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 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As the world's population continues to age, Alzheimer's disease presents a looming public health crisis that, left unchecked, threatens to overwhelm health care systems throughout the developed world. In order to significantly tackle the most catastrophic and devastating symptom of Alzheimer's disease (AD)--dementia--we must be able to detect the disease prior to the onset of clinical symptoms, and be able to offer patients preventative treatments that block or significantly slow disease progression. This review summarizes a variety of the most promising early detection methods for Alzheimer's disease (AD) and mild cognitive impairment (MCI) that could be used to identify those at high risk of developing the disease and used for monitoring disease progression and response to investigational treatments. In addition, treatment research programs that could be developed into disease-modifying treatments that significantly delay the development of dementia are highlighted. These potential treatments target many different pathways, and may one day be dosed in combination to increase efficacy and prevent cognitive deterioration in patients with AD. While we still face numerous challenges, AD researchers have made great progress in understanding disease mechanisms. As we have seen in the treatment of heart disease, even modest preventative treatments can have hugely significant clinical outcomes and drastically reduce disease prevalence on a population scale. Therefore, there is hope that the development of prophylactic treatments, combined with improved early detection methods, will provide dramatic relief for millions of aging individuals threatened by the specter of Alzheimer's disease.
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PMID:Novel strategies for the prevention of dementia from Alzheimer's disease. 1958 48

The demographics of HIV-positive persons in the United States signal a steady shift toward an older population. The relationship between aging and HIV infection suggests that there is an additive and possibly synergistic effect increasing the risk for numerous common medical conditions, including heart disease, cancer, osteoporosis, frailty, depression, and dementia. Given the current crisis in the US health care system regarding universal access to quality primary and geriatric care, the aging of the HIV-positive population will pose numerous challenges to providers and policy makers. This review summarizes key areas of knowledge and concern regarding the care of HIV-positive persons aged 50 years and older.
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PMID:Internal medicine/primary care reminder: what are the standards of care for HIV-positive patients aged 50 years and older? 1958 1

Modifiable factors related to lifestyle have been extensively studied in terms of their effects on the vascular system, particularly the risk of heart disease. In recent years, however, it has become increasingly evident that many of these coronary risk factors also account for a large proportion of strokes, as well as cognitive impairment, dementia, and even Alzheimer's disease occurring in the absence of a clinically recognized vascular "event." Observational studies support a role for hypertension, dyslipidemia, and diabetes mellitus as risk factors for cognitive decline in late life, although there are conflicting results from some studies. Available evidence, although limited, also supports a role for some medical therapies targeting risk factors as a means to reduce the risk of subsequent cognitive decline. In many instances, however, basic lifestyle interventions show great promise for ameliorating the risk of cognitive decline. Such interventions include regular physical exercise or moderate alcohol consumption.
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PMID:Cardiovascular risk factors and cognitive function. 1959 69

The environmental, behavioral, and lifestyle factors that contribute to increases in the risk for cognitive decline and dementia are also factors known to be associated with increases in the risk for heart disease and stroke. The analogies between these chronic diseases go deeper. For example, public health programs designed to reduce the risks for heart disease and stroke, as well as their associated disability and mortality, can serve as valuable models for development of public health programs addressing brain health. We can save the brain by using public health approaches, but the effort will require new approaches and strong collaborative efforts across a diverse array of individuals and organizations.
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PMID:Can we save the brain? A public health question. 1959 78

The current study was aimed at examining the risk factors in 30 patients with Alzheimer's dementia and 30 patients with vascular dementia. The reports of the caregivers and the medical documentation were used to estimate the risk factors. The condition for the patients to enter this study was the age above 60 years. The results showed that the average age in the patients with dementia of the Alzheimer type was statistically significantly higher than in the patients with vascular dementia (p<0.0043), which is the confirmation that the most potential risk factor for Alzheimer's disease is aging, and for vascular dementia it is an additional factor. The incomplete education is more common in patients with Alzheimer's disease than in the group with vascular dementia and the difference had statistical significance (p=0.0199). The patients with vascular dementia have higher rate of heart disease (p=0.0002), hypertension (p=0.0005) and diabetes mellitus (p=0.0228) than in the group with Alzheimer's disease with a statistically significant difference. In regard to marital status, head injury and smoking, the difference had no significance in either groups.
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PMID:Risk factors for dementia of the Alzheimer and vascular type. 1965 May 54

Hormone-replacement therapy (HRT) has been used for more than 40 years to reduce perimenopausal symptoms. Estrogens may protect brain structures and functional systems affected by Alzheimer's disease, which suggests that maintaining high levels of hormones with HRT can protect against Alzheimer's disease. Moreover, high premenopausal estrogen concentrations are thought to be protective against stroke and, consequently, in the past, HRT was considered to be a potential protective agent against stroke. However, large clinical trials have failed to demonstrate a benefit from HRT on either cognitive performance or risk of dementia. In addition, although HRT has been associated with a reduction in the risk of heart disease in observational studies, results regarding stroke have been less clear. Recently, evidence has shown that HRT does not reduce but actually increases vascular risk. Here, the data from the most important studies are examined, concluding that HRT has no beneficial effect on dementia or stroke risk reduction in postmenopausal women.
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PMID:Hormone-replacement therapy, dementia and stroke. 1980 79

The relationship between cigarette smoking and cognitive impairment is not a simple one. Some studies have demonstrated that cigarette smoking is a risk factor for cognitive impairment in the elderly, whereas other studies have shown cigarette smoking to be protective against dementia. This study aims to explore the relationship between cigarette smoking and cognitive impairment in elderly persons without dementia, during a 10-year period. Data were derived from a population-based cohort study of 1436 elderly Taiwanese. Cognitive function was measured by the SPMSQ both in 1993 and in 2003. A total of 1436 participants free of cognitive impairment at baseline (SPMSQ> or =6 in 1993) were included in these analyses. Subsequently, participants were divided into three groups: never, past, and current smokers. The effect of cigarette smoking on cognitive function was assessed using logistic regression. In the logistic regression model adjusted for age, education, hypertension, diabetes, heart disease, and stroke at baseline, persons who had quit smoking (Odds ratio=OR=0.31; 95% CI=0.18-0.53; p<0.001) and those who continued to smoke (OR=0.37; 95% CI=0.20-0.70; p<0.001) were about one-third as likely to develop cognitive impairment as were those who never smoked. However, no dose-response relationship was observed between pack-years and cognitive impairment. Past and current smokers were less likely to develop cognitive impairment during a 10-year follow-up than were those who had never smoked. The present study suggests that smoking may be protective for cognitive function.
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PMID:Cigarette smoking and cognitive impairment: a 10-year cohort study in Taiwan. 1983 98

Alzheimer's disease (AD) is the seventh leading cause of all deaths in the United States and is virtually tied with the sixth leading cause of death-diabetes. AD is the fifth leading cause of death in Americans aged 65 and older. Although other major causes of death have been on the decrease, deaths because of AD have been rising dramatically. Between 2000 and 2006, heart disease deaths decreased 11.1%, stroke deaths decreased 18.2%, and prostate cancer-related deaths decreased 8.7%, whereas deaths because of AD increased 46.1%. Older African-Americans and Hispanics are more likely than older white Americans to have AD or other dementia. Current estimates are that African-Americans are about 2 times more likely, and Hispanics about 1.5 times more likely, than their white counterparts to have these conditions. However, the relationship of race and ethnicity to the development of AD and other dementias is complex and not fully understood. In 2009, nearly 11 million family and other unpaid caregivers provided an estimated 12.5 billion hours of care to persons with AD and other dementias; this care is valued at nearly $144 billion. Medicare payments for services to beneficiaries aged 65 years and older with AD and other dementias are three times higher than for beneficiaries without these conditions. Total payments for 2010 for health care and long-term care services for people aged 65 and older with AD and other dementias are expected to be $172 billion (not including the contributions of unpaid caregivers). An estimated 5.3 million Americans have AD; approximately 200,000 persons under age 65 with AD comprise the younger-onset AD population. Every 70 seconds, someone in America develops AD; by 2050 the time of every 70 seconds is expected to decrease to every 33 seconds. Over the coming decades, the baby boom population is projected to add 10 million people to these numbers. In 2050, the incidence of AD is expected to approach nearly a million people per year, with a total estimated prevalence of 11-16 million people. Dramatic increases in the numbers of "oldest old" (aged 85 years and older) across all racial and ethnic groups will also significantly affect the numbers of people living with AD. This report provides information to increase understanding of the public health effect of AD, including incidence and prevalence, mortality, costs of care, and effect on caregivers and society in general. This report also sets the stage for better understanding the relationship between race and ethnicity and the development of AD and other dementias.
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PMID:2010 Alzheimer's disease facts and figures. 2029 81

In Japan, the average life expectancy exceeds 80 years (79 years in men, 86 years in women in 2009), and elderly persons aged 65 years and older occupy more than 22% of the population. According to the increase of the elderly population, the number of persons requiring care has inevitably increased. Under these circumstances, the long-term care insurance system started in 2000 in order to share nursing care costs for the elderly among the general public. There is a misconception that thorough implementation of lifestyle-related disease prevention will lead to care prevention. While prevention of lifestyle-related disease is undeniably important, prevention of long-term care dependence or care prevention requires a different approach. For example, the major causes of death in those over 65 are neoplasm (cancer), heart disease and stoke. Although stroke remains a cause of long-term care dependence, the other major causes are frailty, fall and fracture, and dementia (these are called the "geriatric syndromes"). The prevention of these geriatric syndromes is the feature of care prevention. Therefore, prevention of long-term care dependence includes not only the prevention of lifestyle-related diseases but also extends widely to the geriatric syndromes.
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PMID:[Significance and limitation of changing the lifestyle among the elderly--strategies on the prevention of lifestyle-related diseases and long-term care state]. 2044 98

The number of dementia patients has been growing in recent years and dementia represents a significant threat to aging people all over the world. Recent research has shown that the number of people affected by Alzheimer's disease (AD) and dementia is growing at an epidemic pace. The rapidly increasing financial and personal costs will affect the world's economies, health care systems, and many families. Researchers are now exploring a possible connection among AD, vascular dementia (VD), diabetes mellitus (type 2, T2DM) and cardiovascular diseases (CD). This correlation may be due to a strong association of cardiovascular risk factors with AD and VD, suggesting that these diseases share some biologic pathways. Since heart failure is associated with an increased risk of AD and VD, keeping the heart healthy may prove to keep the brain healthy as well. The risk for dementia is especially high when diabetes mellitus is comorbid with severe systolic hypertension or heart disease. In addition, the degree of coronary artery disease (CAD) is independently associated with cardinal neuropathological lesions of AD. Thus, the contribution of T2DM and CD to AD and VD implies that cardiovascular therapies may prove useful in preventing AD and dementia.
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PMID:Cardiovascular dementia - a different perspective. 2044 20


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