A Major Cause of Age-Related Memory Loss Identified

Study points to possible treatments and confirms distinction between memory loss due to aging and that of Alzheimer’s

A team of Columbia University Medical Center (CUMC) researchers, led by Nobel laureate Eric R. Kandel, MD, has found that deficiency of a protein called RbAp48 in the hippocampus is a significant contributor to age-related memory loss and that this form of memory loss is reversible. The study, conducted in postmortem human brain cells and in mice, also offers the strongest causal evidence that age-related memory loss and Alzheimer’s disease are distinct conditions. The findings were published today in the online edition of Science Translational Medicine.

“Our study provides compelling evidence that age-related memory loss is a syndrome in its own right, apart from Alzheimer’s. In addition to the implications for the study, diagnosis, and treatment of memory disorders, these results have public health consequences,” said Dr. Kandel, who is University Professor & Kavli Professor of Brain Science, co-director of Columbia’s Mortimer B. Zuckerman Mind Brain Behavior Institute, director of the Kavli Institute for Brain Science, and senior investigator, Howard Hughes Medical Institute, at CUMC. Dr. Kandel received a share of the 2000 Nobel Prize in Physiology or Medicine for his discoveries related to the molecular basis of memory.

The hippocampus, a brain region that consists of several interconnected subregions, each with a distinct neuron population, plays a vital role in memory. Studies have shown that Alzheimer’s disease hampers memory by first acting on the entorhinal cortex (EC), a brain region that provides the major input pathways to the hippocampus. It was initially thought that age-related memory loss is an early manifestation of Alzheimer’s, but mounting evidence suggests that it is a distinct process that affects the dentate gyrus (DG), a subregion of the hippocampus that receives direct input from the EC.

“Until now, however, no one has been able to identify specific molecular defects involved in age-related memory loss in humans,” said co-senior author Scott A. Small, MD, the Boris and Rose Katz Professor of Neurology and director of the Alzheimer’s Research Center at CUMC.

The current study was designed to look for more direct evidence that age-related memory loss differs from Alzheimer’s disease. The researchers began by performing microarray (gene expression) analyses of postmortem brain cells from the DG of eight people, ages 33 to 88, all of whom were free of brain disease. The team also analyzed cells from their EC, which served as controls since that brain structure is unaffected by aging. The analyses identified 17 candidate genes that might be related to aging in the DG. The most significant changes occurred in a gene called RbAp48, whoseexpressiondeclined steadily with aging across the study subjects.

To determine whether RbAp48plays an active role in age-related memory loss, the researchers turned to mouse studies. “The first question was whether RbAp48is downregulated in aged mice,” said lead author Elias Pavlopoulos, PhD, associate research scientist in neuroscience at CUMC. “And indeed, that turned out to be the case—there was a reduction of RbAp48 protein in the DG.”

When the researchers genetically inhibited RbAp48inthe brains ofhealthy young mice, they found the same memory loss as in aged mice, as measured by novel object recognition and water maze memory tests. When RbAp48inhibition was turned off, the mice’s memory returned to normal.

The researchers also did functional MRI (fMRI) studies of the mice with inhibited RbAp48 and found a selective effect in the DG, similar to that seen in fMRI studies of aged mice, monkeys, and humans. This effect of RbAp48 inhibition on the DG was accompanied by defects in molecular mechanisms similar to those found in aged mice. The fMRI profile and mechanistic defects of the mice with inhibited RbAp48 returned to normal when the inhibition was turned off.

In another experiment, the researchers used viral gene transfer and increased RbAp48expression inthe DG of aged mice. “We were astonished that not only did this improve the mice’s performance on the memory tests, but their performance was comparable to that of young mice,” said Dr. Pavlopoulos.

“The fact that we were able to reverse age-related memory loss in mice is very encouraging,” said Dr. Kandel. “Of course, it’s possible that other changes in the DG contribute to this form of memory loss. But at the very least, it shows that this protein is a major factor, and it speaks to the fact that age-related memory loss is due to a functional change in neurons of some sort. Unlike with Alzheimer’s, there is no significant loss of neurons.”

Finally, the study data suggest that RbAp48 protein mediates its effects, at least in part, through the PKA-CREB1-CBP pathway, which the team had found in earlier studies to be important for age-related memory loss in the mouse. According to the researchers, RbAp48 and the PKA-CREB1-CBP pathway are valid targets for therapeutic intervention. Agents that enhance this pathway have already been shown to improve age-related hippocampal dysfunction in rodents.

“Whether these compounds will work in humans is not known,” said Dr. Small. “But the broader point is that to develop effective interventions, you first have to find the right target. Now we have a good target, and with the mouse we’ve developed, we have a way to screen therapies that might be effective, be they pharmaceuticals, nutraceuticals, or physical and cognitive exercises.”

“There’s been a lot of handwringing over the failures of drug trials based on findings from mouse models of Alzheimer’s,” Dr. Small said. “But this is different. Alzheimer’s does not occur naturally in the mouse. Here, we’ve caused age-related memory loss in the mouse, and we’ve shown it to be relevant to human aging.”

To Preserve Memory Into Old Age, Keep Your Brain Active!

A new study from Rush University Medical Center in Chicago claims reading and writing may preserve memory into old age. By keeping your brain active, says study author Robert S. Wilson, PhD, you’re able to slow the rate at which your memory decreases in later years.

This is not the first time researchers have arrived at such a conclusion, of course. Previous studies have also found keeping the brain active by reading, writing, completing crossword puzzles and more can essentially exercise the brain and keep it limber far into old age. One study also concluded that keeping television consumption to a minimal amount may also boost brain power over the years. Wilson’s study was recently published in the journal Neurology.

“Our study suggests that exercising your brain by taking part in activities such as these across a person’s lifetime, from childhood through old age, is important for brain health in old age,” said Wilson in a statement.

For his study, Wilson gathered nearly 300 people around the age of 80. He then gave them tests which were designed to measure both their memory and cognition each year until they passed away at an average age of 89. The same participants also answered questions about their past, such as whether they read books, did any writing, or engaged in any other mentally stimulating activities. The volunteers answered these questions for every part of their life, from childhood to adolescence, middle age and beyond.

When the participants passed away, their brains were then examined at an autopsy as Wilson’s team looked for physical evidence of dementia, such as lesions in the brain, tangles or plaques. After examining the brains of these volunteers and compiling the data from the questionnaires, Wilson’s team found those who had kept their minds active throughout their lives had a slower rate of memory decline than those who did not often participate in mentally challenging activities. Based on the amount of plaques and tangles in the brains, keeping your brain active is responsible for a 15 percent differential in memory decline.

The study also found the rate of memory decline was reduced by 32 percent in people who kept their brains active late in life. Those who were not mentally active had it much worse; their memories declined 48 percent faster than their actively reading and writing peers.

“Based on this, we shouldn’t underestimate the effects of everyday activities, such as reading and writing, on our children, ourselves and our parents or grandparents,” said Wilson.

And this news is hardly surprising. Doctors, teachers and parents have been admonishing children to turn off the television and pick up a book for years. There is no shortage of studies to back up their claims. A 2009 study, for example, found people who keep their brains active saw a 30 to 50 percent decrease in risk of developing memory loss. This study, conducted by doctors at the Mayo Clinic in Rochester, Minnesota observed people between the ages of 70 and 89 with and without diagnosed memory loss.

Those who were likely to read magazines or engage in other social activities were 40 percent less likely to develop memory loss than homebodies who did not read. Furthermore, those who spent less than seven hours a day watching television were 50 percent less likely to develop memory loss than those who planted themselves in front of the tube for long stretches of time.

New chemical approach to beat Alzheimer’s disease

Scientists at the University of Liverpool and Callaghan Innovation in New Zealand have developed a new chemical approach to help harness the natural ability of complex sugars to treat Alzheimer’s disease.

The team used a new chemical method to produce a library of sugars, called heparan sulphates, which are known to control the formation of the proteins in the brain that cause memory loss.

Chemically produced in the lab

Heparan sulphates are found in nearly every cell of the body, and are similar to the natural blood-thinning drug, heparin. Now scientists have discovered how to produce them chemically in the lab, and found that some of these sugars can inhibit an enzyme that creates small proteins in the brain.

These proteins, called amyloid, disrupt the normal function of cells leading to the progressive memory loss that is characteristic of Alzheimer’s disease.

Professor Jerry Turnbull, from the University’s Institute of Integrative Biology, said: “We are targeting an enzyme, called BACE, which is responsible for creating the amyloid protein. The amyloid builds up in the brain in Alzheimer’s disease and causes damage. BACE has proved to be a difficult enzyme to block despite lots of efforts by drug companies.”

“We are using a new approach, harnessing the natural ability of sugars, based on the blood-thinning drug heparin, to block the action of BACE.”

Dr Peter Tyler, from Callaghan Innovation, added: “We have developed new chemical methods that have allowed us to make the largest set of these sugars produced to date. These new compounds will now be tested to identify those with the best activity and fewest possible side effects, as these have potential for development into a drug treatment that targets the underlying cause of this disease.”

Current treatments only help symptoms

There are more than 800,000 people in the UK, and 50,000 in New Zealand living with dementia. Over half of these have Alzheimer’s disease, the most common cause of dementia. The cost of these diseases to the UK economy stands at £23 billion, more than the cost of cancer and heart disease combined. Current treatments for dementia can help with symptoms, but there are no drugs available that can slow or stop the underlying disease.

Research Reveals Possible Reason for Cholesterol-Drug Side Effects

The U.S. Food and Drug Administration and physicians continue to document that some patients experience fuzzy thinking and memory loss while taking statins, a class of global top-selling cholesterol-lowering drugs. 

A University of Arizona research team has made a novel discovery in brain cells being treated with statin drugs: unusual swellings within neurons, which the team has termed the “beads-on-a-string” effect.

The team is not entirely sure why the beads form, said UA neuroscientist Linda L. Restifo, who leads the investigation. However, the team believes that further investigation of the beads will help inform why some people experience cognitive declines while taking statins.

"What we think we’ve found is a laboratory demonstration of a problem in the neuron that is a more severe version for what is happening in some peoples’ brains when they take statins," said Restifo, a UA professor of neuroscience, neurology and cellular and molecular medicine, and principal investigator on the project.

Restifo and her team’s co-authored study and findings recently were published in Disease Models & Mechanisms, a peer-reviewed journal. Robert Kraft, a former research associate in the department of neuroscience, is lead author on the article.

Restifo and Kraft cite clinical reports noting that statin users often are told by physicians that cognitive disturbances experienced while taking statins were likely due to aging or other effects. However, the UA team’s research offers additional evidence that the cause for such declines in cognition is likely due to a negative response to statins.

The team also has found that removing statins results in a disappearance of the beads-on-a-string, and also a restoration of normal growth.

With research continuing, the UA team intends to investigate how genetics may be involved in the bead formation and, thus, could cause hypersensitivity to the drugs in people. Team members believe that genetic differences could involve neurons directly, or the statin interaction with the blood-brain barrier.

"This is a great first step on the road toward more personalized medication and therapy," said David M. Labiner, who heads the UA department of neurology. "If we can figure out a way to identify patients who will have certain side effects, we can improve therapeutic outcomes."

For now, the UA team has multiple external grants pending, and researchers carry the hope that future research will greatly inform the medical community and patients.

"If we are able to do genetic studies, the goal will be to come up with a predictive test so that a patient with high cholesterol could be tested first to determine whether they have a sensitivity to statins," Restifo said.

Detecting, Understanding a Drugs’ Side Effects

Restifo used the analogy of traffic to explain what she and her colleagues theorize. 

The beads indicate a sort of traffic jam, she described. In the presence of statins, neurons undergo a “dramatic change in their morphology,” said Restifo, also a BIO5 Institute member.

"Those very, very dramatic and obvious swellings are inside the neurons and act like a traffic pileup that is so bad that it disrupts the function of the neurons," she said.

It was Kraft’s observations that led to team’s novel discovery.

Restifo, Kraft and their colleagues had long been investigating mutations in genes, largely for the benefit of advancing discoveries toward the improved treatment of autism and other cognitive disorders.

At the time, and using a blind-screened library of 1,040 drug compounds, the team ran tests on fruit fly neurons, investigating the reduction of defects caused by a mutation when neurons were exposed to different drugs.

The team had shown that one mutation caused the neuron branches to be curly instead of straight, but certain drugs corrected this. The research findings were published in 2006 in the Journal of Neuroscience.

Then, something serendipitous occurred: Kraft observed that one compound, then another and then two more all created the same reaction – “these bulges, which we called beads-on-a-string,’” Kraft said. “And they were the only drugs causing this effect.”

At the end of the earlier investigation, the team decoded the library and found that the four compounds that resulted in the beads-on-a-string were, in fact, statins.

"The ‘beads’ effect of the statins was like a bonus prize from the earlier experiment," Restifo said. "It was so striking, we couldn’t ignore it."

In addition to detecting the beads effect, the team came upon yet another major finding: when statins are removed, the beads-on-a-string effect disappears, offering great promise to those being treated with the drugs.

"For some patients, just as much as statins work to save their lives, they can cause impairments," said Monica Chaung, who has been part of the team and is a UA undergraduate researcher studying molecular and cellular biology and physiology.

"It’s not a one drug fits all," said Chaung, a UA junior who is also in the Honors College. "We suspect different gene mutations alter how people respond to statins."

Having been trained by Kraft in techniques to investigate cultured neurons, Chuang was testing gene mutations and found variation in sensitivity to statins. It was through the work of Chuang and Kraft that the team would later determine that, after removing the statins, the cells were able to repair themselves; the neurotoxicity was not permanent, Restifo said.

"In the clinical literature, you can read reports on fuzzy thinking, which stops when a patient stops taking statins. So, that was a very important demonstration of a parallel between the clinical reports and the laboratory phenomena," Restifo said.

The finding led the team to further investigate the neurotoxicity of statins.

"There is no question that these are very important and very useful drugs," Restifo said. Statins have been shown to lower cholesterol and prevent heart attacks and strokes.

But too much remains unknown about how the drugs’ effects may contribute to muscular, cognitive and behavioral changes.

"We don’t know the implications of the beads, but we have a number of hypotheses to test," Restifo said, adding that further studies should reveal exactly what happens when the transportation system within neurons is disrupted.

Also, given the move toward prescribing statins to children, the need to have an expanded understanding of the effects of statins on cognitive development is critical, Kraft said.

"If statins have an effect on how the nervous system matures, that could be devastating," Kraft said. "Memory loss or any sort of disruption of your memory and cognition can have quite severe effects and negative consequences."

Restifo and her colleagues have multiple grants pending that would enable the team to continue investigating several facets related to the neurotoxicity of statins. Among the major questions is, to what extent does genetics contribute to a person’s sensitivity to statins?

"We have no idea who is at risk. That makes us think that we can use this genetic laboratory assay to infer which of the genes make people susceptible," Restifo said.

"This dramatic change in the morphology of the neurons is something we can now use to ask questions and experiment in the laboratory," she said. "Our contribution is to find a way to ask about genetics and what the genetic vulnerability factors are."

The Possibility for Future Research, Advice

The team’s findings and future research could have important implications for the medical field and for patients with regard to treatment, communication and improved personalized medicine.

"It’s important to look into this to see if people may have some sort of predisposition to the beads effect, and that’s where we want to go with this research," Kraft said. "There must be more research into what effects these drugs have other than just controlling a person’s elevated cholesterol levels."

And even as additional research is ongoing, suggestions already exist for physicians, patients and families.

"Most physicians assume that if a patient doesn’t report side effects, there are no side effects," Labiner said.

"The paternalistic days of medication are hopefully behind us. They should be," Labiner said.

"We can treat lots of things, but the problem is if there are side effects that worsen the treatment, the patient is more likely to shy away from the medication. That’s a bad outcome," he said. "There’s got to be a give and take between the patient and physician."

Patients should feel empowered to ask questions, and deeper questions, about their health and treatment and physicians should be very attentive to any reports of cognitive decline for those patients on statins, she said.

For some, it starts early after starting statins; for others, it takes time. And the signs vary. People may begin losing track of dates, the time or their keys.

"These are not trivial things. This could have a significant impact on your daily life, your interpersonal relationships, your ability to hold a job," Restifo said.

"This is the part of the brain that allows us to think clearly, to plan, to hold onto memories," she said. "If people are concerned that they are having this problem, patients should ask their physicians."

Restifo said open and direct patient-physician communication is even more important for those on statins who have a family history of side effects from statins.

Also, physicians could work more closely with patients to investigate family history and determine a better dosage plan. Even placing additional questions on the family history questionnaire could be useful, she said.

"There is good clinical data that every-other-day dosing give you most of the benefits, and maybe even prevents some of the accumulation of things that result in side effects," Restifo said, suggesting that physicians should try and get a better longitudinal picture on how people react while on statins. 

"Statins have been around now for long enough and are widely prescribed to so many people," she said. "But increased awareness could be very helpful."

Memory Implants

A maverick neuroscientist believes he has deciphered the code by which the brain forms long-term memories.

Theodore Berger, a biomedical engineer and neuroscientist at the University of Southern California in Los Angeles, envisions a day in the not too distant future when a patient with severe memory loss can get help from an electronic implant. In people whose brains have suffered damage from Alzheimer’s, stroke, or injury, disrupted neuronal networks often prevent long-term memories from forming. For more than two decades, Berger has designed silicon chips to mimic the signal processing that those neurons do when they’re functioning properly—the work that allows us to recall experiences and knowledge for more than a minute. Ultimately, Berger wants to restore the ability to create long-term memories by implanting chips like these in the brain.

The idea is so audacious and so far outside the mainstream of neuroscience that many of his colleagues, says Berger, think of him as being just this side of crazy. “They told me I was nuts a long time ago,” he says with a laugh, sitting in a conference room that abuts one of his labs. But given the success of recent experiments carried out by his group and several close collaborators, Berger is shedding the loony label and increasingly taking on the role of a visionary pioneer.

Berger and his research partners have yet to conduct human tests of their neural prostheses, but their experiments show how a silicon chip externally connected to rat and monkey brains by electrodes can process information just like actual neurons. “We’re not putting individual memories back into the brain,” he says. “We’re putting in the capacity to generate memories.” In an impressive experiment published last fall, Berger and his coworkers demonstrated that they could also help monkeys retrieve long-term memories from a part of the brain that stores them.

If a memory implant sounds farfetched, Berger points to other recent successes in neuroprosthetics. Cochlear implants now help more than 200,000 deaf people hear by converting sound into electrical signals and sending them to the auditory nerve. Meanwhile, early experiments have shown that implanted electrodes can allow paralyzed people to move robotic arms with their thoughts. Other researchers have had preliminary success with artificial retinas in blind people.

Still, restoring a form of cognition in the brain is far more difficult than any of those achievements. Berger has spent much of the past 35 years trying to understand fundamental questions about the behavior of neurons in the hippocampus, a part of the brain known to be involved in forming memory. “It’s very clear,” he says. “The hippocampus makes short-term memories into long-term memories.”

What has been anything but clear is how the hippocampus accomplishes this complicated feat. Berger has developed mathematical theorems that describe how electrical signals move through the neurons of the hippocampus to form a long-term memory, and he has proved that his equations match reality. “You don’t have to do everything the brain does, but can you mimic at least some of the things the real brain does?” he asks. “Can you model it and put it into a device? Can you get that device to work in any brain? It’s those three things that lead people to think I’m crazy. They just think it’s too hard.”

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Scientists reverse memory loss in animal brain cells

Neuroscientists at The University of Texas Health Science Center at Houston (UTHealth) have taken a major step in their efforts to help people with memory loss tied to brain disorders such as Alzheimer’s disease.

Using sea snail nerve cells, the scientists reversed memory loss by determining when the cells were primed for learning. The scientists were able to help the cells compensate for memory loss by retraining them through the use of optimized training schedules. Findings of this proof-of-principle study appear in the April 17 issue of The Journal of Neuroscience.

“Although much works remains to be done, we have demonstrated the feasibility of our new strategy to help overcome memory deficits,” said John “Jack” Byrne, Ph.D., the study’s senior author, as well as director of the W.M. Keck Center for the Neurobiology of Learning and Memory and chairman of the Department of Neurobiology and Anatomy at the UTHealth Medical School.

This latest study builds on Byrne’s 2012 investigation that pioneered this memory enhancement strategy. The 2012 study showed a significant increase in long-term memory in healthy sea snails called Aplysia californica, an animal that has a simple nervous system, but with cells having properties similar to other more advanced species including humans.

Yili Zhang, Ph.D., the study’s co-lead author and a research scientist at the UTHealth Medical School, has developed a sophisticated mathematical model that can predict when the biochemical processes in the snail’s brain are primed for learning.

Her model is based on five training sessions scheduled at different time intervals ranging from 5 to 50 minutes. It can generate 10,000 different schedules and identify the schedule most attuned to optimum learning.

“The logical follow-up question was whether you could use the same strategy to overcome a deficit in memory,” Byrne said. “Memory is due to a change in the strength of the connections among neurons. In many diseases associated with memory deficits, the change is blocked.”

To test whether their strategy would help with memory loss, Rong-Yu Liu, Ph.D., co-lead author and senior research scientist at the UTHealth Medical School, simulated a brain disorder in a cell culture by taking sensory cells from the sea snails and blocking the activity of a gene that produces a memory protein. This resulted in a significant impairment in the strength of the neurons’ connections, which is responsible for long-term memory.

To mimic training sessions, cells were administered a chemical at intervals prescribed by the mathematical model. After five training sessions, which like the earlier study were at irregular intervals, the strength of the connections returned to near normal in the impaired cells.

“This methodology may apply to humans if we can identify the same biochemical processes in humans. Our results suggest a new strategy for treatments of cognitive impairment.  Mathematical models might help design therapies that optimize the combination of training protocols with traditional drug treatments,” Byrne said.

He added, “Combining these two could enhance the effectiveness of the latter while compensating at least in part for any limitations or undesirable side effects of drugs. These two approaches are likely to be more effective together than separately and may have broad generalities in treating individuals with learning and memory deficits.”

(Image courtesy: UC Berkeley)

Sleep loss precedes Alzheimer’s symptoms

Sleep is disrupted in people who likely have early Alzheimer’s disease but do not yet have the memory loss or other cognitive problems characteristic of full-blown disease, researchers at Washington University School of Medicine in St. Louis report March 11 in JAMA Neurology.

The finding confirms earlier observations by some of the same researchers. Those studies showed a link in mice between sleep loss and brain plaques, a hallmark of Alzheimer’s disease. Early evidence tentatively suggests the connection may work in both directions: Alzheimer’s plaques disrupt sleep, and lack of sleep promotes Alzheimer’s plaques.

“This link may provide us with an easily detectable sign of Alzheimer’s pathology,” says senior author David M. Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of Washington University’s Department of Neurology. “As we start to treat people who have markers of early Alzheimer’s, changes in sleep in response to treatments may serve as an indicator of whether the new treatments are succeeding.”

Sleep problems are common in people who have symptomatic Alzheimer’s disease, but scientists recently have begun to suspect that they also may be an indicator of early disease. The new paper is among the first to connect early Alzheimer’s disease and sleep disruption in humans.

(Image: iStockphoto)