HD Lighthouse Contributing Editor's Comment: There is a lot to be learned from research in Alzheimer's and other dementias. All too often in Huntington's Disease families, the psychological and social stresses that can be caused by dealing with the disease can isolate people. Family members may stay away because they are dealing with their own issues. Friends may fall away, frustrated because they can't 'fix' things and don't think that their friendship makes a difference.

As the disease progresses, it can seem easier and more comfortable to stay home and watch television. This is understandable because social situations can be stressful for anyone and especially those with HD. It's more difficult to filter out distractions, cognitive processing is slow so it's harder to contribute to the conversation, and expectations aren't always clear.

HD families don't have to accept the loss of social networks, however. Close friends can take the place of family. Life long friendships are often made in HD support groups run by the HDSA and other national HD associations. Chapters often have activities to participate in as well. Even online support groups can also result in wonderful friendships. And by making social interactions shorter and part of the weekly routine, even people who are in the later stage of the diseases can enjoy the company of others.

As the disease progresses, the individual may feel more comfortable with shorter visits and familiar activities. Just having a friend from church drop by for a cup of coffee and a fifteen minute visit is helpful and doesn't overly tax the individual.

Even in late stage HD, my mother in law enjoyed a weekly visit to the local pizza place with her long time boyfriend who would pick her up at the nursing home. The restaurant owner expected her and sent her sons out to help her out of the car. They made a fuss over her and made her feel welcome. The weekly outing was familiar so she was comfortable but it was also a change and a chance to interact with others.

After an activity with others, allow some 'downtime' for recovery. If a family picnic goes well on Saturday, don't schedule one on Sunday. Wait a week.

-- Marsha L. Miller, Ph.D.
Posted to the HDL: 23 Apr 2006

Social Networks Protect Older Adults Against Damaging Effects of Alzheimer's Disease

David A Bennett. MD, and colleagues

Having close friends and staying in contact with family members offers a protective effect against the damaging effects of Alzheimer's disease according to research by physicians at Rush University Medical Center in Chicago. The study, which is currently posted online in The Lancet Neurology, will be published in the May print edition of the journal.

While other studies have shown people with more extensive social networks were at reduced risk of cognitive impairment, the study by Dr. David A. Bennett, and his colleagues from the Rush Alzheimer's Disease Center, is the first to examine the relations between social networks and Alzheimer's disease pathology.

Researchers studied elderly people without known dementia who are participating in the Rush Memory and Aging Project, an epidemiological and clinicopathological study of aging and Alzheimer's disease that involves over 1,100 volunteers across northeastern Illinois. Brain autopsy was done at the time of death and post mortem data was available for analysis from the first 89 people.

"Many elderly people who have the tangles and plaques associated with Alzheimer's disease don't clinically experience cognitive impairment or dementia," said Bennett. "Our findings suggest that social networks are related to something that offers a 'protective reserve' capacity that spares them the clinical manifestations of Alzheimer's disease."

Participants in the study underwent clinical evaluations and 21 cognitive performance tests each year. To determine social network, participants were asked about the number of children they have and see monthly. They were asked about the number of relatives, excluding spouse and children, and friends to whom they feel close and with whom they felt at ease and could talk to about private matters and could call upon for help. They were asked to specify how many of these people they see monthly. Their social network was the number of these individuals seen at least once per month.

The relationship between the amount of Alzheimer's disease pathology and cognitive performance changed with the size of the social network. As the size of the social network increased, the same amount of pathology had less effect on cognitive test scores. In other words, for persons without much pathology, social network size had little effect on cognition. However, as the amount of pathology increased, the apparent protective effect on cognition also increased. Thus, social network size appears to have offered a protective reserve capacity despite the fact that their brains had the tangles and plaques indicative of Alzheimer's disease.

The effect was evident across different kinds of cognitive abilities, but was most evident for semantic memory, which is the repository of knowledge about the world and is fundamentally involved in unique human cognitive processes such as language. The results were unchanged after controlling for cognitive, physical, and social activities, depressive symptoms, or number of chronic diseases.

"Identifying factors associated with the ability to tolerate the pathology of Alzheimer's disease has important implications for disease prevention," said Bennett. "Previous studies suggest one factor is education. Now we know that healthy and frequent interactions with friends and family have a positive impact as well."

The researchers are extremely grateful for the remarkable dedication and altruism of the volunteers participating in the Rush Memory and Aging Project. The research was supported by grants from the National Institutes on Aging, which leads the Federal effort to support and conduct basic, clinical, and social and behavioral studies on aging and on Alzheimer's disease.

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Source: Lancet May 2006

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