of stories about football players and their concussions also highlight the connection between repetitive head injuries and the pathology of Alzheimer’s. These concussions are, of course, similar to dementia pugilistica, or the “punch-drunk” syndrome observed among boxers. 15-20% of all boxers are thought to develop this neurodegenerative disease.

Dementia down the road may be the price of a career in boxing.

One last tangent worth considering is that our brains are shrinking as we age. This sets the stage for increased movement of the brain inside the skull. With less protection, does this mean more vulnerability to the production of amyloid-beta protein deposits? Are these plaque build-ups a threat to the brain, or possibly the body’s best defense mechanism against subtle and sometimes not so subtle injuries to the brain? We’ll look more closely at this topic next.

Head injuries contrasted with neurological diseases

Before we move on to memory coping strategies, let’s spend a little more time contemplating minor to major head injuries in general…

Think of the different scenarios when we might have taken a bump to the head while growing up. Maybe on the playground, in activities like gymnastics, little league and especially concussions in football, wrestling, soccer, boxing, skiing or snowboarding, or perhaps a fall from a horse? It could happen in lots of subtle and not so subtle ways.

In more traumatic head injuries, it usually involves cars, motorcycles and other high impact scenarios, like falling from a building. Motorcycles are involved in close to 60% of all TBI cases. Not wearing a seat belt is another factor. These TBI’s could be open or closed head injuries.

We tend to think of our brains as well protected, secure behind a thick skull and safe in fluid….until a major impact occurs. Then we find out that the brain moves and twists and neuronal tissue can be torn. The forehead (and frontal lobe) is often injured, along with the back of the head (occipital lobe) when common whiplash movements result.

In most TBI cases, short term memory is affected. In the worst cases it’s like permanent amnesia, and this loss can be very debilitating. It can affect the simplest executive functions, like answering a phone, to more complicated activities like following a recipe and remembering to turn off the stove. Does this sound familiar? Cooking with Alzheimer’s is just as dangerous. Forgetting whether you brushed your teeth or used deodorant, what television show you just watched or what conversation you just had – these are all similar events, whether suffering from AD or a TBI.

In a previous article we saw that studies of head injuries in the military also showed early signs of the pathology of Alzheimer’s. The correlation is hard to ignore. Beyond memory issues, people that have had TBI’s often experience tremors and hemi-paresis (muscle weakness or full blown paralysis in one side of the body caused by nerve damage) – the same motor neuron damage common in Parkinson’s Disease and strokes. And then there are lower brain stem impairments, that can affect thirst, sleep, and hunger, as well as impulsive behavior. Are head injuries a foreshadowing of what’s to come?

Memory loss in traumatic brain injuries

Certainly not all memory issues indicate progressive neurological diseases are occurring, but short term memory loss can sometimes be an early warning sign of Alzheimer’s Disease. It’s also a very common symptom for people suffering with TBI’s.

Many head injuries involve impact of the forehead and thus possible injury to the frontal lobe. How much of an impact is required to have consequences? We don’t necessarily know. But it can make you think twice about even the most common bumps.

When the frontal lobe has been significantly compromised, short term memory loss is a common symptom. Add to that: attention may become more difficult and require more energy; initiative or self-motivation may decrease, even leading to outright apathy; and abstract thought may be impaired. All of these factors can affect overall memory.

The trials of short term memory loss
Everything becomes more difficult with memory loss. What did I have for breakfast yesterday? Did I eat breakfast today? Did I take my medicine? Did I miss my doctor’s appointment?

And the more drastic the memory loss the more unsettling reality becomes: Who is that in the hallway [themselves in the mirror]? Who is this woman [daughter] poking my finger [testing my blood sugar]? Am I in someone else’s house? Reality may take on an almost dreamlike quality.

Short term memory loss often leads to complications with what are known as “executive functions.” Planning, following directions, and the like. Following directions can certainly be a challenge if you forget one or more of the steps.

Other challenges include:
*Misplacing or losing items.
*Becoming a “poor historian” forgetting details of recent events, which will lead to long term memory problems. Or they may remember details but inaccurately (which is known as Misattribution).
*Trouble communicating – vocabulary may not come as quickly, or at all. Lots of “tip of the tongue” moments.
*Perseveration -this is the term used when a person is constantly repeating stories or phrases unrelentingly. It may seem like they are stuck in a groove.
*Being under the influence of others. If you don’t remember what has occurred, you are vulnerable to believe many things. The term for this is Suggestibility.

But there are several strategies for coping with short term memory loss, and believe it or not, even some advantages. Please stay tuned…

The issue of loss

Seniors certainly understand loss in the aging process – primarily loss of general health and independence. But let’s take a closer look, from the physical to the material, to the psycho-social:

Loss of hair
Loss of teeth
Loss of circulation
Loss of muscle tissue
Loss of stamina
Loss of hearing and vision
Loss of bladder control
Loss of proper hygiene
Loss of sex drive
Loss of speech
Loss of appetite
Loss of sleep
Loss of a driver’s license
Loss of a spouse or child
Loss of income
Loss of social interactions
Loss of leisure options
Loss of self-control
Loss of awareness
Loss of trust
Loss of dignity
Loss of confidence
Loss of respect

Sorry to get your Monday off to a bad start. That’s a big list, and as we age, most of us will experience a lot of this loss at some point. In the world of traumatic brain injuries (TBI’s), this loss is just as dramatic, only the people experiencing it are often much younger. In general, the highest incidence occurs in males between the ages of 16 to 24. Over the age spectrum, the highest risk age categories for TBI’s are 0-4 years, 15-19, and then seniors (65+).

With loss comes grief. A person that has lost chunks of their memory, physical abilities, perhaps their livelihood, their spouse or girlfriend (or children, due to divorce or estrangement), their driver’s license, etc., may be especially bitter when they are only 25 or 30 years old.

They also may not have lived long enough to develop the necessary coping skills. Add to that some of the limitations of Medicaid resources and life can be outright devastating. Grief counseling should never be neglected for a person with a TBI, or a person suffering from dementia.

Like Alzheimer’s, one of the more striking losses for a person with a TBI is loss of short term memory. We’ll cover this next…

Dementia SOS resumes – contrasting dementia and Traumatic Brain Injuries

Meet your author, Marc

After a bit of a hiatus in the work world, Dementia SOS is resuming once more. The author (Marc) has been working as a brain injury specialist for a local home health care company in Denver for the past year and a half and has a number of new insights to share – cognitive impairment due to open and closed head injuries overlaps the topic of dementia considerably.

Some of the near term articles will be focusing on various aspects of brain injury and contrasting symptoms with those of Alzheimer’s, Parkinson’s, and several other causes of dementia. Just as with aging, TBI’s (traumatic brain injuries) affect mobility, affect, memory (of course), and overall limitations in independence.

People with TBI’s also struggle with tremors, seizures, mild and major depression, drug interactions, incontinence issues, trouble swallowing and sleeping, and even some bouts of sun downing. But at the forefront of all of their symptoms is an overriding sense of loss and associated grief. We’ll examine this closer in the next post…

Dementia and head injuries

Statistics vary, but anywhere from 1.5 to 2 million head injuries occur each year in the US.  About 75% of these are mild.  The more moderate and severe head injuries may have symptoms that go away quickly, or last a while, or symptoms that may never go away.  And in some cases, the pathology of Alzheimer’s (plaques and tangles) may even start to appear.

Mild head injury is often synonymous with concussion.  As the degree of severity increases, so too may the symptoms: memory loss, speech impairment, blurry vision, general confusion and even personality changes.  Symptoms that appear right away do not usually get worse over time, but some studies have shown the activation of enzymes, leading to beta amyloid deposits and tau tangles.

The study most often cited (University of California, San Francisco) was conducted with 300,000 war veterans over the age of 55.  7% of the control group went on to develop dementia while 15% of those with head injuries developed dementia and so the conclusion: people with traumatic brain injuries were twice as likely to develop dementia.

Loss of consciousness with head injury is a possible indicator for developing dementia.  This is rated by the amount of time a person is unconscious after the injury:

• Severe = unconscious for greater than 24 hours
• Moderate = unconscious for 30 minutes and up to 24 hours
• Mild = unconscious for less than 30 minutes

The Glasgow Coma Scale is the most frequently used measurement for degree of head injury.  The GCS test measures eye, motor and verbal abilities.  A score of 13-15 is mild, 9-12 is moderate and 8 or less is severe.

Glenn Smith (clinical neurologist at Mayo clinic) says that “It’s important to note that many people who sustain a severe head injury never develop Alzheimer’s disease or later dementia.”  But autopsies and other studies conducted in Vienna, Austria (Kurt Jellinger) have shown a correlation between head injury and the Alzheimer’s pathology.

Another study (Southern General Hospital of Glasgow and University of Pennsylvannia) also found brain tissue abnormalities.  Per William Stewart (lead for the study), one third of the 39 brain injuries examined showed some signs of plaques and tangles.  And these were people in their 40’s and 50’s.

Some other studies have shown that men are more prone to dementia complications from head injuries than women.  The hormones progesterone and oestrogen are thought to provide some protection for women.

Prevention and action steps

Of course, accidents happen.  But there are a few obvious things to keep in mind concerning head injuries:

• Sports like boxing and football will contribute to injury.
• Helmets should be worn (and appropriately) when engaging in biking, rollerblading, skiing and snowboarding, rock climbing, etc.
• Seniors are prone to falls.  Steps should be taken to minimize this as much as possible.
• When a fall occurs, visit your doctor immediately for follow up.  Consider getting an MRI or CAT scan to rule out hemorrhages and other complications.  Make sure the date of the fall is part of your permanent medical record.