Wednesday, January 8, 2020

DR. ROBERTS: Modifying your Alzheimer’s risk

By Sid Roberts, MD
Lufkin Radiation Oncologist
Member, Texas Medical Association

Editor’s Note: An earlier version of this article was originally published on Dr. Roberts’ blog and The Lufkin Daily News.

One of the most feared illnesses today is Alzheimer’s disease. Aloysius Alzheimer, a German psychiatrist and neuropathologist, first described the characteristic brain changes and associated dementia more than one hundred years ago. Despite the rapid advance of medicine and technology over the intervening century, we still know far too little about this devastating and incurable disease.

Diagnosing Alzheimer’s dementia requires expensive testing looking for particular brain damage due to accumulation of beta-amyloid and tau protein, which cause the signature plaques and tangles there. Because of the expense, many patients with dementia never get tested and their condition might not get labeled Alzheimer’s disease. Regardless, most dementia – 80% – is the result of Alzheimer’s.

Alzheimer’s disease can last more than a decade, starting with mild cognitive impairment and relentlessly progressing to more difficulty solving problems, personality changes, getting lost, forgetting people or significant life events, and ultimately losing the ability to care for oneself, to toilet, to speak, and to walk. Some people’s condition progresses more rapidly than others. The Alzheimer’s Association website can be a great resource for caregivers or those wanting more information.

Unfortunately, currently available prescription medications, which may help somewhat with mental function, mood, behavior, and ability to perform activities of daily living (like bathing, dressing, eating, etc.), do little to change the course of the illness or the rate of decline. We don’t yet have a magic bullet.

Genetic factors can increase risk of dementia, but most dementia cases occur sporadically in older adults in whom multiple genes influence risk. We cannot – yet – modify our genes. Changing our lifestyle, however, is one way to reduce the odds of developing dementia, even for those with high genetic risk. Many common dietary and lifestyle habits and activities recommended to improve overall health (think heart disease, cancer, diabetes) may also be of some benefit with dementia.

One Mediterranean-type diet, which researchers named the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay) diet, focuses on consuming foods that help brain health: leafy green vegetables, berries, nuts, olive oil, fish, wine in moderation, and avoiding red meat. The point is, these broad dietary recommendations are not new and not exclusive to affecting Alzheimer’s risk. Let’s just call it healthy eating.

In addition, physical and mentally stimulating activities – such as reading or crossword puzzles – are important as we age. Both diet and exercise may help with Alzheimer’s risk by virtue of preventing conditions like diabetes, hypertension, and coronary artery disease that can exacerbate cognitive decline. Understandably, most older adults cannot keep up the same rigorous workout routine they might have when they were younger. But exercising at least 150 minutes a week, whether by biking, walking, swimming, gardening or doing yard work, can increase the flow of blood to the brain, improve the health of blood vessels and raise the level of HDL cholesterol, which together help protect against both cardiovascular disease and dementia. One study found that people who engaged in more than six activities a month—including hobbies, reading, visiting friends, walking, volunteering, and attending religious services—had a 38% lower rate of developing dementia than people who did fewer activities. Along with physical and mental activity and a healthy diet, individuals who avoid smoking tobacco also have a lower dementia risk.

There is mixed evidence about the use of fish oil supplements to improve thinking and memory in Alzheimer’s. Given the benefit for cardiovascular health, it is reasonable for most people to take a fish oil supplement. Vitamin D deficiency has been identified as an independent risk factor for the development of dementia of any cause, and supplementation is recommended for patients in whom deficiency is diagnosed. However, no dietary supplement has been proven to be effective in boosting memory or preventing dementia.  It is wise to talk to your doctor about the risks and benefits of any over-the-counter medications or supplements you are taking.

As with any recommendations, we must acknowledge that playing by the rules will not guarantee we will prevent Alzheimer’s (or any other disease, for that matter). Probably two-thirds of the risk of developing Alzheimer’s simply can’t be modified. But adopting a healthy lifestyle with heart- and brain-healthy diet and exercise habits will lessen your chances of developing any number of chronic and life-threatening illnesses. When we all work toward that goal, our entire community is healthier. That’s worth striving for!

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