Nursing home patients’ response to music opens new avenues for diagnosis and therapy

A nursing home in California began playing music for residents suffering from dementia, and got responses from patients once considered unreachable.

There are thousands of nursing homes participating in an international music and memory program.

At Villa Coronado, a nursing home in San Diego, 10 residents with traumatic brain injury were given an iPod to listen to music. Over 4,500 residents in 300 California nursing homes are taking part in a statewide experiment. One of the aims of the study is to find out whether music can replace antipsychotic drugs and restraints for agitated patients. With some patients, it seems to work.

This patient population receives little or no therapy, and are mostly bedridden, isolated from the world around them. Researchers are looking to see if the music program can reduce aggressive behavior.

For some people, music brings back memories. It can help dementia patients become more aware of their surroundings. Music will bring a smile to some patients, and can calm those who are agitated. Some patients listening to the music will smile, move rhythmically, and be more responsive to their loved ones.

Music is said to activate more parts of the brain than any other stimulus. New research suggests music therapy could help people in a coma or in a vegetative state.

The patients’ response to music may even help physicians to diagnose consciousness. Studies show there is a high rate of misdiagnosis in vegetative patients, where it is important to determine a patient’s chance of recovery. Observing these patients leads some workers to conclude that rather than a steady state, there is a spectrum of consciousness, and patients drift in and out.

Caroline Schnakers is an associate clinical professor in the Department of Psychiatry at UCLA. Her research indicates there is a 40 to 50 percent error rate in diagnosing a patient’s consciousness. Some patients appear to be unconscious, and yet have some signs of consciousness and awareness of their surroundings.

A patient in a minimally conscious state (MCS) is considered to have more chance to recover than a patient in a vegetative state. If a patient is observed to be sometimes conscious, there is more hope of recovery. The diagnosis of a patient determines medical treatment and end-of-life decisions, so it’s important to diagnose correctly.

Some patients thought to be in a vegetative state are actually in a minimally conscious state, and they respond to the music. One nursing home activities director was excited to see how music affected the residents, saying they just come alive.

Researchers at UC Davis plan to have the initial results of their nursing home study by the end of this year. But regardless of whether music is able to replace medication, it’s worth giving patients music to improve their quality of life.

For more information on the care of dementia patients: Alzheimer’s on Guide To Long Term Care.

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Diabetes drug doing double duty as Alzheimer’s therapy

A drug developed for treating diabetes now shows promise for Alzheimer’s patients, according to scientists at England’s Lancaster University. The drug is described as a triple receptor agonist, or TA. It combines hormones glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and Glucagon, activating these three receptors at the same time. The new study is published in the journal Brain Research.

A group of mice with Alzheimer’s-related symptoms were tested in a spatial water maze. The TA drug was injected once a day for two months. The mice who were treated with the drug remembered their path better than the control group.


In addition to the memory improvement, other symptoms were improved: the accumulation of plaque in the brain was reduced; brain nerve cells were protected from deterioration and loss; and chronic nerve inflammation was reduced, as well as oxidative stress in the cortex and hippocampus. Increased levels of synaptophysin indicated protection from synaptic loss that occurs in Alzheimer’s. An increase of doublecortin positive cells showed improved neurogenesis.

Other diabetes drugs have shown promise for Alzheimer’s patients. The two diseases are known to be related, and type 2 diabetes increases the risk of Alzheimer’s disease. Clinical trials are proceeding to investigate the neuroprotective effects of extendin-4 and liraglutide.

Alzheimer’s cases are expected to triple in the next forty years, requiring more long term care. The increase in patients will bring financial challenges as well as medical ones. For more information on supporting Alzheimer’s and dementia patients, see the Alzheimer’s Section on Guide To Long Term Care.


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Insomnia increases Alzheimer’s risk

Just one night without enough sleep can cause harmful proteins to build up in the brain, increasing the risk of Alzheimer’s disease, according to a new study.

Past studies already linked insufficient sleep to increased risk of Alzheimer’s and other chronic diseases — but this recent study from Washington University,published in the Annals of Neurology, discovered what insomnia actually does to the brain.


One of the functions of sleep is to clear the brain of waste, including amyloid beta proteins which can bond with each other and form plaques on nerve cells. These plaques build up in the brains of people with Alzheimer’s disease.

People with a genetic tendency for Alzheimer’s disease have higher than normal levels of beta amyloid proteins, even before they develop symptoms. After a night without sleep, these higher levels appeared in the healthy study participants.

Inadequate sleep has been linked to a 1.5 fold increase in the odds of developing Alzheimer’s. It’s not surprising, therefore, that research shows that sleep disorders such as sleep apnea increase the risk.

In the study, eight participants with no previous sleep or memory problems were instructed to either stay awake all night, get a normal night’s rest, or use the drug sodium oxybate to help them sleep. The sleep aid is supposed to increase the period of deep, dreamless sleep when the brain is thought to restore itself.

The scientists tested the cerebrospinal fluid surrounding each participant’s brain for amyloid proteins. Measurements were taken before the night of the test, and then every 2 hours the next day, to show how the night of sleep or no sleep affected the accumulation of these proteins in the brain.

Study participants who went without sleep for just one night had a 25-30% increase in the beta-amyloid proteins in their cerebrospinal fluid, bringing the levels to what researchers would expect to see in people who have genes for Alzheimer’s disease. Before the test, the participants all had normal levels. The pills designed to promote the deep sleep did not affect the levels of amyloid protein.

In a healthy person, normal sleep eliminates waste and restores the brain each night. But repeated nights of insufficient rest may overwhelm the brain’s recovery system, allowing amyloid proteins to build up and form plaques which interfere with the brain’s functioning.

For information on Alzheimer’s and also long term care insurance, see Alzheimer’s Section on the Guide To Long Term Care.


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More insights on Alzheimer’s disease – how some brains are protected

A feature of the brain’s neurons called dendritic spines may protect against dementia, according to new findings.

Neurofibrillary tangles and amyloid plaques appear in the brains of people with Alzheimer’s, but not everyone who has these formations goes on to develop the disease. Between 30 and 50 percent of patients with the plaques and tangles do not develop Alzheimer’s disease. Why not? Scientists have been looking for the reasons.

Researchers at the University of Alabama at Birmingham found the answer may lie in dendritic spines. The dendritic spines of a neuron help it make connections with other neurons and send information. These parts of the neuron may protect against Alzheimer’s disease.

Dendrites, the branched projections of a neuron that transfer electrochemical stimulation from other neural cells to the cell body, have small membranous protrustions called dendritic spines. Each dendritic spine receives input from a single axon at the synapse. The loss of dendritic spines results in the loss of synapses, which can impair cognition. Logically, subects with normal brains would have healthy dendritic spines, and those with dementia would not. The researchers tested the structures and published the results in the journal Annals of Neurology.

The scientists compared dendritic spines in 21 patients with Alzheimer’s, 8 patients who had Alzheimer’s brain changes but no symptoms, and 12 healthy patients. Using bright-field microscopy, Professor Jeremy Herskowitz and the team took images of the dendritic spines, then used the images to create a 3-D digital reconstruction.

The healthy control subjects had more dendritic spines than the subjects with Alzheimer’s. The subjects with Alzheimer’s brain changes but no symptoms also had more spines than the Alzheimer’s subjects — and almost the same dendritic spine density as the healthy subjects. The group with pathology but no symptoms group had very long dendritic spines, longer than both the other groups.

Longer dendritic spines might indicate greater neuroplasticity — the capacity to change and form new neural connections. Increased neuroplasticity could enable the neurons to bypass plaques and tangles, and still communicate with other neurons. If so, this phenomenon could explain why some people who have Alzheimer’s pathology do not show cognitive impairment.

The research suggests that it may be possible for the brain to rebuild neurons. The information gained in the study may help scientists to develop new therapies, especially when brain changes are detected before symptoms appear.

In 2014, a study at NYU Langone Medical Center in New York, published in the journal Science, showed that getting sleep after learning helps neurons form connections, through dendritic branches, that may help brain cells pass information to each other and facilitate long-term memory.

The scientists observed mice that were genetically modified so a particular protein in their brain cells would fluoresce when viewed with a laser scanning microscope. The fluorescence allowed the team to track the growth of new spines along each branch of a dendrite. The mice sprouted new dendritic spines within 6 hours of learning a new task. Different structural changes occurred for different types of learning.

Healthier and more numerous dendritic spines may be a genetic trait, but the brain also may respond to healthy diet and lifestyle. According to Medical News Today, research suggests that as many as a third of dementia cases can be prevented by regular exercise and an active social life.

For more information on Alzheimer’s and dementia, and care choices, see the Guide To Long Term Care.


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Urgent Need for Alzheimer’s Disease Study Volunteers

Many researchers are working on a cure for Alzheimer’s disease. But they have run into an obstacle recently: a shortage of volunteers for clinical trials.

There are more than 100 research studies needing around 50,000 volunteers to help. Many studies have been funded, but there are not enough participants.

177851075The trials do not necessarily require people who are elderly or who suffer from dementia, and are not all drug trials. Some studies require participants to do cognitive tests on home computers. Some record data on lifestyle factors such as diet and exercise, or genetic risk factors.

There are studies where the volunteers try out wearable technology. All these tests collect information that can help scientists find ways to help people with Alzheimer’s.

Study subjects can benefit from participating. For example, some people who have Alzheimer’s disease may find a treatment that works. Some people may discover they have a genetic risk of dementia or already are in the early stages, and get prevention or treatment when it is most effective. Many volunteers in these studies will receive medical care for free. Also, some of the drug trials pay participants.

For people with dementia who are isolated, taking part in a study may help them socially. They can make friends with people running the studies and be part of a team. They can also feel good about helping to advance science and benefit others.

Some of the problems scientists have in recruiting study participants: In some studies both the dementia patient and a care partner must be involved. It’s harder to enroll two people. Some drug trials exclude people with certain medical conditions from participating.

Many drug studies require subjects in the early stages of dementia; at this stage there are few, or no, symptoms, so the disease hasn’t yet been identified, making it hard to find subjects.

There are sometimes legal obstacles if a dementia patient is not considered competent enough to give consent. And there are risks with experimental therapies, even though animal studies and FDA reviews are done before human trials.

For information on upcoming trials and on volunteering, visit the Alzheimer’s Association website, they have TrialMatch, a free database where you can find studies that may be right for you.


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The rate of dementia among seniors is going down

The rate of Alzheimer’s and other forms of dementia among seniors has declined significantly over the last ten years, according to a new study.

The Einstein Aging Study followed 1400 men and women age 70 and older from 1993 through 2015. When they entered the study they did not have dementia. Carol Derby, research professor at the Albert Einstein College of Medicine in New York City, analyzed the data. The report was published in JAMA Neurology.

Of 369 people born before 1920, 73 ended up with dementia. Of 285 born 1920-24, 43 developed dementia. Of 344 born 1925-29, 31 developed dementia. Of 350 born after 1929, only 3 got dementia. Similar declining rates have been found in Europe.

Researchers say the reasons for the decline in dementia cases are not known, but there is also a declining rate of stroke and heart attack from one generation to another (though diabetes is increasing).

Efforts to prevent cardiovascular disease in recent decades may be paying off; the incidence of stroke has declined. Since dementia risk is correlated with the health of blood vessels in the brain, it makes sense that the rate of dementia is falling alongside the rate of strokes. A recent study found that healthy lifestyles, including exercise, good diet, no smoking, and proper treatment of chronic medical conditions could prevent 35% of dementia cases.

Although the rate of dementia is going down, the actual number of people with dementia is increasing dramatically as the baby boomer generation ages, inflating the percentage of elderly people in the U.S. population.

Around the world, more than 47 million people suffer from dementia, and 7 million new cases develop each year. The number of cases of dementia is projected to double every 20 years. The number of people with Alzheimer’s disease is expected to reach 106 million by 2050.

Dementia is one of the most expensive health conditions, costing patients and families in medical fees and caregiving time. Long term care insurance can help pay for the costs. You must insure before the diagnosis! For more information see the Guide To Long Term Care – Alzheimer’s.


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Dancing Benefits The Aging Brain

Doctors have long recommended physical exercise to reduce or delay the onset of dementia as people age. But a new study indicates that dancing may give even greater benefits than other forms of exercise.

Dr. Kathrin Rehfeld compared the effects of different kinds of exercise on volunteers with an average age of 68. Over 18 months, participants took part in either traditional fitness training with repetitive exercises like cycling or Nordic walking, or dance lessons which featured something new each week.

The study measured changes in the hippocampus, the area of the brain that is connected with learning, memory, and balance, and is affected by Alzheimer’s and similar diseases. In both groups, the hippocampus region of the brain increased. The dancers had a noticeable improvement in balance.

The dance routines varied and included jazz, square dance, line dance, and Latin. The study was published in the journal Frontiers in Human Neuroscience.

Other studies have found similar benefits to dancing:

A study at the Albert Einstein College of Medicine found that brain-stimulating activities such as reading, writing, and doing puzzles lowered the risk of dementia by 47 percent. This study did not find that regular bicycling, swimming, or team sports lowered the risk of dementia significantly. But ballroom dancing reduced the risk of developing dementia by 67 percent!

A study from Korea found that seniors who learned to dance the Cha Cha improved their memory and cognitive function over six months when compared to controls. A study from Canada found that seniors who danced the tango twice a week improved their cognitive scores.

The challenge of constantly learning a variety of new things may be one of the keys to the success of dance in improving mental ability. Dance requires a combination of mental and physical activity – dancers must remember the steps and executive them in rhythm. Also, dance is usually accompanied by music, and music has also been found to benefit people with Alzheimer’s and dementia. Music stimulates memories and positive emotions, and body response to rhythms; music can also have the effect of making people more outgoing and sociable.

For more information on Alzheimer’s and dementia, see the Alzheimer’s Section of Guide To Long Term Care.

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