How Well Do We Understand Alzheimer's Disease?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Unfortunately, not that well.

Scientists have been studying this disease for many yeas now, intensively so for the past decade. We have learned much and our understanding about the underlying pathology, risks, and avenues of treatment have all progressed.

However, the most basic mystery, what causes the disease, has not yet been solved.

We have described the leading theories (the Cholinergic hypothesis, the Amyloid hypothesis, and the Tau hypothesis) in earlier posts. While the majority of drug development work is currently aligned with the amyloid hypothesis, a new study in the New England Journal of Medicine suggests some weaknesses in that theory.

As described here, researchers examined the brains of 456 deceased people aged 69 to 103 and evaluated the correlation between the amount of amyloid build-up and diagnoses of Alzheimer's disease. While there was a fairly strong correlation in those at age 75, it was much weaker in the population at age 95.

Clearly, there is more work to do before we fully understand the pathology of this disease and make more rapid progress toward a cure.

The Alzheimer's Project: Viewable Online

Contributed by: Dennis Fortier, President, Medical Care Corporation

One of the major barriers to better care in the Alzheimer's field is lack of education. This blog is dedicated to helping solve that problem.

In general, patients and physicians are not adequately informed about the benefits of vigilantly monitoring cognitive health and managing risk factors as successful strategies to promote vital aging. The recent HBO documentary (The Alzheimer's Project) made an excellent contribution to the level of public knowledge and I am happy to report that it is now freely accessible, in its entirety, online.

You can view it here and, if you have not already done so, I encourage you to watch it.

Alzheimer's Test in the News

Contributed by: Dennis Fortier, President, Medical Care Corporation

Over the last two days, many news outlets have reported this story about a "new Alzheimer's test". It is based on analysis of a small sample of skin cells and holds promise for accurately detecting Alzheimer's disease in its early stages. For perspective, I offer the following comments.

This is a bio-marker test. A bio-marker, as defined by researchers at Stanford University is "a specific biological trait, such as the level of a certain molecule in the body, that can be measured to indicate the progression of a disease or condition". In this instance, the test measures the presence of a phosphorous binding enzyme which is theorized to contribute to the Alzheimer's disease process.

Detection vs. Diagnosis
Despite the characterization in many headlines I have seen, this will be a test for "diagnosing" Alzheimer's disease, not for "detecting" it. This means that once a patient is deemed to have a medical condition interfering with normal cognition, a physician will need to consider the possible causes and diagnose the correct one. Since we currently diagnose Alzheimer's disease partially by ruling out other causes, this new test might be an inexpensive, non-invasive, and hopefully accurate means for arriving more directly at a diagnosis of AD.

With a projected cost of several hundred dollars per test, this approach could add certainty while reducing time in the diagnostic process. The test is being co-developed by the Blanchette Rockefeller Neurosciences Institute and Inverness Medical Innovations Inc. with a possible commercial product available within 18 months.

Alzheimer's Disease in other Primates

Contributed by: Dennis Fortier, President, Medical Care Corporation

Step by step, scientists are uncovering pieces of the puzzle that will ultimately let us understand the underlying pathology of Alzheimer's disease. This in turn, will lead us down the pathway to a cure.

In the news this week is a study published in Neurobiology of Aging demonstrating a clear, but yet undefined, difference between the amyloid plaques in human brains and those in the brains of other primates. The role of these plaques in Alzhiemer's disease is not completely understood and has been discussed in an earlier post.

This recent study showed that a particular molecule tag (Pittsburgh Compoud B or PIB) binds readily to amyloid plaques in human brains but not so to the amyloid plaques in the brains of other primates. This strongly suggests a structural difference between the two types of plaques.

More importantly, since other primates have not been found to develop Alzheimer's-like cognitive decline, even when the plaques are present, it is likely that isolating the structural differences between human amyloid plaques and those from other primates will yield important new insights. Understanding these basic differences will give scientists a fresh new clue to explore in their quest to find the cause and potential cure of this poorly understood disease.

Caregiving and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

When you see the way that caregivers often bond with one another, it is clear that they live through an experience that can be fully grasped only by another caregiver. I have known many caregivers and heard their stories but recognize that, until you have done it yourself, you cannot completely relate to the emotional and physical challenges of caring for a loved one with dementia.

For many caregivers, sharing stories about successful care giving approaches is a much needed form of support. Bonding with others through common experience gives them a sense of camaraderie that helps them forge on as they meet the burden of delivering unending, heartfelt care.

With that in mind, it is not surprising that books and other sources of caregiver information have proliferated in recent years as the prevalence of dementia (and therefore the prevalence of caring for demented loved ones) has grown.

Jaqueline Marcell wrote one of the more popular books on the topic of caregiving. It has been widely acclaimed and helpful to many. You can read an excerpt from her experience here and follow her links to more information if you find it helpful.

"Combination Therapy" for Alzheimer's Disease

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

As readers of this blog will recall, two types of medications have received FDA approval for Alzheimer’s treatment. Cholinesterase inhibitors have been available since the mid-1990s and act by inhibiting the breakdown of the neurotransmitter acetylcholine. The drug memantine, which received FDA approval in 2003, is the first of a second class of agents that modulate the actions of the amino acid glutamate and is often used in combination with cholinesterase inhibitors (CIs) in later stages.

Researchers were recently able to conduct a study by analyzing data on patients treated at the MGH Memory Disorders Unit since 1990, including 144 who did not receive any pharmaceutical treatment, 122 treated with a CI alone and 116 who received both a CI and memantine from the outset. As part of their regular treatment, every six months patients received standardized assessments of both cognitive abilities and how well they carried out daily activities.

The results showed significant differences in the rate of symptom progression among all three groups – with the smallest level of decline in those receiving combination therapy. While there was an average of two and a half years’ worth of data on the study participants, the researchers analyzed the information with a statistical model that predicted probable outcomes for up to four years. Although the model’s projection of future benefits is conservative, it predicted that the longer patients kept receiving combination therapy, the smaller their rate of decline would become, suggesting that treatment might even protect brain cells from further damage, a possibility needing further investigation.

Some physicians have started prescribing patients CIs and Namenda combination therapy at the start of therapy to see if these results in fact hold-up.

What About Memory Screening?

Contributed by: Dennis Fortier, President, Medical Care Corporation

Through earlier posts to this blog, we have presented the evidence and made the case that early intervention is a key part of optimal care for many memory-related diseases and disorders, especially for Alzheimer's disease. This begs questions about the value of community based memory screening programs.

As with most things in life, there are many perspectives on the value of community based memory screening. Some emphasize the benefits of identifying early stage problems and facilitating early intervention. Others decry the general lack of assessment standards and point out the many ways a poorly run program could harm the participants. For example, an insensitive assessment tool could erroneously reassure those who with a real medical condition (false negatives) and deter them from seeking care from their physician. On the other hand, an overly sensitive assessment approach could needlessly stress those who are aging normally (false positives) and instigate a series of unnecessary and costly diagnostic exams.

These facts are pretty clear:
- many people are concerned about memory loss
- a large percentage of those who are concerned are perfectly healthy
- the quality of care these concerned patients get through their primary care physicians ranges from very good to very bad.

As such, I think a well run screening program provides an opportunity for those most concerned about their memory to take a proactive approach, get some attention, and further their education about memory loss. As you may have seen in the news today, a national effort to support such programs has been supported by the Alzheimer's Foundation of America.

My one suggestion (which I will make to the AFA) is to strongly consider a renaming of these events with a switch from "screening" to "assessment". The former seems focused on finding illness and can carry some stigma, the latter is more geared toward understanding one's degree of health and learning to improve or maintain it.

I look forward to National Memory Assessment Day with optimism.

Causes of Depression

Contributed by: Dennis Fortier, President, Medical Care Corporation

This site is devoted to distilling the important messages from the daily news and online content. Occasionally this means debunking aggressive treatment claims from the pharmaceutical industry but often times, it is the pharmaceutical manufacturers that provide the most useful consumer information.

Today I highlight the causes of depression posted at, a site sponsored by a major manufacturer of a popular anti-depressant.

Depression is a widespread problem that is slowly (too slowly by most accounts) shedding the stigma attributed to almost all brain-related disorders. The key to further progress in that regard is to promote further education about the causes of depression and to facilitate open discussion about its signs and symptoms.

I hope this posting will nudge us all gently in that direction.

10 Signs of Alzheimer's

Contributed by: Dennis Fortier, President, Medical Care Corporation

The National Alzheimer's Association has revised and re-issued their ten signs of Alzheimer's disease.

Knowing these signs is important because the best treatment results and the best opportunity to plan for the challenges of a dementing disorder both come after an early diagnosis. Recognizing a warning sign and seeking timely medical intervention can have a tremendous impact on quality of life for the patient and for the patient's caregivers.

One point of clarification. Each of the ten warning signs concludes with a short note about "What's typical". These comments describe behavior that is typical among healthy individuals, not among individuals with an early sign of Alzheimer's disease. I found that potentially confusing and wanted to clarify it.

Does Retirement Invite Dementia?

Contributed by: Dennis Fortier, President, Medical Care Corporation

A story about the apparent relationship between retirement and dementia is being widely publicized at the moment. While the study was quite clear, much of the news about the study (suggesting that delaying retirement wards off dementia) is misleading.

The study conducted at Kings College in London was published in the International Journal of Geriatric Psychiatry. Researchers followed 382 men to see if they developed dementia after retirement and then looked at retirement age for a possible correlation with brain health.

The theory behind the headlines is that remaining employed requires ongoing intellectual stimulation which in turn protects against cognitive decline. The authors clearly noted that most of the research subjects who retired early did so for health related reasons which may have ultimately contributed more to their eventual dementia than retirement contributed. But this has not stopped the press from drawing tidier and more interesting conclusions.

Here is a classic example of a misleading headline (although the content of this article is surprisingly fair).

May is National Stroke Awreness Month

Contributed by: Dennis Fortier, President, Medical Care Corporation

The recent news and national dialogue about brain health seems to have been dominated by the HBO documentary on Alzheimer's disease. Nonetheless, it is worth reminding the readership that stroke is a major killer that can be thwarted to a great degree through education and proper management of risk factors.

The website for the American Stroke Association has many great resources for those concerned about stroke, those who have suffered from stroke, those at risk for stroke, and those giving care for stroke victims.

It is worthwhile to take a moment, visit the site, and learn about stroke.

Predicting Dementia Risk

Contributed by: Dennis Fortier, President, Medical Care Corporation

There is much coverage today of a study published in Neurology describing how researchers can predict the risk of an individual developing dementia based on underlying risk factors.

In this particular study, UCSF researcher and lead author Deborah Barnes followed more than 3000 subjects over a six-year period and developed 15 point scale to quantify dementia risk.

I am happy to see this study carried broadly by the media because an educated public, one that understands the many risks that make dementia more likely, will be in a position to monitor and manage risks among themselves.

In the long run, this educational impact might have a greater impact on overall health than any treatments or interventions could hope to bring.

Depression and Memory Loss

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

Studies show that prolonged stress leads to elevated levels of cortisol, a "stress" hormone produced by the adrenal glands. This in turn appears to shrink or atrophy the hippocampus, the sea-horse shaped part of the brain associated with many kinds of memory and learning. The hippocampus is a part of the brain that is particularly vulnerable to stress and stress hormones.

While cortisol levels normally fluctuate over the course of a day and night, they often soar when a person is faced with a stressful situation. Many studies have shown that this affects short term memory. For example, researchers have shown that people taking cortisone pills (which metabolize to cortisol in the body) were not as good at remembering a list of words as people taking placebo pills.

For many people, depression appears to cause similar damage; their cortisol levels remain slightly elevated as long as they are depressed. This moderate, but constant elevated cortisol appears to wear down the hippocampus--and lead to memory difficulties.

More studies are needed to fully understand the molcular connection between stress, depression and memory, and perhaps better treatments.

Type 2 Diabetes and AD

Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

Patients with type 2 diabetes or "insulin resistant diabetes", particularly those who have poorly controlled blood sugar levels, are at a greater risk of developing AD. The reason for this is from a series of studies from Dennis Selkoe's group at Harvard Medical School. As readers of this blog will recall, beta amyloid is thought to accumulate in the brain of patients who develop AD.

An intriguing finding has been that beta amyloid is "broken down" in the brain by Insulin Degrading Enzyme. In patients with type 2 diabetes, the high insulin levels keep this enzyme too busy to break down the beta amyloid. When this occurs, the beta amyloid accumulates in the brain and leads to AD.

The good news is that by keeping blood sugars in check, the insulin levels will be lower, thus allowing the Insulin Degrading Enzyme to break down the harmful beta amyloid.

Re-Posting: Dementia 101

Contributed by: Dennis Fortier, President, Medical Care Corporation

Due to the increased press and interest about Alzheimer's disease this week (fueled by the HBO documentary), I have re-posted this clarification of "Dementia" as a clinical entity.

Based on the various interpretations I read in the press, there seems to be some confusion about the term dementia. The DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, American Psychiatric Association) provides the most commonly used criteria and defines dementia in this way:

Dementia is a clinical state characterized by loss of function in multiple cognitive domains. Diagnostic features include : memory impairment and at least one of the following: aphasia, apraxia, agnosia, disturbances in executive functioning. In addition, the cognitive impairments must be severe enough to cause impairment in social and occupational functioning.

So, in even simpler terms, being demented means that one's mental faculties are impaired to a degree that interferes with their social and occupational function. For the purpose of most discussions, it really is as simple as that.

The confusion begins when people talk about "being diagnosed with dementia" or "treating dementia". In a world of clarity, those same people would speak instead about "being diagnosed with Parkinson's Disease or with Alzheimer's Disease" which may have led to a clinical state of dementia. No one would "treat dementia", they would treat the underlying medical condition causing the impairment that we describe as dementia. It is a simple concept but I hear it confused (or read about it being confused) on a daily basis.

We don't need to detect dementia, we need to detect medical conditions that lead to dementia. We cannot treat dementia, we must treat medical conditions that cause dementia. The word dementia merely describes the extent of some person's cognitive impairment.

HBO Alzheimer's Project: Commentary

Contributed by: Dennis Fortier, President, Medical Care Corporation

Last night was the first portion of this 4-part documentary (continuing tonight and tomorrow night). It focused on showing what life is like for several Alzheimer's patients and their families at various stages of the disease.

I am fairly close to this disease in the respect that I see real AD patients and their families almost daily. It is an emotionally charged experience when people come face-to-face with such a terrible disease and begin to slowly lose a person (either a loved one or themselves) to a progressive decline of cognitive and functional abilities. Even with my daily exposure to the pain that so many suffer from this disease, I found the show powerfully stirring.

Going forward, this documentary will focus more on the science of the disease and the prospects for better treatment going forward. Because there is such a low level of understanding about Alzheimer's disease, I am encouraging everyone to tune in and watch.

More details are available at the HBO site.


Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

Neuroglobin is a protein that was first identified in 2000. It is a member of the globin family, similar to hemoglobin (which carries oxygen inside red blood cells) and myoglobin (which carries oxygen inside muscle cells). It is a highly conserved protein, meaning that it is a very important protein in all species, ranging from mice to humans. It is known to be activated by cerebral ischemia (decreased brain oxygen) and is known to protect neurons from such injury.

Despite its ability to bind to oxygen, like hemoglobin and myoglobin, neuroglobin is unlikely to function as an oxygen delivery system. Instead, it seems to be involved in scavenging reactive oxygen molecules (oxidants) generated in response to brain ischemia and injury. Many researchers believe antioxidants are beneficial in various neurodegenerative diseases.

Recent work had shown that neuroglobin decreases beta amyloid neurotoxicity in animal models of AD. Now, a paper from a group at Johns Hopkins (Zymanski et al, Neurobiology of Aging, 2009), shows that variations in the gene for the neuroglobin protein, may in fact increase one's risk of developing AD, by producing inefficient neuroglobin. This inefficient protein is unable to defend against the toxicity of beta amyloid.

More work will be needed to determine if neuroglobin can be affected in a positive way to reduce beta amyloid toxicity in AD patients.

A Basic Science Breakthrough for AD Treatment

Contributed by: Dennis Fortier, President, Medical Care Corporation

The current issue of Nature has a publication on the discovery of how brain cells function in the process of storing a memory. This research from the Howard Hughes Medical Institute is exciting and is receiving broad coverage in the media.

It is exciting as our basic understanding of the brain advances because it brings us closer to finding solutions for the many diseases and disorders that impair function. It is always useful however, to stay aware of the process from "discovery of new information" to "a commercial product that benefits health".

As Dr. Rafii described earlier, there are many steps along the FDA path and several years will generally pass before a breakthrough in basic science, like this discovery at HHMI, finds its way into the health care system.

This is exciting but don't let some of the more sensational headlines fool you into thinking that the cure for Alzheimer's disease has been found.

AD Treatment Perspective #4

Contributed by: Dennis Fortier, President, Medical Care Corporation

Drug therapy works best when started early and prescribed in conjunction with a healthy diet, physical exercise, ongoing social/intellectual activity, and an educated caregiver.

Bapineuzumab: Phase III Trial Information

Contributed by: Dennis Fortier, President, Medical Care Corporation

A Phase III clinical trial for Bapineuzumab, described in an earlier post, is open and enrolling patients.

The study is seeking subjects aged 50 to 88 with a diagnosis of probable AD. Importantly, subjects will also need a caregiver who is willing to be meaningfully involved in the study.

This drug is administered intravenously and the study protocol calls for 15 infusions over a 65 week period. More details are available here.


Contributed by: Michael Rafii, M.D., Ph.D - Director of the Memory Disorders Clinic at the University of California, San Diego.

Bapineuzumab is an antibody to the beta-amyloid plaques that are believed to underlie Alzheimer's disease pathology. It is currently in a Phase 3 clinical trial, which is the final step towards obtaining FDA clearance. The drug is thought to be promising because it uses a novel approach for treating AD.

In most patients, the immune system detects the presence of the abnormal beta-amyloid protein and tries to remove it. However, in AD patients, the immune response is not sufficient to remove all of the beta-amyloid, and hence the disease occurs. Bapineuzumab is thought to act as a boost to the normal immune system's ability to remove the toxic beta-amyloid. It has been shown to be well tolerated, and initial findings from the phase 2 study have been encouraging.

Interestingly, the concept of immunotherapy has been around for quite some time and antibody treatments are becoming more common and include such treatments as:

Humira for autoimmune diseases
Avastin for colorectal cancer
Erbitux for head and neck cancer
Raptiva for psoriasis
Remicaid for autoimmune disease
Tysabri for multiple sclerosis and Crohns disease
Lucentis for Macular Degeneration
Rituxan for Lymphoma
Herceptin for breast cancer

The future of AD treatment may someday soon include immunotherapy targeting the underlying cause of the disease, beta-amyloid.

More Perspective on Brain Exercises and Supplements

Contributed by: Dennis Fortier, President, Medical Care Corporation

The Stanford Center on Longevity released a statement today describing their perspective on the utility of consumer products for brain health.

Given the proliferation of supplements and software for brain exercises, this center felt it appropriate to issue a cautionary message about the relatively modest evidence so far amassed about the benefits of these various approaches.

We are all hopeful that many approaches to brain health will prove viable but, in the meantime, it is best to be clear and objective while setting realistic expectations about the impact of these consumer products.

5 Truths that Spawned 5 Myths about Alzheimer's and Dementia

Contributed by: Dennis Fortier, President, Medical Care Corporation

Sometimes the truth can be very misleading. This is often the case with complex topics when an “expert” makes a narrow but accurate statement that is subsequently generalized by the lay public. This is a common phenomenon in the fields of Alzheimer’s and dementia.

Here are five examples of true statements that have been so commonly misinterpreted that they have spawned five harmful yet well-entrenched myths.

Narrow Truth:
There is no cure for AD.
General Myth: Because there is no cure, nothing can be done for patients diagnosed with this disease.

Like diabetes and hypertension, we cannot yet cure Alzheimer’s disease. However, physicians can intervene and manage the symptoms with more success than most headlines would indicate. In fact, with a timely diagnosis, a physician can prescribe a treatment plan including pharmaceutical therapy, improved diet, physical exercise, mental and social activity, and certain OTC supplements. When this approach is combined with an educated caregiver, disease progression can be commonly slowed for some meaningful period of time.

Narrow Truth: The only certain method for diagnosing Alzheimer’s disease is to inspect a sample of brain tissue during autopsy.
General Myth: Alzheimer’s disease cannot be accurately diagnosed until death.

If “certain” means 100% accuracy, then there is no certain diagnostic method for many well known diseases (Lou Gehrigs disease springs immediately to mind). However, physicians following published diagnostic guidelines can get a highly accurate diagnosis of Alzheimer’s disease (90%-95), even at a fairly early stage of the disease. This diagnostic accuracy is on par with commonly accepted clinical practice.

Narrow Truth: Current treatments do not stop the progression of AD.
General Myth: Since the disease will continue to progress, there is no need to bother with treatment.

There is no doubt that reversing all memory loss would be the best treatment result and halting further memory loss would be better than ongoing decline. However, this does not mean that slowing the pace of further decline is not a worthy pursuit. We all want better treatment options in the future but until they arrive, preserving quality of life during a patient’s final years is definitely a worthwhile and attainable goal.

Narrow Truth: Cognitive decline is a part of normal aging.
General Myth: Pronounced cognitive deficits just need to be expected and tolerated

As we age, all of our organic functions tend to slow. Our ability to think, make calculations, use judgment, and store and retrieve information is not immune to this process. However, a pronounced loss of cognitive capacity severe enough to impact a person’s ability to lead an independent life is not normal. When such decline occurs, there is some underlying pathological explanation that can be identified and treated by a physician. Accepting significant loss of mental function as a normal artifact of aging is a tragedy.

Narrow Truth: It’s best not to know if you have Alzheimer’s disease
General Myth: It’s best if the problem stays undiagnosed

This final “truth” is a stretch to begin with. I can imagine that, if it were possible, an Alzheimer’s patient might enjoy life more if they could receive the highest standards of care without ever knowing they had a terrible disease. However, this does not make the case that the problem should be ignored. The published evidence in favor of managing the symptoms and prolonging a higher quality of life outweighs the presumed benefits of bliss. Additionally, patients need to know about their condition if they are to participate meaningfully in their own care and end of life decisions.

I hear and read these narrow “truths” in the media everyday. I also see first hand how the public mischaracterizes them and takes away a broader and more harmful message than is intended.

Education remains a major barrier between our current ability to care for AD patients and the higher standards that are within our immediate grasp. I hope we can begin to divorce ourselves from these sound bites of misleading truth and begin to see the Alzheimer’s picture with more clarity.

Dimebon: Trials Planned for Huntington's Disease

Contributed by: Dennis Fortier, President, Medical Care Corporation

Dimebon, a potential new agent for the treatment of Alzheimer's disease, is now enrolling a Phase III clinical trial (the CONNECTION study). If you are over age 50 and have been diagnosed with AD but are not taking other prescription AD medications, you may be eligible to participate.

If interested, please visit the CONNECTION site linked above for more details.

Interestingly, Dimebon has also shown safety and efficacy in a Phase II trial for treatment of Huntington's disease. This agent is being developed in the USA by Medivation and they are currently in the planning process to conduct additional efficacy trials for treating Huntington's disease later this year. (For a review of the necessary steps to gain FDA approval, see Dr. Rafii's earlier post here.)

We will keep you posted as further news is released.

The Alzheimer's Project on HBO

Contributed by: Dennis Fortier, President, Medical Care Corporation

Since the mission of this blog is to educate, I wanted to highlight the upcoming, 4-show series about Alzheimer's disease on HBO.

This documentary begins Sunday, May 10th and continues on Monday, May 11th and Tuesday, May 12. It will be viewable to all cable subscribers.

We are particularly eager to see the science portion of the presentation (Monday at 8pm and replayed on Tuesday at 8pm). We are hopeful that many general misconceptions will be addressed and that the old dogma of "nothing can be done" will be dispelled.

You can learn more about this presentation from the description at the NY Times or from the HBO website.

7 Facts About Stroke and Cognitive Impairment

Contributed by: Dennis Fortier, President, Medical Care Corporation

A good source of information about risks for dementia is The site is sponsored by Medical Care Corporation but, like this blog, it is non-commercial and seeks only to educate. This content about stroke was a popular article from a past issue of Ounce of Prevention, the newsletter associated with that site.

Stroke is the third leading cause of death, behind heart disease and cancer. Each year, about 700,000 people suffer a stroke. Stroke can be a cause of dementia and cognitive impairment.

The following are 7 interesting facts about stroke and cognitive impairment.

1. Stroke is the second most common cause of cognitive impairment and dementia.

2. A thimble full of damaged brain due to stroke can cause dementia.

3. Stroke begins after age 50 and can gradually build up in the brain for decades. This gradual accumulation of tiny strokes progressively interferes with the brain’s function until the individual end’s up demented.

4. The risk of developing cognitive impairment is highest in those persons with vascular risk factors, including hypertension, hyperlipidemia, atherosclerotic vessel disease affecting the aorta, carotid, vertebrobasilar, or major cerebral arteries, homocysteinemia, diabetes, heart disease, hypotension, obesity, physical exercise less than two days per week and 30 minutes per session, smoking, alcohol dependence, coagulopathies, and prior stroke.

5. The most common types of cognitive deficits arising from stroke are disturbances of attention, language syntax, delayed recall and executive dysfunction affecting the ability to analyze, interpret, plan, organize, and execute complex information.

6. The risk of vascular cognitive impairment and dementia as well as the rate of cognitive decline in cerebrovascular disease is highly dependent upon the control of the underlying risk factors for stroke.

7. If left untreated, vascular cognitive impairment and dementia worsen. Annual screening for cognitive impairment in attention, memory and executive function starting at age 50 years old will help detect gradually accumulating cerebrovascular disease that may otherwise typically be undetected for many years.

Worrying about Memory Loss: A Self-Fulfilling Prophecy?

Contributed by: Dennis Fortier, President, Medical Care Corporation

A recent study out of NC State University in Raleigh has been generating a lot of headlines this week.

This study, based on a small sample of subjects, suggested that worrying about memory loss as a result of aging might indeed lead to a decline in memory function. Theoretically, these findings are well grounded and considered "unsurprising" to researchers in this field.

The good news is that being well-informed is the best antidote to excessive worrying. In that regard, readers of the BRAIN Today blog are preparing themselves for healthy brain function today and tomorrow.