by Nina Silverberg, Ph.D., director of the NIA Alzheimer’s Disease Research Centers program

Imagine being able to look inside the brain of a person with Alzheimer’s disease and see the changes that are interfering with that person’s thinking, memory, and other important brain functions. Scientists working in the field of neuropathology are doing just that.

Using a variety of methods, neuropathologists view patterns of abnormal protein clusters and cellular damage in brain tissue under a microscope and through computer-driven imaging. They use that information to characterize the changes that occur in the brain with particular diseases or conditions.

For example, in 1906, the psychiatrist and neuropathologist Alois Alzheimer first identified the abnormal buildup of protein fragments — amyloid plaques and neurofibrillary (tau) tangles — in the brain tissue of a woman who had died from a previously unknown disease that caused a decline in her ability to think, remember, and speak. This illness was later named Alzheimer’s disease, which is the most common form of dementia. Neuropathologists today continue to actively work on identifying the changes that can be seen in the brain after death and connecting those to symptoms and biological processes observed during life.

Neuropathology is the study of diseases of the brain, spinal cord, and nerves through analyzing tissues removed during autopsy or biopsy. This analysis is central to research on Alzheimer’s disease and other neurodegenerative diseases. Neuropathology researchers look for signs of disease and disease progression and can identify whether changes in the brain are related to the protein accumulations seen in Alzheimer’s disease, like in the image below, or to other underlying causes of dementia.

Long before the symptoms of memory loss appear, many molecular and cellular changes take place in the brain of a person with Alzheimer’s. Neuropathology research has been essential in helping to identify these biological changes, called biomarkers, and revolutionizing the methods scientists and doctors can use to diagnose and treat these diseases. For example, 20 years ago, the only sure way to know whether a person had Alzheimer’s was through autopsy. Since then, researchers have developed and tested methods to “see” evidence of protein fragments associated with Alzheimer’s on brain scans, in cerebrospinal fluid, and even in blood while people are still alive. Being able to diagnose Alzheimer’s in the early stages is helping researchers to test new treatments that may slow or stop progression of the disease.

Still, as far as neuropathology has evolved, there is much to learn. For example, not everyone with amyloid plaques and tau tangles — the hallmark signs of Alzheimer’s — will eventually develop this disease. In addition, many people who are diagnosed with Alzheimer’s dementia have evidence of other pathologies in their brain, either instead of or in addition to those associated with Alzheimer’s. What factors influence the development of these different dementia-related pathologies? How can science help to better identify the underlying causes of dementia symptoms, so that we can better diagnose, treat, and prevent dementia? What causes the variability in the rate, severity, and type of cognitive decline among people with Alzheimer’s?

To address these questions and other complexities of dementia diseases, NIA-supported researchers are using the power of neuropathology in both traditional and innovative ways. For example, large studies of healthy adults over many years, new technologies to understand changes in individual brain cells, and collaboration among scientists with different expertise is equipping researchers with the information needed to map the connections between brain changes and risk factors that lead to dementia.

Neuropathology led to the discovery of Alzheimer’s disease and continues to provide invaluable insights today. NIA supports a wide range of neuropathological research to identify how and why these brain changes happen and to help develop tailored treatment and prevention strategies across diverse populations.

If you or a loved one has been diagnosed with Alzheimer’s disease or a related dementia, it may be difficult to think beyond the day to day. However, taking steps now can help prepare for a smoother tomorrow.

Over time, the symptoms of Alzheimer’s and related dementias will make it difficult to think clearly. Planning as early as possible enables you to make decisions and communicate those decisions to the right people.

Advance directives are legal documents that outline your preferences and apply only if you are unable to make decisions. For health care planning, they communicate a person’s wishes ahead of time. Doctors and other providers follow these directives for your medical treatment. There are two main documents that are part of an advance directive:

A living will lets doctors know how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment.

A durable power of attorney for health care names someone as a “proxy” to make medical decisions for you when you are not able.

If advance directives are not in place and a patient can no longer speak for him or herself, someone else will need to make medical decisions on their behalf. Talk to your family, friends, and health care providers about what types of care you would want. It can also be helpful to talk with your doctor about common problems associated with your condition.

Advance directives for financial planning are documents that communicate the financial wishes of a person. These must be created while the person still has the legal capacity to make decisions. Three common documents are included in a financial directive:

A will specifies how a person’s estate — property, money, and other financial assets — will be distributed and managed when they die. It may also address care for minors, gifts, and end-of-life arrangements, such as funeral and burial.

A durable power of attorney for finances names someone who will make financial decisions for you when you are not able.

A living trust names and instructs someone, called the trustee, to hold and distribute property and funds on your behalf when you are no longer able to manage your affairs.

Lawyers can help prepare these documents with you and your family members. A listing of lawyers in your area can be found on the internet, at your local library, through a local bar association, or by contacting the National Academy of Elder Law Attorneys.

As symptoms progress, long-term care may be needed. People diagnosed with Alzheimer’s or a related dementia and their family members should begin planning for the possibility of long-term care as soon as possible. Geriatric care managers, often nurses or social workers, can work with you to create a long-term care plan.

Start discussions early with your family members.

Put important papers in one place and make sure a trusted person knows where.

Update documents as situations change.

Make copies of health care directives to be placed in all medical files.

Give the doctor or lawyer advance permission to talk directly with a caregiver if needed.

Planning now will help you and your loved ones later when symptoms of Alzheimer’s or a related dementia worsen.

by Carol Leish, MA

LiveWell is not just about aging, but aging well.

“Welcome to the 2022 issue of LiveWell, a resource guide designed specifically with older adults, people with disabilities, and caregivers in mind. The landscape of issues for the populations we serve is continually changing, therefore the Ventura County Area Agency on Aging (VCAAA), is continually creating innovative methods and programs to enhance quality of life and provide options to safely, securely, and optimally age in place.

“This year’s issue focuses heavily on services and programs that are available to Ventura County residents and our continued efforts to respond to the COVID-19 crisis and the growing needs of the populations we serve. We understand how critical it is to have access to trusted information, and we are proud to offer a heavily vetted publication that brings vital resources to the individual we serve.” (Introduction to LiveWell, pg. 4.)

VCAAA has changed its focus in order to meet the needs of older adults, individuals with disabilities and their caregivers through this publication. LiveWell debuted in 2017 to replace what was Eldercare. This publication has stories and listings in both English and Spanish.

Many articles and listings in the guide are there to assist people, and their loved ones through some of the challenges that we all face in our quest to maintain independence, which includes advocating for services that you need to live well and age optimally. The various sections in the guide are: Active Living; Caregiving; Community Resources; Transportation; Food Resources; Housing; Medical Services; and, End of Life Information.

LiveWell has been edited by Jannette Jauregui, MSJ. The contributing editor is Teo Nguyen. The graphic designer is GSA Business Support-Creative Services. It has been published by the County of Ventura Area Agency on Aging.

“This guide can be a valuable tool, but remember, it is just that, a guide to help you find various resources,” according to Victoria Jump, Director, Ventura County Area Agency on Aging. “If you have specific questions or need further assistance, don’t hesitate to contact one of our Information & Assistance Specialists to assist you further. They can be reaches at (805) 477-7300, 8:00 a.m. to 5:00p.m., Monday-Friday, and are trained to connect you to the multitude of resources available in Ventura County, and can arm you with the information you need to make those important life decisions.

“LiveWell is available at a variety of locations throughout Ventura County as well as directly through the VCAAA office in Ventura. An online version of the guide is also available at: www.vcaaa.org.”

From the NIH Director’s Blog, a guest post by NIA Director Dr. Richard J. Hodes

As people age, they are more likely to have multiple chronic diseases, and NIA-supported research studies reflect a strong focus on geroscience. This advancing area of science seeks to understand the mechanisms that make aging a major risk factor and driver of common chronic conditions and diseases of older people.

More than 85 years ago, researchers at Cornell University, Ithaca, New York, observed that some lab rodents lived longer when fed a lower calorie diet that otherwise had the appropriate nutrients. Since then, many scientists have studied calorie restriction to shed light on the various biological mechanisms that may explain its benefits and perhaps discover a way to extend healthy years of life, known as our healthspan.

Although there have been many studies of calorie restriction since the Cornell findings, the NIA-supported clinical trial CALERIE, which stands for Comprehensive Assessment of Long-term Effects of Reducing Intake of Energy, provided critical data on the impact of this intervention in people. Completed in 2012, CALERIE was the first carefully controlled study to test whether study participants undergoing moderate calorie restriction would display any of the benefits observed in animal studies.

Volunteers for the CALERIE study were healthy, non-obese adults ages 25 to 45.

In addition to demonstrating that people could sustain moderate calorie restriction for two years, the CALERIE study also showed that this intervention could diminish risk factors for age-related cardiovascular and metabolic diseases2. The CALERIE investigators also made their data and biological samples available for other research teams to study further.

Recently, a team led by Vishwa Dixit, Yale University, New Haven, Connecticut, examined CALERIE data to investigate the effects of calorie restriction on immune function. The findings, published in the journal Science, suggest that calorie restriction may improve immune function and reduce chronic inflammation3,4.

As people age, the size of the thymus, which is part of the immune system, tends to become smaller. As this organ shrinks, its output of T cells declines, which hampers the ability of the immune system to combat infectious diseases. This deficiency of T cells is one of the reasons people over age 40 are at increased susceptibility for a range of diseases.

Dixit’s team noted that MRI scans showed the thymus volume increased among people who reduced their calories for the two-year CALERIE study but was not significantly different in the control group. The increase in thymus size in the group restricting calories was accompanied by an increase in indicators of new T cell production.

Next, the team analyzed immune system effects in belly fat samples from people in the CALERIE study. The team discovered that the PLA2G7 gene — which codes for a protein involved in fat metabolism that is made by immune cells such as T cells — was suppressed after calorie restriction.

To test this hypothesis, the team suppressed the PLA2G7 gene in lab mice. When these mice were 2 years old, which is equivalent to a human age of about 70, the thymus had not decreased in volume. In addition, the mice had decreased fat mass and lower levels of certain inflammation-promoting substances. These findings suggest that mice without the PLA2G7 gene might have been protected from age-related chronic inflammation, which has been linked to many conditions of old age.

Taken together, the findings extend our understanding of the power of calorie restriction and suggest that it might also improve immune function and reduce chronic inflammation in people.

The results also indicate interventions that influence PLA2G7 gene function might have favorable health effects. Additional research is still needed to assess the health effects and to determine whether calorie restriction extends lifespan or healthspan in humans. The NIA is funding more studies to determine the benefits and risks of calorie restriction, as well as the mechanisms that account for its effects.

Eating healthy foods helps everyone stay well. It’s even more important for people with Alzheimer’s disease. Here are some tips for healthy eating.

Buy healthy foods such as vegetables, fruits, and whole-grain products. Be sure to buy foods that the person likes and can eat.
Give the person choices about what to eat—for example, “Would you like green beans or salad?”
Buy food that is easy to prepare, such as premade salads and single food portions.
It may be helpful to have someone else make meals or use a service such as Meals on Wheels America, which brings meals right to your home. For more information, contact Meals on Wheels America at 1-888-998-6325 or www.mealsonwheelsamerica.org.

When a person with early-stage Alzheimer’s disease lives alone, you can buy foods that the person doesn’t need to cook. Call to remind him or her to eat.

Maintain Familiar Routines
Tips to make mealtimes easier for people with Alzheimer’s.
Share this infographic and help spread word about making mealtimes easier for people with Alzheimer’s.
Change can be difficult for a person with Alzheimer’s disease. Maintaining familiar routines and serving favorite foods can make mealtimes easier. They can help the person know what to expect and feel more relaxed. If a home health aide or other professional provides care, family members should tell this caregiver about the person’s preferences.

Try these tips:

View mealtimes as opportunities for social interaction. A warm and happy tone of voice can set the mood.
Be patient and give the person enough time to finish the meal.
Respect personal, cultural, and religious food preferences, such as eating tortillas instead of bread or avoiding pork.
If the person has always eaten meals at specific times, continue to serve meals at those times.
Serve meals in a consistent, familiar place and way whenever possible.
Avoid new routines, such as serving breakfast to a person who has never routinely eaten breakfast.
As Alzheimer’s progresses, familiar routines and food choices may need to be adapted to meet the person’s changing needs. For example, a family custom of serving appetizers before dinner can be preserved, but higher-calorie items might be offered to help maintain the person’s weight.

Stay Safe
In the early stage of Alzheimer’s, people’s eating habits usually do not change. When changes do occur, living alone may not be safe anymore. Look for these signs to see if living alone is no longer safe for the person with Alzheimer’s:

The person forgets to eat.
Food has burned because it was left on the stove.
The oven isn’t turned off.
Other difficulties, such as not sitting down long enough for meals and refusing to eat, can arise in the middle and late stages of the disease. These changes can lead to poor nourishment, dehydration, abnormally low blood pressure, and other problems.

Caregivers should monitor the person’s weight and eating habits to make sure he or she is not eating too little or too much. Other things to look for include appetite changes, the person’s level of physical activity, and problems with chewing or swallowing. Talk with the person’s doctor about changes in eating habits.

For More Information About Healthy Eating for a Person with Alzheimer’s
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
[email protected]
www.nia.nih.gov/alzheimers

Some older adults have more memory or thinking problems than other adults their age. This condition is called mild cognitive impairment, or MCI.

There is no single cause of MCI. The risk of developing MCI increases as someone gets older. Conditions such as diabetes, depression, and stroke may increase a person’s risk for MCI.

The symptoms of MCI are not as severe as the symptoms of Alzheimer’s disease or dementia. For example, people with MCI do not experience the personality changes or other problems that are characteristic of Alzheimer’s. People with MCI are still able to take care of themselves and do their normal daily activities.

Signs of MCI may include:

Losing things often
Forgetting to go to events or appointments
Having more trouble coming up with words than other people of the same age
Movement difficulties and problems with the sense of smell have also been linked to MCI.

How Is Mild Cognitive Impairment Diagnosed?
Family and friends may notice memory lapses, and the person with MCI may worry about losing his or her memory. These worries may prompt the person to see a doctor about their memory problems.

In some cases, memory and thinking problems may be caused by conditions that are treatable. A doctor can perform tests and assessments to help understand whether the source of memory problems is something treatable or may be MCI. He or she also may suggest that the person see a specialist for more tests.

How Is Mild Cognitive Impairment Managed?
There currently is no standard treatment or approved medication for MCI, but there are things a person can do that may help them stay healthy and deal with changes in their thinking.

Because MCI may be an early sign of more serious memory problems, it’s important to see a doctor or specialist every six to 12 months. A doctor can help track changes in memory and thinking skills over time. Keeping a record of any changes can also be helpful.

People with MCI might also consider participating in clinical trials or studies. Clinical trials are research studies that help test if a treatment, like a new drug, is safe and effective in people. People with and without memory problems can take part in clinical trials, which may help themselves, their families, or future generations.

To find out more about participating in clinical trials for people with memory problems and people without cognitive impairment, visit Alzheimers.gov or call the Alzheimer’s and related Dementias Education and Referral (ADEAR) Center at 1-800-438-4380.

Does Mild Cognitive Impairment Lead to Dementia?
Researchers have found that more people with MCI than those without it go on to develop Alzheimer’s disease or a related dementia. An estimated 10 to 20% of people age 65 or older with MCI develop dementia over a one-year period. However, not everyone who has MCI develops dementia. In many cases, the symptoms of MCI may stay the same or even improve.

Research suggests that genetic factors may play a role in who will develop MCI, as they do in Alzheimer’s and related dementias. Studies are underway to learn why some people with MCI progress to Alzheimer’s and others do not.

For More Information About Mild Cognitive Impairment
NIA Alzheimer’s and related Dementias Education and Referral (ADEAR) Center
800-438-4380
[email protected]
www.nia.nih.gov/alzheimers

Free Ventura County Parkinson’s Support Group meetings: a community-based support group focusing on sharing relevant information and education about all things Parkinson’s.

Meetings are held monthly on the third Tuesday, 10-11am, at Crosspointe Church (5415 Ralston Ave.) next meeting Tuesday, April 19.

Ventura County Parkinson’s Support Group gets together every month with skilled, experienced professionals who present significant breakthroughs, strategies and related issues surrounding Parkinson’s. The group’s mission is for participants to better understand and talk about how this information impacts their own lives and affects immediate family members. In addition to those diagnosed with PD, caregivers, family members and friends are all welcome to attend free of charge.

More than just a meeting, all discussions/presentations offer interactive, compassionate, relevant education on PD. Topics range from “How to get up off the floor when you’ve fallen,” to “Nutrition and Parkinson’s” to “The benefits of deep brain stimulation and assessing if you’re a good candidate for DBS.”

Jon Everhart, retired accountant, US Marine and regular group attendee said, “It’s nice comparing treatments, symptoms, and the challenges we all face living with Parkinson’s.” This caring group empowers people like Jon to be more proactive and to participate in deciding the direction of his treatment, complemented by his team of doctors’ suggestions.

This unique group gives everyone a great opportunity to learn more about current PD research, to gain more awareness about local help and resources, to share relevant experiences with others — and to have fun along the way.

The Ventura County Parkinson’s Support Group was recently resurrected (post-Covid) by Dr. Vanessa White, owner of Ventura County Neurofitness (a local fitness program designed specifically for those with Parkinson’s and other neurological degenerative diseases). The impetus for her assuming this responsibility was after her mother-in-law, Toy White, was diagnosed several years ago with PD. This important, special group was born upon her passing.

This month’s meeting will feature Robert and Jenna Adelman, owners of Way of Orient Martial Arts Academy (2750 E. Main St., Ventura) who will be presenting a very important session on senior safety where they will introduce and teach self-defense for seniors.

A new therapy could reverse the aging process by turning back the clock on cells to make them young again, according to a new study.

Scientists from the Salk Institute say the safe and effective technique works by partially resetting cells that impact skin, eyesight, muscles, and the brain. The breakthrough may be able to extend life and help people gain the ability to become more resistant to stress, injury, and disease.

While it may appear to be the Holy Grail of anti-aging research, promising eternal youth, the team cautions that they’ve only successfully tested the treatment on mice so far. Animals at the late stage of their lives treated with cellular rejuvenation therapy started to show signs of getting younger after just seven months.

New tests are now underway to determine whether the treatment only “pauses” or actually reverses aging. In the study, the researchers note that all cells carry a molecular clock that records the passage of time. By adding a mixture of four reprogramming molecules, known as the Yamanaka factors, the cells reset the clock to their original patterns.

The scientists tested three groups of mice at varying ages equivalent to humans being 35, 50, and 80 years-old (12 months, 15 months, and 25 months in mice). There were no blood cell alterations or neurological changes in the mice that received the treatment. The team also found no cancers in any of the groups.

Researchers found after seven or 10 months, the mice resembled younger animals in both appearance and ability. When injured, the youthful skin had a greater ability to heal and was less likely to form permanent scars. Metabolism remained stable, showing no form of age.

“At the end of the day, we want to bring resilience and function back to older cells so that they are more resistant to stress, injury and disease,” says co-first author Dr. Pradeep Reddy of the Salk Institute in a university release. “This study shows that, at least in mice, there’s a path forward to achieving that.”

“We are elated that we can use this approach across the life span to slow down aging in normal animals. The technique is both safe and effective in mice,” adds Professor Juan Carlos Izpisúa Belmonte.

“In addition to tackling age-related diseases, this approach may provide the biomedical community with a new tool to restore tissue and organismal health by improving cell function and resilience in different disease situations, such as neurodegenerative diseases.”

The study is published in the journal Nature Aging.