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Alzheimer’s disease (AD) is a complex disease that begins decades before cognitive symptoms appear.  The cause of this disease remains unknown however recent studies have provided some clarity on the early stage biology. The complexity of the late-stage disease state has hindered the development of an effective therapeutic intervention and increased attention has turned to prevention. 

General Information

For a general introduction to preventing Alzheimer’s disease please see the NIH National Institute on Aging web page (2).  Further information may be found on the Alzheimer’s Association web page (3). (Please see the video “Diet and exercise in Alzheimer’s” by Dr. Carl W. Cotman from University of California, Irvine.) 

Specific Recent Studies

Sleep

Benefits of a good quality sleep may include protection against age-related cognitive declines (4).   For Alzheimer’s disease this is a developing area of research to identify at risk populations and underlying biological mechanisms. A recent report shows an association between sleep-disordered breathing and Alzheimer’s disease-biomarkers in humans (5).  This follows the identification of perturbations in the sleep-wake cycle giving rise to significant changes in Aβ dynamics in mice (6). In a seminal paper by Dr. Maiken Nedergaard from the University of Rochester, she hypothesizes that the restorative aspect of sleep is a consequence of an enhanced rate of removal of neurotoxic waste products that accumulate in the awake central nervous system (7). The linkage between Aβ deposition in the brain and poor sleep continues to be established, however the key question remains whether poor sleep contributes to Alzheimer's onset or if disrupted sleep is an early symptom of this disease.

Surgery and the Elderly

Effects from major surgery and the use of anesthesia on brain pathology and cognition is a controversial yet developing area.  The elderly are more likely to present with a loss in cognitive abilities shortly after surgery.  In addition, some patients report that their first Alzheimer’s disease symptoms correspond to a surgical procedure.  Dr. Roderic Eckenhoff from the University of Pennsylvania, has presented data supporting the hypothesis that the surgery itself, and not the anesthesia, may negatively impact a dementia-vulnerable brain (8).   Furthermore, the negative impact on the brain by a peripheral inflammatory process, that may be induced by surgery, is consistent with recent studies supporting inflammation having a central and potentially causal role in AD pathogenesis and that the peripheral immune system may directly contribute to the AD process.

References:

(1) Norton, S. at al, Lancet Neurol 2014; 13: 788-94.

(2) NIH reference: http://www.nia.nih.gov/alzheimers/publication/preventing-alzheimers-disease/so-what-can-you-do

(3) Alz Assoc: http://www.alz.org/research/science/alzheimers_prevention_and_risk.asp

(4) Scullin, M. K. and Bliwise, D. L., Perspect Psychol Sci 2015; 10(1): 97-137.

(5) Osorio, R. S. et al, Neurobio of Aging 2014; 35: 1318-1324.

(6) Jae-Eun, K. et al, Science 2009; 326: 1005-1007.

(7) Xie, L. et al, Science 2013; 342: 373-377.

(8) http://www.uphs.upenn.edu/news/News_Releases/2012/09/surgery/