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I’d like to introduce this study about centenarians which was published in June. This interesting study was conducted in China to investigate the relationship between healthy lifestyle and likelihood of becoming a centenarian among individuals aged 80 years and older*1. The authors used data from the Chinese Longitudinal Healthy Longevity Survey, a nationally representative and one of the largest prospective cohorts targeting people aged 80 years or older. The sample comprised 5222 participants (61.7% women, average age: 94.3 years), including 1454 identified centenarians and 3768 controls (died before becoming centenarians) matched by age, sex, and year of entry.  An average follow-up period was 5 years. In this large-scale study, a healthy lifestyle score (HLS) was initially based on 5 lifestyle aspects (1. the status of smoking, 2. alcohol use, 3. exercise, 4. dietary diversity: the frequency of consuming five food groups, and 5. BMI) with higher scores indicating potentially better health outcomes.  For the status of smoking and alcohol use, participants were assigned scores of 0, 1, 2 (never: 2, former: 1, and current: 0), and for exercise they were assigned scores of 0, 1, 2 (never: 0, former: 1, and current: 2).  Dietary diversity was assessed according to the frequency of consuming five food groups: fruits, vegetables, fish, beans, and tea. Participants reported “almost every day”, “except winter or sometimes or occasionally” or “rarely or never.” for the intake frequency of each food group, and were assigned scores of 2, 1, or 0 accordingly.  For BMI, participants were assigned scores of 0, 1, 2 for the underweight, overweight/obese, and normal weight as underweight has been associated with increased risk of all-cause mortality among people aged 80 years and older in China.  The authors in this research observed that the overall healthy lifestyle score was associated with the odds of becoming a centenarian in people aged 80 years or older.  When constructing a healthy lifestyle score for 100 (HLS-100) only including smoking status, exercise, and dietary diversity, more interestingly, they observed even greater odds in the association between healthy lifestyle behaviors and the likelihood of becoming centenarians.  Adhering to a healthy lifestyle could be beneficial even at a very advanced age. The authors suggested that the assessment of healthy lifestyle behaviors should be customized in different age groups, and developing intervention strategies targeting lifestyle improvement to promote health and longevity may be universally beneficial across different life stages.   According to the U.S. Census Bureau, there were 80,139 centenarians, defined as people 100 years and over in the 2020 Census. This is a 50.2 percent increase from the 2010 Census. And as you can probably guess, the majority of them were female (78.8 %) *2.  As for my home country, Japan, according to the Japanese Ministry of Health, Labour and Welfare, there were 92,139 centenarians in 2023. And approximately a 89 % of them was female *3.  Considering the fact that the total population of Japan is roughly about 1/3 of the U.S. total population, Japan is indeed a super-aging country. I want to think that we are getting smarter about making healthier choices regardless of our age. In any case, if we want to join the healthy centenarian club in the future, we should probably start living smart and healthy now!! *1. Li Y, Wang K, Jigeer G, et al. Healthy Lifestyle and the Likelihood of Becoming a Centenarian.  JAMA Netw Open.  2024;7(6):e2417931. doi:10.1001/jamanetworkopen.2024.17931 *2. The U.S. Census Bureau (2023). The Older Population: 2020 census briefs. https://www.census.gov/library/stories/2023/05/2020-census-united-states-older-population-grew.html *3 The Japanese Ministry of Health, Labour, and Welfare (2023). Press Release (in Japanese). https://www.mhlw.go.jp/content/12304250/001145390.pdf

I had the honor and privilege to present and attend at the 36th Global Conference of the Alzheimer’s Disease International in late April. The conference was held in Krakow, Poland.  The participants had the choice to either physically attend or to attend online from all over the world.  I chose the online participation option due to schedule conflicts here in the states. The 3-day conference was full of a diversity of topics regarding Alzheimer’s and other dementias such as new treatments and interventions, caregiving, advocacy and policy and more. I presented my life’s work and research on the dementia care quality model during a pre-recorded session titled “Models of Care” among other esteemed presenters and amazing presentations.  More than 1000 delegates participated in this conference. I was personally inspired and moved by so many brilliant people, from Tasmania to Kenya, from Nepal to Scotland, who shared their work/research and their personal experiences/journeys at this conference. What was most in common among these presentations was to make a difference for and in the lives of people living with dementia better. There are a few things that I would like to highlight here. First, I initially had little knowledge about childhood dementia but some of the presentations gave me more information and insight about this complex experience.  Unfortunately, dementia can happen throughout one’s lifetime.  However, there are also great possibilities for treatment and cures for childhood dementia if more research, including clinical trials take place. Secondly, many speakers talked about the lack of diversity, equity and inclusion in the dementia research and support process for people from getting diagnosed to receiving care.  And there are also many targeted movements in place to improve these challenging issues in many countries.  Lastly, Alzheimer’s Disease International has created the Global Dementia Expert Panel as an intentional strategy to enhance advocacy work.  People on this vital panel are also people living with dementia and caregivers.  Now the panel has a representative from each Continent and is aiming to recruit people from each country in the future.  Current members spoke at the conference and reminded us of the importance and values of including the voices that are directly coming from people living with dementia.  My big shoutout and professional respect goes to them!!! I learned so much and hope to continue to learn more from people in this community/field.  I am very blessed and grateful for this experience.  This conference is biennial and the next one is in 2026. Hopefully I can physically attend the next one in France!  Okay, I’ll be back to work now continuing to contribute my very small part to support people living with dementia and their families!! To end this bog, I would like to ask people to participate in this special survey.  ADI is conducting a global survey regarding “Attitude to Dementia”.  It will be helpful if more people can participate in it. You can click the link below to do the survey.  You can select your preferred language from the upper right corner.  Thank you in advance for your help!! https://lse.eu.qualtrics.com/jfe/form/SV_71FXXETjeLzzvzE

I’d like to introduce a new study＊１ conducted in the U.S and published last month. The study’s focus is on our brain volume. The researchers used brain MRI (magnetic resonance imaging) from the participants in the Framingham Heart Study, which is a community-based population study that began in 1948 in Framingham, Massachusetts to investigate cardiovascular and other diseases. This study has continued for 75 years and involved second and third generations of the participants today.  This particular brain study cohort consisted of 3226 participants with an average age of 57.7 years at the time of their MRI.  A total of 1706 participants were female (53%) and 1520 (47%) were male. The birth decades ranged from the 1930s to 1970s. Those who had prevalent dementia, stroke, or other significant neurological disorder (eg, multiple sclerosis) at the time of the MRI were not included in this study. What the researchers found is very compelling and interesting—the participants born in the 1970s had 6.6% larger brain volumes (Intracranial volume) and almost 15% larger brain surface area (cortical surface area) than those born in the 1930s.  The participants born in the 1970s had 7.7% larger volume for white matter, 2.2% larger volume for cortical gray matter, 5.7% larger hippocampal volume, compared to those born in the 1930s.  And this is the result, of course, after they adjusted the height, sex, and age.  So yes, their brains are getting bigger! There is a report that although the number of people with Alzheimer’s is rising with America’s aging population, the percentage of the population affected by the disease is actually decreasing. And the authors of this study hypothesize that improved brain development and size may actually be one of the reasons why. I do believe that this study is very intriguing and has a possible and ongoing significance. However, as the authors of this study admitted and well described, there are some quite serious limitations.  The participants of this study cohort are predominately non-Hispanic White people. And they are healthy and well educated—almost half of the individuals (46%) achieved some college education.   Therefore, they don’t represent the broader US population.  Exclusion of people of color is often the case with the research for Alzheimer’s disease and other forms of dementia.  As the authors mentioned in the study, people of color experience more socioeconomic and health disparities in the US.  We don’t know how these stress and risk factors may affect brain health and development. Again, this is still a very valuable study, and I do hope to see more studies from now on involving people of color, people from LGBTQ+ communities, and people from disadvantaged communities.  These are also the same population of people who make up the U.S. , Right?  So, in that case, they absolutely need to be included.  And research communities need to make an effort to do so. *1 DeCarli C, Maillard P, Pase MP, et al. Trends in Intracranial and Cerebral Volumes of Framingham Heart Study Participants Born 1930 to 1970. JAMA Neurol. Published online March 25, 2024. doi:10.1001/jamaneurol.2024.0469

Usually, I avoid writing very personal matters in this blog page, however, I would like to share this story with you. Recently, my husband’s beloved mother passed away, after having fought against cancer for a several years. She was 85 years old. She raised eight children with her late husband.  Her eight children never even broke any bones growing up!  All have become intelligent, well educated, professionally successful professors, community leaders and executive level directors—and more than good enough adults. Her dedication was not only to her family but also to the community.  She taught the 6th graders, and later, she became the Liturgy Director for the catholic parish for 16 years, where she and her family attended.  Her Catholic faith was central to her life, and she utilized her expertise in Catholic liturgical ritual, liberation theology, and African American faith traditions to support her church and community for many, many years until her death. As a result, she had so many dear friends, respected community members, and even fans, all surrounding her. As a black woman from the south, navigating oppressive systems, such as racism and sexism, she graduated from a prestigious college in Louisiana.  She was very intellectual and witty.  Because she understood my work around dementia, she always jokingly told me that she felt her cognition declining as she aged and ‘was sure’ she would be my client soon.  But the truth was that she was the last person, in my professional opinion, that would ever develop dementia. Even during her chemotherapy, which had been very challenging for her, she knew her schedule, never missed her appointments, and understood the details of her medication and specifics of the side effects.  She was savvier about how to use pc and smart phone than I am!  She understood her condition, and communicated and used fluently the very difficult medical terminology with her doctors. Perhaps she was born with her intelligence. However, her vitality, even when many other American systems were against her as a black woman, was something very special.  She was consistently engaging with people and communities. She was always out there in her church and congregation.  She never withdrew herself from her perspective social groups.  As I touched upon it in my book, social isolation can be a dementia risk factor*1.  My mother-in-law exemplified many things, and especially how to be with people and communities.  She was and is a great role model for keeping her cognition/brain health intact by doing so whether or not she was aware of it. Thank you, Renette Mom, for everything. May your soul rest in eternal peace.  You touched and inspired so many that your beautiful legacy will live on. *1 Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet, 2020;396:413-446. https://doi.org/10.1016/S0140-6736(20)3036-6

This recent study *1 was conducted in the U.S. in order to investigate the prevalence of self-reported cognitive symptoms in post–COVID-19 condition (Long COVID). People in the U.S. who were 18 years and older were participated in the internet survey. There were 14767 individuals reporting test-confirmed SARS-CoV-2 infection at least 2 months before the survey (average age: 44.6 years, 3.8%: Asian,10.0%: Black, 9.5%: Hispanic,73.2%: White, 68.0%: women, 32.0%: men).  And a total of 1683 individuals (11.4%) of the full sample met their definition of post–COVID-19 condition, which means the individuals whose survey start date was more than 2 months after the month in which they initially identified a positive COVID-19 test and who continued to report symptoms at the time of the survey.  The survey questions were about cognitive symptoms, mood, and functional aspects.  I was personally shocked to find out that of the 1683 individuals reporting post-COVID 19 condition, 955 (56.7%) reported at least 1 cognitive symptom experienced daily, compared with 3552 of 13084 (27.1%) of those who did not report post–COVID-19 condition.  Simply put, more than half of the people with post-COVID-19 condition were experiencing some kind of cognitive symptom daily such as slowed thinking, trouble concentrating, having to work hard to pay attention to avoid making mistakes, trouble getting started, trouble remembering (eg: taking medicine or buying something), difficulty multitasking, and trouble making decisions.  Interestingly, they found greater daily cognitive symptoms in post–COVID-19 condition in women than men.  Younger age (the 18- to 24-year and 45- to 54-year groups) was also associated with increased daily cognitive symptoms.  According to the authors, this may reflect increased salience of symptoms or change from pre-COVID-19 baseline in younger individuals relative to older individuals who may already be experiencing age-associated cognitive decline. Also, in those with post COVID-19 condition, cognitive symptoms were associated with greater levels of depressive symptoms, greater reported functional impairment, and less likelihood of full-time employment. As this study suggested, it is important to consider cognitive symptoms in the evaluation and management of post–COVID-19 condition since they are common features of post-COVID-19 condition.  There are many unknown aspects of the COVID pandemic since it was the first event that we as human have experienced together.  I hope that there will be more studies regarding post-COVID-19 condition in the near future and we will have some solid evaluation and management/treatment in place.  And of course, if you are experiencing cognitive symptoms in post-COVID-19 condition, please do not hesitate to seek help from healthcare providers so you can have an individualized care plan to improve your symptoms and quality of life. *1 Jaywant A, Gunning FM, Oberlin LE, et al. Cognitive Symptoms of Post–COVID-19 Condition and Daily Functioning. JAMA Netw Open. 2024;7(2):e2356098. doi:10.1001/jamanetworkopen.2023.56098

My first blog of this year is about pets and dementia.  Let's start with a Japanese study that was published in October of last year. This study was conducted for people aged 65 and over living in Ota Ward by the Tokyo Metropolitan Institute for Geriatrics and Gerontology *1.  Of the 11,194 participants (average age 74.2 years, 51.5% female and 48.5% male, 67.1% married), 959 (8.6%) owned dogs and 704 (6.3%) owned cats at the time of the survey (2016).  Among them, 124 people had both dogs and cats. They followed these participants for about four years to track the incidences of dementia up to 2020.  As a result, those who had dogs had a 40% lower risk of developing dementia than those who did not.  They also looked at the participants' exercise habits and whether they were socially isolated, and found that among dog owners, those who exercised regularly and were not socially isolated had a significantly lower risk of developing dementia. Also, the same effect was not seen in people who owned cats. The researchers concluded that caring for dogs might help owners exercise on a daily basis and maintain more social participation, which in turn may lead to the prevention of dementia in owners. The second study, published in December last year, was reported from the UK and is based on data from a long-term cohort study of community-dwelling adults aged 50 years and older.  Of those, 7,945 individuals (average age 66.3 years, 56% female and 44% male, 97.5% white) were selected.  The participants were evaluated for verbal memory and fluency from 2010 to 2019 every other year. Of these participants, 2,791 (35.1%) had some kind of pet, and 2,139 (26.9%) lived alone.  And the result of this study was that among people who had pets, those who lived alone had a slower decline in verbal memory and fluency than those who lived with others.  People living alone without pets had a faster decline in the above abilities than people who had pets and lived with others. The researchers also concluded from these results that pet ownership might be beneficial for older people living alone. These two studies are very intriguing in that they examined whether pet ownership affects cognition, although the conditions are different.   Since the first study was conducted on Japanese people, it is possible that other ethnic/cultural groups might not have the same result or outcome.  However, considering both studies, it might be beneficial for your cognition to own a dog if you are older and live alone.  If you are a cat lover, I am sorry but maybe, it’s time to consider having a dog instead…or have both?! *1　Taniguchi, Y., Seino, S., Ikeuchi, T., Hata, T., Shinkai, S., Kitamura, A., & Fujiwara, Y. (2023). Protective effects of dog ownership against the onset of disabling dementia in older community-dwelling Japanese: A longitudinal study. Preventive medicine reports, 36, 102465. https://doi.org/10.1016/j.pmedr.2023.102465 *2　Li Y, Wang W, Zhu L, et al. Pet Ownership, Living Alone, and Cognitive Decline Among Adults 50 Years and Older. JAMA Netw Open. 2023;6(12):e2349241. doi:10.1001/jamanetworkopen.2023.49241

On the New Year's Day in Japan, a magnitude 7.6 earthquake struck the Noto Peninsula, Ishikawa Prefecture. As of Jan. 13th (Japan Time), 220 people died, more than 20,000 people are still in the shelters. Ishikawa is my home prefecture, where I was born and raised. Fortunately, my mother, who lives in Kanazawa City which is a capital city in Ishikawa, is safe and uninjured, except for some broken dishes. Kanazawa City have suffered less than the Noto area. My mother's younger brother (my uncle) and his family live in Hakui City where is closer to the epicenter, and although part of their house was damaged by the earthquake, they are fortunate because the house is still livable. As of Saturday the 13th, about 55,550 houses in the prefecture have been without water, and my uncle's family is among them. Even though he is my mother's younger brother, my uncle is 90 years old. I'm worried about his physical and mental health. And there are 15 districts that are still stranded, including 793 people. I am so far away that I am very aware of my own helplessness every day. Under such circumstances, I sincerely hope for the safety of everyone in the affected areas and for the earliest possible recovery. Here I am posting some information regarding how to support (donate) for those who are affected by this earthquake in Japan. I hope that it will be useful for those who read this blog, and together we can make a small change. Thank you so much in advance for your support and prayers. ・For those who want to directly donate to Ishikawa Prefecture. Please look at 7. Frequently Asked Questions, Q1, A1. https://www-pref-ishikawa-lg-jp.translate.goog/suitou/gienkinr0601.html?_x_tr_sl=ja&_x_tr_tl=en&_x_tr_hl=ja ・For those who have mileages for ANA https://www.ana.co.jp/en/jp/shoppingandlife/donation/tukau_noto/ ・For those who have mileages for JAL https://www.jal.co.jp/jp/en/jalmile/use/charity/2024/noto-support/ ・For those who have an account for Rakuten https://global.rakuten.com/corp/donation/noto20240101_en/noto20240101_en.html ・For those who want to donate to nonprofits https://www.globalgiving.org/projects/japan-disaster-relief-and-recovery/ ￥ 怪我もなく 大丈夫でした。

The end of the year has arrived quickly. Now, December is a time when there are more social opportunities to drink alcohol at rituals such as Christmas parties and year-end celebrations. And maybe, there will also be a New Year's party coming up soon too!  I'm not trying to put a damper on these fun occasions, but please be mindful not to drink too much alcohol. The other day, I had the opportunity to hear from someone who is an expert on the topic of "drinking and dementia."  According to this researcher, a recently reported British study*1 found that people who drank more than 7 units of alcohol per week (56g of pure alcohol by UK standards) were more likely to have smaller total volume of the brain's gray matter (such as cerebral cortex and cerebellar cortex) compared to those who drank less alcohol than 7 units per week. Simply put, for example, even if you drink just one can of beer a day (12 ounces of beer usually contains about 14g of pure alcohol), you will have consumed 98g of pure alcohol in a week, which may cause your brain volume to decrease. The same study also found that people who binge-drink everyday had significantly less total gray matter volume in their brains than those who never did.  Also, the relationship between the volume of gray matter in the brain and the type of alcohol consumed seems to be no difference between wine, beer, and spirits (equal opportunity brain shrinkers!). After all, the amount of pure alcohol is important. Of course, I think that the relationship between alcohol and dementia is an area that will require more research, especially in terms of racial, ethnic or cultural differences. In my book, I introduced that alcohol is one of the risk factors for dementia for people between the ages of 45 and 65.  The current standard recommended by Lancet*2 is an alcohol intake of no more than 21 units (168 g of pure alcohol) per week using UK units. However, if the above research results hold true, regardless of racial or cultural differences, the recommended amount of alcohol to prevent dementia may become even lower in the future. In the U.S., CDC (Centers for Disease Control and Prevention) recommends  2 drinks or less in a day for men and 1 drink or less in a day for women, or no drinking at all to reduce the risk of alcohol-related harms, such as car accidents, violence, high blood pressure, and cancers *3. One standard drink means in the U.S. that any drink that contains 0.6 fluid ounces (14g) of pure alcohol, such as approximately 12-ounce beer or 5-ounce wine. Unfortunately (!?) I don't have enough enzymes to break down alcohol in my body, so when I drink alcohol, my face turns bright red and I feel unwell.  It is estimated that about 44 % of Japanese people fall into this category (do not have enough enzymes or do not have them at all).  Although I don't drink any alcohol at all, some people may be perfectly fine with drinking one bottle of wine. In this way, there are large individual differences when it comes to drinking. And you are the one who knows your body best and what it needs to thrive. Please enjoy drinking while considering the appropriate amount of alcohol for yourself, keeping in mind your future physical, cognitive, and mental health! *1　 Topiwala, A., Ebmeier, K. P., Maullin-Sapey, T., & Nichols, T. E. (2022). Alcohol consumption and MRI markers of brain structure and function: Cohort study of 25,378 UK Biobank participants. NeuroImage. Clinical, 35, 103066. https://doi.org/10.1016/j.nicl.2022.103066 *2　 Livingston G, Huntley J, Sommerlad A, Ames D, Ballard C, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet, 2020;396:413-446. https://doi.org/10.1016/S0140-6736(20)3036-6 *3　https://www.cdc.gov/alcohol/fact-sheets/moderate-drinking.htm#:~:text=To%20reduce%20the%20risk%20of%20alcohol-related%20harms%2C%20the,is%20better%20for%20health%20than%20drinking%20more.%204

During my stay in Japan, the Ministry of Health, Labour and Welfare approved the manufacture and sale of the new Alzheimer's drug "Lecanemab" (trade name Leqembi). As I have introduced in my previous blog, "Lecanemab" is a joint development between Eisai of Japan and Biogen of the United States. Clinical trial data showed that it removed the amyloid β accumulated in the brain seen in Alzheimer's disease and slowed the progression of Alzheimer's. Japan is the second country to receive this approval, following the United States. As I wrote in my blog, this "Lecanemab" is only available to people with mild cognitive impairment (MCI) and early Alzheimer's who have accumulated amyloid β. In order to become a candidate who receive this drug, a proper diagnosis is required. To get diagnosed with MCI or early Alzheimer's, PET scans, lumbar punctures, and MRIs may also be required. Of course, side effects (cerebral edema) have also been reported in people who have received "Lecanemab". Administration is a venous drip once every two weeks. I don't mean to dampen the good news, but there's a good chance that these things could get in the way of successful distribution and accessibility. Also, knowing that in the United States, the annual price of this drug is $ 26,500 (3.9 million yen), we are even more worried about the cost in Japan. It will be decided by the end of the year how much the government will bear and how much the out-of-pocket burden of those who will be administered. But in any case, there is no doubt that it will be a very expensive drug. As I have written repeatedly on my blog, it is a new drug that should help many people, so I sincerely hope that in the near future, it will be available equitably not only in the United States and Japan, but also all over the world! Once the drug price is decided in Japan, I will report it on the blog again.

I was back in Japan for a while from late September to early October. During my visit, I was honored to give a lecture at the Department of Occupational Therapy at Kanazawa University, where I previously studied to start my life over again at the age of 30! I was invited by my university professor, Prof. Shibata, to present keynote talk to third-year students in occupational therapy. From the perspective of theory and practice of dementia care, I briefly spoke with students about person-centered dementia care and cultural humility, which I use as frameworks. I was also able to highlight and share the dementia care model that I am currently creating as a tool for caregivers and professionals. I’ve set a goal to present this same care model at an international Alzheimer's Conference to be held next spring. As I’ve mentioned on this website, I believe that it is necessary to have a humble attitude and practice in order to respond to diverse cultures, not only in the United States, where the diversity co-exits, but also in Japan where the number of foreign residents is expected to increase in addition to the number of foreigners engaged in healthcare. My hope is that the students who will become wonderful occupational therapists in the future can understand and integrate my idea of what a healthcare professional should be into their lives and professional practices. I was born and raised in Kanazawa, Ishikawa Prefecture, and my mother, who is now 93 years old, lives alone in Kanazawa. Since the construction of the Shinkansen (bullet train) connecting to Tokyo, Kanazawa has become more international, and there has also been an increasing number of tourists visiting from overseas. Currently, when I walk around the city, I can now hear various and diverse languages. Perhaps some of these tourists are unfortunate enough to visit or be admitted to the hospital due to illness or injury. In such cases, our prejudices and stereotypes about other cultures that we may or may not be aware of should not interfere with treatment and care of these visitors. I think it is important to understand the concept of cultural humility in order to engage in cross-cultural exchanges in a truer sense, not limited to healthcare field. To all of you majoring in and focusing on occupational therapy at Kanazawa University, please become an occupational therapist who will be equipped with cross-cultural experiences and spread your wings around the world. This cross-cultural expertise combined with a culturally humble practice will only help you to serve your clients better! I'm rooting for you. And thank you for having me and being open to my frameworks that are intended on supporting both you and your future clients in a quickly diversifying world!

In my previous blog, I introduced a study from Canada regarding physical exercise, cognitive training, and vitamin D intake. According to the study, vitamin D intake didn’t affect the participants’ cognitive function*1. Vitamin D is probably most known for its role in bone health. Moreover, it is an anti-inflammatory, antioxidant, and neuroprotective. But to be honest, I didn’t know much about the association between vitamin D and cognitive impairment. I was lucky enough to find this very comprehensive review on an overview of its association *2. According to this article, in conclusion, 1)Animal or cellular studies suggested that vitamin D has multiple functions in the central nervous system. 2)Cross-sectional studies (studies that examine the data of a specific population in a specific time) report that vitamin D concentrations are lower in people with cognitive impairment and dementia. However, reverse causality can be a possibility (because the person developed Dementia, which affected their diet, that’s why their vitamin D level is low, not vice versa). 3)Association of low vitamin D with an increased risk of cognitive decline still has no answer. 4)Trials examining the effect of vitamin D supplementation on cognitive outcomes, have produced mixed findings. 5) No consensus over the dosage of vitamin D and no optimal age of treatment for people at risk are identified. 6)More studies are needed! Indeed, we still don’t have definitive answers regarding the relationship between vitamin D and cognitive decline. The lack of improvement results of vitamin D in the study in my previous blog, might be related to the fact that there were only 4 participants who were severely deficient in vitamin D while others were not deficient in vitamin D, as the authors mentioned in the study. In the US, according to the National Institutes of Health *3, average daily recommended amounts of vitamin D are; if one is between 14 and 17 years old, they need to take 15 µg (micrograms). And, if one is older than 71 years, they should be taking 20 µg. A blood test can measure the amount of a form of vitamin D, called 25-Hydroxyvitamin D. If the levels are below 30 nmol/L (nanomoles per liter), they are too low, and if the levels are above 125 nmol/L, they are considered as too high. Both cases (too high/too low) might affect your health in very negative ways. Whether or not vitamin D levels affect our cognition, insufficient levels of vitamin D, for example, can increase the risk of fractures due to osteoporosis especially among the elderly population. Of course, it is a good idea to pay attention to one’s own levels of vitamin D— both too much and too little are not good for our health. But, if a person’s level is among the normal range, I think that it is wise to just keep getting vitamin D from your consistent healthy diet, and not from the dietary supplements. Vitamin D rich foods are, for example, fatty fish such as salmon, some mushrooms, eggs, milk, soy milk, and so on. And it’s also vital not to forget to regularly spend some time in the sun since our body makes vitamin D when our skin gets exposed to sunlight. I live under the gray skies of Washington State, so whenever the sun comes out, I make sure to apply some sunscreen and go directly outside!! *1 Montero-Odasso M, Zou G, Speechley M, et al. Effects of Exercise Alone or Combined With Cognitive Training and Vitamin D Supplementation to Improve Cognition in Adults With Mild Cognitive Impairment: A Randomized Clinical Trial. JAMA Netw Open.2023;6(7):e2324465. doi:10.1001/jamanetworkopen.2023.24465 *2 Sultan S, Taimuri U, Basnan SA, Ai-Orabi WK, Awadallah A, Almowald F, Hazazi A. Low Vitamin D and Its Association with Cognitive Impairment and Dementia. J Aging Res. 2020 Apr 30;2020:6097820. doi: 10.1155/2020/6097820. PMID: 32399297; PMCID: PMC7210535. *3 Vitamin D - Health Professional Fact Sheet (nih.gov)

I previously wrote about this on my blog, but, on July 6, finally, Leqembi which targets amyloid beta, a new drug for Alzheimer's disease developed by Eisai in Japan and Biogen in the United States, was given full approval by the U.S. Food and Drug Administration. The results of clinical trials in the later stage showed that the decline in cognitive function of participants was slowed down by 27% over a period of 18 months. This is estimated that it is equivalent to delaying the progress for four to five months. This delay can be significant and can mean the world to people living with Alzheimer’s and their families. Leqembi is intended and designed for people with mild cognitive impairment or early Alzheimer's, and it is not meant for those embodying advanced symptoms. In the United States, by receiving full approval, the cost of this treatment will be covered by Medicare as long as the providers who prescribe the drug participate in registries to collect evidence. As I mentioned last time, the annual cost is $26,500. 80% is covered by Medicare, which means 20% will be at one’s own expense. In addition, to qualify, first of all, one has to do an expensive PET scan or lumbar punctures that may also put a strain on one’s body. These procedures are necessary in order to confirm there is an accumulation of amyloid beta in the brain. Thus, some economic burden on those who use Leqembi is expected. In addition, this medicine is administered intravenously every other week. Depending on where the treatment is carried out, it can be difficult and a real challenge for some people to go to the hospital twice a month. Currently, clinical trials of self-administration (injection in the thigh) are also underway, so hopefully, in the end, self-injection can solve such a potential problem. We certainly need more time to determine if this Leqembi is a breakthrough or another possible medical/systemic disappointment. In my home country, Japan, it is expected that the results of whether or not to approve Leqembi will be given this fall. I will closely monitor this matter and promise to keep my readers posted on its progress! If you are interested in, here's the press release from Eisai. No.23-49 (eisai.com)