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A new study shows adding olive oil or nuts to that healthy diet can protect your brain.

It might seem against all logic, but adding a little olive oil or a handful of nuts to your diet each day may help keep your mind clear, researchers reported on Monday. It’s the same diet that’s also been shown to reduce deaths from heart attacks and strokes.

The researchers found that people who ate these healthy fats were less likely to show the early signs of  dementia than those who stuck to a more traditional diet.  And this was done in Spain -- where people are already eating a so-called Mediterranean diet.

“Our findings support increasing evidence on the protective effects of the Mediterranean Diet on cognitive function,” Miguel Martinez-Gonzalez of the University of Navarra in Spain and colleagues reported in the Journal of Neurology, Neurosurgery and Psychiatry.

The findings come from a large and well-publicized trial that showed the Mediterranean diet rich in fruits, vegetables, olive oil and a little wine can cut the risk of heart attacks and strokes by 30 percent. Martinez and colleagues took a part data on 500 volunteers from their own study center, who were followed for more than six and a half years after starting the diet.

A Mediterranean diet includes lots of salad, fruit, vegetables, nuts, a little fish, a little lean meat, a small amount of cheese and olive oil.  Wine is also served at meals. In the main study, 7,400 volunteers got extra counseling, and either a weekly supply of extra-virgin olive oil or mixed nuts -- walnuts, almonds and hazelnuts.

The volunteers, aged 55 to 80, were all at high risk of heart disease because of diabetes, a family history of the disease, high blood pressure, unhealthy cholesterol levels -- or they were overweight or smokers. They were randomly assigned to either add more extra-virgin olive oil to their daily diets, a daily handful of the mixed nuts, or just a standard diet with advice to cut fat.

Such “randomized” studies are considered more powerful, because people don’t choose which diet to adopt -- and so other outside factors don’t interfere with the results. For instance, people who choose to eat nuts might also dislike meat, or they might like sweets, or they might exercise more or less than people who don’t think much about eating nuts.

Six years after starting on the diet, the 500 Navarra volunteers took two standardized tests for dementia and the confused thinking, called cognitive impairment, that often leads to dementia.

The researchers found that 60 volunteers had developed mild cognitive impairment. Eighteen had been told to eat more olive oil, 19 had been on the diet with added mixed nuts and 23 of them had been advised to eat a low-fat diet. And 35 people developed dementia: 12 on the added olive oil diet; six who got nuts and 17 on the low-fat diet.

There are several ways that adding olive oil or nuts to the diet might protect the brain, the researchers said. Olive oil and nuts contain monounsaturated fats, which are better for artery health than the saturated fats found in butter, meat and lard. These foods are also high in fiber and vitamin E, as well as minerals. Walnuts are rich in omega-3 fatty acids.

The diet could reduce damaging inflammation, Martinez says. And some studies have suggested that virgin olive oil -- which is cold-pressed and unrefined -- might fight the beta amyloid "plaques" found clogging the brains of Alzheimer's patients. "A third mechanism may be that an improvement in vascular health leads to better brain blood flow," Martinez said by e-mail.

These nutrients protect against the oxidative damage that can cause heart disease, cancer and Alzheimer’s. Various studies have shown little benefit from taking vitamins alone, but this study shows the combination of the factors in a healthful diet does seem to have an effect.

Groups like the Alzheimer’s Association have been warning that the U.S. will have to cope with a tsunami of Alzheimer’s disease as the population ages, with projections that the number of patients with this untreatable form of dementia will triple in the next 40 years, to 13.8 million in 2050.

“Currently, there is no effective therapy to delay the onset or halt the progression of dementia,” the researchers noted.

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• Tasty diet cuts heart disease
• Alzheimer’s rates accelerating
• Alzheimer's fastest-growing health threat
• Healthy diet may delay Alzheimer's

President Obama pitched a human brain research initiative on Tuesday that he likened to the Human Genome Project to map all the human DNA, and said it will not only help find cures for diseases such as Alzheimer’s and autism, but create jobs and drive economic growth.

Obama proposed $100 million in federal funding to kick start the Brain Research through Advancing Innovative Neurotechnologies or BRAIN Initiative.

“Imagine if we could reverse traumatic brain injury and PTSD for our wounded veterans coming home,” Obama said at an event unveiling the initiative at the White House.

He said federal investment in basic research had led to completely unexpected inventions, from the Internet to GPS technology. “The Apollo project that put man on the moon gave us, eventually, CAT scans,” Obama said.

He said the Human Genome Project, completed in 2003, had paid $140 for every dollar invested.

“As humans we can identify galaxies light-years away, study particles smaller than an atom but we still haven’t unlocked the mystery of the 3 pounds of matter than sits between our ears,” Obama said.

"Ideas are what power our economy. It’s what sets us apart. It’s what America has been all about," he added.

"We have been a nation of dreamers and risk-takers; people who see what nobody else sees sooner than anybody else sees it.  We do innovation better than anybody else -- and that makes our economy stronger. When we invest in the best ideas before anybody else does, our businesses and our workers can make the best products and deliver the best services before anybody else."

Obama said he’ll send the proposal to Congress next week as part of his budget request. Although Congress is working to slash the federal deficit, House Majority Leader Eric Cantor signalled an early willingness to pay for this one.

“Mapping the human brain is exactly the type of research we should be funding, by reprioritizing the $250 million we currently spend on political and social science research into expanded medical research, including the expedited mapping of the human brain. It's great science,” Cantor said in a statement.

It's not clear just what the initiative will do. Obama and collins said they'd appointed a "dream team" of experts to lay out the agenda -- they should report back before the end of the summer. They are led by neurobiologists Cori Bargmann of Rockefeller University and William Newsome of Stanford University.

Allen Institute for Brain Research

The brain's "emotion center", the amygdala, is highlighted in this 3-D representation of the human brain from the Allen Human Brain Atlas.

“Investing in biomedical research is one of the wisest choices we can make as a nation,” National Institutes of Health director Dr. Francis Collins told the gathering. “The United States has been at the forefront of one medical breakthrough after another.”

The public-private initiative, with money from groups such as the Howard Hughes Medical Institute and Microsoft co-founder Paul Allen's brain mapping project, aims to find a way to take pictures of the brain in action in real time.

The $100 million funding will come from the National Institutes of Health, the Defense Advanced Research Projects Agency and the National Science Foundation, the White House said.

“We want to understand the brain to know how we reason, how we memorize, how we learn, how we move, how our emotions work. These abilities define us, yet we hardly understand any of it," said Miyoung Chun, vice president of science programs at The Kavli Foundation, which is taking part in the initiative and which funds basic research in neuroscience and physics.

The project has some big money and some big science to build on. Allen pumped another $300 million into his institute's brain mapping initiative a year ago, and has published freely available maps of the human and mouse brains. The Howard Hughes Medical Institute built a whole research campus devoted to brain science, called Janelia Farm, in Virginia.

Arati Prabhakar, director of the Defense Advanced Research Projects Agency (DARPA) pointed to a project that allowed a quadriplegic woman to control a robot arm with her thoughts alone.

"There is nothing like a project to inspire people to go to that next level," Collins told a telephone briefing.

Not everybody is happy about a centralized, administration-led project. Michael Eisen, a biologist at the University of California at Berkeley, said earlier this year that grand projects in biology such as Project ENCODE for DNA analysis were emerging as the "greatest threat" to individual discovery-driven science.

"It's one thing to fund neuroscience, another to have a centralized 10-year project to 'solve the brain,'" Eisen wrote in a Twitter update in February.

Related:

• How researchers shaped the White House's brain-mapping initiative
• Atlas aims to solve mysteries of the human brain
• Institute unveils mouse brain map

This story was originally published on Tue Apr 2, 2013 6:00 AM EDT

A staggering 1 in 3 seniors dies with Alzheimer's disease or other types of dementia, says a new report that highlights the impact the mind-destroying disease is having on the rapidly aging population.

Dying with Alzheimer's is not the same as dying from it. But even when dementia isn't the direct cause of death, it can be the final blow — speeding someone's decline by interfering with their care for heart disease, cancer or other serious illnesses. That's the assessment of the report released Tuesday by the Alzheimer's Association, which advocates for more research and support for families afflicted by it.

"Exacerbated aging," is how Dr. Maria Carrillo, an association vice president, terms the Alzheimer's effect. "It changes any health care situation for a family."

In fact, only 30 percent of 70-year-olds who don't have Alzheimer's are expected to die before their 80th birthday. But if they do have dementia, 61 percent are expected to die, the report found.

Already, 5.2 million Americans have Alzheimer's or some other form of dementia. Those numbers will jump to 13.8 million by 2050, Tuesday's report projects. That's slightly lower than some previous estimates.

Count just the deaths directly attributed to dementia, and they're growing fast. Nearly 85,000 people died from Alzheimer's in 2011, the Centers for Disease Control and Prevention estimated in a separate report Tuesday. Those are people who had Alzheimer's listed as an underlying cause on a death certificate, perhaps because the dementia led to respiratory failure. Those numbers make Alzheimer's the sixth leading cause of death.

That death rate rose 39 percent in the past decade, even as the CDC found that deaths declined among some of the nation's other top killers — heart disease, cancer, stroke and diabetes. The reason: Alzheimer's is the only one of those leading killers to have no good treatment. Today's medications only temporarily ease some dementia symptoms.

But what's on a death certificate is only part of the story.

Consider: Severe dementia can make it difficult for people to move around or swallow properly. That increases the risk of pneumonia, one of the most commonly identified causes of death among Alzheimer's patients.

Likewise, dementia patients can forget their medications for diabetes, high blood pressure or other illnesses. They may not be able to explain they are feeling symptoms of other ailments such as infections. They're far more likely to be hospitalized than other older adults. That in turn increases their risk of death within the following year.

"You should be getting a sense of the so-called blurred distinction between deaths among people with Alzheimer's and deaths caused by Alzheimer's. It's not so clear where to draw the line," said Jennifer Weuve of Chicago's Rush University, who helped study that very question.

The Chicago Health and Aging Project tracked the health of more than 10,000 older adults over time. Weuve's team used the data to estimate how many people nationally will die with Alzheimer's this year — about 450,000, according to Tuesday's report.

That's compatible with the 1 in 3 figure the Alzheimer's Association calculates for all dementias. That number is based on a separate analysis of Medicare data that includes both Alzheimer's cases and deaths among seniors with other forms of dementia.

Last year, the Obama administration set a goal of finding effective Alzheimer's treatments by 2025, and increased research funding to help. It's not clear how the government's automatic budget cuts, which began earlier this month, will affect those plans.

But Tuesday's report calculated that health and long-term care services will total $203 billion this year, much of that paid by Medicare and Medicaid and not counting unpaid care from family and friends. That tab is expected to reach $1.2 trillion by 2050, barring a research breakthrough, the report concluded. 

Related:

• Alzheimer's the fastest-growing health threat
• Alzheimer's to triple by 2050
• Alzheimer's drug disappoints but shows promise

Alzheimer’s disease is the fastest growing threat to health in the United States, but Americans are still most likely to die from diseases caused by their own habits such as overeating and tobacco, according to a new report on global death and disease.

In contrast, AIDS and alcohol are the biggest health threats among Russians, malnutrition threatens children in Africa and Afghanistan and violence is taking the lives of many young men across much of Latin America.

The team at the University of Washington in Seattle looked at thousands of sources of data, from individual death certificates to global surveys on illness, for their report. It compares various causes of death and diseases across 187 countries.

Groups like the Alzheimer’s Association have been warning that the U.S. will have to cope with a tsunami of Alzheimer’s disease as the population ages. A report last month projected that the number of patients with this untreatable form of dementia will triple in the next 40 years, to 13.8 million in 2050.

The University of Washington team looked at Alzheimer's trends and found it’s already up 392 percent as a cause of premature death, as measured by years of life lost. As an overall cause of death – how many people die of Alzheimer's instead of something else – it’s up more than 500 percent.

As for causes of disease, they are mostly self-imposed.

 “Overall, the three risk factors that account for the most disease burden in the United States are dietary risks, tobacco smoking, and high body-mass index,” reads the report, called the Global Burden of Diseases, Injuries, and Risk Factors 2010.

Heart disease, lung and throat cancer and stroke cost Americans the most years of life in 2010, the study, led by the university’s Christopher Murray, found. The single biggest risk factor in the U.S. is diet.

But there’s good news. “Of the 25 most important causes of burden, as measured by disability-adjusted life years, interpersonal violence showed the largest decrease, falling by 26 percent from 1990 to 2010,” the report finds

There’s other good news in the report: AIDS infections appear to have peaked globally and people are living longer and healthier lives.

“While HIV/AIDS has exacted a devastating toll on many countries in sub-Saharan Africa, increasing by 328 percent in terms of healthy years lost from 1990 to 2010, the epidemic appears to have peaked in 2004,” the report says.

Death rates from HIV are now falling, according to the World Health Organization. Programs to get people treated with cocktails of lifesaving drugs, which can also prevent new infections, are the reason. “This success is largely attributable to the massive scale-up in antiretroviral therapy over the past decade,” the report reads.

Other rich countries have similar health profiles to the United States. Residents of Britain and Canada both also suffer most from overeating and smoking. In Britain, the single biggest helath risk to children is second-hand smoke.

In contrast, the three biggest causes of poor health in Ecuador are alcohol abuse, poor diet and high blood pressure. Children are the most hurt by poor breastfeeding.

In Afghanistan, most disease is caused by air pollution from  household fireplaces and cookstoves, underweight children and poor diet.

“A troubling mortality trend is among young adults, especially young men, who are now dying at very high rates in eastern Europe, central Asia, and eastern and southern Africa. This is largely due to the epidemics of alcohol‐related mortality and HIV/AIDS, respectively,” the report says.

“The average mortality rates among males aged 25 to 39 fell by little more than 19.7 percent over the four decades as compared to much higher declines in other age‐groups.”

Related stories:

Alzheimer's to triple by 2050, report finds

New focus on AIDS treatment saves lives

The number of Americans living with Alzheimer’s will triple in the next 40 years, which means that 13.8 million will have the mind-robbing disease by 2050, researchers projected Wednesday.

Previous estimates of what many call “the tsunami of Alzheimer’s” hitting our society as the population ages have come up with similar numbers. This latest projection is notable because it is based on an analysis of more than 10,000 people 65 and older enrolled in the Chicago Health and Aging Project since 1993.

Researchers interview the volunteers every three years to monitor the number who develop Alzheimer’s as they grow older. Census data project that as the baby boom generation ages, the number of Americans ages 65 to 84 will approximately double by 2050. At the same time, the number of those 85 and older will increase almost four-fold to a total of nearly 14 million. The study estimates that 36.6 percent of that population will suffer Alzheimer’s.

Currently an estimated 4.7 million Americans have Alzheimer's, the most common cause of dementia.

“These projections emphasize the need to find either prevention or treatment for Alzheimer’s disease dementia in order to decrease the burden of future disease on individuals, families and the medical care system,” the team at Rush Hospital in Chicago writes in the journal Neurology.

What are the chances of better treatments any time soon?  In a few words: not great. Drug companies and academic researchers are carrying out many trials and we can hope for an unexpected great success. But none is apparent.

The FDA has approved five drugs to treat Alzheimer’s. Most physicians say that in a minority of patients they relieve symptoms for a few months. But none stops the inevitable brain destruction.

Still, the drugs generated sales of $2.9 billion in 2011, according to IMS Health, a healthcare technology and information company. The best selling, Aricept from Pfizer, brought in $1.5 billion. Doctors admit that all too often they will give the patient the pills long after it is clear they have no benefit because they want to help, and families expect them to do something even if it affords no improvement.

Early diagnosis will be playing an increasing role in the effort to stop or slow down Alzheimer’s. Recent studies of people who carry gene variants that bring on Alzheimer’s at an early age found that brain changes leading to the disease began as early as 25 years before memory loss or other symptoms set in. Drug trials are now looking at people with the gene variant that predisposes them to Alzheimer’s, trying experimental drugs decades in advance to see if they can slow the process.

As part of the push for early detection, drug company Eli Lilly won approval from the FDA last April for a radioactive tracer that, used with a PET brain scan, measures the build-up of a substance called amyloid plaque that many experts believe is either the cause of Alzheimer’s or a critical marker for its progression.

The company says the product, called Amyvid, can help doctors diagnose Alzheimer’s and rule out other possible, mostly rare, causes of dementia. There is no evidence to date that it can help predict what will happen to people who do not have symptoms. The price of Amyvid, the PET scan and the doctors’ time adds up to $4,000 and federal advisers say Medicare and Medicaid should not pay for it. 

So what can a person do to reduce the risk of dementia later in life? Dozens of studies have shown that exercise is very helpful.

One of the strongest pieces of research came out Monday from the Cooper Institute in Dallas. Looking at 25 years worth of records for more than 19,000 people who visited the institute, which specializes in preventive care through fitness, it found that those most fit in their late 40s were 36 percent less likely to develop dementia in their 70s and 80s. Exercise is neither new nor glamorous. But for much disease, including Alzheimer's, it remains a strong defense.

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Like anyone else who is getting a little older, former NFL player Wayne Clark sometimes forgets someone’s name. But unlike most people, Clark has an extra reason to worry -- as a retired  football player, he’s had more than his fair share of knocks and is now nervously watching report after report linking concussions with a brain condition known as chronic traumatic encephalopathy (CTE).

“Recalling names, which I recall used to be pretty easy for me, and now I go through stages where I think ‘Why can’t I remember that’?  I always wondered are these age-related or are they concussion-related?” Clark, 65, says.

A new study using brain scans might be able to answer that question. The technique may allow scientists to peer into the brains of the living and spot signs of the abnormally tangled clumps of a protein called "tau" that can cause such symptoms as memory loss, impulse control, mood volatility and, eventually, dementia in people with CTE.

Researchers from the University of California, Los Angeles, used the new technique to scan the brains of five former NFL players 45 and older, along with five healthy men of the same age, according to a preliminary report published Tuesday in the American Journal of Geriatric Psychiatry.

The hope is that studies like this will enable scientists to better understand CTE, says Dr. Gary Small, director of the UCLA Longevity Center, who led the study.

“Then maybe we will be able to detect it sooner and possibly come up with a preventive treatment rather than trying to repair what is damaged,” Small says.

A study of five people doesn’t say much about what might be found in a larger population. But Small and his colleagues are encouraged by what they've seen.

Each of the football players in the study had a history of one or more diagnosed concussions and several had cognitive and/or mood symptoms. The players represented a wide range of positions: linebacker, quarterback, guard, center, and defensive lineman.

At the outset, the players were asked to fill out questionnaires designed to detect signs of cognitive decline and mood symptoms.

To look for signs of CTE, Small and his colleagues injected each study volunteer with a newly developed radio tracer that locks on to the tau protein and shows up in bright colors ranging from red to yellow on PET scans.

The scans from the healthy non-players showed no signs of tau build-up, but the images from the players showed a range that correlated with the number of hits they’d sustained during their football careers.

UCLA

Brain scans of living former NFL players show evidence of the damage linked to a brain-destroying condition called CTE, researchers said on Tuesday.

Though the researchers had asked 19 players initially to participate in the study, only five were willing, Small says. And only one was willing to have his name released to the public. That was Clark, a former quarterback for the San Diego Chargers.

Clark, who had sustained only one concussion while playing football, didn’t have much evidence of tau build-up. But he did have some.

“And when I first saw the scan I thought, whoa, that looks pretty extensive,” Clark says in an video interview on UCLA's website.

“Wayne’s scans show the abnormal protein deposits, just like the other football players in the study,” Small says. “Now he's in his mid-60s and he has very minor memory complaints, which could be part of normal aging, but they also could be related to his concussion. When we do further studies, we’ll be able to find out if there’s a solid connection between the two.”

Clark hopes the research will help doctors eventually identify which players might be at risk of developing permanent brain damage. “My hope is that this study will help diagnose the condition before a player dies and is autopsied,” Clark says. "If we can diagnose it when a player is alive, then we can learn how best to intervene and how to improve equipment and rules and practice habits to we can make the game safer.”

It’s not just NFL players. Brain injuries are common among war veterans, victims of accidents and younger athletes.

The researchers don’t completely understand the relationship between tau deposits and jolts to the head. Clark’s scan suggests that one hit might possibly lead to some accumulation of the abnormal protein -- just not enough to lead to symptoms.

“We don’t know how many hits it takes,” says Dr. Joseph Maroon, a professor of neurosurgery at the University of Pittsburgh Medical Center, and team neurosurgeon for the Pittsburgh Steelers. He was not involved in this study. “We don’t know if one severe hit can lead to this progression. Some players can get thousands of hits and never develop CTE. There are millions of football players in high school, college, and pro level who have taken multiple blows to the head and not developed CTE.”

Another unresolved question is whether multiple “sub-concussive” hits, such as those sustained by linemen on every play, can lead to CTE.

Perhaps the biggest question scientists hope to solve with this type of research is what percentage of concussed players end up with CTE.

Many believe that there is a genetic component that can make a person more susceptible and that those with resilient genetics can take a number of jolts to the brain without developing the disease.

Though most of the former NFL players’ brains autopsied up to this point have shown signs of CTE, those brains have come from players who tended to have pronounced symptoms of the disease before their deaths.

Two years ago when former football star Dave Duerson committed suicide, he left a note explaining that he’d decided to shoot himself in the chest, rather than the head, so scientists might examine his brain to see if the concussions he’d suffered in his 11-year NFL career as a hard-hitting safety for the Chicago Bears, the New York Giants and the Phoenix Cardinals could explain the symptoms that were making his life a misery.

Thus far, Boston University’s Center for the Study of Traumatic Encephalopathy has found evidence of CTE in the autopsied brains of 33 former NFL players, including that of Duerson, according to a report published in December in an early online version of the journal Brain.

Some hope that the new research is just the beginning.

“This is a step forward and it emphasizes the importance of what PET scanning might hold as we go forward in trying to diagnose the condition [in living players],” says Maroon.

Maroon and others say they believe that CTE is the result of a normal inflammatory response to brain injury that runs amok. The theory is that the inflammation switch gets turned on and stays on in people with a certain genetic predisposition, Maroon says.

“One might conjecture that it’s like starting a small brush fire in a dry forest,” Maroon said. “If the predisposition is there and the fire is lit, then it may continue inexorably.”

Maroon hopes that new radio tracers will be found that highlight the early signs of inflammation before tau has even begun to accumulate. Then there might be a chance to find therapies that stop CTE from developing, he says. 

See more NBC Health news: 

• Contact sports leave pattern of brain injuries, study finds
• US launches study into youth sports concussions

Each morning, 48-year-old Troy Prater starts his day by getting breakfast for his teenage triplets. On weekdays he checks homework and then hurries them off to school. Then it’s back home to take care of his mom, Ella, who suffers from Alzheimer’s disease. Life, Prater says, “is organized chaos.” 

Prater is among the millions of Americans who have stepped up to do the right thing and take care of family members who can’t take care of themselves. Unfortunately, most caregivers are spread so thin that they don’t have time to take care of their own needs, NBC's Dr. Nancy Snyderman reports.

“Caregivers don’t go to the dentist; they don’t get mammograms or annual checkups,” says Melissa Gartenberg Livney, a clinical
psychologist with the PENN Memory Center at the Perelman School of Medicine at the University of Pennsylvania. “So they get sick.”

Even worse, Livney says, “there’s some evidence that this kind of stress can contribute to the onset of dementia" which is why she and others are trying to encourage caregivers to get help, to find ways to take breaks, and to make and keep their own doctors’ appointments.

How many people have stepped up to take care of a family member?  

One survey found that nearly one third of American households had someone serving as an unpaid family caregiver. That adds up to almost 40 million households with a caregiver present, according to the 2009 survey conducted by the National Alliance for Caregiving in conjunction with the AARP.

Many of those caregivers are dealing with Alzheimer’s, which Livney says can be incredibly stressful.

"Alzheimer's disease is 10 or 15 years of slow and steady loss of the person you once knew," she says. "Caregivers often suffer in silence and feel guilty when they don't feel up to the work."

Currently, there are 5 million Americans who have been diagnosed with the disease, says Beth Kallmyer, vice president of constituent services at the Alzheimer’s Association. “And we estimate that there are 15 million people caring for them.”

Unfortunately, the number of Alzheimer's patients is growing. The Alzheimer’s Association estimates that there will be 16 million Americans with the disease by mid-century if nothing changes. And that means there will be even more of us taking care of spouses and parents suffering from dementia.

Prater, who juggles caregiving along with his normal responsibilities as a dad, acknowledges the dual roles can be very taxing.

“I’m running on adrenaline,” he says. “I’ve lost quite a few pounds.”

What's the answer to getting caregivers to care for themselves?

People like Prater need to ask for help, Kallmyer says. But most seem to feel that caregiving is something they need to do on their own. And that's a setup for disaster, she says.

“When you’re taking care of someone over a period of time, you can’t just soldier on,” Kallmyer says. “At some point your health will be impacted and that will keep you from being the best caregiver you can be. We often ask people, ‘If you get sick and land in the hospital then what is going to happen?’”

Kallmyer suspects that the urge to go it alone is part of the American character. She’d like to see that change.

So would Livney.

"[Caregivers] need to allow themselves to not be perfect," she says.  

They also need to learn to look after their own needs.

“People need to give themselves permission to take care of themselves,” says Livney. “That’s what we focus on. We don’t spend much time talking about the disease and functional aspects of caring for someone with dementia. We try to help people understand how to take care of themselves."

Raji Cyrus/UCLA

A profile MRI of the brain with color shaded areas corresponding to areas of increased gray matter volume in active people. The blue crosshairs point to increased volume in the hippocampus with more calories burned per week. The hippocampus is the key memory and learning center of the brain.

Seniors who fit in the most daily physical activity – from raking leaves to dancing – can have more gray matter in important brain regions, researchers reported on Monday.

The scientists have images that show people who were the most active had 5 percent more gray matter than people who were the least active. Having more little gray brain cells translates into a lower risk of Alzheimer’s disease, other studies have shown.

“People really want to know what they can do to reduce their risk of Alzheimer’s disease,” said Dr. Cyrus Raji of the University of California in Los Angeles, who presented his team’s findings to a meeting of the Radiological Society of North America.

“This shows it is easier than you think.”

Raji’s team looked at the records of 876 adults, who were recruited into a larger study on heart health starting in 1989. They all got magnetic resonance imaging (MRI) brain scans in 1998 and 1999, when they were on average 78 years old, and filled out detailed questionnaires on exercise and other types of activity.

Most of them were a little overweight – with a body mass index or BMI of 27. People with BMIs above 25 are considered overweight and at 30 they are considered clinically obese.

The researchers found a huge difference in the amount of activity people reported. They were asked about everything from cycling to yard work, dancing and bicycle riding.

“The most active burned 3,434 calories per week (an extra 500 calories per day on average) compared to those in the bottom percentile who only burned 348 calories per week [through activities],” Raji said. “The most active had 5 percent more gray matter volume than the least active. That's a big number when you think about the tremendous biological forces that have to be at work for brain volume to change at all.”

And the MRIs showed the differences were in areas of the brain like the hippocampus, which is heavily damaged in Alzheimer’s disease.

“By strengthening this area, an active lifestyle can reduce risk for Alzheimer's,” Raji said. "Virtually all of the physical activities examined in this study are some variation of aerobic physical activity, which we know from other work can improve cerebral blood flow and strengthen neuronal connections.”

Money is limited for new medical research, so the UCLA team went through the records from another study -- that explains why some of the data is old. "This is the largest study of its kind that has ever been done," Raji said.

But even older data can be a gold mine for researchers. To log exercise, the volunteers wrote down all the activities they could remember over a two-week period. Some went back and filled out questionnaires five years later, so Raji's team could make some comparisons.

"We found that individuals who increased calories burned over five years also had more gray matter volume," Raji said.

Raji isn't sure how some people only managed to burn off 348 extra calories a week, but said they may have been ill or even bedridden.

When they looked in more detail at the surveys, the researchers noted that it was the people who managed to work exercise into their daily lives who racked up the most weekly calories. So unless people enjoy standard “exercise” such as running, they should find something they like and are likely to stick to, said Raji.

“No pharmaceutical drug on the market has been shown to have these effects on the brain -- not a single drug,” said Raji. And exercise is available to anyone. “And it doesn’t cost anything,” he said.

In the first 10 years of the study, 97 people developed Alzheimer’s, and just about a quarter of them were in the top 25 percent of exercisers. Raji said the disease was detected very early in this study because the volunteers were being studied so intensely. “Most had not yet been diagnosed by their primary care physicians,” he said.

Now the team is going to go through the surveys to see if the people who had the most gray matter were the least likely to develop Alzheimer’s – or if the brain disease progressed more slowly in those with the most gray matter. And they want to follow up with as many of the volunteers as possible to see how they have fared.

“I really do believe that we have strong evidence that physical activity can be a way to reduce the risk of Alzheimer’s disease,” Raji said.

How many calories can you burn doing various activities? The Centers for Disease Control and Prevention has a calculator here. An hour of dancing can burn 330 calories an hour while walking burns about 280 calories an hour.

• Related stories:
• Daily activity lowers Alzheimer's risk
• Why working out makes you live longer
• All that stress is shrinking your brain

A gene mutation whose discovery was announced Wednesday triples the risk for Alzheimer’s disease.  It is a headline that might sound frightening but shouldn’t evoke fear.

The mutation in the gene called TREM2 is rare, occurring in about 1 in 150 people.  By comparison one in five people carry a form of a different gene called APO-E that also triples the risk.  One in 50 carries a form of APO-E that raises risk 13 times. APO-E’s relation to Alzheimer’s was discovered in 1993.   So in terms of public health implications, TREM2 is a small player, and is one of an ever growing list of genes implicated in Alzheimer’s

Still, the research from two teams, one headed by  Dr. Kari Stefansson at DeCode Genetics in Iceland and the other by Dr. John Hardy of University College London and both published in the New England Journal of Medicine, is critically important science that may yield clues about the causes of Alzheimer’s disease and the search for better treatments. 

TREM2 in its normal form plays a role in inflammation, the body’s response that sends white blood cells to destroy invading germs and diseased tissue.  The mutation cuts the ability to mount an inflammatory response, so it ispossible the ability to fight other diseases is tied up with the risk for Alzheimer’s.  For more than a century pathologists have noted a buildup of white blood cells in the brains of people who died from Alzheimer’s.

No one is sure what causes Alzheimer’s, which already affects more than 5 million Americans and costs the U.S, economy more than $148 billion a year, according to the Alzheimer’s Association. The numbers are projected to worsen as the baby boomer generation ages. There is no treatment and no cure.

The leading contender as the main cause of Alzheimer’s is the accumulation of plaques of protein called amyloid-beta.  It is likely that the inflammatory response is attempting to keep that buildup at bay. Last July, Stefansson’s team discovered a different gene mutation, even more rare, that actually protects against Alzheimer’s. That, too, was important science because that gene is responsible for production of amyloid-beta.  So it both supports the hypothesis about the cause and leads to ideas about how to make drugs to stop it.

Stefansson established DeCode in 1996 to find disease-causing genes in Iceland, a country with a homogenous population and national health service with excellent records.  At first it was a profit making venture, but despite an impressive record of locating genes associated with several diseases, the company was forced to declare bankruptcy in 2009.  It continues as a non-profit enterprise.  The two Alzheimer’s genes discovered in the past few months illustrate why the genetic research is so important even though it does not lead to immediate public health benefits or profits.

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By Julie Steenhuysen
Reuters

CHICAGO -- The latest data from a long-running study of hormone therapy suggests women who started taking hormone replacements within five years of menopause were 30 percent less likely to develop Alzheimer's disease than women who started years later.

The findings, reported on Wednesday in the journal Neurology, add to evidence suggesting that taking hormone treatments around the time of menopause may be doing more than just helping women cope with hot flashes and night sweats.

"Our results suggest that there may be a critical window near menopause where hormone therapy may possibly be beneficial," Peter Zandi of Johns Hopkins University in Baltimore, one of the study leaders, said in a statement.

The findings come as menopausal women and their doctors continue to parse out the risks and benefits of hormone replacement therapy.

Most researchers agree that hormone replacements do not protect women from diseases of aging, and taking these drugs for long periods of time are associated with significant risks, including breast cancer, heart disease and gall bladder disease.

Earlier this week, the U.S. Preventive Services Task Force reaffirmed its 2005 guidelines recommending against the treatment as a way to prevent chronic disease.

But the influential advisory panel did not weigh in on the use of hormones to treat symptoms of menopause, a practice many professional societies endorse as long as the drugs are prescribed at the lowest possible dose for the shortest period of time.

The most definitive study on hormone replacement therapy to date comes from the Women's Health Initiative study, a large, randomized trial that was stopped early in 2002 when it became clear that women who were taking a combination of estrogen and progestin for five years had higher rates of ovarian cancer, breast cancer, strokes and other health problems.

A related study known as the Women's Health Initiative Memory Study also showed an increased risk of Alzheimer's disease in women who took hormone therapy.

The findings came as a shock to many doctors and their patients, who thought the study would show a protective benefit. Prescriptions of hormone treatments plummeted, with sales of Wyeth's combination estrogen and progestin pill Prempro cut in half since 2001 to around $1 billion a year. Wyeth is now owned by Pfizer.

Because the average age of women in the Women's Health Initiative study was 63, several years past menopause, questions remain about whether the findings apply to younger women.

30 percent lower risk
Zandi and colleagues decided to investigate whether the timing of starting hormone replacement therapy had any effect.

Their findings come from the Cache County Study on Memory, Health, and Aging, a study backed by the National Institute on Aging that has been following nearly all of the residents of Cache County, Utah, over age 65 since the study began in 1995.

Earlier results of the Cache County study published in 2004 had suggested that hormone treatments might help reduce the risk of Alzheimer's disease.

So, the team turned back to this population, looking specifically at the timing of when women started taking hormone therapy and their risk of Alzheimer's disease.

Zandi's team followed 1,768 women ages 65 and older for 11 years. A total of 1,105 women had used hormone therapy, which consisted of estrogen alone or estrogen in combination with progestin. During the study, 176 women developed Alzheimer's disease, including 87 of the 1,105 women who had taken hormone therapy compared to 89 of the 663 others.

The study found that women who began hormone therapy within five years of menopause had a 30 percent lower risk of Alzheimer's dementia than those who had not used hormone therapy.

There was no change in the risk among other hormone users who had begun treatment more than five years after menopause, but they did find a higher risk of dementia among women who started combined estrogen and progestin at age 65 or older.

Zandi said the study findings support the so-called timing hypothesis - that earlier treatment with hormones may be beneficial while later treatment may be harmful.

"It doesn't prove the hypothesis, " Zandi said. "But it does suggest there might be something to that merits further investigation."

Given that there are no treatments that can alter the course of Alzheimer's disease, Zandi said a 30 percent reduction would be meaningful, if it proves to be real.

For now, however, the results should not be used to make treatment decisions, said Dr. Victor Henderson of Stanford University, who wrote an editorial on the study.

"The consideration of whether or not to use hormone therapy in midlife shouldn't be driven by concerns for Alzheimer's disease risk," Henderson said in a telephone interview.

But, he said, as women seeking treatment for menopausal symptoms weigh the other benefits and risks that go along with the decision, the Cache County study may offer evidence of another potential benefit, rather than an added risk.

Most professional societies advise against hormone therapy for chronic disease prevention, including the American Heart Association, the American Congress of Obstetricians and Gynecologists and the American Academy of Family Physicians.