LISA HANCHEY
Posted: Friday, October 21, 2011 11:27 am

Dr. Jeff Keller

Louisiana has a higher incidence of Alzheimer’s disease – and onset at a younger age – than the rest of the country. In fact, studies at the Pennington Biomedical Center in Baton Rouge show that our citizens are at significantly greater risk of developing this incurable condition.

Nationwide, 1 in 7 people aged 65, and 1 in 2 aged 85 and older, have Alzheimer’s disease (AD). AD is the sixth leading cause of all deaths in the US, and the main cause of cause of death in the elderly. “We are working on developing those numbers and giving it more accurately, but the incidence of AD in Louisiana is going to be much higher,” confirmed Dr. Jeffrey Keller, associate executive director at Pennington Biomedical Research Center and director of the Institute for Dementia Research and Prevention (IDRP). “People here get it earlier, and it tends to be more rapidly progressing.”

Since June, 2008, IDRP has been conducting the Louisiana Aging Brain Study on 1,600 participants aged 60 and over, with plans to expand to 2,000. Ninety-seven percent of participants, who are from 37 parishes, come back year after year. Participants receive a free detailed cognitive evaluation annually. “Their reason for participating is that they get a free dementia screening,” Keller explained. “So, they get access to early changes in cognition.”

Through LABrains, Pennington’s  scientists are learning how factors such as sleep, physical activity, obesity, anxiety and depression affect whether people remain stable, decline or develop dementia over time. To date, about 11 percent of participants have developed a dementia during the study. Compared to 50 similar studies nationwide, the number of people in Louisiana who are declining or developing dementia are twice as high as the other states. But, the bigger issue is that LABrains’ participants are developing dementia sooner.

“Our average of participants is right at 70 years of age,” Keller observed. “And, in most of the other studies, the average age is in the 80s. So, not only do we have a higher incidence, but it’s happening at a younger age. And, as I work with physicians around the state, they also see a disproportionate number of early onset dementias in people. So, this is a very real thing.”

What’s the reason? For the past 60 years, researchers believed that plaques and tangles in the brain caused Alzheimer’s disease. “That’s no longer thought to be the case,” Keller revealed. “They clearly play some kind of role. But, they don’t appear to be the sole cause of AD.”

A recent study in Japan with more than 1,000 older adults showed that people who were pre-diabetic in their 40s were at much higher risk of developing dementia in later life. “We think that Alzheimer’s disease is going to be highly linked to metabolic disease and physical activity,” Keller opined. “Just about everybody in the field of AD believes that diabetes is a major factor in developing dementia.”

Louisiana consistently falls within the Center for Disease Control’s diabetes, stroke and cancer belts. Our citizens also have higher rates of atherosclerosis and cardiovascular disease. “What we now understand is that dementia is one of these other features,” Keller explained. “And so, it’s really not surprising that Louisiana has higher rates of dementia.”

While the average lifespan in the US has increased every year, Louisiana is one of three states with a decrease in lifespan. “So, it’s no surprise that in states where lifespan is decreasing, those people also have more age-related diseases,” Keller observed.

Studies also show clear links between urban versus rural lifestyles and the incidence of dementia. Louisiana has a higher rural population and a lower economic status than much of country. “There is clearly a lifestyle issue in Louisiana, which is one of the biggest predictors as to whether or not people will develop AD,” Keller confirmed.

Pennington has secured large international pharmaceutical trials for the latest in dementia treatment. Currently, four drugs are on the market to help alleviate the symptoms of Alzheimer’s. With Louisiana’s higher numbers of Alzheimer’s patients, pharmaceutical companies are flocking to the state to talk to the center about new products in development. 

IDRP’s researchers are finding that the medications which are now available are effective in about 25 percent of patients and work for an average of nine to 12 months. “So, 75 percent of the people get no benefit, and for those people who do get benefit, it doesn’t work for more than a year,” Keller said. “So, this is a big problem.”

Pennington invites physicians to send their patients to IDRP for the latest clinical trials. “Feel free to contact us and send us your patients,” Keller said. “We can work with them, not only to enroll them in a study, but also to enroll them in these trials. We are a great partner with physicians; we are not a competitor.”

Besides LABrains, Pennington is conducting the Jo Lamar Dementia Study for patients who have been diagnosed with dementia. A major focus of both studies now is understanding fall risk in the elderly and the role dementia plays. For this component, IDRP researchers perform very state-of-the-art measures of gait and physical performance. “There is a strong relationship between the function of the brain and the decreased performance of the body,” Keller observed. “These things are highly related to falls. If we can improve some of these things involved in fall risk, we might be able to impact the rate at which the brain function declines over time. And conversely, it opens the door to anything that can help slow the deterioration and specific aspects of cognition may help reduce fall risk.”