TIME Mental Illness

Depression Is a Risk Factor for Dementia, New Research Says

The two have been linked before, but the new study says depression may be an independent risk factor for the disease

The link between depression and dementia is puzzling for researchers. Many studies have noticed a correlation between the two diseases and a 2013 review of 23 studies of about 50,000 older men and women reported that older adults suffering from depression were more than twice as likely to develop dementia and 65% more likely to develop Alzheimer’s. But these have often only been associations. The newest study, published Wednesday in the journal Neurology, takes it further. The researchers believe that their findings, while not definitive, show that depression is in fact an independent risk factor for dementia — and not the other way around.

Researchers looked at 1,764 people with no memory problems around age 77 and followed them for about eight years. They discovered that people with mild cognitive decline as well as people with dementia were likely to have higher levels of depression symptoms before they were diagnosed, and that having these symptoms was associated with a greater decline in memory. Depression symptoms, the researchers estimated, accounted for 4.4% of the difference in memory decline that could not be caused by brain damage.

The reasons for the link between the two diseases are more unclear. Some research suggests that people with depression may have high levels of hormones that interfere with the region of the brain responsible for learning and memory aptitude. Gary Kaplan, an osteopath who runs the Kaplan Center for Integrative Medicine, as well as a handful of other researchers, has another theory: that inflammation caused by hyperreactivity of immune cells can hinder blood flow to — and impact neural pathways in — the brain.

Kaplan, who was not involved in this research, views depression as a symptom of inflammation in the nervous system, and not a disease in itself. “Depression is manageable,” says Kaplan. “We can modify risk for depression by lowering neuroinflammation. And these findings are completely consistent with depression as an inflammatory disease.”

It’s also possible that depression adds stress to the brain, and that can play a role in its deterioration.

If it was possible that treating depression could curb dementia risk, that would be game changing, medically speaking. That hasn’t been proved yet, but it’s an active area of research. The Mayo Clinic recommends that patients opt for treatments that are safe for both issues — for instance, taking antidepressants for depression, though “these medications may not be as effective at treating depression with Alzheimer’s as they are at treating depression alone,” they write. Kaplan thinks treating depression can be done with practices like meditation and getting more sleep — activities thought to calm the brain and improve overall brain health.

If the new research is right, finding new ways to treat depression may have an impact on dementia risk — even if it’s small.

MONEY Aging

Help for People Who Can’t Handle Their Money Anymore

Younger person assisting elderly client.
Gary John Norman—Getty Images/Cultura

A daily money manager can pay bills, keep spending under control, and protect a client from scams.

Martha Nurenberg knew her 86-year-old father, Paul, had a problem when he was almost taken in by a letter promising untold riches if he provided a bank account number and payment of legal fees for a money transfer.

Though Paul never sent any money, he did answer the letter with interest.

As dementia set in, Paul could no longer remember the password to his computer where he kept his financial records. Then Nurenberg received a call from the director of her dad’s senior living facility, who said Paul had not paid his last two bills.

“We realized that he couldn’t keep the financial records anymore,” says Nurenberg, who runs the AARP’s employee volunteer program in Washington, D.C. But neither she nor her three siblings lived anywhere near their dad’s facility in Middlesex, N.Y. Nor did their mother, who is also suffering from dementia, know anything about the complicated records her husband kept.

So they called a professional, Jacquelyn Bell, a Rochester, N.Y.-based CPA who wears a second hat as a daily money manager for clients such as the Nurenbergs. Instead of just filing quarterly or annual tax forms, Bell receives her clients’ mail, pays their bills, balances their checkbooks and helps them keep to a budget if they are on a fixed income.

For the families of the more than 5 million Americans suffering from Alzheimer’s or another form of dementia, such hands-on services can be a necessity. “Most of my clients fall into a few categories — no family or children, have children but not local, children are too busy, or elder financial abuse,” says Bell.

CHOOSING AND USING THE RIGHT MANAGER

Demand for daily money management services as America ages is likely to grow significantly, but at least for now the profession is virtually unknown. The American Association of Daily Money Managers (aadmm.com), the profession’s primary trade group, has only about 700 members nationwide.

What is more, no government agency regulates daily money managers, even though they have access to clients’ sensitive financial information. For this reason, properly vetting a potential manager is essential. That means asking for references from other clients, and, when possible, checking with state professional licensing boards for credentials and for such things as malpractice.

The AADMM provides certification to daily money managers and lists of credentialed members. This guarantees at least a certain level of proficiency in the field.

To avoid fraud, be sure to establish certain safeguards. Money managers should provide monthly reports of all their financial work, including copies of bills paid, if requested. Some clients create a bank account specifically for the money manager that has limited funds, just enough for the monthly bills and a small amount left over.

Meanwhile, the rest of the client’s money is off limits.

EXPERTISE

Bill paying alone is usually not all that hard, but if health, long-term care or other complex issues become part of the mix, expertise may essential.

That is where someone such as Sheri Samotin may come in. Prior to founding her daily money management business, LifeBridge Solutions, in 2009, she spent some 25 years in the healthcare industry, much of it as a manager of a medical practice where she often negotiated with health insurers unwilling to pay claims. She is familiar with the complex codes hospitals and insurers use for medical procedures, including what is covered and what is not by different policies.

But if tax, estate or small-business issues are more of a concern, a CPA such as Bell would likely fit the bill.

TRUST

Also, since trust is such an important factor, ceding power to a manager all at once may not be wise. Initially, Nurenberg’s father would sign all the checks Bell was writing for the bills so he had a chance to review them. As he deteriorated, Nurenberg, who had power of attorney for her parents, signed them. Now Bell, having proven herself, handles everything.

Dementia or other disabilities are not the only reasons to hire a money manager. Parents often hire managers to handle the affairs of their mentally disabled children’s estates after they are gone.

Addictions are another reason. Bell has shopaholic and gambler clients whose checkbooks she keeps in her safe so they cannot get to them.

For many the service can be a matter of convenience. “While mom’s very capable of paying her bills, this lets her focus on enjoying her retirement,” says Mitchell Dannenberg, a Naples, Fla. insurance salesman who hired Samotin to handle his mother’s finances.

Costs of daily money managers vary depending on the services required and your location. Bell charges $90 an hour but says services can cost as much as $150 a hour in pricier New York City. Some clients only require an hour of service a month while others need five to six, she says.

It is not cheap by any means. But for Nurenberg, Bell is more than a financial security blanket. She is a “godsend,” Nurenberg says.

TIME Research

In 2025, Everyone Will Get DNA Mapped At Birth

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What will the future hold? REB Images—Getty Images/Blend Images

Scientists have scoured trends in research grants, patents and more to come up with these 10 innovations that will be reality in 10 years (or so they think)

Everybody likes to blue-sky it when it comes to technology. Driverless cars! Fat-burning pills! Telepathic butlers! But the folks at Thomson Reuters Intellectual Property & Science do it for a living—and they do it with data.

By examining who’s investing in what, who’s researching what and who’s patenting what, the group has come up with 10 predictions of innovation for 2025, which they presented at the Aspen Ideas Festival. The list included the first attempts at testing teleportation, the ubiquity of biodegradable packaging and electric air transportation.

Here’s what they say will be commonplace in medicine in a decade:

1. Dementia will be on the decline

While the World Health Organization predicts that more than 70 million people will be affected by dementia, much of it related to Alzheimer’s disease, by 2025, that upward trajectory of cases may be blunted somewhat by advances in genetics that will lead to earlier detection and possible treatment of the degenerative brain disorder.

2. We’ll be able to prevent type 1 diabetes

Unlike type 2 diabetes, which generally develops when the body gradually loses its ability to break down sugar properly, type 1 diabetics can’t produce enough insulin, the hormone that dispatches sugar from the diet. Advances in genetic engineering will lead to a more reliable technique for “fixing” genetic aberrations that contribute to type 1 diabetes as well as other metabolic disorders, making it possible to cure these conditions.

3. We will have less toxic cancer treatments

Building on the promise of targeted cancer therapies, which more precisely hone in on tumor cells while leaving healthy cells alone, researchers will have a deeper knowledge of the Achilles’ heels of cancer cells, which will help them to develop more powerful and precise drugs that can dispatch tumors with fewer side effects.

4. Every baby will get its DNA mapped at birth

It’s already a trendy thing to have your genome sequenced, but today there isn’t much you can do with the information. Having that information, however, may prove useful in the near future, both for predicting your risk of developing diseases as well as your ability to respond (or not) to certain drugs. As knowledge about the genome, and what various genes, or versions of genes do, grows, so will doctors’ ability to predict health outcomes and treat patients based on genetic information. So within a decade, getting a baseline DNA map at birth could be a valuable way of preparing to lead a healthier and possibly longer life.

TIME Aging

‘Vampire’ Mice May Hold Key to Eternal Youth

Mouse
Getty Images

New studies published in Science and Nature Medicine find that older mice who are given blood from younger rodents quickly become rejuvenated, raising hopes for treating age-related degenerative conditions in humans like dementia and Alzheimer's

Aging mice gain energy, while also exhibiting greater strength and memory, when injected with the blood of younger specimens, according to a new study.

Scientists at Harvard and the University of California, San Francisco, carried out experiments on rodents with ages equivalent to humans in their 20s and 60s.

A protein called GDF11 — also found in human blood — is behind the rejuvenating properties, they suggest in research published in the journals Science and Nature Medicine. Concentration of the substance appears to decline in advanced years.

The findings could be used to treat age-related diseases such as dementia and Alzheimer’s. However, some have cautioned that stimulating the rapid regrowth of cells could possibly lead to increased risks of cancer.

TIME

Families Would Welcome Alzheimer’s Screening, But Task Force Says It’s Too Early

Though there's growing hope for detecting the disease before memory loss and confusion set in, doctors aren't ready to recommend early detection

For Bernie Limper, the first hints that her mother might be suffering from Alzheimer’s disease came in the usual way. “I noticed my mother was more than just a little forgetful,” she says. If she called her mother, who was then 80 years old, and told her she’d be there to pick her up, Limper would arrive to find her mother had completely forgotten about the appointment. When her mother moved in with Limper’s family, she started to wander out of the house on her own and get lost, not knowing where she was or how she got there. Limper started to sleep in her mom’s bedroom and lock the door with a key so her mother wouldn’t leave the house in the middle of the night.

That was in the 1980s, and doctors then had much less confidence than they do now in diagnosing the neurodegenerative disease. It’s still only confirmed upon autopsy, when pathologists verify the presence of sticky protein plaques and the debris of damaged nerve cells in the brain. But recent studies on dementia make it clear that the process of cognitive decline starts long before the first symptoms of memory loss and confusion appear. Experimental tests that can detect signs of these proteins in the spinal fluid and blood, and imaging tests that can pick up signs of the growing plaques, are giving doctors hope for diagnosing Alzheimer’s at its earliest stages, even before the symptoms of memory loss, confusion, and cognitive decline appear.

MORE: New Research on Understanding Alzheimer’s

Anywhere from 2.4 million to 5.5 million Americans suffer from dementia, up to 80% of which is related to Alzheimer’s disease. While rates of the condition increase with age, from 5% among those aged 71 years to 79 years to 37% among those older than 90, there is no standard treatment for cognitive decline.

But screening for early signs of dementia has a ways to go before experts recommend it the way they do for cancer, according to the latest report from the U.S. Preventive Services Task Force (USPSTF) and published in the Annals of Internal Medicine. While the USPSTF did find evidence that some of the current treatments for symptoms can be effective, they didn’t find enough data to recommend or reject the idea of universal screening of all elderly, even before they show any symptoms.

MORE: Breakthrough Discoveries of Alzheimer’s Genes

Particularly lacking was data on how simply knowing about potential cognitive problems could help both patients and families cope and plan for the future. In general, screening is a way to identify people at risk or in the early stages of a disease so they can take advantage of treatments or therapies that can slow or even reverse the process. Currently, medications can relieve some of the symptoms of the condition, but no drugs can reverse or cure the disease. And measuring the effects of something like psychological and emotional comfort isn’t something that clinical trials do well. “Psychosocial research is complicated to study,” says Beth Kallmyer, vice president of constituent services at the Alzheimer’s Association. “It isn’t the same as giving one group a medication, and another group a placebo and seeing what happens.”

But many caregivers and family members say the knowledge can help them be better prepared to manage the needs of a loved one with dementia – “it can change their personality, and sometimes a very gentle person becomes very very angry,” says Limper – and help them make practical financial decisions as well. After learning that his wife Greta was suffering from memory loss, for example, Bruce Buller, a retired pastor in Minnesota, anticipated what might happen if she were to outlive him. “It meant giving power of attorney to our daughter, having bank accounts in multiple names, and changing the will,” he says.

MORE: Dementia Cases Expected to Triple in Coming Decades

Limper says having such an early head start would have been helpful in her mother’s case. Knowing that an elderly person’s forgetfulness and confusion is related to Alzheimer’s, and not just normal aging, can also help caregivers to be more patient. “When my mom thought I was her mother instead of her daughter, if I would have argued with her and told her she was wrong, it would have upset her,” she says. “I just didn’t argue. What they’re finding out now is that you just have to get the patients through those moments.”

Conducting more research, as challenging as it may be, on how such factors contribute to the benefits and risks of screening is critical, especially since patients and caregivers consider them an important part of the calculation. “I always believe it’s a good thing to know what you’re dealing with,” says Limper, who, like many, believes that there are things we can do to fend off the disease, and does a lot of puzzles and mental exercises to keep her brain active. “I can’t believe that having a screening test wouldn’t have made a difference for my mother somehow.”

TIME

Women at Higher Risk of Developing Alzheimer’s Disease Than Men

The latest research from the Alzheimer's Association shows a woman's lifetime risk of developing the neurodegenerative disease is one in six, compared with one in 11 for men. More than 5 million Americans suffer from the disorder

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Alzheimer’s disease may hit women harder than men in the coming decades, according to the latest report from the Alzheimer’s Association. The organization’s figures show a woman’s lifetime risk of developing the condition is 1 in 6, compared with 1 in 11 for men.

More than 5 million Americans in total are now living with the neurodegenerative disease, per the report.

Women are also shouldering the responsibility for caring for parents affected by Alzheimer’s. More than twice as many women as men provide 24-hour care for a loved one with the disease, and twice as many women as men gave up working full time in order to do so.

(MORE: New Research on Understanding Alzheimer’s)

Such unpaid care totals about $220 billion in lost wages and other care. Much of that cost is for helping patients to bathe, eat, dress and use the bathroom, rather than for treating the symptoms of dementia and memory loss, for which there are no effective therapies.

“We have to change that balance,” says Maria Carrillo, vice president for medical-and-scientific relations at the Alzheimer’s Association.

Here are some of the highlights from the group’s report:

  • By 2050, 16 million people will be living with Alzheimer’s disease.
  • African Americans are twice as likely as whites to develop Alzheimer’s.
  • About one-third of seniors who die each year in the U.S. have been diagnosed with Alzheimer’s or dementia.
  • Women in their 60s are twice as likely to develop Alzheimer’s as they are to develop breast cancer over their lifetime.
  • In 2013, Americans, mostly women, provided 17.7 billion hours of unpaid care to patients with Alzheimer’s.
  • In 2014, Americans will spend $214 billion to care for patients with Alzheimer’s. In 2050, that amount will reach $1.2 trillion.

The full 2014 Alzheimer’s Disease Facts and Figures report can be read here.

TIME

Blood Test Could Predict Alzheimer’s, Study Finds

A woman, suffering from Alzheimer's dese
Sebastien Bozon - AFP/Getty Images

Scientists say the test could predict the disease with 90% accuracy

Scientists say a new blood test could detect Alzheimer’s disease three years before the patient develops symptoms of memory loss.

The study, published in the journal Nature Medicine, identified 10 molecules in the blood that predicted Alzheimer’s with 90% accuracy. Researchers wrote the bloods tests “can change how patients, their families and treating physicians plan for and manage the disorder.”

On the other hand, experts warned the Guardian that a test for an incurable disease with a 10% rate of error would have to be approached with caution, both by the doctor and the patient.

[Guardian]

TIME Dementia

Alzheimer’s Bigger Killer Than We Realize, Study Says

Research found that medical staff often lists people's immediate cause of death, such as pneumonia, on death certificates, when Alzheimer's was the underlying cause. If properly accounted for, Alzheimer's could rival heart disease and cancer as a leading cause of death

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Alzheimer’s disease kills more Americans than we realize, researchers say.

Death certificates often do not list dementia as the underlying cause of death. Instead, the immediate cause, like pneumonia, is listed, obscuring Alzheimer’s-related deaths, according to Bryan D. James of Rush University Medical Center in Chicago and lead author of a study published in the journal Neurology.

The researchers followed 2,566 people between the ages 65 and older who had yearly tests for dementia. After about eight years, 1,090 of the participants died, and 559 of the participants who did not have dementia at the start of the study developed Alzheimer’s disease. The death rate among participants was four times higher after a diagnosis of Alzheimer’s in people between 75 to 84, and almost three times higher in people over age 85.

The researchers say this equates to an estimated 503,400 deaths from Alzheimer’s in Americans over age 75 in 2010. This is six times greater than the 83,494 deaths from Alzheimer’s disease the CDC reported. Currently, Alzheimer’s is the sixth leading cause of death in the U.S., according to the CDC. Heart disease and cancer are numbers one and two, at 597,689 and 574,743 deaths, respectively.

“Determining the true effects of dementia in this country is important for raising public awareness and identifying research priorities regarding this epidemic,” said James in a statement.

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