The puzzle of Alzheimer's
Thursday, March 09 2006, 06:25 PM EST
Contributed by: R.J. Ignelzi
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For 72-year-old Mary Lynch, it's a no-brainer.
Although there's no cure for Alzheimer's disease, some studies theorize that by keeping the body and mind healthy and active, we can delay the disease or possibly prevent it.
That's good enough for this former Air Force nurse. Although Lynch is retired, she's not idle. If she's not walking around the San Diego Zoo or playing golf, she's volunteering at the Alzheimer's Association, reading one of her favorite historical novels, or completing crossword puzzles.
"When it comes to the brain, if you don't use it, you're going to lose it," says the San Diego resident, who is a diabetic (one of the risk factors for Alzheimer's) and has a family history of the disease.
Recent research indicates that what helps your cardiovascular system might also benefit your gray matter and protect it from disease. Simple common sense rules of healthy living, such as maintaining a normal weight, eating lots of fruits and vegetables, getting plenty of exercise, and not smoking may also help the brain.
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"The observations that have been made are things that make sense. The brain is an organ just like any other organ in your body. If the heart is healthy, it pumps more blood to the brain. But nothing's been proven," says Mary Sundsmo, program director for the Shiley-Marcos Alzheimer's Disease Research Center at the University of California San Diego.
Although research has been done on animals and observational human studies have been performed, there is no hard data showing that Alzheimer's can be prevented.
"What we need are controlled clinical trials," Sundsmo said.
Until we get scientific proof, the best thing is "to do what your mother always told you to do," she said. Go outside and play, eat lots of fruits and vegetables, and don't sit in front of the TV all day.
And the younger you start these healthy behaviors, the better.
Unfortunately, the two greatest risk factors for Alzheimer's are things we can't control: age and genetics.
Currently, 4.5 million Americans have Alzheimer's disease. By 2050 that number could grow to 16 million as the last of the baby boomers live long into their golden years. Ten percent of people over 65 have Alzheimer's and 50 percent of those over 85 have the disease.
Alzheimer's disease is not a normal part of aging. Older people who develop this mind-wasting disease slowly develop abnormal deposits in the brain. Scientists now know those deposits, called Alzheimer's plaque, form in the cerebral cortex and hippocampus, regions that allow humans to remember, reason and think clearly.
The plaque prevents communicating nerve cells from sending electrical impulses to each other. This communication breakdown leads to forgetfulness, confusion, or the inability to carry out everyday tasks.
Currently, the FDA has approved four drugs - cholinesterase inhibitors - to treat Alzheimer's. Used to aid memory loss and other cognitive symptoms in people with mild to moderate Alzheimer's, the drugs help prevent the breakdown of a chemical messenger in brain cells that are important to thinking skills.
"While the drugs can improve the quality of life and may slow the progression for a short period of time, it won't be sustained," Sundsmo says. "Nothing pushes back the disease."
Although none of the following "maintain your brain" tips has been proved definitively to stave off the disease, "none of them will hurt you," says Merle Brodie, president of the Alzheimer's Association of San Diego and Imperial counties. "In fact, the things we recommend will probably only make you healthier."
Control your blood pressure. Lowering high blood pressure may be almost as good for the brain as it is for the heart, no matter if you control it through diet, exercise and weight loss or by taking anti-hypertensive drugs. In a recent Swedish study, lowering high blood pressure with medication significantly reduced the risk of Alzheimer's even for people known to have a genetic predisposition to the disease.
Prevent/control type 2 diabetes. There is some evidence that diabetes increases the risk of Alzheimer's. This might be because diabetes damages blood vessels, including those in the brain. Also, the high levels of insulin, which are characteristic of diabetes, appear to coincide with declining memory, according to a recent study in Neurology magazine. Being overweight or obese - which puts you at high risk for diabetes and heart disease - also increases your risk for dementia.
Lower total cholesterol levels. High blood cholesterol is known to promote atherosclerosis (hardening of the arteries), but it may also contribute to the brain plaques typical of Alzheimer's. Cholesterol-lowering statin drugs, such as Lipitor and Zocor, may help prevent Alzheimer's as well as lower total cholesterol. Raising HDL cholesterol (good cholesterol) levels might also help. In a large study of women over 65, Harvard researchers found the strongest factor that positively influenced mental performance was a high level of HDL cholesterol.
Exercise. Physical activity might help preserve brain function. Studies that appeared in the Journal of the American Medical Association suggest that older people who get regular exercise are less likely to decline mentally. Regular exercise can benefit the brain just as it benefits the cardiovascular system by helping to lower blood pressure, control weight, improve cholesterol levels and blood sugar. It's believed that exercise improves blood flow to the brain and may encourage the formation of new brain cells.
Don't smoke. In a standard test, the cognitive function of smokers in a 2004 study declined at an annual rate five times faster than individuals who never smoked. The study, conducted by the European Community Concerted Action Against Epidemiology of Dementia, involved more than 9,000 adults ages 65 and older.
Keep your mind active. Mentally stimulating work, games and hobbies may strengthen brain cells, and the connections between them and might even trigger the growth of new nerve cells.
"Most important, no matter what your age, is to make sure you're mentally active. Do things like crossword puzzles, play bridge, keep up your golf game, volunteer, and put yourself in situations that challenge the brain," says Dr. Mary Kalafut, Scripps Clinic neurologist. "As people get older, there's a tendency to stay at home and watch television and not be active. However, it's extremely important to keep the brain working. You can take all the vitamins you want, but if you're not using your neurons, it's not helpful."
Remain socially involved. Social activity not only makes physical and mental activity more enjoyable, it can also reduce stress levels, which might help maintain healthy connections among brain cells. Brodie recommends people volunteer, join a club, take a class or become active in a church or synagogue.
Eat a healthy diet. A heart-healthy diet based on fruits, whole grains, vegetables, and low-fat proteins may also be good for brain cells and protect against Alzheimer's disease.
Researchers at the Rush Institute for Healthy Aging in Chicago published an epidemiological study showing that senior citizens who ate fish at least once a week reduced their risk of Alzheimer's four years later by 60 percent. B vitamins in food (whole grain cereals and green leafy vegetables) or in multivitamin pills help lower homocysteine, a blood chemical linked to heart attacks, strokes and possibly Alzheimer's.
"B vitamins like niacin and folic acid help control inflammation and may play a role in creating new brain cells," says Brodie.
On the opposite side of the spectrum, saturated fat and trans fats, long a target of the American Heart Association, may increase the incidence of Alzheimer's.
Pump up the antioxidants. Antioxidant vitamins, such as vitamins A, C and E, might slow down Alzheimer's disease. Antioxidants act as scavengers for free radicals which can cause damage to cells and possibly lead to diseases. High doses of some vitamins can cause side effects, so check with your doctor before taking large antioxidant doses.
Calm down. Unrelenting stress from such conditions as post-traumatic stress disorder, depression, overwork, pain, anxiety, fear, and worry damages the hippocampus - an area of the brain that's critically important for memory and information. Regular relaxation methods such as meditation, yoga, stretching, or listening to music may help ameliorate the effects of stress.
Consider aspirin and similar drugs. Like statins, nonsteroidal anti-inflammatory drugs (NSAIDs such as aspirin, ibuprofen and naproxen) may help prevent Alzheimer's because inflammation plays a role in Alzheimer's as well as heart disease. However, it's important to remember that such pain relievers do have known risks and you should check with your doctor before you start taking these medications.
SIDEBAR
Reasonable expectations
BY R.J. Ignelzi
Copley News Service
Some forgetfulness is to be expected with age.
You've misplaced your car keys. Again. You can't remember your sister's boyfriend's name. And balancing your checkbook has become a major undertaking.
Signs of a busy, stressful life or symptoms of Alzheimer's disease? While some forgetfulness is common as we age, there are certain behaviors and personality changes that need to be evaluated by a doctor.
The Alzheimer's Association ( www.alz.org) offers a list of warning signs for the disease:
1. Memory loss
Normal: Occasionally forgetting someone's name or an appointment.
Not normal: Forgetting recently learned information is one of the most common early signs of dementia. A person begins to forget more often and is unable to recall the information later.
2. Difficulty performing familiar tasks
Normal: Occasionally forgetting why you came into a room or what you were about to say.
Not normal: Planning or completing everyday tasks becomes difficult. A person may lose track of the steps to prepare a meal, place a phone call or operate a common appliance.
3. Problems with language
Normal: Sometimes having trouble finding the right word.
Not normal: People with Alzheimer's disease often forget simple words or substitute unusual words, making their speech or writing difficult to understand. Instead of asking for a toothbrush, for example, they may ask for "that thing for my mouth."
4. Disorientation to time and place
Normal: Occasionally forgetting the day of the week or where you were going.
Not normal: Alzheimer's patients can become lost in their own neighborhoods, forget where they are and how they got there, and not know how to get back home.
5. Poor or decreased judgment
Normal: Making a questionable decision from time to time.
Not normal: People with Alzheimer's may dress inappropriately, wearing layers of clothing on a warm day or little clothing on a cold day. They may also show poor judgment about money, sometimes giving large sums to telemarketers or buying things they don't use or want.
6. Problems with abstract thinking
Normal: Finding it difficult to balance a checkbook.
Not normal: Someone with Alzheimer's disease may have difficulty performing simple arithmetic. They may even forget what numbers are and how they should be used.
7. Misplacing things
Normal: Misplacing keys or a wallet temporarily.
Not normal: Alzheimer's patients put things in unusual places: an iron in the freezer or a wristwatch in the sugar bowl, for example.
8. Changes in mood or behavior
Normal: Occasionally feeling sad or moody.
Not normal: A person with Alzheimer's may show rapid mood swings - from calm to tears to anger - for no apparent reason.
9. Changes in personality
Normal: Slight changes in temperament with increasing age.
Not normal: The personalities of dementia patients can change dramatically. They may become extremely confused, suspicious, fearful or angry.
10. Loss of initiative
Normal: Sometimes feeling weary of work or social obligations.
Not normal: Alzheimer's patients may become very passive, sitting in front of the TV for hours, sleeping more than usual or not wanting to do usual activities.
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