Take care of your senses

About one third of older adults have some form of vision problems or loss by age 65, and nearly 50% of people older than 75 have disabling hearing loss. Anosmia, which is the medical term for the decline or loss of smell, can also be a significant blow to quality of life. Still, for most older adults, these common signs of aging don’t affect cognitive health.

Too many older adults consider sensory decline to be something that they must learn to live with, yet there are treatment options available. Scientists are studying whether the risk of cognitive problems can be reduced when these conditions are treated — with glasses, eye surgery, hearing aids, or other health care approaches. Read on to learn how NIA-funded investigators are finding new insights into how the eyes, ears, and nose might be windows into our overall cognitive health.

Alison Abraham, Ph.D., M.S., M.H.S., associate professor of epidemiology and ophthalmology at the University of Colorado School of Public Health, has long studied the relationship between the eyes and the brain. She is a principal investigator with the NIA-funded Eye Determinants of Cognition (EyeDOC) Study.

Abraham has a family history of vision problems that has fueled her personal interest in how vision loss affects emotional well-being, physical functioning, social interaction, and brain health. In her work, she collaborates with community groups and care providers on strategies for increasing routine vison screening and broadening access to vision care for older adults.

Abraham’s research focuses on the retina, the area at the rear of the eyeball that relays visual information through the optic nerve to the brain. “In the womb, the development of the retina and the brain are closely linked,” said Abraham.

In the EyeDOC study, Abraham uses a noninvasive imaging method called optical coherence tomography (OCT) to examine the retina. OCT is currently used to diagnose and manage diseases, including diabetes-related retinopathy and glaucoma. Compared to more intrusive brain imaging tests such as MRIs or PET scans, OCT provides an easier, less expensive way to learn about the health, thickness, and architecture of retinal nerves and blood vessels. Initial studies with OCT have shown obvious differences in retinal nerve fiber thickness between cognitively healthy older adults and people with Alzheimer’s disease and related dementias.

Abraham is continuing studies in this area and is hopeful that OCT could be repurposed to develop retinal biomarkers for earlier screening of people at risk for cognitive impairment. Other researchers found that cataract extraction was significantly associated with a lower risk of dementia development.

As you age, you may have concerns about the increased risk of dementia. You may have questions, too. Are there steps I can take to prevent it? Is there anything I can do to reduce my risk? There are currently no approaches that have been proven to effectively treat or prevent Alzheimer’s disease and related dementias. However, as with many other diseases, there may be steps you can take to help reduce your risk.

A risk factor is something that may increase the chance of developing a disease. Some risk factors can be controlled while others cannot. For example, a person is not able to control their age, which is the greatest known risk factor for Alzheimer’s and related dementias. Another uncontrollable risk factor is a person’s genes. Genes are structures in our body’s cells that are passed down from a person’s birth parents. Changes in genes — even small changes — can cause diseases.

Race and gender are also factors that influence risk. Research shows that African Americans, American Indians, and Alaska Natives have the highest rates of dementia, and that risk factors may differ for women and men. Researchers are investigating what’s behind these differences.

However, people do have control over their behavior and lifestyle, which can influence their risk for certain diseases. For example, high blood pressure is a major risk factor for heart disease. Lowering blood pressure with lifestyle changes or medication can help reduce a person’s risk for heart disease and heart attack.

To determine which risk factors may prevent a disease or condition, researchers first conduct observational studies to make associations. They then conduct carefully controlled clinical trials.

For example, researchers identified an association between high blood pressure and heart attacks and then completed clinical trials to determine that lowering a person’s blood pressure would indeed lower the likelihood of having a heart attack. This is not to say that people who lower their blood pressure definitely won’t have a heart attack. But it significantly lowers the chances.

For Alzheimer’s and related dementias, no behavior or lifestyle factors have risen to the level of researchers being able to say: This will definitely prevent these diseases. But there are promising avenues.

The number of older Americans is rising, so the number of people with dementia is predicted to increase. However, some studies have shown that incidence rates of dementia — meaning new cases in a population over a certain period of time — have decreased in some locations, including in the United States. Based on observational studies, factors such as healthy lifestyle behaviors and higher levels of education may be contributing to such a decline. But the cause and effect is uncertain, and such factors need to be tested in a clinical trial to prove whether they can prevent dementia.

A review of published research evaluated the evidence from clinical trials on behavior and lifestyle changes to prevent or delay Alzheimer’s or age-related cognitive decline. The review found “encouraging but inconclusive” evidence for three types of behavioral changes (called interventions): physical activity, blood pressure control, and cognitive training. The findings mean that interventions in these areas are promising enough that researchers should keep studying them to learn more. Researchers continue to explore these and other interventions to determine whether — and in what amounts or forms — they might prevent dementia.

Eating healthfully and having an active lifestyle can support healthy aging.

Simple adjustments can go a long way toward building a healthier eating pattern. Follow these tips to get the most out of foods and beverages while meeting your nutrient needs and reducing the risk of disease:

Enjoy a variety of foods from each food group to help reduce the risk of developing diseases such as high blood pressure, diabetes, and heart disease. Choose foods with little to no added sugar, saturated fats, and sodium.

To get enough protein throughout the day and maintain muscle, try adding seafood, dairy, or fortified soy products along with beans, peas, and lentils to your meals. Learn more about protein and other important nutrients.

Add sliced or chopped fruits and vegetables to meals and snacks. Look for pre-cut varieties if slicing and chopping are a challenge for you.

Try foods fortified with vitamin B12, such as some cereals, or talk to your doctor about taking a B12 supplement. Learn more about key vitamins and minerals.

Reduce sodium intake by seasoning foods with herbs and citrus such as lemon juice.

Drink plenty of water throughout the day to help stay hydrated and aid in the digestion of food and absorption of nutrients. Avoid sugary drinks.

It can be hard for some people to follow through on smart food choices. Read about common roadblocks and how to overcome them and check out the USDA’s tips for older adults.

Eating habits can change as we grow older. The USDA has developed Food Patterns to help people understand different ways they can eat healthy. The food patterns include:

Healthy U.S.-Style Eating Pattern: This is based on the types of foods Americans typically consume. The main types of food in this eating pattern include a variety of vegetables, fruits, whole grains, fat-free or low-fat dairy, seafood, poultry, and meat, as well as eggs, nuts, seeds, and soy products. Check out this sample menu to get started.

Healthy Mediterranean-Style Eating Pattern: This one contains more fruits and seafood and less dairy than the Healthy U.S.-Style Eating Pattern.

Healthy Vegetarian Eating Pattern: This pattern contains no meat, poultry, or seafood, but does contain fat-free or low-fat dairy. Compared with the Healthy U.S.-Style Eating Pattern, it contains more soy products, eggs, beans and peas, nuts and seeds, and whole grains.

Visit the USDA Food Patterns webpage for more information on each eating pattern and recommended daily intake amounts for each food group.

Use these tips to plan healthy and delicious meals:

Plan in advance. Meal planning takes the guesswork out of eating and can help ensure you eat a variety of nutritious foods throughout the day.

Find budget-friendly foods. Create a shopping list in advance to help stick to a budget and follow these SNAP-friendly recipes.

Consider preparation time. Some meals can be made in as little as five minutes. If you love cooking, or if you’re preparing a meal with or for friends or family, you may want to try something a little more challenging.

Keep calories in mind. The number of calories people need each day varies by individual.

Always discuss your weight and fitness goals with your health care provider before making big changes. Read about calorie goals and healthy food swaps.

Happy New Year! Looking for a way to stay on top of your health in 2023? Medicare covers many preventive and screening services. These services can help keep you from getting sick, and can help find health problems early when treatment is most likely to work best. Talk to your doctor about which ones might be right for you.

See What’s Covered

If you have Original Medicare (Part A and/or Part B), sign in to your secure Medicare account to see a personalized list of current and upcoming preventive services. If you don’t already have an account, it’s free — and easy — to sign up.

If you’re in a Medicare Advantage Plan, contact your plan for a list of covered preventive services. MA Plans must cover all the same preventive services as Original Medicare, and some may offer additional services.

Good news: Now people with Medicare Part D drug coverage will pay nothing out-of-pocket for even more vaccines, including the shingles vaccine, that are recommended by the Advisory Committee on Immunization Practices.

Here’s to your health in the new year!

Sincerely,

The Medicare Team

Alzheimer’s disease and related dementias affect more than 46 million people worldwide. Safe and affordable treatments to prevent cognitive decline in older adults are urgently needed. In response to this need, certain dietary supplements have been touted as having protective effects on cognition.

Normal brain function requires various vitamins, minerals, and other nutrients. Deficiencies in these nutrients may increase the risk for cognitive decline and dementia with age. Yet clinical trials of individual nutrients’ effects on cognition have yielded mixed results. Prior research suggests that flavanols in particular — compounds found in high levels in unprocessed cocoa — might benefit cognition.

Much of the research on flavanols was based on observational studies, rather than clinical trials. And previously, the effects of a multivitamin on cognition in older adults had been studied only in a few short clinical trials (less than 12 months) and a single longer trial that included older male physicians.

An NIH-funded research team led by Drs. Laura Baker and Mark Espeland at Wake Forest University School of Medicine aimed to fill the gaps in our understanding of these supplements’ effects on cognition. They examined more than 2,200 participants, ages 65 and older, who enrolled in the study from August 2016 to August 2017. The participants’ average age was 73.

Participants were given a cocoa extract supplement and/or a multivitamin-mineral supplement daily for three years, or an inactive placebo for comparison. They completed a battery of cognitive tests over the phone at the beginning of the study and once a year afterward. The researchers evaluated participants on global cognition (a wide range of cognitive measures), memory, and executive function (attention, planning, and organization). Results appeared in the journal Alzheimer’s & Dementia on Sept. 14, 2022.

The team found no difference in global cognition between those who took cocoa extract and those who did not. But participants taking the multivitamin had higher global cognition scores than those who didn’t. The improvement was most pronounced in those with a history of cardiovascular disease. Significant improvements with daily multivitamin use were also seen in memory and executive function. Cocoa extract had no effect on either.

The results suggest that a safe and affordable daily multivitamin-mineral supplement might improve cognition in older adults or protect cognitive health with age. Yet the researchers caution that the results, while promising, are still preliminary.

“It’s too early to recommend daily multivitamin supplementation to prevent cognitive decline,” Baker says. “While these preliminary findings are promising, additional research is needed in a larger and more diverse group of people. Also, we still have work to do to better understand why the multivitamin might benefit cognition in older adults.”

— by Brian Doctrow, Ph.D.

This research was supported in part by NIA grant R01-AG050657.

High blood pressure, diabetes, heart disease, and obesity are risk factors that may raise a person’s chances of experiencing the type of brain blood vessel damage that often underlies strokes and other neurovascular disorders. A gene called FMNL2 may play a critical role in linking these factors to the brain damage seen in some cases of Alzheimer’s disease, according to an NIA-funded study by Columbia University researchers.

NIA-funded scientists found that a gene called FMNL2 may tie cerebrovascular risk factors to Alzheimer’s disease. Experiments in zebrafish suggested that FMNL2 helps reshape the protective blood-brain barrier during Alzheimer’s. Courtesy of Mayeux lab, Columbia University Irving Medical Center.

FMNL2 encodes a protein that is known to help build the structures (known as cytoskeletons) found in cells throughout the body. The findings, published in Acta Neuropathologica, suggest that in Alzheimer’s, FMNL2 helps reshape a protective barrier between the brain and blood vessels, and that this process may speed the removal of damaging proteins.

For decades, some scientists have strongly suspected that Alzheimer’s is, in many ways, a blood vessel disorder. About 70% of patients show signs of the types of brain blood vessel damage often observed after strokes, and many of the risk factors that raise the chances of developing heart disease do the same for Alzheimer’s. In this new study, the researchers searched for clues as to how these factors may interact with one’s genes to elevate the chances of experiencing Alzheimer’s.

To this end, they analyzed the health and genomic data of 14,669 individuals of diverse racial and ethnic backgrounds who participated in several aging and Alzheimer’s studies conducted across the United States. The average age of the participants was approximately 80 years old, and nearly 38% had been diagnosed with Alzheimer’s.

First, the researchers used four factors to calculate a cerebrovascular risk score: diabetes; heart disease; obesity; and hypertension, which is sometimes called high blood pressure. Multiple previous studies have indicated these factors are often associated with experiencing strokes and other cerebrovascular diseases, as well as with Alzheimer’s.

In this study, about 70% of the participants had hypertension, 33% had heart disease, and 21% had diabetes. Based on body mass index scores, the average participant could also be classified as obese. Hypertension and diabetes were both highly correlated with and strongly influenced the Alzheimer’s risk scores.

Next, the team used several advanced data analysis techniques to test how the risk factors may combine with each gene on an individual’s chromosomes. They consistently found that the FMNL2 gene interacted the most with the cerebrovascular risk factors to raise Alzheimer’s risk.

Further support for this idea evolved when the scientists examined autopsied brain tissue. The brains of Alzheimer’s patients had high levels of the FMNL2 proteins surrounding blood vessels. The proteins appeared concentrated in astrocytes, which are star-shaped brain cells that line the blood-brain barrier. The blood-brain barrier prevents pathogens and toxins, which circulate throughout the blood system, from entering the brain.

In the brains of people who had died with Alzheimer’s, some astrocytes appeared “reactive” — in other words, in a diseased state — and detached from the barrier. The researchers observed these findings regardless of whether the person had been diagnosed with atherosclerosis, a disease that hardens blood vessels. In contrast, in the brains of age-matched control subjects without Alzheimer’s, FML2 proteins appeared sparsely, the astrocytes looked healthy, and the blood-brain barriers were intact.

The researchers saw similar signs of damage in the brains of mice that had been genetically engineered to mimic certain aspects of Alzheimer’s, supporting the idea that these changes may be a common reaction to the disease.

Overall, the results suggest that FMNL2 and other genes involved with blood-brain-barrier maintenance may be important candidates for developing new treatments that can counteract the damage caused by Alzheimer’s, especially in those who experience cerebrovascular risk factors.

The National Alzheimer’s Coordinating Center (NACC) provided some of the data for this study. NACC provides researchers with free, standardized clinical and neuropathological data collected from NIA’s Alzheimer’s Disease Research Centers.

If a primary care doctor suspects Alzheimer’s, he or she may refer the patient to a specialist who can provide a detailed diagnosis or further assessment. Specialists include:

Geriatricians, who manage health care in older adults and know how the body changes as it ages and whether symptoms indicate a serious problem.

Geriatric psychiatrists, who specialize in the mental and emotional problems of older adults and can assess memory and thinking problems.

Neurologists, who specialize in abnormalities of the brain and central nervous system and can conduct and review brain scans.

Neuropsychologists, who can conduct tests of memory and thinking.

Memory clinics and centers, including Alzheimer’s Disease Research Centers, offer teams of specialists who work together to diagnose the problem. In addition, these specialty clinics or centers often have access to the equipment needed for brain scans and other advanced diagnostic tests.

What are the benefits of an early Alzheimer’s diagnosis?
Alzheimer’s disease slowly worsens over time. People living with this disease progress at different rates, from mild Alzheimer’s, when they first notice symptoms, to severe, when they are completely dependent on others for care.

Early, accurate diagnosis is beneficial for several reasons. While there is no cure, there are several medicines available to treat Alzheimer’s, along with coping strategies to manage behavioral symptoms. Beginning treatment early in the disease process may help preserve daily functioning for some time. Most medicines work best for people in the early or middle stages of the disease. Learn more about Alzheimer’s medications.

In addition, having an early diagnosis helps people with Alzheimer’s and their families:

Plan for the future
Take care of financial and legal matters
Address potential safety issues
Learn about living arrangements
Develop support networks
An early diagnosis also provides people with more opportunities to participate in clinical trials or other research studies testing possible new treatments for Alzheimer’s.

Sign up for e-alerts about Alzheimers.gov highlights
Email Address
For more information about Alzheimer’s
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
[email protected]
www.nia.nih.gov/alzheimers
bout Alzheimer’s & Dementia, please call us at 1-800-438-4380, Mon-Fri, 8:30 am-5:00 pm Eastern Time or send an email to [email protected]

Many people are unprepared to deal with the legal and financial consequences of a serious illness such as Alzheimer’s disease or a related dementia. Legal and medical experts encourage people recently diagnosed with a serious illness — particularly one that is expected to cause declining mental and physical health — to examine and update their financial and health care arrangements as soon as possible. Basic legal and financial documents, such as a will, a living trust, and advance directives, are available to ensure that the person’s late-stage or end-of-life health care and financial decisions are carried out.

A complication of diseases such as Alzheimer’s and related dementias is that the person may lack or gradually lose the ability to think clearly. This change affects his or her ability to make decisions and participate in legal and financial planning.

People with early-stage Alzheimer’s or a related dementia can often understand many aspects and consequences of legal decision-making. However, legal and medical experts say that many forms of planning can help the person and his or her family address current issues and plan for next steps, even if the person is diagnosed with later-stage dementia.

There are good reasons to retain a lawyer when preparing advance planning documents. For example, a lawyer can help interpret different state laws and suggest ways to ensure that the person’s and family’s wishes are carried out. It’s important to understand that laws vary by state, and changes in a person’s situation — for example, a divorce, relocation, or death in the family — can influence how documents are prepared and maintained. Life changes may also mean a document needs to be revised to remain valid.

Families beginning the legal planning process should discuss their approach, what they want to happen, and which legal documents they’ll need. Depending on the family situation and the applicable state laws, a lawyer may introduce a variety of documents to assist in this process, including documents that communicate:

Advance directives for health care are documents that communicate a person’s health care wishes. Advance directives go into effect after the person no longer can make decisions on their own. In most cases, these documents must be prepared while the person is legally able to execute them. Health care directives may include the following:

A durable power of attorney for health care designates a person, sometimes called an agent or proxy, to make health care decisions when the person with dementia can no longer do so.

A living will records a person’s wishes for medical treatment near the end of life or if the person is permanently unconscious and cannot make decisions about emergency treatment.

A do not resuscitate order, or DNR, instructs health care professionals not to perform cardiopulmonary resuscitation (CPR) if a person’s heart stops or if he or she stops breathing. A DNR order is signed by a doctor and put in a person’s medical chart.

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