Memory

Memory

Loading
Loading Social Plug-ins...
Language: English
Save to myLibrary Post page as Slide Download PDF
Go to Page # Page of 10
 
Author: Peter V. Rabins, M.D., M.P.H. (Fellow) | Visits: 1722 | Page Views: 1728
Domain:  Medicine Category: Therapy Subcategory: Amyloid Diseases 
Upload Date:
Short URL: http://medical.wesrch.com/pdfME1LYYCPIAIQI

Loading
Loading...



px *        px *

* Default width and height in pixels. Change it to your required dimensions.

 
Contents:
T H E J O H N S H O P K I N S W H I T E PA P E R S

MEMORY

2 0 0 7

Peter V. Rabins, M.D., M.P.H.

JOH NS HOPKI NS M EDICI NE B A LT I M O R E , M A R Y L A N D

Dear Readers: With the pace of medical research accelerating each year, there has never been a time when keeping up with the latest health information is so personally important. The goal of the Johns Hopkins White Papers is to help you do just that, empowering you with the best advice on the health conditions that impact your life. To this end, the editorial staff of the Memory White Paper has gathered research on the most important developments and medical advice of the past year. And there's a lot to report. Here are a few of this year's highlights: � New scans unlocking mysteries of the brain: A new imaging agent may revolutionize dementia detection and treatment. (page 40) � Distance caregiving--how to monitor a loved one's Alzheimer's care from afar. (page 58) � Simple, low-tech screening tests (a sniff test?) may offer snapshots of cognitive health. (page 26) � Distinguishing normal "senior moments" from worrisome memory lapses. (page 23) � Innovative Alzheimer's care--new approaches bring dignity. (page 54) � Coping strategies for dementia-related behavior problems. (page 32) � The link between emotion and cognition: Depression and stress take a toll on brain "fitness." (page 18) � Experimental treatments for Alzheimer's disease: Many promising drugs are under investigation. (page 50) � Everyday assaults on memory: Simple changes can be a quick fix. (page 14) � Can a biomarker detected in skin cells confirm suspected Alzheimer's? (page 43) Whether you're worried about Alzheimer's disease or just dealing with those senior moments when you forget the name of a book or a movie, I hope this White Paper will empower you to make informed health decisions regarding your cognitive health. Sincerely,

Peter V. Rabins, M.D., M.P.H. Codirector, Division of Geriatric and Neuropsychiatry Johns Hopkins University School of Medicine P.S. Please or order: Click here to read more visit www.HopkinsMemory.com for the latest news on memory and
http://www.johnshopkinshealthalerts.com/white_papers/memory_wp/digital_landing.html?st=link&s=DMW_070320_001 other information that will complement your Johns Hopkins White Papers.

THE AUTHOR
Peter V. Rabins, M.D., M.P.H., received his medical degree from Tulane Univer-

sity School of Medicine and his degree in public health (M.P.H.) from the Tulane University School of Public Health. He completed his residency in psychiatry at the University of Oregon. Currently, he is codirector of the Division of Geriatric Psychiatry and Neuropsychiatry at the Johns Hopkins University School of Medicine, as well as a professor of psychiatry with a joint appointment in the Department of Internal Medicine and the Bloomberg School of Public Health. Dr. Rabins is serving as the principal investigator on a National Institute of Mental Health study of Alzheimer's disease in the community and a National Institute of Neurological Disorders and Stroke study of late-stage care for Alzheimer's disease patients. Dr. Rabins has spent his career studying psychiatric disorders in the elderly. His current research includes the development of scales to measure impairment in people with severe dementia and the study of visual hallucinations in a variety of psychiatric and neurological conditions. He has published extensively in such journals as the American Journal of Psychiatry, the Journal of the American Geriatrics Society, and the Journal of Mental Health.

CONTENTS
The Biology of Memory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Age-Associated Memory Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Preventing Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Mild Cognitive Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Dementia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Reversible Memory Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Irreversible Dementias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Alzheimer's Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Coping With Caregiving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Chart: Medications for Treating Alzheimer's Disease 2007 . . . . . . . . . . . . . . . . . . . . . . . 46 Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Health Information Organizations and Support Groups . . . . . . . . . . . . . . . . . . . . . . . . . 64 Leading Hospitals for Neurology and Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66

MEMORY
Shakespeare called memory "the warder of the brain," charged with keeping watch over an individual's personal account of being. If this sentry begins to fail, a person's own record of self is endangered. This is a frightening prospect for most people. Memory loss can range from age-related impairment (a normal degree of forgetfulness) to several types of dementia (a loss of intellectual abilities, including memory, judgment, and abstract thinking). Alzheimer's disease, the most common form of dementia, affects 4.5 million Americans. According to the American Academy of Neurology, 10% of people over age 65 and nearly 50% of people over age 85 suffer from Alzheimer's disease. A study published in the Archives of Neurology predicts that by the year 2050, the number of Americans with Alzheimer's will have grown to 13.2 million if no effective prevention strategy or cure is found. Although Alzheimer's disease is irreversible, memory impairment associated with other conditions, such as depression or thyroid problems, may be correctable. Recent research advances leading to improved treatments for Alzheimer's disease offer reassuring news on that front as well.

The Biology of Memory
Deep within the brain lies a small, "S"-shaped structure known as the hippocampus (Greek for "seahorse," which it resembles). This relatively small region of the brain plays a major role in the process of forging memories: It instantly evaluates incoming data from the five senses and determines whether to store or discard the information. But memories are not stored in the hippocampus or, for that matter, in any other single site in the brain. Instead, they are stored throughout the brain, especially in the cerebral cortex (the outer layer of gray matter that constitutes the "thinking" portion of the brain) and in the cerebellum (the fist-sized structure at the base of the brain, beneath the cortex, that coordinates movement and balance). (See illustration on page 3.) Scientists' understanding of memory has expanded in recent years. Sophisticated brain imaging procedures now make it possible

1

2 0 0 7


s

HopkinsMemory.com

to watch specific areas of the brain "turn on" as a person performs various types of mental activity. Studies of people with brain injuries also have helped researchers identify the brain structures involved in different aspects of memory. In addition, a type of neurologic test known as an event-related potential can pinpoint and measure the brain's electrical activity as the neurons (nerve cells) respond to mental stimulation. These and other advances have moved memory research beyond the simple concepts of short-term and long-term memory. Today scientists describe four memory systems that process incoming information for storage and retrieval. The systems are episodic, semantic, procedural, and working. Each system is believed to involve several structures within the brain. The episodic memory system is involved in remembering personal experiences, such as a phone conversation you had yesterday or the movie you watched last week. Problems with episodic memory can make it difficult to learn new information or to recall recently learned information. The semantic memory system manages the storage and retrieval of general knowledge and facts, such as the number of days in a year or the colors in a rainbow. People with problems in semantic memory may have difficulty in naming common objects or describing a named object. The procedural memory system allows us to learn activities and skills that will then be performed automatically with little or no conscious thought. Examples are riding a bicycle or driving a car. Loss of long-mastered skills or significant difficulties in learning new skills are signs of problems with procedural memory. The working memory system governs our ability to pay attention and concentrate, and it enables us to temporarily keep needed information in mind (such as a phone number or the directions to a restaurant). Disorders in working memory make it difficult to pay attention or to learn a multistep task. Even when these memory systems are working well, some memories will be stored and recalled more easily than others. A memory with a strong emotional component, such as where you were on September 11, 2001, will likely be retained for the rest of your life. Similarly, information is more likely to be stored properly when it is recognized as important. The brain discards massive bits of insignificant information throughout the day. New information is also more likely to be retained and recalled if it is related to information already stored. The links between the new and old information
http://www.johnshopkinshealthalerts.com/white_papers/memory_wp/digital_landing.html?st=link&s=DMW_070320_001

Click here to read more or order:

2

M E M O R Y


s

2 0 0 7

Memory and the Brain
prefrontal cortex

cerebral cortex

hippocampus

temporal lobe cerebellum

The human brain contains an estimated 100 billion nerve cells (neurons). Chemical and electrical activity allows these neurons to perform their tasks and to communicate with one another. This elaborate communication system controls vital body functions and enables us to think, see, move, talk, remember, and experience emotions. Normal aging leads to changes in the brain, especially in areas involved in learning and memory. Some neurons shrink; others are disabled by damaging molecules called free radicals. Daily "insults," such as high blood pressure or elevated low-density lipoprotein (LDL) cholesterol, also take their toll. Over time, these changes can make it more difficult for an older person to learn new tasks or to retrieve information from memory, such as someone's name. With Alzheimer's disease, the damage is more severe and ultimately affects larger regions of the brain. The different memory systems--episodic, semantic, procedural, and working--involve multiple areas of the brain. The illustration above shows the major, most identifiable structures involved in memory. The temporal lobe, which contains the hippocampus, and the prefrontal cortex are important to episodic memory, which enables us to learn new information and remember recent events. The hippocampus is one of the first brain structures damaged in Alzheimer's disease and accounts for Click here to read more or order:

one hallmark of early Alzheimer's: difficulty remembering recent events, without any trouble remembering events from long ago. Semantic memory governs general knowledge and facts, including the ability to recognize, name, and categorize objects. This system also involves the temporal lobes and, researchers suspect, multiple areas within the cortex. People with Alzheimer's disease may be unable to name a common object or to list objects in a category, such as farm animals or types of birds. The cerebellum is one of the structures involved in procedural memory. Procedural memory is what enables people to learn skills that will then become automatic (unconscious), such as typing or skiing. This memory system typically is not damaged in Alzheimer's disease or is one of the last cognitive domains to deteriorate. Working memory involves primarily the prefrontal cortex. This memory system governs attention, concentration, and the short-term retention of needed information, such as a street address or phone number. Problems with working memory can impair a person's ability to pay attention or to accomplish multi-step tasks. Numerous cognitive disorders, such as Alzheimer's, Parkinson's, and Huntington's disease as well as dementia with Lewy bodies, can affect working memory. s

http://www.johnshopkinshealthalerts.com/white_papers/memory_wp/digital_landing.html?st=link&s=DMW_070320_001

3

GLOSSARY

acetylcholine--A neurotransmitter crucial to memory and learning. ADmark Assays--Two clinical tests for Alzheimer's disease. One measures beta-amyloid and tau protein in the spinal fluid; the other tests for the apolipoprotein E 4 genotype. age-associated memory impairment--Normal forgetfulness that increases with age. Alzheimer's disease (AD)--A progressive brain disorder that is characterized by deterioration of mental faculties resulting from the loss of nerve cells and the connections between them. amnestic syndrome--Severe memory loss despite maintenance of normal intelligence. amyloid plaques--Dense deposits of beta-amyloid, pieces of damaged nerve cells, and other proteins. Found in the brains of virtually all people with Alzheimer's disease. amyloid precursor protein (APP)--A protein that is split in two by enzymes to produce beta-amyloid. aphasia--A partial or complete inability to use or understand language. apolipoprotein E (APOE)--A gene on chromosome 19. The 4 version of this gene is associated with an increased risk of Alzheimer's disease. beta-amyloid--A sticky, starch-like protein that is the main component of amyloid plaques. bovine spongiform encephalopathy (BSE)--An infectious disease of cows with manifestations similar to Creutzfeldt-Jakob disease in humans. More commonly known as mad cow disease. carotid endarterectomy--Surgical removal of a blockage in one of the carotid arteries (the main arteries leading to the brain). cerebellum--A fist-sized structure that coordinates movement and balance. Located at the base of the brain beneath the cerebral cortex. cerebral cortex--The convoluted outer layer of gray matter that constitutes the "thinking" portion of the brain. choline--A substance used by the body to produce acetylcholine. Present in foods such as egg yolks, liver, and wheat germ. cholinesterase inhibitors--Medications that slow the breakdown of acetylcholine. Used in the treatment of Alzheimer's disease. colchicine--An anti-inflammatory drug commonly used to treat gout. Currently being tested as a treatment for Alzheimer's disease. complete blood cell count--Measures cellular elements of blood: red blood cells, white blood cells, and

platelets. Helps rule out anemia, infections, and vitamin B12 deficiency as causes of dementia or as factors that can exacerbate dementia. computed tomography (CT)--An imaging technique that uses x-rays to create a two-dimensional image of the brain or other parts of the body. Creutzfeldt-Jakob disease (CJD)--A rare, fatal brain disorder that causes a rapid, progressive dementia. Sometimes mistaken for Alzheimer's disease. Cushing's disease--A disorder resulting from the overproduction of hormones by the adrenal gland. Also called Cushing disease. dementia--A significant intellectual decline or impairment in several areas of thinking that persists over time. dementia with Lewy bodies--A type of dementia characterized by episodes of confusion, falls, and hallucinations, as well as signs of parkinsonism early in the disease. frontotemporal dementia--A spectrum of disorders associated with impaired initiation of plans and goal setting, personality changes, language difficulties, and unawareness of any loss of mental function. gray matter--The area of the brain, gray in appearance, that contains cell bodies (as opposed to white matter, which contains the nerve fibers that extend from the cell bodies). hippocampus--A small, "S"-shaped structure in the brain that appears to play a major role in the process of forging memories. Huntington's disease--A rare, hereditary disorder of the central nervous system characterized by uncontrollable movements and dementia. Also called Huntington disease. incontinence--An inability to control urination or defecation. lecithin--A substance used by the body to produce acetylcholine. Occurs naturally in food. Lewy bodies--Abnormal structures found in cells throughout the brain in people who have the type of dementia named for these structures (see "dementia with Lewy bodies" above). long-term memory--Holds information that was learned as recently as a few minutes ago and as long ago as early childhood. magnetic resonance imaging (MRI)--An imaging technique that uses a powerful magnet, rather than x-rays, to create a two-dimensional image of various areas of the body, including the brain. microtubules--An internal transport system in nerve cells. Collapsed microtubules form neurofibrillary tangles.

GLOSSARY

Click here to read more or order:

http://www.johnshopkinshealthalerts.com/white_papers/memory_wp/digital_landing.html?st=link&s=DMW_070320_001

62

INDEX

A
Acetaminophen (Tylenol), 21 Acetylcholine, 7, 36, 40�41, 44, 45 Acrostics, 8 ADmark Assays, 42 Advil (ibuprofen), 21 Aerobic capacity, 12�13 Aerobic exercise, 13, 19 Age and aging, 3�7, 36�37 Age-associated memory impairment normal memory lapses vs. dementia, 4, 23 overview, 1, 4 slowing of mental processes, 4, 6�7 strategies to assist memory, 5�8 timeline of normal brain aging, 6�7 AIDS, 28, 50 Alcohol use blood pressure, 11 risks of dementia, 7, 9, 14�16, 24, 28 vitamin deficiencies, 15, 20 Alzheimer's Disease Neuroimaging Initiative (ADNI), 41 Alzheimer's disease risk factors age, 36�37 apolipoprotein E, 36, 38�39 apolipoprotein E (APOE) gene, 26, 35, 36, 53 cardiovascular disease, 39 depression, 19, 39�40 Down syndrome, 36, 39 fruit or vegetable juices, 53 gender, 37 genetic mutations and abnormalities, 37 genetic predisposition, 37�38 head injury, 36, 39 high blood pressure, 11, 18, 36, 39 lipoprotein(a), 36, 39 numbers affected, 1 stroke, 18 See also Beta-amyloid plaques Alzheimer's disease symptoms and diagnosis ADmark Assays, 42 apolipoprotein E (APOE) testing, 42 behavior changes, 24, 32�33, 34, 45, 54 beta-amyloid 42 (A beta 42), 35, 39 catastrophic reactions, 34 diagnosis by autopsy, 17, 34, 37, 40, 42 early symptoms, 3, 13, 25 episodic memory loss, 3, 37 imaging studies, 40�41, 43�44 laboratory tests, 42�43 lapses in attention, 25 neurofibrillary tangles, 19, 22, 34�35, 36, 51 neuron destruction, 4, 33�34, 36, 44

neurotransmitter changes, 36, 44 overview, 1, 33�34, 40�41, 42 physical function losses, 13 progression, 34, 44 sniff test, 26, 43 spinal fluid testing (spinal tap), 26�27, 35, 41, 42, 43 statin drugs, 9�10, 51 See also Beta-amyloid plaques; Dementia Alzheimer's disease treatments Alzheimer's vaccine (AN-1792), 49�51 Alzhemed (tramiprosate), 49, 50 antidepressant medications, 55�56 antipsychotic medications, 55 art therapy, 54�55 Avandia (rosiglitazone), 21, 51 cholinesterase inhibitors, 45�47, 48, 53, 54 clioquinol, 52 collaborative-care model of treatment, 45 dietary supplements, 53�54 electroconvulsive therapy, 55�56 estrogen therapy, 22, 52�53 Evista (raloxifene), 51 experimental drug treatments, 50�51 FK962, 50 Flurizan, 50 hormone replacement therapy, 22 intravenous immunoglobulin (IVIg), 50�51 Montessori-type activities, 55 NMDA (N-methyl-D-aspartate) receptor antagonists, 46�48 nonsteroidal anti-inflammatory drugs (NSAIDs), 21, 50, 51, 52 omega-3 fatty acids, 16, 53 psychotherapy, 55�56 research overview, 44, 49, 50�51 statins, 10, 51 Alzhemed (tramiprosate), 49, 50 Amnesia, 29, 32�33 Amygdala, 4, 7 Amyloid precursor protein, 35, 36 Amyloid precursor protein (APP) gene, 37, 39 Anemia, 8 Antidepressant medications, 14, 28, 55�56 Antioxidants, 11�12, 48, 53 Antipsychotic medications, 30, 55 Aphasia, 30 Apolipoprotein E, 36, 38�39 Apolipoprotein E (APOE) gene, 26, 35, 36, 38�39, 53 Aricept (donepezil), 24, 29, 45, 46�48 Art therapy, 54�55 Aspirin, 19, 53 Avandia (rosiglitazone), 21, 51

B
Beta-amyloid plaques beta-secretase, 35 brain destruction in Alzheimer's disease, 19, 34 as cause of Alzheimer's disease, 36 composition and formation process, 35 and depression, 19 diagnosis by autopsy, 17, 34, 37, 40, 42 imaging with Pittsburgh Compound B (PIB), 40�41, 43�44 and odor perception, 26 See also Alzheimer's disease risk factors; Alzheimer's disease symptoms and diagnosis Beta-amyloid protein beta-amyloid 42 (A beta 42), 35, 39, 41 and glucocorticoids, 19 and HDL cholesterol, 10 Beta-secretase, 35 Blood-brain barrier, 40 Blood flow to brain, 5, 7, 12, 15 Blood pressure, high. See High blood pressure Blood sugar, 14, 20, 21, 26 Body mass index (BMI), 17, 39 Bovine spongiform encephalopathy (BSE), 31 Brain anatomy, 3 blood-brain barrier, 40 blood flow, 5, 7, 12, 15 gray matter, 1 location of memories, 1, 3 timeline of normal brain aging, 6�7 white matter lesions, 7 Brain imaging procedures, 4, 7, 26, 40�41, 43�44 Brain injuries, 2, 36, 39 Brain tumors, 24, 28, 43

INDEX

C
Cardiac arrest, 25, 29 Cardiovascular risk factors, 9, 39 Caregivers and collaborative care, 45 coping strategies, 56�57, 58�59 long-distance caregiving, 58�59 managing behavior problems, 32�33 singing, 54 support groups, 33, 56, 59 Cerebellum, 1, 3 Cerebral cortex, 1, 3, 32, 34, 36 Cholinesterase inhibitors Alzheimer's disease, 45�47, 48, 53, 54 dementia with Lewy bodies, 30 vascular dementia treatment, 29

Click here to read more or order:

66 http://www.johnshopkinshealthalerts.com/white_papers/memory_wp/digital_landing.html?st=link&s=DMW_070320_001

The information contained in this White Paper is not intended as a substitute for the advice of a physician. Readers who suspect they may have specific medical problems should consult a physician about any suggestions made.

Copyright � 2007 Medletter Associates, LLC. All rights reserved. No part of this White Paper may be reproduced or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. Please address inquiries on bulk subscriptions and permission to reproduce selections from this White Paper to Medletter Associates, LLC, 6 Trowbridge Drive, Bethel, CT 06801. The editors are interested in receiving your comments at editor@johnshopkinshealthalerts.com or the above address but regret that they cannot answer letters of any sort personally. ISBN 1-933087-50-1 Printed in the United States of America

Click here to read more or order:

http://www.johnshopkinshealthalerts.com/white_papers/memory_wp/digital_landing.html?st=link&s=DMW_070320_001

The Johns Hopkins White Papers are published yearly by Medletter Associates, LLC.

Visit our website for information on Johns Hopkins Health Publications, which include White Papers on specific disorders, home medical encyclopedias, consumer reference guides to drugs and medical tests, and our monthly newsletter The Johns Hopkins Medical Letter: Health After 50. www.JohnsHopkinsHealthAlerts.com

The Johns Hopkins White Papers
Gabrielle Weiner Editorial Director Marianne Doran Writer Tim Jeffs Art Director Scott Hunt Graphic Designer Jacqueline Schaffer Medical Illustrator Patricia Maniscalco Information Specialist Leslie Maltese-McGill Copy Editor

Johns Hopkins Health Publications
Rodney Friedman Publisher and Editor Stuart Jordan Chief Operating Officer Tom Damrauer, M.L.S. Chief of Information Resources Barbara O'Neill Business Manager Wilma Garcia Associate Consumer Marketing Director BJ Forlenzo Associate Circulation Manager Sherry Sabillon Controller

JohnsHopkinsHealthAlerts.com
Tim O'Brien Web Marketing Director Joan Mullally Web Audience Development Director Marjorie Lehman Web Managing Editor

Subscribe
x