The aging brain: Exploring the connection between neurology and elevation
Colorado clinicians say more research is needed about Alzheimer’s and other dementias in high-elevation mountain communities
The Aspen Times
ASPEN — It isn’t noticeable at first. It starts with changes for which the brain can compensate, meaning no real impact on day-to-day functions or cognition.
But as time passes, the brain can no longer compensate for the damage it’s experiencing. Subtle problems with memory and thinking begin to pop up. Subtle turns to noticeable. Noticeable turns to difficulty carrying out everyday activities. Eventually, around-the-clock care is required.
This is the broad view progression from preclinical to severe Alzheimer’s disease, a degenerative brain disease that becomes worse with time and age, and is the most common cause of dementia, according to the Alzheimer’s Association.
In Colorado, an estimated 76,000 people are living with Alzheimer’s dementia, and that number is expected to increase 21% to 92,000 by 2025, a 2020 Alzheimer’s Association report states. As of July 2019, 14.6% of Coloradans, or about 840,000 people, were 65 or older, U.S. Census Bureau data shows.
While it’s been shown that living in higher elevation communities can lead to a more active, healthier lifestyle and even prolonged life, it’s less clear how living at high elevation correlates with degenerative brain diseases.
In short, the answer is complicated and not well researched.
“As far as I know, there isn’t a lot of evidence one way or another about high altitudes versus low altitudes for Alzheimer’s disease risk,” said Dr. Huntington Potter, director of the Alzheimer’s and Cognition Center at the University of Colorado Anschutz Medical Campus. “… We can’t say one way or another whether high altitude is a risk factor for Alzheimer’s.”
Dementia at elevation
At the Alzheimer’s and Cognition Center, which is part of the CU Anschutz Medical Campus and School of Medicine, clinicians and researchers are dedicated to discovering effective early diagnostics, preventions, treatments and ultimately cures for Alzheimer’s disease and related neurodegenerative disorders, according to its website.
For Potter, that means looking at biomarkers or diagnostic proteins in the blood that can help clinicians predict the disease earlier, conducting projects that look at the lifespan of people with Alzheimer’s disease, and other research that can quickly be translated to better care, treatment and hopefully a cure.
Right now, the center is studying a drug called Leukine, which preliminary data shows might improve Alzheimer’s disease in the short term, Potter explained. The center also is studying other drugs that attack the disease.
“Leukine may be the first one we found that looks promising, but we have several coming up that look promising, as well,” Potter said.
When it comes to looking at the potential correlation between living at high elevation and the risk for dementia-inducing diseases, Potter and Dr. Peter Pressman of the Alzheimer’s and Cognition Center said it would take great effort, time and funding to research.
Pressman, who is a behavioral neurologist and researcher with the center, said on top of securing and carefully selecting a large group of people living at elevation to participate in a study, researchers also would have to follow that group for about a decade to get meaningful results.
“It’s easy to fund a study for a few years,” Pressman said. “People give you money to do something for two to three years, but two to three years is not enough time for a process as slow as Alzheimer’s and dementia to really even pick up. I’m not saying that’s not possible. It’s doable, but it would take some effort.”
Dr. Brooke Allen, neurologist, founder of Roaring Fork Neurology in Basalt and medical director at Renew Roaring Fork, an assisted living and memory care center in Glenwood Springs, expressed similar thoughts.
Residents of high-elevation mountain communities are living longer, healthier lives in part because high-quality care is closer to home than ever before.
Sept. 4: Staying active: Orthopedics helps aging population keep moving
Sept. 11: The aging brain: The connection between neurology and elevation
Sept. 18: Access to care: Medical facilities on the rise across the High Country
Sept. 25: New frontiers in treatment: Patients seek holistic approach to wellness
Read more at SummitDaily.com/longevity
As a part of any mild cognitive impairment or dementia evaluation, Allen said her team checks the oxygen level a patient has and considers the elevation at which that person spends most of their time.
Lower oxygen levels can contribute to people experiencing confusion, dizziness and mild short-term memory issues. But outside of looking at oxygen levels and how they could be contributing to symptoms, Allen said she doesn’t consider elevation a higher risk situation.
Allen said she feels High Country residents 65 and older tend to be much younger than their age in terms of their lifestyle, which is a positive in terms of dementia prevention.
About four years ago, Allen and her team conducted a long-term preclinical Alzheimer’s trial as part of the Alzheimer’s Prevention Initiative’s Generation Program, a study that looked at the effectiveness of preventative treatments for individuals between 65 and 75 who had no symptoms of dementia.
Allen said more than 250 people came in to participate in the study and all generally led healthy, active lifestyles.
“I think in our valley, I’ve experienced meeting those kinds of people and not thinking of altitude as a risk factor but as a lifestyle opportunity in a rural area like ours,” Allen said about the people who participated in the study.
Looking at the potential correlation between living at high elevation and risk of degenerative brain diseases is not just a difficult feat for Colorado researchers. Little research with concrete findings exists nationally or globally.
One study published in 2015 by Dr. Stephen Thielke in JAMA Psychiatry looked at deaths attributed to Alzheimer’s dementia reported in 58 counties in California to try to determine whether rates of dementia were associated with average elevation of residence. The study found that the counties at higher elevation generally had lower rates of dementia mortality.
“Additional work is needed to determine whether this relationship holds in other populations,” the study notes.
But beyond this study, there isn’t much conclusive evidence for or against a correlation, as emphasized by Dr. Brent Kious, a psychiatrist, assistant professor and researcher with University of Utah Health and the school’s Department of Psychiatry.
Kious has studied the link between living at high elevations and major depressive disorder, anxiety and suicide, and he said he and his research team have been interested in the impact of elevation on the incidence and median age of onset of Parkinson’s disease.
However, Kious said decrements in cognitive performance due to chronic exposure to moderately high elevation might not necessarily translate into an increased risk of dementia.
“It is not clear whether altitude would affect those neurodegenerative processes or not, though there is some reason to think that they involve oxidative damage … so relative hypoxia might slow them,” Kious wrote in an email. He went on to note that relative and prolonged hypoxia, or a lack of oxygen, has been associated with dementia risk. “In any case, a good epidemiological study of the association between altitude and dementia should control for things that might be associated with both.”
Better understanding and access to care
While there’s not good data for or against high elevation as a risk factor for degenerative brain diseases, there is evidence that people living in more rural communities do not have the same access to dementia care and treatment as those living in urban areas.
According to the 2020 Snapshot of Rural Health in Colorado, produced by the Colorado Rural Health Center, 721,500 people are living in rural Colorado and 19% of the rural population is age 65 or older. Rural is defined as a nonmetropolitan county with no cities over 50,000 residents.
Chad Federwitz — a gerontologist, or specialist in the study of aging, and manager of Pitkin County senior services — said he hasn’t seen any correlation between living at high elevation and dementia risk. Anecdotally, he does know that people move to Grand Junction or the Front Range if they have dementia because of a lack of care resources in the High Country.
“Given the nature of our rural-ish community, we don’t have the same resources,” Federwitz said, referring to things like long-term assisted living and memory care options. “You can go to Grand Junction or the Front Range and have pages and pages of resources as opposed to here.”
While there are some dementia care resources in more rural Colorado communities, the Alzheimer’s and Cognition Center is working to do more to develop meaningful relationships with health care providers and dementia patients in the state’s mountain communities as part of its mission.
According to Pressman, who is heading this charge on behalf of the CU center, a lot of projects are in the planning stages but include virtually educating medical providers, nurse practitioners and primary care doctors on Alzheimer’s and general healthy brain aging as well as mutual, participatory research with rural Colorado communities and communities of color.
Pressman explained that a lot of research related to Alzheimer’s overwhelmingly is based on middle-class, well-educated, white participants. And so while researchers think they know a lot about the disease in general, they really only know about the disease related to this demographic group.
Through the center’s outreach and efforts to better connect with underrepresented communities, Pressman hopes to conduct better science and better serve the larger Colorado community.
“What motivates me is trying to do good work, trying to do good science and to make sure our results actually represent real life,” Pressman said. “We want to make sure we’re helping everybody, not just a niche group, and that our services are available equitably to as many people as possible.”
Editor’s note: This is Part 2 of a four-part series on longevity in the High Country. The series is being produced in partnership with The Aspen Times, Glenwood Springs Post Independent, Steamboat Pilot & Today and Vail Daily. Read more at SummitDaily.com/longevity.
Alzheimer’s disease is a degenerative brain disease that becomes worse with time and age and is the most common cause of dementia. Dementia is not a single disease, but the general term for cognitive changes that limit independence, like loss of memory, language, problem solving and other thinking abilities.
Other diseases that cause dementia are cerebrovascular disease, Lewy Body disease and Parkinson’s disease.
Alzheimer’s disease is namely the result of the accumulation of the protein fragment beta-amyloid outside of neurons in the brain and of an abnormal form of the protein tau inside neurons.
These accumulations over time can contribute to the damage and death of neurons by interfering with neuron-to-neuron communication at synapses and can block the essential transport of nutrients and other essential molecules inside neurons resulting in early symptoms of memory loss, apathy and depression. Later symptoms include impaired communication, disorientation, confusion, poor judgment and behavioral changes. The final stages of the disease include difficulty speaking, swallowing and walking as neuron damage gets worse.
An estimated 5.8 million Americans ages 65 and older are living with Alzheimer’s dementia, the third and most developed phase of the disease.
— Alzheimer’s Association
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