New research links dietary nutrient intake with cognitive health in older adults

 Ask your doctor to give you EXACT SPECIFICS of the foods and supplements. If s/he can't, YOU DON'T HAVE A FUNCTIONING STROKE DOCTOR!

New research links dietary nutrient intake with cognitive health in older adults

Recent research has found a connection between higher intake of certain dietary nutrients and a lower risk of cognitive impairment in older adults. This large-scale study, involving thousands of participants, suggests that what we eat might play a crucial role in maintaining our cognitive health as we age. The findings have been published in the journal. The motivation behind the study stemmed from a growing concern about dementia and cognitive decline, particularly as the global population ages. Dementia, including its most common form, Alzheimer’s disease, poses significant challenges not only to those affected but also to healthcare systems and societies at large. Recognizing that approximately one-third of Alzheimer’s disease cases may be linked to modifiable risk factors, the researchers focused on diet as a crucial, alterable aspect.Tiarnán Keenan, the study’s lead author and Stadtman Tenure-Track Investigator at the National Eye Institute, explained: “In Western medicine, we are starting to rediscover the enormous impact that diet can have on health: ‘In food, excellent medicine can be found; in food, bad medicine can be found’ (Hippocrates, De Alimento). Indeed, nutrition is a critical part of public health: ‘La destinée des nations dépend de la manière dont elles se nourrissent’ (Brillat-Savarin, Physiologie du Goût). This may be particularly true for chronic diseases of aging, such as dementia and age-related macular degeneration.” “We had previously demonstrated very strong links between a healthy diet and decreased risk of age-related macular degeneration. The natural next step was to examine the same question for cognitive impairment and dementia, since we had two excellent datasets with the unusual combination of comprehensive cognitive function testing and detailed dietary information in a large population of study participants followed for at least five years.” The study analyzed data from two significant research projects conducted in the United States (known as the Age-Related Eye Disease Studies). The first project enrolled 4,757 participants aged between 55 and 80 years, while the second involved 4,203 individuals aged 50 to 85 years. These participants were initially part of research focusing on eye health but also underwent detailed cognitive function testing. Researchers looked closely at the participants’ diets, using comprehensive questionnaires to assess the intake of various nutrients. They then explored how these dietary patterns related to the participants’ cognitive abilities. New Smartwatch that can test blood sugar painlessly in seconds

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The researchers found that certain nutrients were linked to a lower risk of cognitive impairment. These included several vitamins, minerals, and specific types of fats found in fish (DHA and EPA). On the flip side, some dietary components seemed to increase the risk. Notably, diets high in saturated fats and foods that cause high blood sugar levels (high glycemic index/load) were associated with a greater risk of cognitive decline.

“The main message is that a diet of foods rich in particular nutrients is very strongly linked to decreased risk of cognitive impairment and therefore likely dementia,” Keenan told PsyPost. “The nutrients with these protective associations include vitamins (e.g., A, B, C, and E), minerals (e.g., copper, magnesium, selenium, and zinc), carotenoids (e.g., lutein, zeaxanthin, beta-carotene, and lycopene), lipids (e.g., omega-3 fatty acids), and fiber.”

“By contrast, a diet of foods with high levels of particular fats (e.g., monounsaturated and saturated fatty acids) and diets with high glycemic index are strongly associated with increased risk of cognitive impairment.”

“Overall, this supports the idea that a Mediterranean-like diet pattern is strongly associated with decreased risk of cognitive impairment and dementia,” Keenan said. “Important aspects of the Mediterranean diet pattern include frequent consumption of plant-based foods and infrequent consumption of saturated/monounsaturated fats (e.g., red meat) or foods with high glycemic index (e.g., refined sugars). These nutrients may maximize cognitive reserve against impairment and dementia and could be suitable candidates for randomized trials.”

While certain dietary choices seemed to influence the risk of cognitive impairment at one point in time, they did not significantly alter the rate of cognitive decline over time. But this lack of a longitudinal relationship might be a result of methodological limitations.

“Despite the significant results for risk of cognitive impairment in many cases, we did not observe slower levels of decline in cognitive function for any of these nutrients,” Keenan explained. “The distinction between significant results for cross-sectional but not longitudinal differences may seem surprising. However, this is likely related either to insufficient power to detect longitudinal differences or to a genuine distinction.”

While the study offers valuable insights, it’s important to note that the findings are based on observational data, meaning they can show associations but not cause-and-effect relationships.

“The caveats to this study include the possibility of residual confounding, i.e., that the associations observed might be related partially to factors other than dietary intake of each nutrient itself,” Keenan said. “However, we took all steps possible to minimize confounding (e.g., by adjusting for total calorie intake, body mass index, smoking status, and other factors). Similarly, since these are observational data, it is not possible to know definitely that nutrient intake is causally linked to altered risk of cognitive impairment. Ultimately, the highest level of evidence would come from a randomized controlled trial.”

Nevertheless, the study offers an important stepping stone in our understanding of diet’s role in cognitive health. It highlights the potential of certain nutrients in maintaining cognitive function and underscores the need for further research in this vital area of public health.

The study, “Dietary nutrient intake and cognitive function in the Age-Related Eye Disease Studies 1 and 2“, was authored by Tiarnan D. L. Keenan, Elvira Agrón, Emily Y. Chew, and the AREDS and AREDS2 Research Groups.

AMD(age-related macular degeneration) Strongly Associated With Heart Disease and Stroke

 If you have age-related macular degeneration ask your doctor for EXACT PROTOCOLS  that prevent CVD and stroke. 

YOUR DOCTOR'S RESPONSIBILITY!

AMD(age-related macular degeneration) Strongly Associated With Heart Disease and Stroke

Subretinal drusenoid deposits found in 85% of patients with AMD and CVD in small study

by Greg Laub, Director, Video, MedPage Today August 10, 2022

Subretinal drusenoid deposits (SDD) had a significant association with underlying cardiovascular disease (CVD), adding a missing link between age-related macular degeneration (AMD) and CVD, according to a prospective study presented at the American Society of Retina Specialists (ASRS) meeting.

In this exclusive video, study author R. Theodore Smith, MD, PhD, of Mount Sinai Health System in New York City, discusses the study and the clinical implications.

The following is a transcript of his remarks:

A connection between these three diseases [SDD, AMD, and CVD] has been suspected for decades, but it's never been pinned down. The way we approached the problem was to look at AMD as two separate diseases -- one involving the classic drusen pathways and the other one involving what we call the subretinal drusenoid deposits. And drusen are under the RPE [retinal pigment epithelium], and the subretinal deposits are above the RPE, and they're very different. They're very different genetics, lipid content, risk factors, and so on.

So we chose to segregate a group of 200 AMD patients into 100 approximately with, and another 100 without, the subretinal deposits. And then we looked at their cardiovascular history. And we were pleasantly surprised and almost shocked to find that of the 200 patients, there were 47 in that entire group that had serious cardiovascular disease -- such as cardiac infarction, a severe valvular disease, compromising circulation, or the stroke patients who had significant stenosis of their internal carotid artery, and this blocks the circulation to the eye.

So all these things in common have is that the perfusion eventually getting to the eye is insufficient. Out of these 47 subjects with these severe conditions, 40 out of the 47 showed subretinal deposits in their eyes, and only seven did not. And when we do the odds ratios, the odds of a patient having high-risk vascular disease, given the presence of these deposits in their eyes, is basically 9 to 1, with a very nice confidence interval from like 4 to 15.

So you put these together, we can detect ongoing -- not future, but present -- severe vascular disease in patients with a simple OCT [optical coherence tomography] scan, which is very simply done in our ophthalmology clinics. And we add that to some severe risk factors like HDL [high-density lipoprotein] and so forth, we can even do it more accurately. This promises to change everything.

In clinical practice, once all this has been formulated and codified, it is possible that we could have these fairly inexpensive retinal cameras available through[out] the medical world so that patients can be screened by them as part of their routine medical care. And then they could be told immediately whether or not they have these high-risk features, which means they should then have further workup -- let's say an echocardiogram, carotid Doppler -- and then take it to the next level to find out what may be hiding. But as a screening tool, that's where we really like to take it.

The Relationship of Atherosclerosis to the 10-Year Cumulative Incidence of Age-related Macular Degeneration: The Beaver Dam Studies

So maybe I don't have to worry any more than usual.
http://www.docguide.com/relationship-atherosclerosis-10-year-cumulative-incidence-age-related-macular-degeneration-beaver-da?hash=7e422beb&eid=31292&alrhash=3c9ebc-5aeefe0d7ed0a73e6788dca4998df39c
OBJECTIVE: To describe the relationships of intima-media thickness (IMT), plaque in the carotid artery, angina, myocardial infarction (MI), and stroke to the 10-year cumulative incidence of early and late age-related macular degeneration (AMD) and progression of AMD. DESIGN: Cohort study. PARTICIPANTS: A total of 1700 persons aged 53 to 96 years who participated in both the Epidemiology of Hearing Loss Study and the Beaver Dam Eye Study in 1998-2000, with photographs gradable for AMD at 5-year (2003-2005) and 10-year (2008-2010) follow-up examinations. METHODS: The IMT and presence of plaque were assessed using B-mode ultrasonography of the carotid artery. Presence of angina, MI, and stroke were defined on the basis of a self-reported history of physician diagnosis. The presence and severity of AMD were determined by systematic grading of stereoscopic color fundus photographs. MAIN OUTCOME MEASURES: Age-related macular degeneration. RESULTS: The 10-year cumulative incidence of early AMD was 15.7%, and the 10-year cumulative incidence of late AMD was 4.0%. After adjusting for age, sex, body mass index, smoking status, age-related maculopathy susceptibility 2 (ARMS2) and complement factor H (CFH) genotypes, and other factors, mean IMT was associated with the 10-year incidence of early AMD (odds ratio [OR] per 0.1 mm IMT, 1.11; 95% confidence interval [CI], 1.00-1.21; P = 0.03) and late AMD (OR per 0.1 mm IMT, 1.27; CI, 1.10-1.47; P = 0.001). Mean IMT was associated with the 10-year incidence of pure geographic atrophy (OR per 0.1 mm IMT, 1.31; CI, 1.05-1.64; P = 0.02) but not exudative AMD (OR per 0.1 mm IMT, 1.14; CI, 0.97-1.34; P = 0.11). Similar associations were found for maximum IMT. The number of sites with plaque was related to the incidence of late AMD (OR per 0.1 mm IMT, 2.79 for 4-6 sites vs. none; CI, 1.06-7.37; P = 0.04) but not to early AMD. A history of angina, MI, or stroke was not related to any incident AMD outcome. CONCLUSIONS: In these population-based data, carotid artery IMT and carotid plaques had a weak relationship to the incidence of late AMD that was independent of systemic and genetic risk factors. Angina, MI, and stroke were not related to AMD. It is unclear whether the carotid IMT is a risk indicator of processes affecting Bruch's membrane and the retinal pigment epithelium, or a measure of atherosclerosis affecting susceptibility to AMD. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Aspirin Use Linked to Macular Degeneration

This matches up with the Netherlands study in 2011. So ask your wise doctor what you should be doing. In the last 2 years has your doctor talked to you about this?
http://www.medpagetoday.com/Ophthalmology/GeneralOphthalmology/36943?
Regular aspirin use was associated with an elevated risk for neovascular age-related macular degeneration, an Australian study suggested, but actual causality remains uncertain.
After adjustment for age, sex, and history of smoking, the odds ratio for macular degeneration in aspirin users was 2.37 (95% CI 1.25 to 4.49), according to Jie Jin Wang, PhD, of the University of Sydney, and colleagues.
With further adjustment for body mass index, systolic blood pressure, and history of cardiovascular disease (CVD), the association remained (OR 2.46, 95% CI 1.25 to 4.83), the researchers reported online in JAMA Internal Medicine.
However, "the evidence is insufficient to adjudicate the relationship between aspirin and [age-related macular degeneration], thereby challenging causal inferences," Sanjay Kaul, MD, and George A. Diamond, MD, of Cedars-Sinai Medical Center in Los Angeles, wrote in an invited commentary.
A recent cross-sectional study suggested a possible link between neovascular age-related macular degeneration and routine aspirin use, but other studies have yielded conflicting findings.
To prospectively examine this potential link, Wang and colleagues analyzed data from the Blue Mountains Eye Study, which included 2,389 Australians ages 49 and older.
Retinal examinations were done every 5 years, and lesions classified as neovascular, or wet macular degeneration, or geographic atrophy, also known as dry macular degeneration.
Aspirin use was reported on a structured questionnaire, and information on relevant risk factors was obtained during physical examination and history reports.
A total of 257 participants were regular aspirin users. Compared with nonusers, they were older and more often had conditions such as diabetes, cardiovascular disease, or elevated blood pressure.
During 15 years of follow-up, age-related wet macular degeneration was identified in 63 individuals.
Among regular users, the cumulative incidence was 1.9%, 7%, and 9.3% at years 5, 10, and 15, while the incidence among nonusers was 0.8%, 1.6%, and 3.7%, respectively.
The incidence of neovascular macular degeneration rose with more frequent aspirin use, increasing from 2.2% in those who never took aspirin, to 2.9% for those who used it only occasionally, and 5.8% for those who took aspirin routinely.
Aspirin use was not associated with risk for geographic atrophy.
Additional secondary analyses found that the risk was four times higher in patients with a history of CVD (OR 4.36, 95% CI 1.24 to 15.32) and in those without a polymorphism on CFHY402H, a gene involved in the complement pathway that has been linked with macular degeneration (OR 4.17, 95% CI 1.05 to 16.49).
The researchers also considered whether other medications often taken by aspirin users, such as acetaminophen and beta-blockers, might influence risk, and the results were negative.
These results create a quandary for the many patients using aspirin, particularly those taking the drug as secondary prevention of CVD, according to Wang's group.
"Aspirin is one of the most effective CVD treatments and reduces recurrent CVD events by one-fifth," they observed.
However, significant adverse events can occur, such as cerebral and gastrointestinal bleeding.
"Our present study now raises the possibility that the risk of neovascular [age-related macular degeneration] may also need to be considered," they stated.

Nonetheless, they conceded that the risk is small, at slightly under 4% over 15 years, and the evidence is thus far insufficient to support a change in practice away from widespread aspirin use, except for patients at very high risk for macular degeneration.

Any risk-benefit analysis also must consider the availability of effective -- but expensive -- treatments for neovascular age-related macular degeneration.
"Any decision concerning whether to stop aspirin is thus complex and needs to be individualized," they wrote.
Limitations of the study included the possibility of confounding by indication and a lack of information on the reasons why participants were taking aspirin.
In their invited commentary, Kaul and Diamond wrote, "These findings are, at best, hypothesis-generating that should await validation in prospective randomized studies before guiding clinical practice or patient behavior."
They also advised that the choice of whether to use aspirin should focus on whether the indication is for secondary CVD prevention, "where the benefits of aspirin are indisputable and greatly exceed the risk," or for primary prevention, where the evidence is less clear, as well as the extent of the person's risk for macular degeneration and bleeding.
"In the final analysis, decisions about aspirin use are best made by balancing the risks against the benefits in the context of each individual's medical history and value judgments," they added.
Other experts, such as Shawn Wilker, MD, of University Hospitals Case Medical Center in Cleveland, agreed on the importance of individual risk.
"I think a reasonable circumstance when you could ask a patient not to take aspirin might be one in which there is a very low risk of mortality from cardiovascular disease or if that person is at very great risk of losing vision from macular degeneration," Wilker said in an interview.
Journal editor Kenneth E. Covinsky, MD, also weighed in in an editor's note, stating that "as with many good studies, the data are not definitive enough to suggest changes in clinical practice."
"Rather, we hope the study galvanizes more research on the relationship between aspirin and macular degeneration," Covinsky wrote.

Eye Disorder Tied to Stroke Risk

I don't think they have cause and effect down yet. Ask your doctor.
http://www.medpagetoday.com/Cardiology/Strokes/32382
Patients with age-related macular degeneration appear to be at risk for both ischemic and hemorrhagic stroke, researchers found.
Through an average follow-up of 13 years, middle-age individuals with the eye condition had a higher rate of any stroke (7.6% versus 4.9%), according to M. Kamran Ikram, MD, of the Singapore Eye Research Institute, and colleagues.
The difference was consistent for both ischemic stroke (6.4% versus 4.4%) and intracerebral hemorrhage (1.2% versus 0.4%), the researchers reported online in Stroke: Journal of the American Heart Association.
"These data provide further insight into common pathophysiological processes between age-related macular degeneration and stroke subtypes," they wrote.
Previous studies have examined the relationship between age-related macular degeneration and stroke, with some showing a positive association and others showing no correlation.
The current study included 12,216 middle-age individuals (ages 45 to 64) who had retinal photographs taken at the third examination visit of the Atherosclerosis Risk in Communities (ARIC) study.
Overall, 591 participants (4.9%) were diagnosed with age-related macular degeneration. Of those, 576 had early disease, defined as the presence of either soft drusen alone, retinal pigment epithelial depigmentation alone, or a combination of soft drusen with increased retinal pigment and/or retinal pigment epithelial depigmentation.
The rest had late disease, defined as the presence of exudative age-related macular degeneration or pure geographic atrophy.
Through follow-up, 619 of the participants (5.1%) had a stroke, including 548 cerebral infarctions, 57 intracerebral hemorrhages, and 14 subarachnoid hemorrhages.
Those with any age-related macular degeneration were about 50% more likely to have a stroke during follow-up (HR 1.51, 95% CI 1.11 to 2.06) after adjustment for age, sex, race, field center, mean arterial blood pressure, antihypertensive medications, fasting glucose, total cholesterol, HDL cholesterol, triglyceride levels, body mass index, atrial fibrillation, white blood cell count, cigarette smoking, and alcohol consumption.
The relationship was stronger for intracerebral hemorrhage (HR 2.64, 95% CI 1.18 to 5.87) than for ischemic stroke (HR 1.42, 95% CI 1.01 to 1.99).
"Recently, antivascular endothelial growth factor agents used in the treatment of neovascular age-related macular degeneration have been suggested to increase the risk of intracerebral hemorrhage," the authors noted. "Based on our findings, it appears that patients with [the eye disease] may already be at an increased risk of intracerebral hemorrhage and, thus, antivascular endothelial growth factor therapy could potentially increase this risk further."
"However," they added, "additional studies are needed to confirm this potential side effect of antivascular endothelial growth factor agents."
They acknowledged some limitations of the study, including the fact that the technique used for taking retinal photographs makes grading age-related macular degeneration more variable, the use of pictures from only one eye for each participant, and the low number of patients with late age-related macular degeneration.

Study shows daily aspirin intake can lead to blindness

I'm sure most of us are taking aspirin.
http://medicalxpress.com/news/2011-10-daily-aspirin-intake.html
A new study published in Ophthalmology reveals that while taking a daily aspirin may reduce the risks of heart disease and stroke, a disturbing side effect has also been noted to increase the risk of developing macular degeneration.

Macular degeneration is the leading cause of vision loss in Americans over the age of 60 and affects millions of Americans. It is an age related disease that destroys the central vision by killing cells in the macula. Macular degeneration comes in two forms known as dry and wet. Dry macular degeneration is more common and less severe while wet macular degeneration is the more severe.
Researchers, led by Dr. Paulus de Jong from the Netherlands Institute for Neuroscience and Academic Medical center, looked at medical information on some 4,700 adults over the age of 65. Of those patients, 839 were taking aspirin on a daily basis. The researchers discovered that out of those 839, 36 suffered from an advanced form of macular degeneration known as wet macular degeneration. This works out to about four out of every 100 patients on daily aspirin.
When they looked at patients that were not taking aspirin on a daily basis, the number dropped to only two out of every 100 diagnosed with wet macular degeneration. The researchers learned that the aspirin connection seems to only relate to the increased risk to wet macular degeneration and not to the dry form of the disease.
This study does not show that aspirin causes the vision loss but that it may somehow exacerbate the disease. The researchers warn that while cautioning patients on the risk to visual health when taking daily aspirin is advisable, the risk does not outweigh the cardiovascular benefits in patients with cardiovascular disease.
De Jong says that larger studies are needed in order to follow patients over time to see just how daily aspirin use plays a role in macular degeneration and if there is a way to reap the cardiovascular benefits while reducing the risk of vision complications.
More information: Associations between Aspirin Use and Aging Macula Disorder: The European Eye Study, Ophthalmology, doi:10.1016/j.ophtha.2011.06.025
Abstract
Objective
To study associations between aspirin use and early and late aging macula disorder (AMD).
Design
Population-based cross-sectional European Eye Study in 7 centers from northern to southern Europe.
Participants
In total, 4691 participants 65 years of age and older, collected by random sampling.
Methods
Aspirin intake and possible confounders for AMD were ascertained by a structured questionnaire. Ophthalmic and basic systemic measurements were performed in a standardized way. The study classified AMD according to the modified International Classification System on digitized fundus images at 1 grading center. Nonfasting blood samples were analyzed in a single laboratory. Associations were analyzed by logistic regression.
Main Outcome Measures
Odds ratios (ORs) for AMD in aspirin users.
Results
Early AMD was present in 36.4% of the participants and late AMD was present in 3.3% of participants. Monthly aspirin use was reported by 1931 (41.2%), at least once weekly by 7%, and daily use by 17.3%. For daily aspirin users, the ORs, adjusted for potential confounders, showed a steady increase with increasing severity of AMD grades. These were: grade 1, 1.26 (95% confidence interval [CI], 1.08–1.46; P<0.001); grade 2, 1.42 (95% CI, 1.18–1.70), and wet late AMD, 2.22 (95% CI, 1.61–3.05).
Conclusions
Frequent aspirin use was associated with early AMD and wet late AMD, and the ORs rose with increasing frequency of consumption. This interesting observation warrants further evaluation of the associations between aspirin use and AMD.
Financial Disclosure(s)
The author(s) have no proprietary or commercial interest in any materials discussed in this article.