Wrong Temperature in the Home = Worsening Dementia

Can ambient temperature in the home affect cognitive performance in seniors?  So it appears.  According to a new study, a 7 degree F (4 degrees C) variation either way from an optimal band results in doubling cognitive difficulties in test participants over 65.  And what's the optimal temperature range to preserve memory and cognition?  It's 68-75 degrees F, or 20-24 degrees C.

When I read this, I thought, "Isn't everyone's home like that?  Mine is."  But last winter we had more than a week of single-digit highs.  And a couple of summers ago, we set a local record of a three or four weeks with triple-digit highs every day.  During the summer, I needed the HVAC guy to come over and get our system to work properly.  I could afford that.  Can everyone?

When we first moved here, everyone had swamp coolers to cool their homes.  From my observation, they worked OK when temperatures got up into the 90s in our very dry (steppe desert) climate.  But I don't know about when it gets up to 112F or so.  We hit 118F about four years ago.  So keeping in that ideal range could be hard for a lot of folks.

One of the most important factors in preventing and controlling Alzheimer's disease is sleep.  The Sleep Foundation says the ideal temperature for sleep is 65-68F.  They say you should keep your bedroom there.  I've read some experts who say 68F is the target value, which would put you at the low end of the range identified in the research.

I tried keeping our bedroom at 68F, but my wife couldn't sleep with it that cold.  So I keep it at 70F at night.  Seems to work OK for us, although I continue to have problems with insomnia.

So how did they do this research?  It was published in the Journals of Gerentology, Series A, as "Home Ambient Temperature and Self-reported Attention in Community-Dwelling Older Adults."  It was a longitudinal study, meaning they relied on surveys to analyze what happened with different populations.  They monitored the temperatures in the homes of 47 adults, aged 65 and older for a year, using the surveys to measure perceptions of difficulties in keeping attention.  So, the data was self-reported, and not the result of any cognitive tests. 

Here's some more reading on this research.

I'm guessing they had instruments in the homes to track temperatures, and the temperatures were those preferred by the test participants.  How accurate were the reports of cognitive difficulties?  Your guess is as good a mine.  But the researchers said that this study was a "proof of concept" indicating that they or someone else should do a randomized control trial to investigate this phenomenon more deeply.

But I'm a little frustrated.  I see one promising "proof of concept" study or some other exploratory study after another where they say "more research is necessary."  But I never seem to see the more research that was necessary.  Why not?

Huffing Xenon gas to treat your Alzheimer's...

Xenon gas is one of the chemically inert, or noble gases, along with neon, argon, helium, radon, and krypton.  So, if it's chemically inert, you'd think that it would have no biological effect in the body.  But, it turns out that's not the case.  Inhaled xenon has long been used as an anesthetic -- meaning, it can interact with the nervous system.  More recently, researchers have been exploring its property as a neuroprotectant in cases of hypoxia and traumatic brain injury.  So would that apply to the injury to the brain caused by Alzheimer's disease?

Well, at least in mice, the answer seems to be yes.  And it seems to do this by changing the behavior of microglial cells in the brain to stop them from causing inflammation.  We discussed microglial cells and their likely role in Alzheimer's disease in Beating the Dementia Monster.  Microglial cells are central players in the brain's unique immune system.  Microglia cells cause inflammation, because inflammation helps to protect damaged tissues.  But when poorly regulated, inflammation also causes damage itself, and much of our effort to control Alzheimer's is directed at tamping down inflammation.

Mice that had been bred to have a brain disorder mimicking Alzheimer's disease were placed in a chamber containing an atmosphere of 30% xenon gas and 21% oxygen -- the same oxygen as in regular air.  I guess the remaining 49% was, like our normal atmosphere, nitrogen.  They were exposed to this atmosphere for 40 minutes.  Their microglia were examined after intervals of 3, 7, and 14 days. 

Inhaling xenon gas by mice lowered amyloid plaques and reduced neurodegeneration associated with that tau tangling.  The researchers went so far as to insert some human brain tissue in the brains of some mice (no, I don't know how they got it), and they found that what worked with mouse brain tissue also worked with human tissue.  So, in the vernacular of the drug culture, it's now time to get some humans to huff xenon and see if this works in people.

The research with "mouse models" was published in the journal Science Translational Medicine.

You can read more here, but it gets a little deep for most of us.

One Million Cases of Dememtia per Year by 2060!

There's a new study projecting that, by the year 2060, we will be getting a million new cases of dementia each year.  The researchers conducting the study calculated that adults over the age of 55 have a 42 percent average risk of developing dementia within their lifetime.  Past studies had put the risk at up to 14 percent for men and up to 23 percent for women.  That's a huge jump!

Why will that be happening?  Well, baby boomers will be getting older, but here is my editorial opinion: Only approximately 20% of US adults are meeting recommended lifestyle and cardiovascular health targets.  And cardiovascular health targets are Alzheimer's disease prevention targets!  You know -- eat right, get enough exercise, don't smoke, address hearing loss.  That kind of stuff.  When people don't hit their targets, the incidence of Alzheimer's disease goes up.  And up.

In Beating the Dementia Monster, we discussed what seemed to be an emerging trend of declining cases of dementia.  This was believed to be a consequence of significant advances in steps to improve cardiovascular health and prevent heart attacks.  But according to this new research published in the journal Nature Medicine, that's not what we're anticipating any more.  (If that link doesn't work for you, here's an article from Smithsonian Magazine with a link in it that should work.)

The researcher's hailed from some of the most prestigious institutions studying dementia in the United States.  They drew their data from a large, earlier study of heart disease that provided health and lifestyle data for about 15,000 subjects, "The Atherosclerosis Risk in Communities Study."  Data went back to 1987.  The new dementia study included the following statements: "The lifetime risk of dementia after age 55 years was 42% ...  Rates were substantially higher in women, black adults and APOE ε4 carriers, with lifetime risks ranging from approximately 45% to 60% in these populations.  The number of US adults who will develop dementia each year was projected to increase from approximately 514,000 in 2020 to approximately 1 million in 2060.  The relative growth in new dementia cases was especially pronounced for black adults."

And, "[M]ore than four in 10 adults developed dementia in this large, longstanding, community-based cohort study, with higher rates in APOE ε4 carriers, women, and black adults.  Approximately 1 million US adults will develop dementia annually by 2060.  Policies that enhance prevention and healthy aging are urgent public health priorities for reducing the substantial and growing burden of dementia."  Yep.

A New Way to Live to 150?

Many years ago (40 years?), I began seeing articles in popular media about extending your life simply by eating less -- "caloric restriction" they called it.  It was noted that mice, yeast, and monkeys all lived longer if they consumed less calories -- sometimes what seemed like starvation level caloric restriction.  What was attracting attention were people doing extraordinary things to reduce their caloric intake (starving themselves) in the hope that they'd live to (as I read one man say) 150.  This phenomenon has been studied, and there is peer reviewed research (like this) about how that might work.

This suggests that anorexic people should live longer, but I wouldn't call that a good plan.  It may, however, relate to why intermittent fasting has such a positive effect on the chronic diseases (like Alzheimer's) that too often characterize old age.

I very often read about and hear from people wondering if there might not be a pill you can take that would do the same thing that fasting, dieting, and exercise do for the brain.  Well, there's a new candidate for something that might do that.  And not just the brain, perhaps every aspect of aging.  There's a "bile acid" called lithocholic acid (LCA) that might do it.  That's according to a research team at Xiamen University in China.  The acid apparently works by activating the metabolic master regulator AMP-activated protein kinase (AMPK).  Makes sense, right?  (If you figure that out, please let me know.) 

According to the researchers, significant caloric restriction  in people appears to improve metabolic health and markers of aging, even when people are not overweight to start with.  Tests with mice on Alzheimer’s disease suggest caloric restriction suppresses production of amyloid and tau and speeds removal of amyliod from the brain.  In us older folks, caloric restriction benefits working memory and processing speed but perhaps at the expense of our ability to conduct tasks that rely on good hand-eye coordination and cognitive flexibility.  But this means starving all the time and losing muscle mass, so it's not a good idea for most of us. 

According to this research, bacteria produce LCA in the small intestine when they break down primary bile acids.  LCA emulsifies fats to render them digestible.  But LCA can also be absorbed into the blood like other fatty acids produced by the microbiome, some of which improve the health of the brain.  

Remember the gut-brain axis?  Some really weird stuff goes on between the bacteria in your gut and your brain.  So take care of those bacteria.  (Eating beans and fermented foods, like kimchi, can help with this.  Some would add yogurt.  But aspartame and sucralose can be hard on the gut biome.)  

The scientists added LCA to the drinking water of some well-fed mice, and it activated AMPK in their skeletal muscles to the same degree seen in calorie-restricted mice.  While it didn’t extend their lifespans, it did boost their vigor: Old mice that ingested LCA ran farther on a treadmill and gripped a pressure-sensing bar harder. Their insulin sensitivity and glucose tolerance were better, and their muscles recovered faster after damage.  My reaction to this that, despite the promises, feeding people LCA may not actually extend your life.  But it's still improving important markers of Alzheimer's disease, notably insulin sensitivity and glucose tolerance.

So it seems like there's something here.  But all of these breakthroughs we keep seeing are frustratingly far from becoming reliable treatments.

How Bad Are Ultraprocessed Foods?

How bad are ultraprocessed foods?  Well, it depends on who you ask.

But first, what are we even talking about?  Back in August 2022, we discussed a relationship between a lifestyle of consuming ultraprocessed foods and Alzheimer's disease.  One thing we did in that article was explain what ultraprocessed foods are and give examples.  We also cited specific research associating things we eat that may qualify more as industrial products than food with the development of dementia.  For our purposes, in the Dementia Toolkit, we focused on the correlation of refined sugar and refined flour with inflammation and oxidation in the brain.  That's bad for Alzheimer's disease.  But the thought is that, beyond that, more bad stuff is going on with carbonated soft drinks, sweetened breakfast cereals, candy, packaged snacks, powdered instant soup, reconstituted meat products, etc.  These may (or may not) be causing the worldwide obesity epidemic, and obesity is associated with the development of Alzheimer's disease.

I came across a fascinating article in The New Yorker magazine that first looked at some interesting research conducted at the National Institute of Health but then interviewed some of the critics of the research.  The outcome was a sort of survey of diverse thinking on this subject.  And it is diverse.  

The concept of ultraprocessed foods was proposed by the Brazilian researcher we discussed in the 2022 article, but research aimed at confirming the hypothesis that anything meeting the definition of ultraprocessed food will put you in memory care has been mixed.  The research was published in the journal Cell Metabolism.  They weren't concerned with Alzheimer's disease, but rather obesity.  Does consuming ultraprocessed foods really cause obesity, or is that a myth?  And if so, why?  (Anything causing obesity will lead to Alzheimer's.)  

The answer is yes, it does.  But calorie for calorie, the influence on body mass is the same between ultraprocessed foods and real food.  It seems that, more than anything, people just like the soda and salami a lot more than real food, and so they eat a lot more of it.

The article did discuss the spectrum of foods that can be classified as ultraprocessed, noting that they're not all bad for you.  It kind of depends.  Yogurt without cane sugar can be considered ultraprocessed, but the article says that doesn't mean that it's bad for you.  (Exceptions: people with lactose intolerance and those concerned that dairy in general has a downside.)  Organic whole grain bread can also be considered ultraprocessed, but it's part of the MIND diet.  So some critics don't think there's been adequate discernment between the types of ultraprocessed foods that are or are not a problem.

How the research was conducted was quite interesting.  They took 10 men and 10 women and locked them away for a couple of weeks.  They were watched closely enough to make sure that no one ate anything that wasn't provided to them in the study protocol.  They were given as much food as they wanted to eat during 60 minute meal times, rotating between unprocessed and ultraprocessed foods at the end of each week.  Steps were taken to obscure what class of food people were being given.  Test participants were weighed at the end of each rotation of foods.

Participants gained an average of nearly 0.9 pounds after a week on ultraprocessed foods, but lost an average of about 0.7 pounds after a week on real food.  The authors concluded, "Our data suggest that eliminating ultra-processed foods from the diet decreases energy intake and results in weight loss, whereas a diet with a large proportion of ultra-processed food increases energy intake and leads to weight gain."

I try to stick with the MIND diet, avoiding ultraprocessed foods.  I do eat plain yogurt that I sweeten with allulose and monk fruit sweeteners (mixing in walnuts and blueberries), which might qualify as ultraprocessed.  And I eat a couple of slices of whole grain bread, as called for by the MIND diet.  But, even when I combine this diet with regular fasting, I still struggle to keep my weight where I want it.

Another day, another cognitive test

My care team began testing my memory and cognition annually in 2015.  I didn't get the 10 minute Mini-Mental Status Exam (the MMSE) or the minimally more sophisticated Montreal Cognitive Assessment (the MoCA).  No, it was the whole three-hour suite that probes every nook and cranny of your brain.  (Dr. Phatak discussed these tests in Beating the Dementia Monster.)  But in 2019, I was doing so well, they decided to relax it to every 2 years, and now I haven't had a test in almost three years.  They want to continue testing me triennially, but I'm able to get a sense for what's going on just in my daily activities.  For example, in a little while I'll have one of my practice sessions in Spanish with a friend in Ecuador.  How well will I be able to keep up the conversation?  I've been feeling pretty good about these activities for some time.  Nevertheless, my care team plans to test me diagnostically again this summer.

At the same time, I have been enrolled in a number of studies, mostly from the Alzheimer's Disease Research Center in Seattle.  One such study is referred to as vCog, and they want to see if these tests are just as valid if administered via Zoom as when they are administered in person.  So they have us take the test over Zoom, and then they test us a couple of months later in person.  And they repeat the whole process a year later.  Do the test results match?  Or do they show that tests administered via Zoom on your computer are less reliable than those administered in person?  We'll find out when they're done.  

But today, I had my last Zoom test.  And we should make the journey across the mountains to Seattle at the end of February for the last in-person test.  Since it's for research and not diagnostic, they're not allowed to tell me the results.  But I didn't have any trouble seeing that I did pretty well -- I feel very well about it all.  Of course, they will be able to share with me the results of the diagnostic tests I take this summer.

I've said this before, and I'll say it again.  Every morning when I wake up, I can hardly believe it.  I think back to how things were in 2015 -- when I was in free-fall -- to today, and I'm just amazed.  Of course, the first thing on the agenda every morning is a trip to the gym for an hour and a half.  That, along with the other members of the Dementia Toolkit, are the reason I can live the way I do.  Life is good.