Alzheimers/Dementia & OSA?

I need your help finding some references... We have a friend of the family and he has progressive memory loss. Up until yesterday our family members kept saying it was Alzheimers. I finally pushed for more information, and it turns out the friend has been having lots of mini strokes (or lots of "thrombosis" clots? in the brain). His short term memory is getting worse (has been, for the last years). I think his friends call his condition Alzheimers because of the memory loss. To me, it sounds more like Vascular Dementia (if i remember the name correctly). Apparently his sister has something similar. He is 68. Yesterday I learned that he snores so much his wife cannot sleep. So in my mind, the first thing that I thought of of course was OSA.

He has a neurologist he sees, so I will not pretend to diagnose or treat him (and anyway I don't have all his medical history). Nevertheless, I would like to hand him and his wife enough info that they can take to their doctor, in order to convince the doc to give him a sleep study. He does not fit the typical OSA profile: he is skinny, not much daytime sleepiness as far as I know, but I cannot remember his jaw/neck/face shape right now. The key is the excessive snoring and the strokes or blood clots.

Do any of you have any good references/articles that talk about:
- link between (vascular) dementia and OSA? Comorbidity, or rates of co-occurence
- effect of successful pap therapy on (vascular) dementia (reversibility or slowing of decline?)
- any other type of info that might help a neurologist look at OSA As the cause of his neural problems...
- possibly the same, for alzheimers (but i do not think he has both alzheimers and vascular dementia, it is one or the other)

Thank You!!!

echo wrote: ....
He has a neurologist he sees, so I will not pretend to diagnose or treat him (and anyway I don't have all his medical history).

One of the good things I did for my mother was to fire her arrogant neurologist and have the drugs he prescribed discontinued. He was treating her with drugs for Alzheimers when IMO it was clearly vascular dementia caused by years of untreated OSA that caused all of her problems. The family agrees with my decision because my mother improved after the Alzheimer's drugs were discontinued. Mom's GP also agrees with the decision. (Unfortunately all this was done after mother's dementia progressed to the point she would never be able to understand or use CPAP.)


Neurologists will fiercely fight a diagnosis of sleep apnea causing dementia. This is because they have a lot of education and time in theories that say otherwise. Plus with all that education and board certifications they don't want to admit it is a simple little thing like CPAP that can treat their patients problems - no GLORY for the neurologists in prescribing a little fan and mask. No GLORY in making a diagnosis that a typical cpaptalk member can make with a little observation and questioning. No grants, entertainment and trips from the drug makers!!!

Here are some resources on dementia/brain damage and sleep apnea.

Dr. Steven Park

Researchers found that when people with Alzheimer’s and OSA are treated with CPAP, cognition and memory improves. This study was published in the November edition of the Journal of the American Geriatrics Society. They estimated that about 70-80% of Alzheimer’s patients have at least 5 apneas every hour.

….

Another study showed that people with sleep apnea had significantly reduced blood flow rates to certain critical areas of the brain. Other studies have shown that the acoustic trauma from snoring can worsen carotid artery plaque formation.

http://doctorstevenpark.com/sleep-apnea ... rs-disease
http://doctorstevenpark.com/can-sleep-a ... zheimers-2

Brain Structural Changes in Obstructive Sleep Apnea
from the book Deadly Sleep by Dr. Mack Jones


A number of neuroimaging studies have been performed on patients with OSA

including CT, MRI. PET and SPECT scans, revealing various defects, but none has

displayed anything quiet as astonishing or as dramatic as in a study published in

SLEEP July7, 2008, by Dr. Paul M. Macey. et.al. (10) The report reveals results of a

new MRI technique called DTI (Diffusion Tensor Imaging). Without going into details of

this new test, let me tell you that it is an extremely sensitive method of determining

damaged nerve fibers (axons). This new test, not available until recently, reveals

multiple areas of brain damage in OSA patients never known to exist.


DTI revealed various sized color-coded yellow-orange patches of brain damage

scattered throughout the brains of a group of forty-one men and women subjects with

OSA. Their ages ranged from thirty-eight to fifty two years old and they had not yet

been treated. The areas of nerve fiber injury are located in critical regions of brain

including prefrontal, temporal and parietal lobes. The cerebellum and brainstem were

equally involved. This is the first report of DTI imaging of a middle aged group with

OSA to my knowledge. The findings are momentous.

Other resources:

Study links sleep apnea to memory loss http://newsroom.ucla.edu/portal/ucla/uc ... 51534.aspx

Sleep apnea's effect on the brain may be more severe than previously thought http://www.physorg.com/news163245364.html

And an encouraging report:

CPAP Therapy Restores Brain Tissue in Adults with Sleep Apnea
Obstructive sleep apnea patients had reductions of gray-matter volume at baseline but showed significant gray-matter volume increase after 3 months of CPAP therapy, according to a research abstract at SLEEP 2010.

Results indicate that obstructive sleep apnea patients showed focal reductions of gray-matter volume at baseline in the left hippocampus, posterior parietal cortex, and right superior frontal gyrus. Significant gray-matter volume increases were observed after 3 months of CPAP therapy in hippocampal and frontal structures. No further improvement in gray-matter volume was observed after 1 year of CPAP therapy.

"OSA patients showed cognitive impairment associated with neurostructural damage affecting specific cerebral regions," said principal investigator Vincenza Castronovo, PhD, clinical psychologist and psychotherapist and sleep laboratory coordinator at the University Vita-Salute San Raffaele and San Raffaele Scientific Institute in Milan, Italy. "In addition, we show that most of the neuropsychological deficits are reversed after three months of treatment with CPAP and, for the first time, that such cognitive improvements parallel an increase of grey-matter volume in specific hippocampal and frontal brain regions. The increase of grey-matter volume in these regions is significantly correlated with the improvement at neuropsychological tests of executive functioning and short-term memory."
http://www.sleepmeeting.org/PosterViewing.aspx

Good luck with your friend and tell that neurologist Rooster says to .... Oh, nevermind.

Rooster, thanks for the links to journal articles.

Interesting links there, Rooster, thanks.

Thank you very much for the links Rooster!!! I will print them out and read them in detail this weekend. I will try to get him to wear my pulse ox this weekend. If he truly has some desats, I will give him my backup cpap as a temporary solution. Interesting observation about neurologists... maybe we need to talk to his GP instead (who might still defer to the neurologist though ). Anyway, first step, gathering info and doing overnight pulse ox!

I am sorry to hear about your mother. I had a vague memory about several people on the forum mentioning this issue, one of them must have been you, sorry I didn't remember. With all that's known about Alzheimer's and the advanced abilitities of MRI and nuclear medicine scanners, you would think a differential diagnosis between the two would be easy! We learned about them in one of my neuro classes a few years ago, and there is a very clear (visible) difference between the two diseases, when you image them for example with PET or SPECT. I guess they don't do them routinely, in order to save money?!

Good links, thanks Rooster.

The cause of the multi-infarct type of dementia is clearly the repeated strokes that literally leave holes in the brain. It's strongly associated with damage to small arterioles due to hypertension; so the whole nexus of causes of hypertension is involved. OTOH, the Alzheimer's type of gradual degeneration probably has multiple causes. I think Rooster's hypothesis that OSA can be a cause and has been overlooked is reasonable, and I'm glad to see that evidence is starting to be published.

However, in the situation Echo's dealing with, debating the cause of her friend's dementia with his neurologist is probably not a worthwhile approach.

I would take the tack that whatever the cause of his dementia, adding on repeated episodes of hypoxia can't be good. If anything, hypoxia must make things worse, or at least, interfere with the brain's process of recovery (recruiting new neurons to do the tasks previously done by the missing ones). Taking an oximdtry printout to the neurologist seems like a good strategy.

It would be surprising if a neurologist, whatever his/her theories, dismissed an oximetry record documenting episodes of desaturation.

M.D.Hosehead wrote:However, in the situation Echo's dealing with, debating the cause of her friend's dementia with his neurologist is probably not a worthwhile approach.

Agreed. I would not even debate it with his GP. Just collect all the obvious symptoms of sleep apnea and present them to the GP.

Medicare will not agree for a sleep study due to Alzheimers, vascular dementia, or memory problems. You need to present all the "accepted" symptoms - snoring, excess daytime sleepiness, fatigue, witnessed breathing cessations during sleep, neck and belly fat, jaw structure. Hopefully the GP is aware of the symptoms and wide prevalence of OSA.

After years of our long-time GP trying unsuccessfuly to convince my husband he needed a sleep study and subsequently undergoing 2 Triple Bypasses and 1 Aortic Valve Replacement,we than put ourselves in the hands of a neurologist who really didn't know his patient. He was insisting he had severe vascular dementia or Alzheimers and wanted to prescribe meds as well as an Excelon patch which I believe is a pretty heavy duty Alz drug. I knew his condition was very serious but I just didn't believe he had Alz/Dementia. Our GP also raised holy hell with that diagnosis and finally Mike agreed to a sleep study. Fast forward 6 months into cpap therapy and he was playing games and puzzles on the computer, going to the library for books, watching TV until bedtime and making his corny jokes again. He never has fully regained his short-term memory although he's a little sharper now and our Dr feels years of oxygen deprivation is the cause coupled with the normal aging factor. I try not to think of the wasted years and I'm grateful he has responded so well to cpap therapy.

Roster, thanks for this thread, an informative one as usual and a chance to vent.

Based on the hx of having TIA or stoke probably more likely vascualr dementia. Often it can be revealed by MRI if there is damage. Alzheimer's usually goes by hx. As far as having OSA. Depending on where the damage is in the brain the vascular damage could affect his breathing.

Not sure where you live but i am in Ontario Canada and the Alzheimer's society here has ++ info that may help. I am sure there must be a UIS equivalent.

The Alzheimers Association is dominated by neurologists and exists for neurologists, not patients. They are looking only for neurological causes and treatments of dementias.

They will fight any reference to sleep apnea being a cause of dementia and they see their jobs, power and influence declining dramatically if it is found that a large portion of dementia cases are caused by sleep-disordered breathing.