Q: My father, who is 72, was just diagnosed with Alzheimer’s disease. I’m deeply concerned about him, and at the same time, I’m becoming concerned about my own risk, and my children’s risk, of developing the disease, too. I want to learn everything I can about prevention: What can we do to minimize our chances of developing Alzheimer’s?
Answer provided by Michael Mega, M.D., Ph.D., director of the Alzheimer’s Disease/Dementia Program at Providence Brain Institute and associate medical director of Providence Center on Aging: You are asking the same questions that scientists at the National Institutes of Health (NIH) — and many others — are asking.
In February 2006, the NIH announced the findings of an expert panel that had combed previous research to come up with solid ideas for helping Americans keep their brains in the best shape possible.
Because of genetics, a small percentage of people — perhaps less than 1 percent — inherit a 50 percent familial risk of developing Alzheimer's disease. Those with an inherited tendency toward the disease usually exhibit symptoms by the time they are 65 years old (or as young as age 30 in some families), and their decline is usually more rapid than those who develop the disease later.
But for most of us, genetics plays a much smaller role than the simple process of aging. The odds of developing Alzheimer's or another form of dementia grow year by year so that, by the age of 85, the risk for all of us is nearly 50-50. However, research is showing that we can reduce those odds through lifestyle choices that help maintain the brain's health.
This advice isn't just for senior citizens.
People who ultimately succumb to Alzheimer's are under the disease's quiet influence for many years before they develop clinical, observable symptoms. Research indicates that Alzheimer's begins its slow but steady campaign of diminishing the brain's effectiveness perhaps 20 years before symptoms are noticed and the disease finally manifests itself.
To thwart Alzheimer's, we should work to improve our brain health before we exhibit symptoms — and ideally by the time we reach our 30s or 40s.
What the NIH advises
An overview of all the research studies reveals that people who lead lives that are healthy, active and stimulating in all spheres — physically, mentally and spiritually — have the greatest chance of eluding Alzheimer's.
The NIH panel found data that pointed to a handful of promising avenues for reducing the risk of Alzheimer's. They recommend these steps:
Reduce your stress.
Exercise your brain by working it with cognitive challenges.
Improve your cardiovascular health.
Maintain friendships and participate in a rewarding social life.
Increase your feelings of well-being by developing your spirituality, emotional self-awareness and psychological maturity.
Much of the brain health research is based on large, long-term studies that follow normal individuals as they age. Keep in mind that, while the data may reveal interesting associations, they don’t necessarily identify what kept Alzheimer's from developing. These studies provide clues that researchers can frame as hypotheses to test in further studies. Although this process is slow, it is necessary to separate the true preventive factors from the red herrings.
For example, one study found that the larger a person's head size, the lower his or her risk of exhibiting Alzheimer's disease. Without more information, we don't know whether it was the sheer size of the head — the brain mass — or some other factor that made the difference. For instance, the larger head may correlate with better maternal nutrition during gestation; in that case, the real protective factor may be good prenatal care.
As a second example, we know that people who have been knocked unconscious for a minute or more have a threefold increase in their risk of developing Alzheimer's. Does the risk arise from tissue loss due to brain trauma? Or, as a group, do people who get knocked out — whether from getting in fights, playing contact sports or neglecting to wear a helmet — have less formal education, which has been associated with a higher risk for Alzheimer's? Future studies, perhaps, will tell.
Reduce stress
One study that followed elderly people without dementia found that those who ultimately developed Alzheimer's had a smaller hippocampus at the start of the study than those who did not develop Alzheimer's. (The hippocampus is a part of the brain that plays a very important role in learning and in encoding short-term memory to long-term memory.) As with the previously mentioned examples, some questions remain: Were those people born with a smaller hippocampus? Or did some other influence during adulthood shrink it from its original size?
Brain scans of individuals who have undergone severe stress — such as clinical depression or post-traumatic stress disorder — show that their hippocampus is shrunken compared to those in a control group. Based on this information and the current understanding of what it takes to maintain brain health, the NIH advises people to minimize stress and to treat serious depression.
Exercise your brain
One of the most solid recommendations we can make to protect the brain is to exercise it: Achieve a higher level of education; perform complex tasks on the job; continually take on varied mental challenges.
Why does this help?
In its early stages, Alzheimer's disease starts pruning the number of connections that nerve cells make with one another. These connections, called synapses, allow neurons to pass messages throughout the nervous system. The more synapses you have, the more effectively your neural network can fire, passing along critical communication.
As you learn new information and tackle unfamiliar tasks, you are constantly adding new branches to this neural network. By continually taking on cognitive challenges — as opposed to letting yourself veg out in front of the TV — you can increase the density of your synaptic network.
There are all kinds of fun and interesting things that you and your children can do to exercise your brains. Here’s a short list to get you started:
Learn a new language.
Work crossword puzzles or other brain teasers.
Learn how to play a musical instrument.
Experiment in the kitchen with new recipes.
Read meaty literature.
Attend provocative lectures.
Put away the calculator and do mental math instead.
Explore new hobbies.
Decipher maps.
Memorize constellations, poems or sports statistics.
Learn the tricks your cell phone can do.
Lifelong learning creates such a thicket of synapses that your brain may end up with a surplus. Scientists theorize that, should Alzheimer's start pruning those branches, this thicket of extra synapses would enable your brain to better withstand the damage. You could delay clinical symptoms of Alzheimer's for years beyond the usual onset.
Another theory holds that, as people grow smarter and more glib with more education, they gain the ability to talk their way around any cognitive lapses better than less-educated people at the same stage of Alzheimer’s.
My advice: As scientists continue exploring the connection between Alzheimer's and education, keep learning and giving your brain complex problems to chew on.
Improve your cardiovascular health.
Remember this: If it helps your heart, it helps your mind. Three different studies observed that elderly people who exercise moderately are more likely to remain mentally sharp than those who are sedentary. Physical activity increases the amount of blood, oxygen and nutrients pumped through the brain.
Researchers now need to figure out what type of exercise — and how much — is most beneficial. For now, we can recommend improving your cardiovascular health to help avoid dementias in general, and perhaps Alzheimer's specifically. Besides staying physically active, you can enhance your cardiovascular health by keeping your blood pressure, cholesterol and weight at healthy levels; giving up smoking and avoiding secondhand smoke; and controlling your diabetes if you have it.
Maintain friendships and participate in a rewarding social life.
Various studies around the world have found that a strong psychosocial life — indicated by things such as having close relatives, a spouse and/or a good number of confidants; memberships in clubs; and participation in cultural activities or sporting events — is associated with a lower incidence of dementias, including Alzheimer's.
Increase your feelings of well-being by developing your spirituality, emotional self-awareness and psychological maturity.
A Swedish study that looked at the risk of inheriting Alzheimer's found that individuals who were at high familial risk had a significantly lower chance of actually developing Alzheimer's if they were emotionally open, used supportive coping strategies and were satisfied with the quality of their personal relationships and everyday life. These findings, published in 2003, have been echoed in other studies, as well.
Other strategies: an inflammatory discussion
Alzheimer's inflames the brain tissue, which is why one area of recent research had involved anti-inflammatory medications and antioxidants. This research was suspended a couple of years ago when the anti-inflammatory medicines were associated with an increased risk of heart attack and stroke.
But data from animal studies indicates that turmeric extract (curcumin), a spice with anti-inflammatory properties, might offer protection from Alzheimer's. Thus, turmeric extract could possibly be useful — while presenting no harmful side effects. We don't know what the optimal dose might be, but for myself, I take 500 mg a day. You and your children could consider doing the same.
Learn, love, laugh
Many of these suggestions are, of course, the same things that medical science has been telling us to do all along for a healthy life. The only novel recommendations are to keep challenging ourselves cognitively and to lead a rich social and spiritual life late into adulthood. Luckily for our society and for public health officials, these are lifestyle habits that many baby boomers have already embraced.
