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Old Age

The eyes are the window to spotting early signs of dementia

As the population of the West ages. New innovations in detecting early signs of Dementia are being explored.

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A look within. (Reuters/Noor Khamis)

As our body’s central control center, the brain has to keep going at all costs. It makes sense that it’s surrounded by biological safeguards: a bony skull, a sack of tissue, and blood vessels that filter out most infectious bugs. When neurons start to decline—as some do naturally with age—the brain can even quickly rewire networks before we notice anything is amiss.

But these same safeguards are a huge obstacle for scientists trying to study the brain’s decline—specifically dementia. Grey matter is excellent at adapting to the slow buildup of abnormal proteins, the cause of several forms of dementia, and it lacks the same pain receptors as the rest of our body. So by the time a patient starts becoming forgetful, or having trouble concentrating, the cellular damage is already substantial—and usually irreversible.

In order to slow or prevent dementia, scientists will have to be able to spot it before cognitive systems collapse. Current diagnostic tools for Alzheimer’s, the most common form of dementia, can confirm the build-ups of misshapen amyloid-beta or tau, the hallmarks of the condition. But they are both expensive (PET scans) and painfully invasive (spinal taps). Blood tests are a promising strategy, though after years of research scientists are still struggling to distinguish the chemical signs of normal aging from the signs of dementia.

So a smaller contingent of researchers are trying a novel strategy. They’re looking instead at changes in our sight—a complex sense with several processing steps, each one providing an opportunity for scientists to capture a blip that signals impending doom for the brain. This research is in its infancy. But with the population of aging adults at risk for dementia increasing daily, it’s a critical route of exploration.

The eyes have it

Vision requires our eyes to collect information and send it to the brain, where an entire region works to interpret it in fewer than 120 milliseconds (paywall) by some estimates.

The first stop is the eye—specifically the retina, which picks up images for the brain to interpret. “The retina is a direct extension of your brain,” says Sandra Weintraub, a neurologist at Northwestern University’s School of Medicine. “It actually has neuronal cells.” When something is wrong in the brain, the retina could reflect that damage as inflammation damages tiny blood vessels, called capillaries, around its neuronal cells.

Weintraub thinks that lower capillary counts could help indicate the early signs of dementia. In April of this year, she and her colleague Amani Fawzi, an ophthalmologist also at Northwestern, published work showing noticeable differences in the retinal blood vessels of individuals with mild cognitive impairment or early Alzheimer’s disease and healthy individuals. People with cognitive impairment had fewer capillaries in their retina than those who did not.

It was a small study: just 32 people total, half of them with symptoms of cognitive decline and the others healthy. That’s not enough data to predict if a person is in the early stages of dementia. In order to strengthen this research, Weintraub’s team will next look at a larger group of individuals—preferably with a wider set of ages, and at different stages of progressing dementia.

Making sense of sight

In addition to the eye itself, the brain’s interpretation of images could also serve as an indication of brain health. “The eye isn’t a camera,” says Alyssa Brewer, a neuroscientist at the University of California, Irvine. “The brain fills in all kinds of info based on prior experience and expectation about how things normally look.” This trick likely has an evolutionary purpose: It makes it much easier for us to quickly suss out our environment, and in particular to pick out faces. (This is also why it’s common for us to find faces in objects that are not human, or even animals.)

 

Changes in the way our brains make sense of the visual world can indicate a larger neurological change. That’s why Brewer studies the brain’s visual cortex, where the bulk of our image processing happens. In particular, she looks at the way regions of the visual cortex are organized into so-called visual field maps. In a small study published in 2014, she and her team used magnetic resonance imaging to compare the visual cortices of a handful of college students, healthy older adults, and two adults of the same age who had been diagnosed with mild Alzheimer’s disease. Although the participants with Alzheimer’s had normal vision, “their maps were completely disordered,” Brewer says. “We were definitely surprised the level of changes that were happening very early on in Alzheimer’s.”

That work measured participants’ visual status quo. By extension, one way to detect early changes in the brain’s visual capacity would be to challenge the system with a hard task—like spotting animals in black and white images flashed for a hundredth of a second on screen.

That’s the idea that London-based start-up Cognetivity is betting on. In January of this year, their research team published work in the journal Nature Scientific Reports showing that their technique could be used as part of cognitive health assessments given in doctors’ offices, although they have yet to be given clearance for clinical use. Tom Sawyer, Cognetivity’s chief operating officer, told Quartz that the company is hoping to run the test on larger populations, including people who have depression or multiple sclerosis, to try to identify subtle changes in visual cognition common among neurological conditions.

Although these are all good leads for better diagnostic tests, they have one problem in common: There’s too much person-to-person variability in eye structure, cortex organization, and visual processing to create a static metric for brain health, the way there is for blood pressure. “We don’t have a good enough handle of what ‘normal’ is in many aspects, even in vision,” says Brewer.

That said, simpler ways of taking snapshots of the brain’s health could make it easier for health care providers to track their patients’ progress over time—and note any seriously concerning dips in cognitive abilities. Even if these tests couldn’t diagnose a specific form of dementia, they could cue health care providers to order tests like PET scans or spinal taps for their patients sooner. Having an earlier diagnosis before their symptoms progress makes it easier for patients and loved ones to plan for the care they’ll need, and it opens the door for them to be enrolled in potentially beneficial clinical trials.

via – Quartz | Source – Quartz | Search  》Dementia Alzheimers Diagnosis

Good Advice in Taking Care Of Frail, Aging Parents

Judith Graham of Kaiser Health News offers this very helpful article on the difficult & challenging subject of caring for a parent, or parents, facing the inevitable.

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The difficulties & challenges of caring for an elderly parent. (iStock/Getty Images)

“This won’t go on for very long,” Sharon Hall said to herself when she invited her elderly mother, who’d suffered several small strokes, to live with her.

That was five years ago, just before Hall turned 65 and found herself crossing into older age.

In the intervening years, Hall’s husband was diagnosed with frontotemporal dementia and forced to retire. Neither he nor Hall’s mother, whose memory had deteriorated, could be left alone in the house. Hall had her hands full taking care of both of them, seven days a week.

As life spans lengthen, adult children like Hall in their 60s and 70s are increasingly caring for frail, older parents — something few people plan for.

“When we think of an adult child caring for a parent, what comes to mind is a woman in her late 40s or early 50s,” said Lynn Friss Feinberg, senior strategic policy adviser for AARP’s Public Policy Institute. “But it’s now common for people 20 years older than that to be caring for a parent in their 90s or older.”

A new analysis from the Center for Retirement Research at Boston College is the first to document how often this happens. It found that 10 percent of adults ages 60 to 69 whose parents are alive serve as caregivers, as do 12 percent of adults age 70 and older.

The analysis is based on data from 80,000 interviews (some people were interviewed multiple times) conducted from 1995 to 2010 for the Health and Retirement Study. About 17 percent of adult children care for their parents at some point in their lives, and the likelihood of doing so rises with age, it reports.

That’s because parents who’ve reached their 80s, 90s or higher are more likely to have chronic illnesses and related disabilities and to require assistance, said Alice Zulkarnain, co-author of the study.

The implications of later-life caregiving are considerable. Turning an elderly parent in bed, helping someone get into a car or waking up at night to provide assistance can be demanding on older bodies, which are more vulnerable and less able to recover from physical strain.

Emotional distress can aggravate this vulnerability. “If older caregivers have health problems themselves and become mentally or emotionally stressed, they’re at a higher risk of dying,” said Richard Schulz, a professor of psychiatry at the University of Pittsburgh, citing a study he published in the Journal of the American Medical Association.

Socially, older caregivers can be even more isolated than younger caregivers. “In your 60s and 70s, you may have recently retired and friends and family members are beginning to get sick or pass away,” said Donna Benton, research associate professor of gerontology and director of the Family Caregiver Support Center at the University of Southern California.

Caregiving at an older age can put hard-earned savings at risk with no possibility of replacing them by re-entering the workforce. Yvonne Kuo, a family care navigator at USC’s caregiver support center, has been helping an 81-year-old woman caring for her 100-year-old mom with vascular dementia in this situation.

“There’s no support from family, and she’s used up her savings getting some paid help. It’s very hard,” Kuo said.

Judy Last, 70, a mother of three adult children and grandmother of six youngsters, lives with her mother, Lillian, 93, in a mobile home park in Boise, Idaho. Last moved in three years ago, after her mother had a bout of double pneumonia, complicated by a difficult-to-treat bacterial infection that put her in the hospital for eight weeks.

“You don’t know if it’s going to be permanent at the time,” said Last, whose father died of dementia in January 2016 after moving to a memory care facility. “Mom had asked me several years before if I would be there when she needed help and I told her yes. But I didn’t really understand what I was getting into.”

Feinberg said this isn’t uncommon. “People in their 90s with a disability can live for years with adequate support.”

Last doesn’t find caregiving physically difficult even though she’s had two hip replacements and struggles with arthritis and angina.   Her mother has memory problems and chronic obstructive pulmonary disease, relies on oxygen, uses a walker, has lost most of her hearing, and has poor eyesight.

But things are hard, nonetheless. “I had plans for my retirement: I imagined volunteering and being able to travel as much as my bank account would allow,” Last said. “Instead, I don’t take time off and leave my mother. A big thing I deal with is the loss of my freedom.”

Hall, who’s turning 70 in September and who lives in Cumming, Ga., managed her mother’s and husband’s complex needs for years by establishing a strict routine. Monday and Friday they went to a dementia respite program from 10 a.m. to 3 p.m. On other days, Hall cooked, shopped, did laundry, helped them with personal tasks, made sure they were well occupied, provided companionship and drove them to medical appointments, as necessary.

“I did not expect this kind of life,” said Hall, who has had two knee replacements and a broken femur. “If someone had told me it would be years caring for my mother and your husband is going to get dementia, I would have said ‘No, just no.’ But you do what you have to do.”

A few weeks after our conversation, Hall’s mother entered hospice following a diagnosis of aspiration pneumonia and life-threatening swallowing difficulties. Hall said she has welcomed the help of hospice nurses and aides, who ask her at each visit, “Is there anything else you need from us that would make it easier for you?”

Though older caregivers get scant attention, resources are available. Over the years, Hall has shared caregiving ups and downs at CareGiving.com — a significant source of information and comfort. Across the country, local chapters of Area Agencies on Aging run caregiver support programs, as do organizations such as the Caregiver Action Network, the Family Caregiver Alliance, the National Alliance for Caregiving and Parenting Our Parents, an outfit focused on adult children who become caregivers. A helpful list of resources is available here.

Sometimes, caring for a parent can be a decades-long endeavor. In Morehead City, N.C., Elizabeth “Lark” Fiore, 67, became the primary caregiver for her parents when they moved around the corner from her, in a mobile home park, in 1999. “My dad took me for a walk one day and asked if I could look after them as they got older and I said yes. I’m the oldest child and the oldest assumes responsibility,” she said.

For years her father — a difficult man, by Fiore’s account — had heart problems; her mother had a nervous breakdown and a slow, extended recovery. “They wanted me to be in their lives and I wanted to do for them — I’m a Christian — but it was killing me. My heart was in the right place but emotionally, I was a wreck,” Fiore said.

After her father’s death from kidney cancer in 2010, her mother became even more needy and Fiore found herself spending more time responding to calls for assistance — often about suspected medical emergencies. “My mom had a way of acting as if something was horribly wrong and then it turned out it wasn’t,” she explained.

Fiore’s health isn’t good: She says she has chronic fatigue syndrome and thyroid problems, among other issues. But she didn’t know how to ask for help and no one volunteered it, even when her husband, Robert, was diagnosed six years ago with dementia. “I always expected myself to handle everything,” she said.

Finally, the stress became unbearable last year and Fiore’s mother moved to a senior living community close to Fiore’s 62-year-old sister, 400 miles away. Now, Fiore spends more time attending to her husband’s needs and tries to support her sister as best she can.

“At 90, my mom is healthy as a horse, and I’m glad of that but it’s been a long time caring for her,” she said. “I’ve changed a lot as a result of caregiving: I’m more loving, more aware of people who are suffering. I’ve found out that I am willing to go the extra mile. But I have to admit what I feel is tired — just tired.”