Doctors have suspected for some time that white spots appearing in MRI brain scans are associated with cognitive decline. However, the relationship between the number and size of spots and the likelihood of dementia has been mostly a judgment call. Now, a new study from New York University's Grossman Medical Center proposes the first standardized, objective measurement tool designed to predict cognitive decline when considered alongside other factors.
The study is published in the journal Academic Radiology.
White spots and educated guesses
The white spots, or "hyperintensities," are brain lesions—fluid-filled holes in the brain believed to have been left behind by the breaking down of blood vessels that had previously provided nourishment to brain cells.
Prior to the new research, the quantity of white spots was assessed using an imprecise three-point scale indicating ascending likelihoods of dementia: A minimal number of spots was considered as level 1, a medium number of spots level 2, and a great number of them level 3.
How the new measurements were derived
Credit: sfam_photo/Shutterstock
The team of researchers from NYU's Langone's Center for Cognitive Neurology and Alzheimer's Disease Research Center were led by Jingyun "Josh" Chen. They analyzed 72 MRI scans from a national database of older people taken as part of the Alzheimer's Disease Neuroimaging Initiative (ADNI). The scans were mostly of white people over age 70, and there were a roughly equivalent number of men and women. Some had normal brain function, some were presenting moderate cognitive decline, and some had severe dementia.
Without knowing each individual's diagnosis, the researchers analyzed the white spots in their scans. While the team counted each scan's lesions, the innovation they introduced was the production of a 3D measurement for each lesion's fluid volume. The measurement was derived by measuring a lesion's distance from opposite sides of the brain.
Measurements of 0 milliliters (mL) were assessed for areas without white spots, with other white spots coming up as containing 60 mL of fluid. Chen's team predicted that volumes over 100 mL could signify severe dementia.
"Amounts of white matter lesions above the normal range should serve as an early warning sign for patients and physicians," Chen told NYU Langone Health NewsHub.
When the team compared the likely diagnoses derived from their calculations against the individuals' medical records, they found that their predictions were correct about 7 out of 10 times.
The researchers compiled their formulas into an online tool that's available to physicians for free via GitHub. The researchers plan to further refine and test it using an additional 1,495 brain scans representing a more diverse group of individuals from the ADNI database.
The new tool and its limits
Chen notes that white spots alone may not tell the entire story of an individual's cognitive decline or the onset of dementia. Other factors must be considered as well, including memory loss, hypertension, and brain injuries.
Nonetheless, says senior investigator Yulin Ge, "Our new calculator for properly sizing white matter hyperintensities, which we call 'bilateral distancing,' offers radiologists and other clinicians an additional standardized test for assessing these lesions in the brain, well before severe dementia or stroke damage."
Having an objective means of measuring white hyperintensities will allow physicians not only to get a better handle on the association between white spots and dementia, but also to track the spots alongside changes to a person's tau and beta-amyloid proteins, two chemicals implicated in Alzheimer's disease and dementia.
Watch out forest bathers, you have competition.
Perhaps better put, you have an addition to your ritual. According to a new study, published in the journal Emotion, one surefire way to improve your mental health is by taking regular 15-minute "awe walks."
Researchers at the UC San Francisco Memory and Aging Center and the Global Brain Health Institute wanted to see if these focused walks in the woods could improve prosocial emotions in seniors. The team chose this cohort due to longstanding links between cognitive decline and mental health problems associated with anxiety and depression.
According to associate professor Virginia Sturm, loneliness is particularly damaging to older adults and can help drive the onset of Alzheimer's disease. She was quite happy with the results.
"What we show here is that a very simple intervention – essentially a reminder to occasionally shift our energy and attention outward instead of inward – can lead to significant improvements in emotional well-being."
The walking group was comprised of volunteers in their sixties to eighties. Each participant was told the study was about exercise, when in reality their task—taking a selfie at the end of each walk—revealed the actual intentions of researchers.
Finding Happiness Through "Awe Walks"
Importantly, participants were instructed to observe details while walking around the forest. If the goal was only exercise, volunteers were likely to power through trails without noticing their surroundings. This is where awe comes into the picture.
UC Berkeley psychologist Dacher Keltner explains the relevance, noting that feelings of awe help us feel more generous and humble, while increasing our overall well-being.
"Awe is a positive emotion triggered by awareness of something vastly larger than the self and not immediately understandable — such as nature, art, music, or being caught up in a collective act such as a ceremony, concert or political march."
The post-walk selfie is key. Week after week, their smiles grew larger. Incredibly, their bodies shrunk in the photos—the photographer stepped back to include more of nature. Instead of the normal close-ups we associate with selfies, volunteers naturally became more integrated with their environment, without any prompting from the research team.
Research on individualist versus collectivist societies shows that the members of individualist societies tend to prioritize independence and autonomy. These seem like positive qualities, though higher rates of anxiety and depression are reported in such cultures. By contrast, collectivist societies emphasize interdependence, which ultimately makes members feel like they're part of a bigger landscape.
This is exactly what was reflected in those selfies.
Credit: Rudmer Zwerver / Shutterstock
Classical Japanese art offers plenty of examples of interdependence. Humans are rarely the focal point in these landscape paintings. People only appear as part of a much larger scene. This trend cuts across Buddhist art, perhaps unsurprisingly given the philosophy stresses collectivity. Happiness levels tend to be higher in these societies than in individualist nations.
America, arguably the global leader in individualism, has continually ranked lower on world happiness charts over the last 40 years. Meanwhile, our rates of Alzheimer's disease rise every year.
Can a 15-minute awe walk change all of that? Not completely, but we'll take whatever help we can get. As mythologist Joseph Campbell once remarked, "awe is what moves us forward." He cited awe as a primary driver in the creation of mythology: the overwhelming sensation that you're part of something grand.
As Sturm says, this is a low-cost, worthwhile means for alleviating distress and filling people with gratitude and compassion. Given the state of the world, those qualities are in high demand.
"I find it remarkable that the simplest intervention in the world – just a three-minute conversation at the beginning of the study suggesting that participants practice feeling awe on their weekly walks – was able to drive significant shifts in their daily emotional experience. This suggests promoting the experience of awe could be an extremely low-cost tool for improving the emotional health of older adults through a simple shift in mindset."
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Stay in touch with Derek on Twitter, Facebook and Substack. His next book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
An estimated 5.8 million Americans over the age of 65 live with Alzheimer's disease. That number is increasing: within five years, The Alzheimer's Association predicts there will be 7.1 million. In 2020, $51.2 billion dollars in Medicaid payments will be made to treat nearly six million patients suffering from this condition.
Even though Alzheimer's is a well-known disease—it's the sixth-leading cause of death in the US—it turns out that it's not well understood. According to a new survey conducted by MDVIP/Ipsos, only 35 percent of Americans know the symptoms even though 80 percent of respondents want to reduce their risks.
Specifically, 74 percent of respondents didn't realize hearing loss damages the brain; 72 percent didn't know diabetes is a risk factor for dementia (the disease that Alzheimer's often leads to); 64 percent were ignorant of the fact that lack of sleep shrinks brain size; and half of respondents didn't know the impact of emotional well-being on brain health. Over half of those surveyed also didn't realize high cholesterol and poor dental care play a role in Alzheimer's disease.
The researchers also discovered disturbing COVID-19-related data. While 58 percent of adults report changes in sleep, 57 percent note mood swings, and 51 recent suffer from emotional withdrawal during this time, only 8 percent are looking for professional help.
Dr. Andrea Klemes, MDVIP Chief Medical Officer, notes that checkups during the pandemic are especially important.
"We don't yet know the long-lasting consequences that the pandemic will have on the brain, and we hope that research such as ours will continue to shine a light on this very serious health issue."
Credit: logika600 / Shutterstock
Remaining healthy requires regular screenings. Here again we see a disassociation between risk reduction and proactivity. Seventy-seven percent of respondents don't talk to their doctors about lifestyle habits that support brain health; 51 percent have never been screened for depression; 44 percent have never had a neurological exam; and 32 percent have never been screened for hearing problems.
Common early warning signs of dementia, according to Dr. Jason Karlawish, co-director of the Penn Memory Center, include repetitive questions and stories, difficulties with complex daily tasks, and trouble with orientation.
In terms of intervention, exercise, diet, building a brain reserve, and challenging your brain (such as learning a new language or musical instrument) are all proven methods for staving off the ravages of Alzheimer's. Oxytocin has also showed promise in brain-addled mice, while researchers found positive results for a group of intermittent fasters in promoting neurogenesis.
Epidemiologist Bryan James says that dementia is not an inevitable result of aging.
"It's simply not pre-destined for all human beings. Lots of people live into their 90s and even 100s with no symptoms of dementia."
Professor of neurology at Boston University School of Medicine, Andrew Budson, recommends aerobic exercise and the Mediterranean diet. As has long been known, whole grains, fruits and vegetables, fish and shellfish, and healthy fasts like nuts and olive oil seem to have brain-boosting properties.
To learn more, take the Brain Health IQ quiz.
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Stay in touch with Derek on Twitter, Facebook and Substack. His next book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
While Americas watch the battle for the most cognitively-fit president unfold on social media and television, the problem pundits are really discussing is dementia. Currently, 5.7 million Americans are suffering from diseases of dementia. Alzheimer's disease accounts for between 60-70 percent of these cases.
There has long been speculation about the cause of Alzheimer's. We know that exercise, diet, and continued education play a role in staving it off. Considering an estimated 13.9 million seniors worldwide will fall victim to dementia by 2060, it's a problem we need to address.
While somewhere between 1 and 5 percent of cases have been identified as genetic, one potential cause of Alzheimer's is the amyloid hypothesis. This idea, first proposed in 1991, states that the brain becomes riddled with extracellular amyloid beta deposits. These amyloid plaques compromise cognitive functioning by negatively affecting memory, decision-making, and planning, while causing depression, distrust in others, delusions, apathy, and changes in sleeping patterns.
Under normal circumstances, beta-amyloid plays a protective and reparative role in the central nervous system. When grouped together in plaques, however, the same peptide leads to disruption in cell function and neuronal death—the trigger for dementia.
This hypothesis was updated in 2009 to reflect the aging-related process of an amyloid-related protein. Regardless, the strongest indicator of Alzheimer's appears to plaque buildup. New research is pointing toward oxytocin as a potential therapeutic intervention.
Oxytocin gained popular currency as the "love hormone" due to its role in mammalian bonding. After an orgasm, oxytocin spreads throughout your bloodstream, resulting in feelings of satisfaction and contentment. Crying babies are calmed by the oxytocin provided by their mother's milk.
Photo: Varlamova Lydmila / Shutterstock
As Eleftheria Kodosaki, an academic associate in Biomedical Sciences at Cardiff Metropolitan University, writes, male mice were recently treated with the toxic beta-amyloid, resulting in the desired effect: their brain's synaptic plasticity suffered. The researchers then treated mice with the toxic beta-amyloid and oxytocin, which did not affect their neural plasticity. The team speculates that oxytocin may play a role in staving off memory loss.
That may is key. Kodosaki notes that this disease remains baffling.
"In theory, being able to stop groups of toxic beta-amyloid from forming could potentially prevent memory loss and cognitive decline. Unfortunately, Alzheimer's disease is way more complicated than just an accumulation of beta-amyloid in the brain."
Plaque buildups have been discovered in people that don't have the disease or suffer from any symptoms. The beta-amyloid angle is only a theory, and there are others: as mentioned, genetics, as well as the Tau hypothesis. In 2002, researchers at the Institute of Psychiatry in De Crespigny Park, London speculated that tau proteins form neurofibrillary tangle inside of nerve cell bodies, resulting in the collapse of neuronal transport systems.
Kodaski points out that all medication targeting beta-amyloid has failed. She also notes that research needs to be conducted on female mice, as women are more likely to develop Alzheimer's than men. Of course, humans are not mice, though taking note of sex differences in mice might help researchers gauge potential therapies in humans.
As most studies conclude, more research is needed. But it is a hopeful sign for treating the frustrating realm of dementia. In an aging world with a declining population, we need to protect our seniors the best we can.
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Stay in touch with Derek on Twitter, Facebook and Substack. His next book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."
