Exercise has no upper age limit: Moving more in old age linked to sharper memory

Older adults who move more, either with daily exercise or even simple routine physical activity like housework, may preserve more of their memory and thinking skills, even if they have brain lesions or biomarkers linked to dementia, according to a study published in the January 16, 2019, online issue of Neurology.

The study examined 454 older adults; 191 had dementia and 263 did not. All participants were given physical exams and thinking and memory tests every year for 20 years. Participants agreed to donate their brains for research upon death. The average age at death was 91. The brain tissue was examined after death for lesions and biomarkers of dementia and Alzheimer’s disease.

The study found that people who had better motor skills had better thinking and memory skills compared to those who did not move much at all. For every increase in physical activity by one standard deviation (SD), participants were 31% less likely to develop dementia. For every increase in motor ability by 1 SD, participants were 55% less likely to develop dementia. This association was consistent in people who had dementia and people who did not.

Today, most of us are less physically active even though the benefits of exercise on physical health as well as mental health are known to us all. Lack of initiative or lack of safe open spaces may have contributed to this scenario. A heavy work schedule is often a deterrent to physical activity for many of us.

Walking is the best form of exercise, which requires no investment, no special training. Walking in natural environments such as parks also reduces mental stress and fatigue and improve mood via the release of the ‘feel good’ endorphins. This proximity to nature also helps in the inward spiritual journey and shifts one from the sympathetic to parasympathetic mode manifested by lowering of blood pressure and pulse rate

(Source: American Academy of Neurology News Release, Jan. 16, 2019)

Dr KK Aggarwal

Padma Shri Awardee

President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Past National President IMA

Harm Reduction 2 : “Less harmful alternatives to tobacco”

Continuing our series on Harm reduction, we present the views of Jeannie Cameron, Founder and MD JCIC International, a UK-based strategic advocacy consultancy specializing in tobacco harm reduction. She also attended the seminar on “Harm Reduction” organized on 27th September at IIC, New Delhi.

When I spoke to her about tobacco harm reduction and e-cigarettes, this is what she had to say.

“There is a product called Swedish snus, which is like pasteurized smokeless tobacco product that you put in the mouth. Sweden has this product historically for 300 years. In Sweden, which is very good at its medical health and epidemiology, they have studied this for more than 50 years, and found zero or nil deaths from tobacco snus product.  Norway, next door in Scandinavia, also has started to use this product and also found zero deaths from it. When you compare that with a country like India which has significant use of oral and smokeless (tobacco) and you have huge deaths – 30-40% of tobacco related deaths are coming from that.

In Sweden, they were so wanting to ensure that they didn’t want to lose this product that when they joined the European Union (EU) in the 1970s, they have a special derogation in the law under the treaty to join EU to protect their use of this product. That’s how important it was for Sweden at the time. And the evidence everyone who is anywhere in the world, anyone would tell that it is less harmful than smoking.

I am not an expert on e-cigarettes so much because  when I did my legal dissertation at the time in 2007 on harm reduction and tobacco harm reduction, e-cigarettes were not even available. They were not really discovered then. So this information has come later.

The Royal College of Physicians and all the research that is coming in now – independent research, some research is coming from tobacco companies, but they put it out for independent scrutiny – it is all showing and the RCP saying that it is up to 95% less harmful than smoking.  

There are three products available now, which are less harmful than smoking.

One is Swedish snus, which is significant in Sweden. The other one is e-cigarettes; UK has now the fastest fall in smokers since they have been available because the UK allows them freely.

And, vaping is taking off all over the world as smokers find it’s a good replacement.

The third is the heated tobacco, which is launched in Japan only two years ago. It’s already something like 27% of Japanese smoking market. Japanese are known to be big smokers and they have switched over to using heated tobacco. Japan does not allow e-cigarettes, but they allow heated tobacco.

The way to think about is both these products are vaping because they are not producing smoke, whether it is a heated tobacco or whether it is an e-cigarette. They are producing vapor and vapor is not causing any harm to the lung like smoke is.

And as we know, it’s the nicotine they want … they smoke for nicotine, but they die from the smoke.

If we can provide people with something that is helpful to them in terms of their health, but still gives them the nicotine that they want, then that’s a much better thing. In India, that could make a huge difference.

All the time, there are new developments being made on nicotine, and nicotine is now being used to help cases of Parkinson’s, Alzheimer’s ... I think in the future there will be lot of emerging research, which will show that.  

But, I think, one of the big concerns also is the tax side and of the growers and economies which are dependent on tobacco should see it as potentially for future business opportunity in some respects because it is transitioning people. They don’t need to be afraid of it and in some parts of the world, where there are big growing places like Brazil or Indonesia and maybe a bit in India, they should see it as an opportunity.”

Differences between Alzheimer's dementia and vascular dementia

Dementia is an umbrella term for a syndrome marked by deterioration in memory, other cognitive abilities and the ability to perform everyday activities. Although dementia mainly affects older people, it is not a normal part of aging. It is one of the major causes of disability and dependency among older people worldwide (WHO). There are several types of dementia. The most common is Alzheimer’s disease. Vascular dementia is another type of dementia.

While Alzheimer’s disease and vascular dementia are both types of dementia, their causes, symptoms and prognosis differ.

·         Vascular dementia is caused by an acute event such as stroke or transient ischemic attack (TIA), while the cause of Alzheimer’s disease still remains unknown.

·         Diabetes, hypertension, coronary artery disease, high cholesterol levels are risk factors for vascular dementia. Alzheimer’s disease is an irreversible, degenerative disease of the brain. Age is the best known risk factor for Alzheimer’s disease. Genetics may also have a role.

·         In vascular dementia, cognitive impairment occurs more suddenly and then remains stable for some time (step-like decline) and is related to an acute event like stroke or TIA. Whereas, in Alzheimer’s disease, memory problems are characteristically one of the first warning signs of cognitive loss and memory gradually declines over time.

·         Physical disability occurs at the same time as cognitive impairment in vascular dementia. In Alzheimer’s, cognitive impairment occurs first followed by physical disability.

·         A CT scan or MRI can detect an area of brain affected by stroke or TIA (infarcts). Alzheimer’s disease, on the other hand, is a diagnosis of exclusion. All other causes of dementia such as B12 deficiency (reversible) need to be ruled out before diagnosing a person with Alzheimer’s disease.

·         Prognosis of vascular dementia depends on the extent of damage in brain. Alzheimer’s disease progresses over the years. Survival after a diagnosis of Alzheimer’s disease is usually 8.4 years.

Dr KK Aggarwal

Padma Shri Awardee

Vice President CMAAO

Group Editor-in-Chief IJCP Publications

President Heart Care Foundation of India

Immediate Past National President IMA

Ask Dr KK:Does memory impairment means onset of Alzheimer?

1.     First rule out B 12 deficiency and hypothyroidism.

2.     Rule out organic brain disease.

3.     Mild cognitive impairment (MCI) represents a state between normal aging and dementia.

4.     MCI includes patients with cognitive deficits that are insufficiently severe to meet criteria for dementia.

5.     Neuropsychological testing in individuals suspected of having MCI should be done. Those meeting criteria for MCI and those with prominent subjective complaints should have follow-up testing to evaluate for progression between one and two years after the initial assessment.

Dr KK Answers: What are Dementia syndromes?

The major dementia syndromes include

• Alzheimer disease
• Dementia with Lewy bodies
• Frontotemporal dementia
• Vascular (multi-infarct) dementia
• Parkinson disease with dementia 

Dr KK Answers: What is Alzheimer disease?

Ad is the most common form of dementia in the elderly, accounting for 60 to 80 percent of cases.