Science
Dementia May Not Always Be the Threat It Is Now. Here’s Why.
Joan Presky worries about dementia. Her mother lived with Alzheimer’s disease for 14 years, the last seven in a memory-care residence, and her maternal grandfather developed dementia, too.
“I’m 100 percent convinced that this is in my future,” said Ms. Presky, 70, a retired attorney in Thornton, Colo.
Last year, she spent almost a full day with a neuropsychologist, undergoing an extensive evaluation. The results indicated that her short-term memory was fine — which she found “shocking and comforting” — and that she tested average or above in every cognitive category but one.
She’s not reassured. “I saw what Alzheimer’s was like,” she said of her mother’s long decline. “The memory of what she went through is profound for me.”
The prospect of dementia, which encompasses Alzheimer’s disease and a number of other cognitive disorders, so frightens Americans that a recent study projecting steep increases in cases over the next three decades drew enormous public attention.
The researchers’ findings, published in January in Nature Medicine, even showed up as a joke on the Weekend Update segment of “Saturday Night Live.”
“Dementia is a devastating condition, and it’s very much related to the oldest ages,” said Dr. Josef Coresh, director of the Optimal Aging Institute at NYU Langone Health and the senior author of the study. “The globe is getting older.”
Now the findings are being challenged by other dementia researchers who say that while increases are coming, they will be far smaller than Dr. Coresh and his co-authors predicted.
Using data from about 15,000 Americans over age 55, collected at four research clinics around the country from 1987 through 2020, Dr. Coresh’s team projected a lifetime dementia risk much higher than previous studies had: 42 percent, though most of that risk didn’t emerge until after age 85.
The higher lifetime number probably reflected the study’s reliance on a more diverse sample than earlier researchers had used, Dr. Coresh said, and more dementia cases identified through in-depth questionnaires, regular phone calls, medical records and death certificates.
The researchers applied their risk calculations to the U.S. population and estimated that the number of people who would develop dementia each year would roughly double, to about a million by 2060, from 514,000 in 2020.
Eric Stallard, an actuary and co-director of the Biodemography of Aging Research Unit at Duke University, read the study and thought the team “seemed very competent at their analysis” of individual risk.
But when it came to the projection that cases would double, which assumed that the incidence of dementia would remain stable over the next 40 years, “I don’t believe it,” Mr. Stallard said.
“The notion that the number of people with dementia will double over the next 25, 30 or 35 years due to the aging of baby boomers is widespread, it’s pervasive — and it’s wrong,” he added.
He and two other Duke researchers recently published a commentary in JAMA pointing out that the age-specific prevalence of dementia in this country had steadily declined for 40 years.
“If your risks are lower than your parents’ risks and this trend continues, you won’t see the doubling or tripling of dementia that’s been projected,” said Dr. Murali Doraiswamy, director of the Neurocognitive Disorders Program at Duke and a co-author of the JAMA article.
To be clear, experts agree that the number of people with dementia will climb in coming decades, simply because the disorder rises so steeply with age and the number of older adults in the United States will increase.
But Mr. Stallard estimates that the increase will be more like 10 to 25 percent by 2050. “It will still be a significant challenge for the health system in the U.S.,” he said.
The Duke group relied on its own long-term study of people over age 65, with more than 21,000 respondents in 1984 and about 16,000 in 2004, plus later data from the national Health and Retirement Study and the National Health and Aging Trends Study.
Their analysis found that among 85- to 89-year-olds, for instance, the proportion with dementia was about 23 percent in the cohort born in 1905. In those born 10 years later, the figure had dropped to about 18 percent.
By the time Americans born in 1935 reached their late 80s, about 11 percent had dementia; the projection for those born from 1945 to 1949 is now about 8 percent.
To Dr. Coresh, whose primary interest was in individual risk, the assumption that past declines would continue at about the current rate “would be great, but is quite an optimistic, dramatic decrease,” he said in an email.
Yet in another longitudinal study of older adults in England and China, published in Nature Aging last year, “we also found these quite marked improvements in more recently born cohorts,” said the lead author, Dr. John Beard, a medical epidemiologist at the Mailman School of Public Health at Columbia University.
“You would expect the increase in the absolute numbers of people with dementia in the U.S. will be less than we feared,” Dr. Beard said.
What has led to the decrease in dementia, also seen in several European countries? Often cited explanations include rising education levels, reduced smoking and improved treatment for high blood pressure and high cholesterol.
The Lancet Commission on dementia, intervention and care has developed a list of 14 modifiable risk factors, including greater use of hearing aids and reduced air pollution, that could still lead to greater declines.
Yet the reverse could also happen. If earlier and more widespread testing increases the number of dementia diagnoses, or if the definition of dementia broadens, rates will increase, Dr. Doraiswamy noted. Increasing life expectancy would have the same effect.
Obesity and diabetes, more common in recent decades, could lead to more dementia, but much-touted new drugs that reduce them could blunt that trend — if people can get them.
“None of this is inevitable,” said Dr. Gill Livingston, a psychiatrist at University College London who leads the Lancet Commission. “It depends on what we do.”
Public health policy makes a major difference, she noted, and, “The U.S. is in a time where policy is changing enormously.”
Dementia rates might rise, for example, “if people have less access to health care, so they are less likely to get their blood pressure treated and their high cholesterol treated,” Dr. Livingston said.
Slashed Medicaid coverage could lead to that result. So could a rollback of environmental policies, “if air pollution increases because of fossil fuels,” she added.
Already, dementia afflicts some American populations far more than others, researchers point out. Older women and Black people face greater risk, along with those who carry the APOE4 gene associated with Alzheimer’s disease.
Health disparities could mean that “affluent people will see lower rates of dementia” because of the new diabetes and obesity drugs, Dr. Doraiswamy said. “People who can’t afford them and whose conditions are not well-managed will see rates go up.”
The debate about how many older adults will develop dementia in coming decades, and about how individuals, families, government and the health care system should respond, will likely continue.
So will Ms. Presky’s fears.
For now, she enrolls in lifelong learning classes, takes walks and yoga classes despite orthopedic problems, listens to podcasts and reads a lot of history and fiction. She and her husband take in theater in New York and Phish concerts on the West Coast and will soon be heading to London and Paris.
Still, her advance directive contains many provisions about dementia. “I remain pessimistic,” she said, noting that her mother was diagnosed at 77. “I have seven more years before I meet her fate.”
Science
What My Father’s Experience Taught Me About Memory and the Brain
A couple of years ago, in the middle of the night, I crept downstairs to find my father sitting at the kitchen table, sobbing like a child.
My mother was beside him, trying to comfort him, an activity that took up more and more of her time. He was 87 and had dementia. It wasn’t unusual to find him upset or confused. But on this night, something seemed to be happening to him in real time — in 1941.
He was 6 years old, and was leaving Pittsburgh, the only home he had ever known, for an Air Force base in San Antonio, where his father had been ordered for duty. He and his parents were traveling there by train, transferring in Chicago.
It was the beginning of a lonely, difficult time for my father’s family, moving between Air Force bases in the South, where landlords sometimes turned them away because they were Catholic. An only child, he had been allowed to take one pet with him, a canary he was carrying in a birdcage.
As they were changing trains in Chicago, the bottom fell out of the cage. The canary flew out, up into the vaulted atrium of the station’s Great Hall. There was no way to get the bird — there was no time, they had to board a train to Texas. So my 6-year-old father shuffled after his parents, holding an empty cage.
In the years that had elapsed, he had negotiated arms treaties with the Soviets, had advised presidents, had served as a U.S. ambassador, all with the same watchful, wisecracking reserve. I thought I knew who he was. I could count on one hand the times I had seen him cry. Now here he was, sobbing over the canary as if it were yesterday.
This was all, it seemed, because of his brain. He had fallen hard in their house in Washington, D.C., smacking his head on the hardwood floor. Blood rushed into spaces in his brain, and cells starved of oxygen began to die. Eventually, he was diagnosed with vascular dementia, which is most often caused by strokes.
For five years after that, my parents lived with my family outside Boston, and we learned firsthand how brain injury affects behavior. My father recovered in some ways, but he became chaotic, his thoughts broken into mirror shards.
The biggest problem was that he had no idea where he was. Specifically, he did not know why he was living with us in Massachusetts, and no matter how many times we tried to remind him, over and over, he tried to leave. We would catch him packing the car, and gently — or not so gently — guide him back into the house.
This child-father was full of surprises. He bought surprising things: Five laptops! A cruise on the Norwegian fjords! Recurring $2 donations to every Democrat running for any office, anywhere! Once, in a weeklong cascade of Amazon deliveries, we received seven identical birdbaths from China.
Science
Dirty mind? Study suggests gut movement may flush excess material from our brains
With each step you take, coordinated contractions in your abdominal muscles help keep you stable and upright.
Now, new research finds that those gentle changes in tension and pressure also affect your brain, and may play a role in the organ’s overall health.
Imaging in humans and other animal species has long shown that the brain gently moves inside the fluid-filled skull cavity, but it’s never been clear what, exactly, is propelling this motion, said neuroscientist Patrick Drew, a Penn State University professor and associate director of the Huck Institutes of the Life Sciences.
Using advanced imaging, Drew’s team observed mice brains before and after the animals began walking. They realized that the brain actually moved just milliseconds before a mouse took a step — the brief moment when the animal’s abdominal muscles contracted in preparation for movement.
To test the observation, they strapped pressure sensors around the bellies of lightly anesthetized mice and observed the brain when slight pressure was applied only to the abdominal muscles. The same motion followed. Breathing or cardiac activity didn’t trigger the same response.
The connection, Drew and his colleagues determined, is the vertebral venous plexus, a network of veins that connects the abdomen to the spine in mice and humans alike.
“It’s like a hydraulic system. It really is very much like the jacks that push your car up, or something that an excavator might have,” Drew said. “Whenever you tense those muscles, which you do whenever you make a movement … that pushes blood into the spinal cord, it increases the pressure on your brain, and it moves your brain forward.”
The paper, which was published April 27 in Nature Neuroscience, answers a puzzling question about the mechanism controlling this long-observed cerebral movement.
It also puts forward hypotheses about why this belly-brain choreography exists.
Drew and his team ran computer simulations of fluid’s motion in and around mouse brains. The kind of contraction generated by walking moves cerebrospinal fluid out of the brain, leading Drew to hypothesize that the mechanism plays an important role in flushing out protein waste and other unnecessary material.
“It’s more speculative, but using simulations, we can see that this sort of motion should drive fluid movement and could help clear waste in the brain,” Drew said.
In future research, Drew said, the team would like to explore whether the brain is detecting these mechanical signals, and how physical conditions like obesity affect the hydraulic relationship between the abdominal muscles and the brain.
These current findings clarify the relationship between the brain and physical movement, illuminating fundamental mechanics that can apply to other research, said Michael Goard, an associate professor at UC Santa Barbara who studies sensory and spatial processing.
“He did, what I think is a very thorough job figuring out what’s causing this movement in the case of locomotion and tying down the mechanical elements,” Goard said.
Science
The Longevity Secrets Helping Athletes Blow Past the Limits of Age
The assessment covers seven simple movements — various lunges, jumps and timed balances — and produces a player score relative to the rest of the league and the player’s own history. The report also includes “jump” and “landing strategy” metrics that chart the distribution of force across a player’s hips, knees and ankles, and it translates arcana like “max ankle dorsification angle” into the lingua franca of basketball: “how small your ankle angle can get like when you get low on a quick first step.” The file, which a player can access throughout his career, regardless of team, is meant to give him information about how hard he can push his body — and, just as critically, when it’s time to ease off.
“When you’re younger, there’s days you can take as many — for us — baseball swings as you want,” New York Yankees first baseman Paul Goldschmidt, who is 38, told me. We were talking in mid-February at the team’s spring training facility in Tampa, Fla., as he was getting ready for eight straight months of baseball. “As you get older, there’s times when rest is more important than work.”
For some athletes, the right biometric data presented in the right context represents “permission to rest,” says Ana Montero, a co-founder of Atlas, a San Francisco-based company that makes brain-wave-scanning, behind-the-ear wearables about the size of Mentos candies. “It’s quantifiable evidence that is showing you: Dude, today — or right now — is not the day. Go to the gym, go for a walk, go for whatever it is. And then coming back and actually seeing that you’ve bounced back.”
The Atlas device gathers several types of data, including electroencephalography, or EEG, which measures electrical activity in the brain, and galvanic skin response, or G.S.R., which is what a polygraph test measures. That data is sorted into five categories (among them agility, vitality and stress) and then delivered with advice through a smartphone app.
“There’s always some noise in brain activity because neurons are not perfect chips or transistors,” André Marques-Smith, Atlas’s other co-founder, says. “So mistakes get made.” He adds that what causes neurons to lose their precision are things that we’re all familiar with: fatigue, stress, anxiety, hunger, aging. Tom Ryan, the N.B.A.’s senior vice president of basketball strategy, says Launchpad chose Atlas because it was eager to find a device that collected this sort of data in real time. If it works the way it’s supposed to, then a vet like Goldschmidt will know exactly when he’s good for some extra batting practice and when he should take a nap instead.
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