Their study, published in the journal Neurology, looked at 121 people aged over 60, around half of them in the early stages of the disease.

Those with Alzheimer’s who were less fit had four times more signs of brain shrinkage than those who were fit.

The Alzheimer’s Research Trust said other research showed exercise reduced the risk of dementia.

“People with early Alzheimer’s disease may be able to preserve their brain function for a longer period of time by exercising regularly” Dr Jeffrey Burns University of Kansas School of Medicine

Some 700,000 people in the UK are living with dementia, with this number predicted to grow quickly over the next two decades, as the proportion of older people in the population increases.

Other studies looking at the relationship between dementia and exercise tend to focus on whether being active can reduce the risk of the condition developing in the first place.

Dr Jeffrey Burns, from the University of Kansas School of Medicine, said his was one of the first to look at whether exercise could affect the progress of the illness.

His volunteers underwent a treadmill test to see how fit they were and then their brains were scanned for shrinkage, which is one way of measuring the severity of their Alzheimer’s.

Brain volume

While there was no relationship between brain size and exercise in people tested who did not have Alzheimer’s, Dr Burns said the four-fold difference in those who did was evidence that exercise might help.

He said: “People with early Alzheimer’s disease may be able to preserve their brain function for a longer period of time by exercising regularly and potentially reducing the amount of brain volume lost.

“Evidence shows decreasing brain volume is tied to poorer cognitive performance, so preserving more brain volume may translate into better cognitive performance.”

Susanne Sorensen, head of research at the Alzheimer’s Society, said: “Exercise increases blood flow to the brain, delivering oxygen and nutrients to brain cells.

“This is one possible explanation why dementia progresses slower in people who are physically fit.

“Exercise also reduces your risk of developing dementia so it’s important to take regular exercise. A healthy heart means a healthy brain.”

Rebecca Wood, chief executive of the Alzheimer’s Research Trust, said: “This adds to previous research showing that exercise helps reduce the risk of dementia and slows down its onset.

“A balanced diet and regular exercise can improve the quality of life of older people with dementia, as well as those who do not have the condition.”

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Alzheimers Research Trust
Alzheimers Society

One woman, who helps care for her husband at home, talks about her fight for help.
Freddie was 64 when he was diagnosed with dementia

Freddie Smith was just 64 when he was diagnosed with a form of dementia brought on by a series of mini-strokes.

“It suddenly became clear,” says his wife, Angela.

“For a while he had been asking me what the time was or keeping bags of change in his pocket – he didn’t know what they were worth so kept paying with notes.”

That was 11 years ago and ever since his condition has been deteriorating, so that now he struggles to move and cannot communicate.

The 49-year-old, from Kent, said she soon found herself asking for help caring for her husband.

But despite his diagnosis, she was told she would have to pay for the help he needed dressing, eating and going to the toilet.

“Mrs Smith, who works as an exercise instructor and in a post office, says: “In the end all my wages, about £200 a week, was going on paying for his carers. What gets me is that this is a medical condition, he was diagnosed, and yet he did not get the help he needed” Angela Smith

“I even had to rely on my mother, who was in her 80s, to help him out, make him drinks and drive him to the day centre.

“What gets me is that this is a medical condition, he was diagnosed, and yet he did not get the help he needed from the NHS. My life was a nightmare.”

However, that has now changed. Four years ago, after many years of battling, she finally convinced the NHS to fund Freddie’s care.

He now has what is called a continuing care package, which means carers are now funded to look after him at home.

Mrs Smith even gets respite care meaning she can put him in a home while she goes on holiday.

“It has made the world of difference. Like many people, I would not want him to go in a home full-time, but to do that you do need help.

“I am getting that now, but I know I am one of the lucky ones. So many people don’t get what I do and I think that is wrong.”

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Alzheimers Society

Alzheimers Research Trust
Alzheimers Society

Dutch researchers found Alzheimer’s was 2.5 times more likely in people with a history of depression.

Similarly, US researchers, examining Catholic clergy, found those with signs of depression were more likely to go on to develop Alzheimer’s.

The Dutch appears in the journal Neurology and the US study in Archives of General Psychiatry.

The Dutch study was small – 486 people over an average of six years, with just 33 people developing Alzheimer’s.

But it found that people who showed signs of depression before the age of 60 were four times more likely to develop Alzheimer’s.

“We don’t know yet whether depression contributes to the development of Alzheimer’s disease, or whether another unknown factor causes both depression and dementia” Dr Monique Breteler Erasmus University Medical Center

The researchers, from the Erasmus University Medical Center in Rotterdam, said more work was needed to fully understand the link between Alzheimer’s and depression.

Lead researcher Dr Monique Breteler said: “We don’t know yet whether depression contributes to the development of Alzheimer’s disease, or whether another unknown factor causes both depression and dementia.”

One theory is that depression leads to the loss of cells in two areas of the brain, the hippocampus and the amygdala, which then contributes to Alzheimer’s disease.

However, the latest study found no difference in the size of these two brain areas in people with depression and people who had never developed the condition.

Second study

The findings were echoed in a second study by Rush University in the US published in Archives of General Psychiatry.

The researchers followed more than 900 members of the Catholic clergy for up to 13 years during which time 190 developed Alzheimer’s.

They found that those with more signs of depression at the start of the study were more likely to develop Alzheimer’s.

But there was little evidence of an increase in depressive symptoms during the early stages of disease.

Even after the diagnosis of Alzheimer’s was made there was no general increase in depression, but rather an increase that was confined to individuals with certain personality traits.

The researchers said their findings suggested that depression was a risk factor for Alzheimer’s disease – rather than a subtle early sign of its underlying pathology.

Researcher Dr Robert Wilson said: “Depressive symptoms may be associated with distinctive changes in the brain that somehow reduce neural reserve, which is the brain’s ability to tolerate the pathology associated with Alzheimer’s disease.”

Rebecca Wood, of the Alzheimer’s Research Trust, said the research was interesting, and potentially useful.

She said: “Identifying people at higher risk could lead to ways to reduce the number of people who develop dementia, help researchers to understand more about dementia and create new avenues of research.”

Dr Susanne Sorensen, head of research at the Alzheimer’s Society, said: “More research is needed to clarify the relationship between dementia and depression and determine whether depression causes changes in the brain that make dementia more likely.”

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A US team compared the brains of 35 people who had Alzheimer’s “plaques”, some of whom died with sharp minds and others who showed no dementia symptoms.

The hippocampus, an area at the base of the brain, was on average 20% larger in those with cognitive functions intact.

The Alzheimer’s Society cautioned that it was a “relatively small study”.

The research was presented at a meeting of the American Academy of Neurology.

It has long been recognised that people can die with all the biological evidence of Alzheimer’s – such as a build-up of plaques and tangles within the brain – but having remained perfectly lucid until the last.

Researchers at Oregon Health and Science University in Portland compared the brains of 12 such people with 23 others who had similar levels of plaques, but had been diagnosed with Alzheimer’s before death.

Prevention strategies

“This work is consistent with increasing research that has shown that people with higher levels of education or cognitive reserve may be protected from some of the effects of dementia” Professor Clive Ballard Alzheimer’s Society

The hippocampus is located close to the junction with the spinal cord and is believed to “encode” experiences so they can be stored as long-term memories in another part of the brain.

“This larger hippocampus may protect these people from the effects of Alzheimer’s disease-related brain changes,” said lead researcher Deniz Erten-Lyons.

“Hopefully this will lead us eventually to prevention strategies.”

The Alzheimer’s Society said it remained unclear from this “relatively small study” whether the larger hippocampus really was the reason why people with dementia did not display the signs.

“However this work is consistent with increasing research that has shown that people with higher levels of education or cognitive reserve may be protected from some of the effects of dementia,” said Professor Clive Ballard.

“This is an exciting area of research which needs more exploration.”

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A study of 900 people aged over 60 found early onset was most likely in those who also had a high-risk gene.

A second US study found people with high cholesterol in their early 40s are one and a half times more likely to develop Alzheimer’s.

The research was presented at an American Academy of Neurology meeting.

It has been estimated that a delay in the onset of Alzheimer’s disease by five years would lead to a 50% drop in the number of cases.

“It’s possible that if we can reduce or eliminate heavy smoking and drinking, we could substantially delay the onset of Alzheimer’s disease for people and reduce the number of people who have Alzheimer’s at any point in time” Dr Ranjan Duara

The researchers said their findings showed heavy drinking and smoking were two of the most important preventable risk factors for the condition.

Those taking part in the study had been diagnosed with possible or probable Alzheimer’s disease and smoking and drinking history was obtained from family members.

Risk factors

Heavy drinking, defined as more than two drinks a day was found to lead to an almost five-year earlier onset of Alzheimer’s.

And those who smoked more than 20 cigarettes a day developed the disease two years sooner.

People with a specific gene – APOE variant 4 – developed Alzheimer’s disease three years earlier than those without the gene variant.

All three risk factors together were associated with onset of the disease 8.5 years earlier than those with none of the risk factors.

Study leader, Dr Ranjan Duara, from Mount Sinai Medical Center in Florida said: “It’s possible that if we can reduce or eliminate heavy smoking and drinking, we could substantially delay the onset of Alzheimer’s disease for people and reduce the number of people who have Alzheimer’s at any point in time.”

In the second study, 9,700 men and women were followed from the age of 40.

Those with cholesterol levels higher than around six millimols per litre (mmol/L) had a one and a half times higher risk of developing Alzheimer’s than those with low cholesterol.

“High mid-life cholesterol increased the risk of Alzheimer’s disease regardless of diabetes, high blood pressure, obesity, smoking and late-life stroke,” said researcher Alina Solomon.

Dr Susanne Sorensen, head of research at the Alzheimer’s Society said the research added to the weight of evidence on drinking and smoking habits and the risk of developing dementia.

“The best way to reduce your risk is to eat a balanced diet rich in antioxidants and vitamins and to exercise regularly.

“Not smoking, drinking only in moderation and getting your blood pressure and cholesterol checked regularly throughout life are also important ways people can reduce their risk of dementia.”

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Alzheimers Society

Two studies support a link between high blood pressure and dementia risk – with one by an Imperial College London team suggesting treatment could cut this.

This study, by published in the Lancet Neurology journal, found blood pressure drugs reduce dementia by 13%.

The Alzheimer’s Society said better control could save 15,000 lives a year.

“Only half of people over 65 receive effective treatment, yet we know treatment works” Professor Clive Ballard Alzheimer’s Society

As many as one in four people has high blood pressure, in many cases undiagnosed or untreated.

The precise reasons why high blood pressure might increase the risk of dementia are not fully understood although many scientists believe that it can starve the brain of bloodflow and the oxygen it carries.

Patients suffering this restricted bloodflow are often described as having “vascular dementia”, and account for approximately a quarter of dementia patients.

Other types of dementia, such as Alzheimer’s disease, have no obvious link to bloodflow, but some experts think that blood pressure may still be somehow contributory in some cases.

The Lancet Neurology study looked at a trial of elderly patients with high blood pressure to see if those who were receiving treatment were less likely to develop any form of dementia compared with those left untreated.

Clear benefit

The trial was stopped early after the benefits of treatment in terms of reducing strokes and heart disease were so obvious it became unethical to deny them to everyone.

Although this meant that no benefits in terms of dementia could be found, when these results were combined with other similar studies in different age groups, the incidence of dementia was 13% lower in the treated groups.

Dr Ingmar Skoog, from the Institute of Neurosciences at Sweden’s Goteburg University, said that the need to treat high blood pressure, reducing heart attacks and strokes, was clear, even without the additional results on dementia.

Rebecca Wood, from the Alzheimer’s Research Trust, said the finding was an “exciting development”, which, if repeated, could offer hope to the 700,000 people in the UK with dementia.

Healthy living

The Alzheimer’s Society, however, stressed the need to try to prevent the disease.

Its own unpublished research suggested that vascular dementia was six times more likely to develop in people who had high blood pressure in their 40s and 50s.

If “best practice” in blood pressure treatment was applied to the UK population, it said, with every case detected and treated appropriately, this would save 15,000 lives a year.

Professor Clive Ballard, its director of research, said: “Only half of people over 65 receive effective treatment, yet we know treatment works.”

The charity’s chief executive, Neil Hunt, urged everyone, even those in middle age, to have regular blood pressure and cholesterol checks.

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Alzheimers Society

Who’s affected?
The older a person is, the greater the chance they will develop a disease that harms the brain. Diseases that damage the areas that control thinking, memory, reasoning and language can lead to dementia.

It’s rare in people under the age of 60, but affects one person in 20 over the age of 65 and one in five over 80.

What causes it?

In a small number of cases the disease is reversible

When someone is diagnosed with dementia it’s vital the cause is established as far as possible because in a small number of cases the disease is reversible.

Even when the cause is not reversible, a clear diagnosis is important as different drugs are recommended in different types of dementia.

Causes include:

– Diseases resulting in progressive degeneration or death of nerve cells. These include Alzheimer’s (which accounts for more than half of all cases), Parkinson’s disease, Huntington’s disease, Creutzfeldt-Jakob disease and a group of conditions referred to as frontotemporal dementia (FTD). Another condition, called Lewy Body dementia, affects 20 per cent of people with dementia.
– Conditions, such as atherosclerosis, that harm the blood vessels supplying the brain. This type of dementia is known as vascular dementia and accounts for about 20 per cent of dementia cases.
– Conditions producing a dementia that can be reversed with treatment. These include hypothyroidism (underactive thyroid), vitamin B12 deficiency, folate deficiency, syphilis of the nervous system, subdural haematoma (a blood clot round the brain, usually following a blow to the head), hypercalcaemia (abnormally high calcium levels), undiagnosed diabetes, brain tumours or infections, and a condition called normal pressure hydrocephalus.
– Some medicines can interfere with concentration and memory, producing dementia-like symptoms. These include tranquilisers and sleeping pills, antidepressants and certain drugs with an anticholinergic effect (for example, some hayfever and cold remedies, some stomach ulcer drugs and treatments for diarrhoea).

What are the symptoms?
People with dementia often don’t look ill, especially in the early stages, and may have no particular symptoms. But family and friends may notice a change in the person’s personality, or that they seem to have problems remembering things.

The condition usually progresses slowly, and three types of symptoms may appear:

– Cognitive problems – a disturbance of understanding, memory, thinking, calculation, learning capacity, language and judgement.
– Functional problems – difficulty carrying out complex tasks and, as the condition progresses, difficulty with daily living activities, such as personal hygiene and dressing.
– Emotional problems – changes in mood, loss of emotional control and a withdrawal from previous interests, activities and social interactions.

Different types of dementia show slightly different patterns of disease. For example, in Lewy Body dementia, severity varies markedly from day to day, while in Alzheimer’s there is only slight variation from day to day.

In frontotemporal dementia (including Pick’s disease), shrinking of the frontal and temporal lobes of the brain typically causes problems with either behaviour and/or language but not with memory.

People with FTD often become disinhibited and irritable, rude, aggressive or apathetic. They may change their normal habits, become more interested in sex and neglect basic personal hygiene.

At the same time, they lose insight and don’t understand why their behaviour’s causing distress. Alternatively, or at the same time, they may progressively struggle to speak or understand speech. FTD tends to affect younger people (average age of onset is 60), has a strong inherited pattern and is usually relentlessly progressive with behaviour that’s difficult to control.

How is it diagnosed?
There’s no single test that can identify dementia, although a range of blood tests and sophisticated brain scans can help and are important in ruling out reversible causes.

Diagnosis is made by an assessment of symptoms and the use of brief questionnaires that test ability to remember facts, or draw simple diagrams.

What’s the treatment?
Most types of dementia progress slowly. People may live with the condition for ten years or more, requiring increasing levels of support as they become less independent. By carefully planning the person’s environment, and giving structure to their day with supportive activities, it may be possible to reduce the impact of the symptoms.

While there is no treatment that can cure progressive dementia, drugs (especially a type known as cholinesterase inhibitors) play an important part in controlling symptoms and can enable a person with dementia to live independently in the community for longer.

These treatments may also help behavioural symptoms such as restlessness or agitation, and improve the quality of life for the person with dementia and their carers. Some people don’t respond to any existing treatments.

Possible future treatments
Scientists are investigating the use of stem cell therapy, antioxidants and vaccination to stop plaque build-up in the brain.

It’s unclear how beneficial the herb Gingko biloba is in delaying the progression of Alzheimer’s and vascular dementia, and relieving their symptoms. There’s some evidence suggesting it may help.

Mental activity is believed to slow the progress of certain types of dementia, so keeping the brain active by doing puzzles and crosswords, for example, is recommended.

Depression is common among people with dementia and antidepressants can also help to improve symptoms.

This article was last medically reviewed by Dr Rob Hicks in January 2008

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Alzheimers Society

What causes it?
The exact cause of Alzheimer’s disease isn’t known, although some risk factors are known. The risk of developing the disease increases with age, for example.

There’s a higher risk of Alzheimer’s if a family member has the disease. However, inherited genetic factors are responsible in only a small number of families.

When the disease is inherited, it tends to lead to early onset of Alzheimer’s, usually between the ages of 35 and 60. One of several different genes may be at fault, such as the presenilin-1 gene on chromosome 14 or the amyloid precursor protein gene on chromosome 21.

Most cases of Alzheimer’s develop later in life and the genetic link is weaker. The genes at fault here are those for apolipoprotein E. Problems with these genes increase the risk of disease but don’t make it certain – other factors are involved.

Scientists believe other problematic genes may be located on chromosomes 9, 10 and 12. Clearly, it’s a complicated situation with much yet to be explained.

What are the symptoms?
Memory and the ability to think clearly are gradually lost over time. There may also be a change in personality. Someone who used to be a calm person may become agitated or upset more easily, for example. Behaviour problems and communication difficulties may also occur.

People with severe Alzheimer’s may find it difficult to perform everyday tasks, such as dressing, washing and eating. As time passes they may not recognise people or their surroundings, so it’s common for them to go for a walk and get lost.

Other problems, such as depression, may also develop.

What’s the treatment?
There’s no cure for Alzheimer’s disease, but drugs are available that may slow the loss of mental function in mild to moderate cases.

There’s some evidence the herb ginkgo biloba and vitamin E may help delay progression of the disease, too, but further research is required.

Treatment can be given for symptoms such as depression. Techniques to aid memory, such as writing lists or reminders, can be helpful in the early stages.

Support and help can be provided by social services for those with Alzheimer’s disease and their carers, but full-time residential care may be necessary in the later stages of the disease.

Tests to identify those in the early stages of Alzheimer’s disease are in development.

Can it be prevented?
The same risk factors for heart disease are believed to increase the risk of Alzheimer’s. So although there’s no definitive way to prevent the disease, not smoking, keeping blood pressure and cholesterol at healthy levels, taking regular exercise, maintaining a healthy weight and eating a healthy diet rich in the antioxidant vitamins C and E and oily fish are all sensible.

Some research has suggested that taking non-steroidal anti-inflammatory drigs (NSAIDs) or cholesterol-lowering statin drugs may lessen the risk of Alzheimer’s disease, but this research continues.

Other research into brain stem cell therapy, antioxidant therapy and a vaccination to prevent build up of plaques on the brain is also ongoing.

Advice and support
Alzheimer’s Society
Tel: 020 7306 0606
Email: enquiries@alzheimers.org.uk
Website: www.alzheimers.org.uk

Alzheimer’s Scotland – Tel: 0131 243 1453

This article was last medically reviewed by Dr Rob Hicks in October 2007

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Alzheimers Society

An Alzheimer’s Society poll of 2,300 people in England found two thirds of patients paid towards care such as help with washing, eating and dressing.

The charity said this should be free as it was linked to a medical condition, but was often classed as a social care need and therefore means-tested.

The government said dementia was a significant challenge facing society.

An estimated 570,000 people have the condition in England, and the figure is expected to double within 30 years.

“Dementia is now one of the most significant health challenges facing our society” Department of Health spokeswoman

The survey, of patients and carers, found a third of people being cared for at home were paying more than £50 a week, while more than half of those in care homes were paying £300.

The Alzheimer’s Society estimates that, overall, patients pay £2bn a year in fees that should be picked up by the NHS, and described it as a dementia tax.

The charity said dementia patients were discriminated against in a way other patients, such as those with cancer, would never be.

Alzheimer’s Society chief executive Neil Hunt said: “The system is not functioning and the way dementia patients are being treated is unfair.

“As the care is because of a medical condition it should be treated free under the NHS. That is not happening and probably won’t if we are being realistic.”

The charity has produced its report as the government carries out a consultation ahead of its social care green paper early next year, which is expected to propose a reform of funding.

Currently, anyone with assets of more than £22,250, including property, has to pay for their care.

Similar systems operate in Wales and Northern Ireland, but in Scotland personal care is free.

However, all four nations have been dogged by problems of rationing, with ever more limited packages being offered as councils struggle to keep pace with the ageing population.

‘Fair and transparent’

Mr Hunt said he believed people would be willing to contribute towards the cost of their care, but that it should be a fair and transparent system.

He said the charity did not have a recommended model in mind, although many experts favour some sort of basic care guarantee that could be topped up by contributions from the individual.

The Department of Health said its consultation ahead of the green paper on social care funding was aimed at finding a fair solution for “patients and taxpayers”.

But a spokeswoman added good quality care was “not just about money, but how services are provided and coordinated” – something which was being addressed by the dementia strategy launched earlier this month.

And she said: “Dementia is now one of the most significant health challenges facing our society.”

News reported by The BBC

Alzheimers Research Trust
Alzheimers Society

An Alzheimer’s Society poll of 2,300 people in England found two thirds of patients paid towards care such as help with washing, eating and dressing.

The charity said this should be free as it was linked to a medical condition, but was often classed as a social care need and therefore means-tested.

The government said dementia was a significant challenge facing society.

An estimated 570,000 people have the condition in England, and the figure is expected to double within 30 years.

“Dementia is now one of the most significant health challenges facing our society” Department of Health spokeswoman

‘My wages went on husband’s care’

The survey, of patients and carers, found a third of people being cared for at home were paying more than £50 a week, while more than half of those in care homes were paying £300.

The Alzheimer’s Society estimates that, overall, patients pay £2bn a year in fees that should be picked up by the NHS, and described it as a dementia tax.

The charity said dementia patients were discriminated against in a way other patients, such as those with cancer, would never be.

Alzheimer’s Society chief executive Neil Hunt said: “The system is not functioning and the way dementia patients are being treated is unfair.

“As the care is because of a medical condition it should be treated free under the NHS. That is not happening and probably won’t if we are being realistic.”

The charity has produced its report as the government carries out a consultation ahead of its social care green paper early next year, which is expected to propose a reform of funding.

Currently, anyone with assets of more than £22,250, including property, has to pay for their care.

Similar systems operate in Wales and Northern Ireland, but in Scotland personal care is free.

However, all four nations have been dogged by problems of rationing, with ever more limited packages being offered as councils struggle to keep pace with the ageing population.

‘Fair and transparent’

Mr Hunt said he believed people would be willing to contribute towards the cost of their care, but that it should be a fair and transparent system.

He said the charity did not have a recommended model in mind, although many experts favour some sort of basic care guarantee that could be topped up by contributions from the individual.

The Department of Health said its consultation ahead of the green paper on social care funding was aimed at finding a fair solution for “patients and taxpayers”.

But a spokeswoman added good quality care was “not just about money, but how services are provided and coordinated” – something which was being addressed by the dementia strategy launched earlier this month.

And she said: “Dementia is now one of the most significant health challenges facing our society.”

News reported by BBC