Showing posts with label dementia risk factors. Show all posts
Showing posts with label dementia risk factors. Show all posts

Monday, June 20, 2011

Low linguistic ability in early life linked to Alzheimer’s later on

Nun Study as unique source for the long-term Alzheimer’s research

In 1991, David A. Snowdon, Ph.D., Professor at Sanders-Brown Center on Aging College of Medicine, University of Kentucky, Lexington, began what has come to be known as the Nun Study. Participants in this study are 678 American members of the School Sisters of Notre Dame religious congregation. The nuns in the study are age 75 to 106.

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The Nun Study is an ongoing, one-of-a-kind resource for the study of brain diseases in the elderly. It is expected that data, tissue, and genetic material collected in this study will be used by scientists for decades into the future.

Each of the 678 participants in the Nun Study agreed to participate in annual assessments of their cognitive and physical function, medical exams, blood drawing for genetic and nutritional studies, and brain donation at death for neuropathologic studies. The Nun Study represents the largest brain donor population in the world. In addition, the sisters have given investigators full access to their convent and medical records. The convent archives are particularly useful in our study of Alzheimer's disease because they contain accurate risk factor data spanning the entire lifespan of the participants. Accurate information on early and mid-life risk factors is difficult or impossible to obtain in most other studies on Alzheimer's disease because individuals with this memory disorder cannot accurately recall their history. The convent archives contain a wealth of information including baptismal records, birth certificates, socioeconomic characteristics of the family, education documentation, autobiographies written in early, mid, and late life, as well as residential, social, and occupational data describing their mid and late lives.

Many factors that confound (or confuse) the findings of other studies are either eliminated or minimized because of the relatively homogeneous adult lifestyles and environments of these women. Participants in this study are non-smokers, drink little if any alcohol, have the same marital status and reproductive history, have lived in similar housing, held similar jobs, and had similar access to preventive and medical care.

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Findings from Nun Study

Some of the findings received from the Nun Study confirm the results, received from other researches, but there are some absolutely new insights obtained for the additional risk factors and causal relationship between personal characteristics and traits to the chance of the Alzheimer’s development at some moment in life.

Among the findings were:
1. Those, who had revealed better linguistic abilities in early life, were less likely to have dementia later.
2. Those, who demonstrated set of positive emotions in early life, had greater longevity.
3. Low linguistic ability in early life was associated both with dementia in later life and less longevity.
4. Those with low serum folate levels were more likely to have Alzheimer's disease of other dementia.
5. There was no significant relationship found between dental amalgams (silver fillings) and dementia.
6. Those with brain infarcts had poorer cognitive function and a higher prevalence of dementia.
7. Dementia was unrecognized by nursing staff in a number of cases.
8. Higher education in early life was associated with less cognitive decline in later life.

The study has confirmed, for example, that a history of stroke and head trauma can boost your chances of coming down with debilitating symptoms of Alzheimer's later in life; and that a college education and an active intellectual life, on the other hand, may actually protect you from the effects of the disease.

One of the most surprising results of the Nun Study, however, is the discovery that the way we express ourselves in language, even at an early age, can foretell how long we'll live and how vulnerable we'll be to Alzheimer's decades down the line. After analyzing short autobiographies of almost 200 nuns, written when they first took holy orders, he found that the sisters who had expressed the most positive emotions in their writing and who expressed the better linguistic abilities as girls ended up living longest, and that those on the road to Alzheimer's expressed fewer and fewer positive emotions as their mental functions declined.

So, the study found that low idea density shown in the writings of the young women was strongly linked with low cognitive test scores and the presence of Alzheimer's disease in late life. For example, the nuns with low idea density scores were 30 times more likely to do poorly on a standard measure of cognitive function, the Mini-Mental State Exam, than those with more complex writings. An even more dramatic difference was observed when cognitive ability and characteristics of brain tissue were compared in the nuns who died. Neurofibrillary tangles of Alzheimer's disease appeared in about 90 percent of those nuns who had low linguistic ability in early life.

Among other findings there are some, which still do not have the valid scientific explanation, as why there is not always the direct correlation between the medical evidence for the Alzheimer’s disease appearance in the brain and the actual behavioral symptoms doctors can see on these patients.

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"Most of the brains neatly fit our expectations, with little or no evidence of disease in a tack-sharp sister and abundant damage seen in a sister who had dementia," Dr. Snowdon wrote. "But sometimes (Dr. Bill) Markesbery (the neurologist who did the autopsies) finds little evidence of Alzheimer's in a sister who had the classic symptoms of the disease. And sometimes brains from other sisters who appeared mentally intact when alive show extensive evidence of the disease."

This surprising information wasn't a set-up by the researchers.  In fact, Dr. Snowdon noted that Dr. Markesbery was not informed prior to conducting the autopsy about the mental status of that particular sister. After the autopsy, Dr. Markesbery met with Dr. Snowdon and the study's neuropsychologist, Dr. Kathryn Riley, to compare notes.


In one case - that of Sister Maria - Dr. Markesbery found that the nun had some plaques and tangles, but the number was not large. The nun's brain itself weighed within the normal range (most Alzheimer's brains have lower weights). Furthermore, the sister's brain rated Stage II on the Braak scale. (The Braak scale defines six distinct stages of the disease based on an autopsy. Stage 0 indicates the general absence of tangles. Stages 1-VI described the increasing range of the number and spread of the tangles throughout the brain.)


Following Dr. Markesbery's report, Dr. Riley shared Sister Maria's scores on three evaluations conducted prior to her death. These evaluations showed that Sister Maria had suffered progressive loss of her mental, physical and social functions in a way that was consistent with Alzheimer's disease.


Yet the reverse can happen as well. For instance, Dr. Markesbery's autopsy of Sister Bernadette's brain yielded the findings that she had Braak Stage VI, which indicates the most severe presence of Alzheimer's. However, Dr. Riley's report on the cognitive evaluations conducted in the years prior to Sister Bernadette's death showed that the nun was mentally sharp.


 "The Nun Study's real eye-opening findings...are the ones that add to the evidence that Alzheimer's is not a yes/no disease," Dr. Snowdon wrote. "Rather it is a process - one that evolves over decades and interacts with many other factors." Using the data from the Nun's Study, Dr. Snowdon pointed out, "Of sisters in stages I or II, only 22 percent had evidence of dementia. For stages III and IV, that jumped to 43 percent. And by stages V and VI, 70 percent of the sisters had dementia."

While there is no magical cure for Alzheimer’s so far, the findings from Nun Study may give a hope that even you may not be able to eliminate the negative neurochemical changes in your brain, you still can fight the symptoms actual appearance by filling your life with regular physical and mental exercises, healthy diet, lowering stress, attempting to happy and present, etc. This way, you can be proactive in altering how this disease may affect you at some point, if you have predisposition, and follow in Sister Bernadette's footsteps, living a long and vital life.

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Saturday, March 20, 2010

Is there a Link Between Aluminum and Alzheimer's Disease

The first study linking aluminum and Alzheimers disease was conducted by a group led by Klatzo.  In the 31 years proceeding their initial conclusion, countless dollars have been gone towards research attempting to find a possible linkage between Alzheimers and aluminum, resulting in a wide range of conclusions.

One of the researches shows that autopsies performed on persons who have died of Alzheimer's disease have revealed accumulation of up to 4 times the normal amount of aluminum in the nerve cells in the brain. Especially high concentrations of aluminum have been found in the region of the hippocampus, which plays a role in memory.

British researchers concluded that the risk of contracting Alzheimer's disease was 50 percent higher in regions of Great Britain where drinking water contained elevated levels of aluminum. The threat from aluminum may be increased by chronic calcium deficiency, which may change the way in which the body uses minerals and result in greater accumulations of aluminum.

While the British populations must contend with the threat of aluminum-tainted water, Americans can ingest aluminum through a wide variety of products. While there is still a great deal of controversy as to whether the accumulation of aluminum in the neurons is the cause or a result of neuronal dysfunction, there is wide-spread opinion among scientists and general population, that it is best to avoid aluminum as much as possible as a preventive measure. 

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Elevated Aluminum Levels in the Brains of Alzheimers Disease Patients?

One of the most fundamental arguments in this debate is the presence of elevated aluminum levels in the brain tissue and the surrounding cerebralspinal fluid (CSF). Collectively, a majority of all the reviewed studies concurrred with the conclusion that the concentration of aluminum was greater in the brains of AD patients than those not afflicted with the disease. For example, a study led by M. Hollosi showed that the aluminum levels in AD patients ranged between 6 and 12 parts per million (ppm) in lesion containing areas and between 0 and 15 ppm in areas that had not gone through any noticeable degeneration, which is much higher than the amount found in non-Alzheimer disease brains.

Another study, led by P. Evans, states that, "of the various environmental factors that have been implicated, the one with the greatest amount of supportive evidence is aluminum". In the studies found that opposed the majority's consensus, methodological practices were cited as the major cause of discrepancies between the two conclusions, such as not taking into account the taclum powder inside latex examination gloves. M. Lovell and his group showed that samples analyzed and corrected for multiple substances that interfered with the measurement of the aluminum level reflected a nonexistent to minimal elevation in the concentration of aluminum in AD patients, also citing other groups that had failed to find a difference in aluminum amounts.
Also contradicting the norm is a study focusing on the concentration of aluminum in the CSF, led by E.
Kopaki. This group pointed out the controversial argument dealing with poor sampling and handling of samples and inferior analysis procedures for the level of aluminum present in previous studies of CSF. Being careful to follow a strict procedure to avoid contamination of samples and a control group with which to compare the results, the Kopaki group concluded that any possible increase in the aluminum concentration level in the brain is not evident in the CSF.

Can Aluminum Pass the Blood Brain Barrier?

An additional area dealing with aluminum in the brain that is currently in question is the extent to which aluminum present in the bloodstream is able to cross into the brain tissue. Aluminum is thought to cross the blood-brain barrier (BBB) by using the iron transport and storage systems because the solution chemistries of aluminum and iron are very similar. The hypothesis is supported by the gradual buildup of aluminum in bone and brain tissue.

A possible mechanism for crossing the BBB has been suggested as a "Trojan horse" method of transport for aluminum, where aluminum is mistaken for iron, once again because of their similar properties, and brought into the brain from the bloodstream by hematogenous macrophages and monocytes. It has also been hypothesized that the increased absorption of aluminum in the brain is enhanced by the possible increase in permeability of the BBB as a result of the development of AD.

The Effect of Aluminum on Neurofibrillary Tangles

Involved in the ongoing debate is the speculation that aluminum somehow affects neurofibrillary tangles. Initially, the scientific community believed that the high concentration of aluminum in NFTs was an irreparable event in a dying neuron. Presently, it is believed that aluminum plays a role in NFT formation by acting on the tau protein, the major component of NFTs.

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Because tau contains multiple phosphorylation sites, aluminum acts as a catalyst for the nonenzymatic covalent shift of the triphosphate group from adenosine triphosphate (ATP) to tau. Aluminum, having a positive charge of three, bonds with three phosphates of ATP, each having a negative charge, because the triphosphates have a higher affinity for aluminum than the adenosine. From there, the phosphates, having a greater affinity for the tau protein than the aluminum, are transferred to the protein, causing its precipitation. When this occurs, the entire triphosphate group is transferred to the protein and results in the aggregation of tau.

Also, evidence of aluminum induced NFT formation in animals has been provided as support that aluminum does affect neurofibrillary tangles. In 1965, Klatzo and coworkers reported that the injections of aluminum salts in the brains of rabbits caused NFT formation. Later, it was found that in cultured rat neurons, aluminum treatment prompts the formation of NFTs. In opposition, Lovell et al. argued that no significant differences in aluminum levels were found in "NFT-bearing neurons compared with NFT- free neurons" in AD patients. In a study performed by M.P. Mattson and colleagues, data indicated that neuronal damage and an alteration of tau did not occur with increases in aluminum. The data collected in this same study indicated that the collection of aluminum alone in neurons cannot perpetuate NFTs, the tell-tale features of Alzheimers disease.

The Effect of Aluminum on Senile Plaques

A similar argument surrounds the possible involvement of aluminum in the formation of senile plaques. The roles that beta-amyloid protein and aluminum play in this formation has been the subject of many studies. Kuroda and colleagues performed a study on this relationship and concluded that aluminum promoted the aggregation of synthetic beta-amyloid protein. Because the aggregation of beta-amyloid protein results in neurotoxicity, the elevated presence of aluminum in the brain accelerates the aggregation of beta-amyloid protein in the brain tissue, therefore, accelerating the development of senile plaques and AD.

A differing idea relating aluminum to the protein has been presented by M. Clauberg and J.G. Joshi, who speculate that aluminum could have an effect on the production of beta-amyloid protein by suppressing the inhibitor domain, making the cell incapable of suspending the production of the protein when there is an excess amount in the cell. Without anything to hold its level of production within a normal range, the beta-amyloid protein accumulates and increases the rate at which senile plaques are formed. In opposition to both of these ideas are many scientists who have failed to find a considerable elevation in aluminum levels in senile plaques. A group led by H. Jacqmin and associates concurs with the conclusion that there is no reliable evidence for aluminum in senile plaques.

Drinking Water Studies on the Effects of Aluminum

An area in which myriad studies have been conducted regarding aluminum as an environmental factor is the correlation between the number of diagnosed AD cases and the aluminum levels in public drinking water. The reason aluminum is added to drinking water is most commonly as a clearing agent. The amount of aluminum present in drinking water has been recommended to be below 200 micrograms per liter by the World Health Organization.

In a study conducted by D.R.C. McLachlan and colleagues, it was found that a relationship did exist between the number of diagnosed AD cases and the level of aluminum present in the drinking water supply. This study concluded that between 15,180 and 26,910 of the estimated 66,000 to 117,000 cases of AD might have been prevented if the aluminum concentration in the municipal water supply had been kept below 100 micrograms per liter. A similar study performed by H. Jacqmin and associates using different variables showed no significant effect for aluminum in drinking water when pH was not included in the experiment model, but showed a small relationship between aluminum and AD when pH was also taken into consideration.

Several other studies have shown no relationship to exist between AD and aluminum, for example, those lead by DJ Wood and A. Wettstein. Their conclusion, that the silicon in the water reacted with the aluminum to reduce the neurotoxicity presented by aluminum, concurs with the previous conclusion by Birchell et al.. Birchell suggested in his report that the inverse relationship between soluble aluminum and soluble silicon shows that maintaining a constant level of approximately 3 milligrams per liter of soluble silicon in drinking water would be enough to protect the population against neurotoxic effects of the absorption of all forms of aluminum in the diet.

Is There Treatment For Excess Aluminum?

Possibilities for treatments of excess aluminum in the body have been suggested by a number of different researchers. D.R.C. McLachlan and colleagues suggest decreasing the amount of the aluminum with the trivalent chelating agent desferrioxamine (DFO). The results of tests monitoring a group of AD patients taking DFO and one without showed that the rate of cognitive decline of the no DFO patients was twice that of the group receiving the DFO. Another study using chelating agents as a method to slow the progression of AD was one led by G. Fasman, concluding that the use of silicates to chelate the aluminum in the body could possibly be used to help slow the buildup of aluminum in the brain. Progress in this area of research could play an important role in the possible treatment and even prevention of AD.

Other Possible Health Issues with Aluminum

Exposure to aluminum can cause many more health problems than just Alzheimer's Disease.

The MedicineNet.com website says aluminum toxicity occurs in people with renal insufficiency. This generally applies to people who are treated by dialysis with aluminum-contaminated solutions or oral agents that contain aluminum, however today many people have weak kidneys from being overstressed by other environmental toxins. It is likely that most people today have some degree of renal insufficiency--not to the point of needing dialysis, but enough that their kidneys are probably not working optimally to flush the aluminum out of the body.

MedicineNet.com notes "The clinical manifestations of aluminum toxicity include anemia, bone disease, and progressive dementia with increased concentrations of aluminum in the brain. Prolonged intravenous feeding of preterm infants with solutions containing aluminum is associated with impaired neurologic development."

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Sources of Aluminum

If you want to reduce your exposure to aluminum, cookware is not at the top of the list either.
According to Food and Drug Administration FDA, "in a worst-case scenario, a person using uncoated aluminum pans for all cooking and food storage every day would take in an estimated 3.5 milligrams of aluminum daily." By contrast, "one antacid tablet can contain 50 milligrams of aluminum or more, and it is not unusual for a person with an upset stomach to consume more than 1,000 milligrams, or 1 gram, of aluminum per day. A buffered aspirin tablet may contain about 10 to 20 milligrams of aluminum." If you use these products, look for aluminum-free antacids and plain, non-buffered aspirin.

Other sources of aluminum exposure include:
  • table salt which is industrial sodium chloride--use a natural salt instead
  • baking powder 5 to 70 milligrams of sodium aluminum sulfate per teaspoon and baked goods and packaged baking mixes containing baking powder check your natural food store for aluminum-free baking powder and natural baking mixes and baked goods made with aluminum-free baking powder
  • antipersirants containing aluminum chlorohydrate again, check your natural food store for aluminum-free deodorants
  • aluminum beverage cans
  • aluminum foil
  • anti-dandruff preparations magnesium aluminum silicate or aluminum lauryl sulfate
  • feminime douches aluminum salts
Summary

So far most of the mainstream studies have failed to document a clear role for aluminum in causing Alzheimer’s. Every perspective from which researchers have explored the question has yielded contradictory data. For virtually every study suggesting that aluminum may be linked to Alzheimer’s, there is another study failing to confirm those results.

The vast majority of the scientists now believe that if aluminum plays any role at all in Alzheimer’s, that role is small. If aluminum exposure had a major impact on risk, scientists would have gained a clearer picture of its involvement over the decades that they have been studying the issue, even though certain factors hamper research. One such issue lies in the widespread occurrence of both aluminum and Alzheimer’s, which complicates the effort to characterize their relationship. Aluminum is Earth’s third most common element after oxygen and silicon, and Alzheimer’s occurs frequently in older adults. Another factor is the lack of an animal model in which to study aluminum’s effects. The best animal models of Alzheimer’s disease are mice that are genetically engineered to mimic human Alzheimer pathology, but mice lack sensitivity to aluminum. Rabbits have the necessary sensitivity, but there is no transgenic Alzheimer rabbit model.

Although research into the Alzheimer’s/aluminum connection continues, most mainstream health professionals believe, based on current knowledge, that exposure to aluminum is not a significant risk factor. Public health bodies sharing this conviction include the World Health Organization (WHO), the U.S. National Institutes of Health (NIH), the U.S. Environmental Protection Agency (EPA), and Health Canada. Further, it is unlikely that people can significantly reduce their exposure to aluminum through such measures as avoiding aluminum-containing cookware, foil, beverage cans, medications, or other products. Even if aluminum were clearly implicated in Alzheimer’s, these routes of exposure account for only a small percentage of the average person’s intake. Most experts encourage people to focus their wellness efforts on measures with a proven impact on health or quality of life—avoiding smoking, exercising regularly, eating moderately, maintaining social connections, and remaining intellectually active.

The following points summarize some of the conflicting findings about aluminum and Alzheimer’s disease:
  • Aluminum is known to be toxic to the nervous system, but its effects differ from those of Alzheimer’s disease.
  • Some studies show elevated aluminum levels in the Alzheimer brain, but others do not. These studies include both “bulk” investigations measuring amounts of aluminum by weight and advanced analysis using laser microprobes.
  • There is some evidence that in laboratory cultures of nerve cells, aluminum promotes aggregation of the protein fragment beta-amyloid into the amyloid plaques that are a hallmark Alzheimer abnormality. However, efforts to correlate aluminum levels with plaque density in people with Alzheimer’s have been inconclusive.
  • Research has failed to document a clear elevation of Alzheimer risk in individuals with occupational exposure to aluminum.
  • Studies finding the most consistent link have examined elevated levels of aluminum in drinking water and increased incidence of Alzheimer’s. However, there is no evidence that Alzheimer’s disease is more prevalent in cultures that traditionally drink large amounts of tea, even though tea is one of the few plants whose leaves accumulate large amounts of aluminum that may leach into the brewed beverage.
Even as there is no sufficient proof that there is connection between normal Aluminum exposure with Alzheimer’s Disease, you may want to reconsider your consumer’s habits, trying to avoid the unnecessary exposure to Aluminum. Better be safe than sorry.


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Thursday, January 14, 2010

Small Head Circumference as Risk Factor for Alzheimer’s Disease

The size of the skull is fixed by age 7. Brain size approximates the head size until old age, when it begins to shrink. Some evidence has reported an association between small head size (and therefore less brain volume) and Alzheimer's disease. Nevertheless, other studies have found no association between a small head size and Alzheimer's disease.

Some experts suggest that the relationship observed in other research may simply be due to social and economic factors, such as malnutrition or low birth weight, which have been associated with both Alzheimer's disease and small head size. Small head size independent of other factors, they argue, does not pose a higher risk for either Alzheimer's disease or low intelligence.

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University of South Florida Research
According to researchers of University of South Florida (2001), the size of a person's head may be indeed one risk factor for Alzheimer's disease. People with a gene predisposing them to Alzheimer's who also have small heads were 14 times as likely to develop the disease than people without that gene variant and with larger heads.

The researchers believe people with smaller brains may be less able to compensate for the brain cell damage that is a hallmark of Alzheimer's disease, so symptoms like memory loss occur earlier in these people. But still this idea is debatable.

To test the theory, Borenstein Graves and her colleagues followed 1,700 healthy Americans age 60 or older for an average of about four years. During that time, 50 people developed Alzheimer's disease. The researchers measured the circumference of people's heads around the eyebrows and across the widest part of the skull. According to a study, participants with the smallest head measurements were slightly more likely to develop Alzheimer's than the people with the larger heads.

People with a gene variant called alipoprotein E 4 or ApoE4, a known risk factor for the disease, were 4.8 times more likely to be diagnosed with Alzheimer's. Alzheimer's developed most often among people with the ApoE4 gene variant and a small head circumference.

According to her head circumference probably does not influence the pathology (the underlying biological damage) of Alzheimer's, but is a mitigating factor in the development of symptoms. While brain growth is controlled in part by genetics, it also may be influenced by nutrition, infection, family size, and birth order. This study is not enough to definitively link smaller head size with an increased risk of Alzheimer's.

"Head circumference probably doesn't influence the pathology (the underlying biological damage) of Alzheimer's, but is a mitigating factor in the development of symptoms," Graves said. While brain growth is controlled in part by genetics, it also may be influenced by nutrition, infection, family size, and birth order, she said.

This study is not enough to definitively link smaller head size with an increased risk of Alzheimer's, said Neill Graff-Radford, chair of the department of neurology at the Mayo Clinic in Jacksonville, Fla. For one thing, a relatively small number of people developed Alzheimer's. Also, the study also shows "smaller head size is linked with older age, female gender, and less education," Radford said.

Previous studies have suggested people who have more education tend to be resistant to Alzheimer's disease, while women are more susceptible than are men. Increasing age probably is the biggest risk factor for Alzheimer's, while poor nutrition among children might explain their smaller heads, Radford said. "While it is plausible that head size might be related to Alzheimer's disease," he said, "it's still far from proven." "The question of brain reserve remains an open question," said Bill Thies, vice president for medical and scientific research at the Chicago-based Alzheimer's Association. "While head circumference may, long term, give us a better idea who should get preventive medicine, we don't have any such medicine available right now."

Chonnam National University Hospital Research
Community residents aged 65 or over (n = 916) within a defined geographic area of South Korea were screened clinically for dementia and dementia subtypes. Data on anthropometric measures (head circumference and leg length), demographics (age, gender), apolipoprotein E, and early life environment (birth order, number of siblings, parental occupation, area of residence, education) were gathered. Reproductive history was also ascertained in women.

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Both smaller head circumference and shorter leg length were associated with increased age, rural residence in childhood and lower education. After adjustment for these factors, they were both independently associated with Alzheimer's disease but only in women. Reasons for gender differences in associations require clarification but, for this population and age group, may include preferential treatment of male children in Korea.

Summary
The studies about the relationship between brain and head size and the development of dementia has a pretty long history, for its linkage to the “brain reserve theory” developed by Katzman. In this theory the onset of dementia is related to the brain (size) and cognitive reserve (education). The head circumference is well related to the brain volume, and both are smaller in women, so head size may be a “natural” predisposing factor for dementia in the female gender. But caution is needed when taking such conclusions. At first the findings of the Korean researchers must be considered: height and head size are strongly related, but are also independent factors for dementia and both may reflect a poorer childhood condition. Also lower education, a well known risk factor for dementia, may be due to the social condition and other data suggest an important correlation between head size and education. In particular data coming from the “Nun study” examined deeply this association, and found that it was strong in those who were destined to develop AD, those who carried apoE4 genotype and those who fulfilled neuropathologic criteria for AD. These findings are partially consistent with other studies that demonstrate an increased risk effect of the ApoE4 genotype in presence of smaller head circumference, with a younger age of onset of the disease. All these data may support the “brain reserve” theory: education for the cognitive reserve, apoE4 for the genetic reserve, head circumference for the brain/neurons reserve.

On the other hand we know that social condition can affect at least in part body size and education, and that female gender can sum up a smaller congenital size, a lower education and, at least in some developing countries, less nutrition in childhood, so to have a diminished brain reserve because of both biological and social conditions. These conditions might be a major contribution to the high presence of Alzheimer disease among women.

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