June 20, 2005
Brain Scans Can Predict Alzheimer's Disease Onset 9 Years In Advance

Brain PET scans of the brain's hippocampus analysed with new software can predict who will get Alzheimer's Disease at least 9 years in advance. (same article here)

New York University School of Medicine researchers have developed a brain scan-based computer program that quickly and accurately measures metabolic activity in a key region of the brain affected in the early stages of Alzheimer's disease. Applying the program, they demonstrated that reductions in brain metabolism in healthy individuals were associated with the later development of the memory robbing disease, according to a new study.

"This is the first demonstration that reduced metabolic activity in the hippocampus may be used to help predict future Alzheimer's disease," says Lisa Mosconi, Ph.D., a research scientist in the Department of Psychiatry, who developed the computer program and led the new study. "Although our findings need to be replicated in other studies," she says, "our technique offers the possibility that we will be able to screen for Alzheimer's in individuals who aren't cognitively impaired."

How would you like to get a brain scan and then be told that in 5 or 10 years you will start to lose your memory and eventually forget everything thing you know?

Dr. Mosconi and colleagues have recently published the technical details of the program, called "HipMask," in the June 2005 issue of the journal Neurology. She will present the new findings on June 20 at the Alzheimer's Association International Conference on Prevention of Dementia held in Washington.

The computer program is an image analysis technique that allows researchers to standardize and computer automate the sampling of PET brain scans. The NYU researchers hope the technique will enable doctors to measure the metabolic rate of the hippocampus and detect below-normal metabolic activity.

The technique grew out of years of research by Mony de Leon, Ed.D., Professor of Psychiatry and Director of the Center for Brain Health. His group was the first to demonstrate with CT and later with MRI scans that the hippocampus, a sea-horse shaped area of the brain associated with memory and learning, diminishes in size as Alzheimer's disease progresses from mild cognitive impairment to full-blown dementia.

Yet until now there has been no reliable way to accurately and quickly measure the hippocampal area of the brain on a PET scan. The hippocampus is small and its size and shape are affected greatly in individuals with Alzheimer's, making it difficult to sample this region. HipMask is a sampling technique that uses MRI to anatomically probe the PET scan.

MRI relies on electromagnetic energy to excite water molecules in the brain to create an anatomical map of the brain. The MRI was used in the study to determine the total volume of the hippocampus and then to define that portion (namely the HipMask) that was shared by all persons regardless of their disease status. PET employs radioactively labeled glucose to show the brain at work and the HipMask was applied to these scans to derive estimates of the hippocampal glucose metabolism.

The researchers followed 53 healthy, normal subjects between the ages of 54 and 80 for at least 9 years and in some cases for as long as 24 years. All subjects received two FDG-PET scans -- one at baseline and a follow-up after 3 years. Thirty individuals had a second follow-up scan after another seven years. Altogether there were 136 PET scans.

The researchers applied the HipMask to all 136 scans. The results showed that hippocampal glucose metabolism, as determined by the HipMask, was significantly reduced 15% to 40% on the first scan, compared to controls, of those 25 individuals who would later experience cognitive decline related to either mild cognitive impairment or to Alzheimer's. The researchers found that the baseline hippocampal glucose metabolism was the only brain or clinical measure that predicted the future cognitive decline.

"Right now, we can show with great accuracy who will develop Alzheimer's nine years in advance of symptoms, and our projections suggest we might be able to take that out as far as 15 years," says Dr. de Leon, whose longitudinal study is funded by the National Institutes of Health (NIH).

"Our basic results will need to be replicated in other studies and expanded to include PET data from diverse patient groups," adds Dr. De Leon. "But we're confident this is a strong beginning, demonstrating accurate detection of early Alzheimer's disease. Now we have a better tool to examine disease progression, and we anticipate this might open some doors to prevention treatment strategies."

Most people are not going to get brain PET scans. The greater value of this finding is in research on methods to prevent or delay the onset of Alzheimer's Disease.

Don't wait for that PET scan result to come back with bad news. Reduce your risk of Alzheimers.

Drinking fruit or vegetable juice 3 times a week appeared to prevent three quarters of Alzheimer's cases.

People who drink fruit or vegetable juice at least three times a week seem four times less likely to develop Alzheimer's than nonjuice drinkers, according to a study of 1,800 elderly Japanese Americans. The theory is that juice contains high levels of polyphenols, compounds that may play a brain-protective role.

Less education, gum disease early in life, or a stroke were more important than genes in determining who got dementia, concluded a study of 100 dementia patients with healthy identical twins. Education stimulates neuronal growth; gum disease is a marker of brain-harming inflammation.

Exercise and moderate alcohol consumption also appear to lower the risk of Alzheimer's Disease.

Middle-aged sons and daughters of people with Alzheimer's disease may be able to reduce their risk of getting the disorder through lifestyle measures such as exercise, avoiding gum disease, moderate alcohol consumption, and drinking fruit and vegetable juice, according to new research.

Keep your teeth clean. Drink some V-8 or pure fruit juice. Get regular exercise. They'll all protect your brain.

Update: Periodontal disease increases the risk of Alzheimer's.

A new study of dementia in identical twins suggests that exposure to inflammation early in life quadruples one's risk of developing Alzheimer's disease.

Margaret Gatz, lead author and professor of psychology in the USC College of Letters, Arts and Sciences, is slated to present her findings at the first Alzheimer's Association International Conference on Prevention of Dementia, to be held June 18-21 in Washington, D.C.

If confirmed, the link would add inflammatory burden to the short list of preventable risk factors for Alzheimer's.

Previous studies by Gatz and others have shown that Alzheimer's is strongly genetic: If one twin has the disease, his or her identical twin has a 60 percent chance of developing it.

Stroke and a short period of formal education both increase the odds of dementia, but not of Alzheimer's specifically, the new study found.

Dementia is an umbrella term for many conditions, including Alzheimer's.

"People can plan a life span that will alter dementia risk," Gatz said. "And these aren't risk factors that are unique to dementia. Many of these are also risk factors for other disorders. This is good news."

Gatz's team, which included researchers from the Karolinska Institute in Stockholm, Sweden, sifted the 20,000 participants in the Swedish Twin Registry for the 109 "discordant" pairs where only one twin had been diagnosed with dementia.

Information about participants' education, activities and health history came from surveys they completed in the 1960s, when the registry was created, and from hospital discharge records.

The surveys included questions about loose or missing teeth. Gatz and colleagues used the answers to build a crude indicator of periodontal disease.

"We're talking about gum disease, but it was measured by teeth lost or loose," Gatz said. "It's not perfect. Given it's not perfect, it's even more striking that it's such a solid risk factor."

The conclusion is not that good oral health can prevent Alzheimer's, but that an inflammatory burden early in life, as represented by chronic gum disease, may have severe consequences later.

I think that previous sentence is poorly worded. Surely good oral health will reduce the risk of Alzheimer's. Poor oral health is not the only souce of inflammatory burden. But it is one big source.

Gatz was inspired to focus on inflammation by the work of USC gerontologists Caleb Finch and Eileen Crimmins, who published a paper in the journal Science linking today's record life spans to lower rates of childhood infectious diseases, such as gum disease, flu, rheumatic fever, tuberculosis and other illnesses.

Such diseases are often preventable, raising hope for prevention of Alzheimer's.

"If what we're indexing with periodontal disease is some kind of inflammatory burden, then it is probably speaking to general health conditions," Gatz said. "There was in our twins quite a lot of periodontal disease, and at that time in Sweden there was a lot of poverty."

The study, titled "Potentially Modifiable Risk Factors From Dementia: Evidence From Identical Twins," also found that mental activities at age 40, such as reading or attending cultural events, did not seem to lower the risk of developing Alzheimer's.

So crossword puzzles do not help. Then I guess writing a blog isn't going to help either. Heavy sigh.

Previous reports have suggested a link between education and lowered risk of Alzheimer's. But when education is controlled for by using twins with different levels of education then the education effect becomes very low. One possible explanation might be that level of education is a proxy for level of intelligence. Higher intelligence people might be more likely to avoid behaviors (like eating junk food or not practicing good dental hygeine) than lower intelligence people. Or perhaps having smarter brains allows a person to deteriorate for longer from a higher level of initial cognitive function before the effects of Alzheimer's become apparent.

Participants who had more education than their twins were at slightly lower risk of developing dementia, but the influence of education on Alzheimer's risk was statistically negligible.

"Once one controls for genes, the level of education is not a huge risk factor," said Gatz, who questioned popular attitudes linking Alzheimer's or dementia to mental inactivity.

Drinking soda leads to tooth decay. So if you don't want your kids to get Alzheimer's Disease in their old age then do not let them drink soda.

Share |      Randall Parker, 2005 June 20 12:33 AM  Brain Alzheimers Disease

Kurt said at June 20, 2005 8:51 AM:


You ask how would you like to know that you're going to loose it all to Alzheimer's in the next 10 years? I would want to know this information ONLY if I had the right to go into cryonic suspension immediately AND to take my financial assets with me, with ZERO interference from the government. I would also want the right to instantly terminate the life (in an extremely painfull manner, with extreme prejudice) of any politician, bureaucrat, or religious person who even thought to question my choice to a decent cryopreservation, while my neurostructure is still intact.

People ask me why I have a ferocious hostility towards religion. I tell them, "my hostility towards religion will go away the day that religion accepts the sovereignty and autonomy of the individual to determine his or her own destiny". Until religion recognizes this right, I can never accept it as my friend.

Engineer-Poet said at June 20, 2005 9:34 AM:

Physician consultation:  $250

Combination brain scan:  $1275

Individual genetic screening and review with lifestyle counselor:  $225

Knowing that you're on the road to Alzheimer's in time to take an exit ramp:  Priceless.

Medicare is fine if you don't mind wasting away in a nursing home; for everything else, there's MasterCard.

bigelow said at June 21, 2005 5:21 AM:

"Drinking fruit or vegetable juice 3 times a week appeared to prevent three quarters of Alzheimer's cases."

My fatherinlaw went from Alzheimer's. It sucked very much. Pay attention to the drinking more juice and teeth cleaning.

Lei said at June 21, 2005 8:30 AM:

Fruit juices aren't really much better than soda. They're just as full of sugar and calories that will increase your chances of obesity and insulin resistance.

Curious said at June 21, 2005 2:53 PM:

Does fruit definately not have the same beneficial effect as fruit juice? Or is it that the effect of fruit juice is known, and the effect of fruit is unknown?

Randall Parker said at June 21, 2005 3:46 PM:


I linked to an article that claims the pure juices are more beneficial since they have higher concentrations of polyphenols. Perhaps the pulp doesn't much polyphenols in it.

Be aware that vegetables and fruits vary considerably in their polyphenol concentrations. I'd google up some rankings but I'm too busy at the moment. Suffice to say that they vary by orders of magnitude. So you could probably do better by eating particular fruits and vegetables than by drinking juices instead of whole foods.

Elisabeth Otero, RD/LD, CDE said at June 22, 2005 10:06 AM:

I'm with curious and Lei. I doubt that the same benefits would not apply to whole fruit consumption. Juice is liquid sugar. Our state-and country for that matter-need to be very careful about the amount of liquid sugar being consumed (flavored drinks, soda, sports drinks, iced coffees, juices etc.) as I believe (seen in professional and personal life) excess consumption of these products leads to obesity and diabetes.

Randall Parker said at June 22, 2005 10:55 AM:

Lei, Elisabeth Otero,

Surely there are plenty of fruit drinks that have added sugar and artificial flavor and little in the way of benefit. But pure 100% real fruit juices provide compounds that have health benefits. Yes, the fructose is still a problem. But it is far from clear that the harm of the fructose in pure juices outweighs the benefits of polyphenols and other compounds.

remo williams said at June 22, 2005 10:59 AM:

er...drinking apple juice and excercising is great, but doesnt the FuturePundit have anything to say about a cure for Alzheimer's within 5 years as specialists think ? We will have other things to worry about, but none of us reading this will personally develop the disease.

Elisabeth is wrong to insinuate excess consumption of juice, etc leads to diabetes. They can lead to becoming overweight which can lead to diabetes if a person also doesnt excercise. Important steps to include.

Randall Parker said at June 22, 2005 11:41 AM:


Alzheimer's starts causing cognitive decay a decade or two before diagnosis. Someone in their 40s or 50s or 60s who reads this (and I'm guessing you are younger than that) and who follows the advice may well have better brain function in the coming decade as a result.

I've posted in the past on promising immunotherapy treatments against Alzheimer's. I've complained about the attitudes of regulatory agencies toward vaccines that cause side effects. I think 5 years is far too optimistic because even if an effective curative treatment entered phase I trials tomorrow I don't think it would be thru phase III and approved and on sale in 5 years. We might have a cure on the market in 10 years. I think 15 years is highly probable. But what about the aging if your brain in the meantime?

remo williams said at June 22, 2005 8:35 PM:

_Very_ few people get Alzheimer's cognitive decline before 60 and most after 75 , although I agree people should drink especially apple juice , excercise, etc. The 5 year timeline was reported after a recent conference, but I suspect we will see major improvement within 5 years and and end to the disease 5 years after that.

"Research indicates that 1 percent of the population aged 65-74 has severe dementia, increasing to 7 percent of those aged 75-84 and to 25 percent of those 85 or older...the lifetime risk is under 1%"

Id argue that the risk for anyone 55 or younger approaches zero, assuming a cure 10 years away.

Randall Parker said at June 22, 2005 9:15 PM:


Let me explain all my unstated assumptions.

First off, yes, some people get Alzheimer's at age 55. So they started declining when 40 or 45. But put that aside. Look at the bigger of brain aging.

Your mind will be 5 years older 5 years from now and 10 years older 10 years from now. My guess (and this is a moderately knowledgeable guess) is that food compounds which delay the onset of Alzheimer's probably do it by quenching reactive oxygen species or perhaps reducing brain inflammation by some other mechanism. My guess is that those compounds also slow general brain aging. Well, a cure for Alzheimer's is not going to reverse all of the other causes of brain aging. Ditto for a cure for Parkinson's.

The brain is the hardest thing to rejuvenate because you can't replace it as a whole and you don't want to selectively kill old cells in it the way that it would be desirable to do in the rest of the body (killing senescent cells is one of the 7 SENS therapies - and senescent cells probably are source of reactive oxygen species - i.e. free radicals). I'm keen on anything that slows brain aging. I look at every report on factors that delay the onset of any neurodegenerative disease as potentially a method to slow general brain aging.

Brain rejuvenation will certainly be helped by treatments that remove or reshape misshapen proteins. So som of the cures for Alzheimer's and Parkinson's treatments might be worth getting for for non-disease sufferers. But brain rejuvenation will require a lot more than just those treatments. I want to slow the rate of cognitive decline for the next 20 or 30 years because it is going to take that long or perhaps longer before we can reverse all the causes of brain aging.

So, yes, drink that apple juice and grape juice and cherry juice and pineapple juice and eat whole fruits. Ditto for vegetables.

remo williams said at June 22, 2005 10:02 PM:

We still need a perspective of what the fruit juices can do in terms of brain deterioration. I would encourage everyone to drink the apple juice, etc but 99% are never going to get Alzheimers. And 100% of those not inflicted with Alzheimer's and Parkinsons are going to have brain decline that is not regarded as serious. Apple juice helps this mostly at the margin. Like eating blueberries and strawberries, it is good to get that 5% margin, but we have to be realistic about the effects of the apple juice, crannberries etc.

I think we disagree on the pace of brain rejunivation therepy. Supposedly we are near developing memory enhancers that would restore a 65 yr old memory to that of a 35 year old. In general, everything seems to point to more of a 10-20 year time frame for serious rejuvinatrion and enahncement rather than 20-30.

Apple juice and excercise until then.

Divna Unipan said at June 25, 2005 2:23 PM:

My father has advance dementia. I do not know if it is Alzheimer or another disease. How I can find out the true diagnosis and if it can be cure?

Thank you,


Alex said at July 11, 2005 6:15 PM:

I wonder if those who published research on fruit juice looked at the people who actully prone to drink regulary fruit juice. I bet they are health/diet and exersice fanats. Most likely the fruit-drinking folks have some other healthy habits or may be even genetic makeup that makes them different from those who are indifferent to juices. Alex (MD)

Jane said at September 14, 2005 9:02 AM:

One problem which I see with this study, at least as it is reported, is that it does not give the total amounts of fruits and vegetables consumed by the subjects. What are we comparing here? Are the people drinking juice simply bringing their total consumption up to an adequate level (say, for example, the recommended six 1/2 cup servings per day) or are they ingesting more than is generally considered adequate?

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