THE TOP TEN TREATMENTS
FOR PREVENTING ALZHEIMER’S DISEASE
J. Wesson Ashford,
The field of Alzheimer’s disease is rapidly uncovering
information for the treatment and prevention of Alzheimer’s disease.
While much discussion about cause is still speculative, there is mounting
evidence to support several ideas about how Alzheimer’s disease develops.
Though there is never enough evidence to prove any scientific theory,
there is frequently enough evidence to discuss a particular idea with patients
and to make practical recommendations. In
the field of Alzheimer’s disease, there are several such issues that can now
be brought to the clinic setting. There
are some recommendations based on current experience with treating Alzheimer
patients or the associations between Alzheimer’s disease and other dementing
disorders. Other suggestions are
based on scientific hypotheses with only preliminary evidence.
Take your blood pressure regularly and be sure that the systolic pressure
is always less than 130. This
recommendation is based on the association between stroke and Alzheimer’s
disease and several articles relating high blood pressure to poor memory and a
higher incidence of Alzheimer’s disease, particularly in association with
certain genes. There is also some
evidence that patients taking diuretics for their elevated blood pressure get
less Alzheimer’s disease. So keep
track of your blood pressure and, if necessary, make sure that it is well
Watch your cholesterol; if your cholesterol is elevated, get treated with
“statin” drugs and be sure your cholesterol is fully controlled.
First, cholesterol levels are related to arteriosclerotic vascular
disease, which is in turn related to heart disease and stroke.
So, this is a good idea in any case.
There is recent evidence that that cholesterol plays an important role in
memory in the brain and is controlled by Apolipoprotein E, which may be
associated with 50% of the Alzheimer risk.
Two recent studies have suggested that individuals taking “statin”
drugs are less likely to get Alzheimer’s disease.
While these findings cannot be considered to warrant prescription without
cholesterol elevation, clearly these data give individuals with elevated
cholesterol have another reason to take their prescribed medications. There has been one epidemiological study associating animal
fat intake with Alzheimer risk across many different countries, but this study
is not convincing enough to ask everyone to take all animal fat out of their
diet. But, if the fatty chemicals
in your blood are not good, you should discuss modification of your diet with
Exercise your body and mind regularly.
There are many studies extolling the virtues of exercise.
While there are no specific links between exercise and Alzheimer’s
disease, there are links between exercise and health and cognition.
People can get smarter by exercising.
So, there is a logical recommendation to exercise to reduce the risk of
Alzheimer’s disease. But, beyond
this, there are recent theories linking insulin to Alzheimer’s disease.
The blood insulin level peaks about an hour after you eat.
If you exercise about 30 minutes after you eat, even if just walking for
about 15 minutes (that’s after each meal), you might reduce your peak insulin
level and leave the insulin-degrading enzyme to do its other task of breaking
down the harmful beta-amyloid that forms fibrils in the brains of Alzheimer
patients. There are also several
studies linking education to delayed onset of Alzheimer’s disease and some
recent evidence suggesting that keeping your mind active can also delay onset.
Though all of these studies can be criticized in various ways, it makes
sense to stay in school as long as possible and continue seeking intellectual
stimulation throughout your life.
Wear your seat belt; wear a helmet when you are riding a bicycle or
participating in any activity where you might hit your head.
There have been many reports of a relationship between head injury and
Alzheimer’s disease. While head
trauma probably accounts for less than 5% of the cases of Alzheimer’s disease,
safety can help to reduce this factor.
If you have diabetes, make sure that your blood sugar is optimally
controlled. One of the greatest
advances in medicine has been the ability to control diabetes.
Patients with diabetes have a tendency to get vascular disease, and this
disease can injure the brain. While
there is not clear relation between diabetes and Alzheimer’s disease, patients
who have had blood sugars that have gone too high or too low may lose memory and
be at greater risk for suffering from dementia.
Consult your doctor about treatment for your arthritis pain.
There have been several studies indicating that arthritis patients who
take NSAIDs (non-steroidal anti-inflammatory drugs) have a reduced risk of
Alzheimer’s disease. A recent
study (t’Veldt et al., 2001, New England Journal of Medicine) suggested that
arthritis patients who had taken NSAIDs for over 3 years had an 80% reduction in
their risk of getting Alzheimer’s disease.
Because the risks of these drugs (especially internal bleeding) are so
great, they cannot be recommended for routine prevention.
However, if you have arthritis, you should seek the advice of your doctor
for treatment. Of additional great
interest is another suggestion (from the lab of E. Koo), that only certain
NSAIDs may prevent the development of a toxic protein in the brain that may be a
specific cause of Alzheimer’s disease (beta-amyloid-1-42).
The particular NSAIDs identified with this benefit so far are ibuprofen
(Motrin, Advil), sulindac (Clinoril), and indomethacin (Indocin).
Indomethacin may be the most potent, and one study suggested that this
drug does slow down the course of Alzheimer’s disease.
Ibuprofen is most readily available.
However, a good recommendation for pain patients at this time is for
sulindac because it is the most easily administered and has the least side
Take your vitamins. There is
little reason not to take supplemental vitamins after you turn 50 years of age,
and they might even help if you have some transient deficiency in your diet (see
Willett & Stampfer, 2001, New England Journal of Medicine).
There is general support to take extra supplements of Vitamin E (400
international units) and Vitamin C (500 milligrams) together (once per day for
prevention, twice per day if memory problems are present, and three times per
day if Alzheimer’s disease is diagnosed).
These recommendations are based on the oxidation/free-radical theory of
aging and Alzheimer’s disease and one large study which suggested that Vitamin
E delayed specific end-points for Alzheimer patients by as much as 6 months.
Though the free-radical theory of Alzheimer’s disease has not been
shown to be causal and the Vitamin E study has not been replicated, this
“neuroprotective regimen” has become a common treatment of Alzheimer’s
disease and taken by many as a preventive.
B12 and folate have also been
advocated as brain protective agents. B12
recommendations are complicated by the issue of intestinal uptake by intrinsic
factor. The RDA for folate is 400
mcg per day, but this dose can be increased to 1 mg per day if memory difficulty
is a concern and B12 levels are not low. Recent correlation between elevated homocysteine levels and
Alzheimer’s disease (Sheshadri et al., 2002, New England Journal of Medicine)
brings a focus on this substance and the associated intake of B12 (which is
inadequate with a “vegan” diet) and folate.
B12 and folate supplementation can keep homocysteine levels in check.
Alcohol and caffeine intake and tobacco use increase homocysteine.
Discuss sex-hormone replacement therapy with your physician.
There are general recommendations to post-menopausal women to take
hormone replacement therapy to reduce the risk of heart disease and improve life
in a variety of ways. There is also
some evidence that these hormones might reduce the risk of Alzheimer’s
disease. However, one study has
suggested that the treatment of female Alzheimer patients with hormone
replacement therapy may have more risk than benefit.
The issue of sex-hormones is of interest because these chemicals seem to
enhance the function of many brain cells. This
leads to another question, which is, would sex-hormone replacement help elderly
males as well?
If you have difficulty getting to sleep, consider trying 6 milligrams of
melatonin at bedtime. Melatonin is
a natural substance produced by the pineal gland in the brain.
This substance is produced only in the dark and may help to initiate and
sustain sleep. As you get older,
the brain produces less melatonin, and older people sleep less.
Sleep is good for the body and brain in any case and may help to keep
Alzheimer pathology from developing. There
is only scant scientific evidence that melatonin helps sleep, but there are many
patients and their family members that claim that it helps a great deal.
A big problem is that melatonin is a health food, not regulated by the
FDA, so potency is not monitored. Also,
it may help sleep only in those individuals with a significant melatonin
deficiency. However, melatonin is
an excellent anti-oxidant and some recent laboratory evidence has suggested that
melatonin may prevent the formation of toxic amyloid fibrils in the brain, and
these fibrils may be the primary cause of Alzheimer’s disease.
you have significant difficulty with your memory, talk to your doctor about
cholinesterase inhibitors. Several
drugs from this class, including tacrine (Cognex), donepezil (Aricept),
rivastigmine (Exelon), and galantamine (Reminyl), have been approved by the FDA
for treating Alzheimer patients with mild dementia.
While the primary evidence suggests that these drugs have only a modest
benefit on cognition, there have been several studies that have suggested that
these drugs may slow down the progression of Alzheimer’s disease.
Note that these studies are only suggestive, not conclusive, but many
physicians agree with this suggestion based on their own observations. Importantly, if these drugs can slow Alzheimer progression,
then they may have their biggest advantage very early in the disease course.
While doctors are not prescribing these drugs for preventing
Alzheimer’s disease, many physicians are prescribing these drugs beneficially
for patients with mild memory problems. It
is possible that these drugs may become a central part of preventive therapy for
Alzheimer’s disease in the future.
There are several treatments in addition to those listed
above that have been recommended for Alzheimer’s disease as treatment or
preventive agents. At this point,
there is not enough data to make more explicit recommendations.
For example, a recent review of Ginkgo Biloba suggested that the
recommendations for this substance “remain ambiguous” (Sommer &
shatzberg, 2002, Psychiatric Annals). Co-enzyme Q-10 has also been recommended without wide
support. There is not enough
evidence that aluminum is associated with Alzheimer’s disease to recommend
throwing out your aluminum pots, but you probably shouldn’t cook tomato sauce
in them. Tobacco was shown in some
studies to protect against Alzheimer’s disease, but later analyses have
suggested that it is not preventive. Alcohol
in very low quantities may protect against heart disease and has been suggested
to protect against Alzheimer’s disease as well, but anything more than minimal
use is not wise.
Several studies are exploring potential new preventions and
treatments for Alzheimer’s disease. The
“amyloid vaccine” is one of the most interesting, but the development of
this treatment has suffered a recent setback because some of the volunteers
trying the treatment developed brain inflammation.
Also, there may be specific drugs now available that might slow Alzheimer
pathology. For example, lithium and
valproic acid, two drugs used to treat manic-depression, may inhibit a brain
enzyme (glycogen-synthase-kinase-3-beta), which could prevent the development of
neurofibrillary tangles, a late Alzheimer pathology.
Many patients with Alzheimer’s disease, including those
in very early phases, have problems with depression and paranoid ideas.
These symptoms can and should be treated.
Another critical question in Alzheimer’s disease,
especially if early treatment can slow progression and delay dementia, is early
recognition. Screening tests to be
used routinely in doctors’ offices for patients over 60 years of age are now
being developed and may help many patients to get help sooner.
At this time, there are many genes being uncovered that appear to be associated with Alzheimer’s disease. In the future, it is likely that specific individuals will be told not only what their risk is for developing Alzheimer’s disease, but also how they can modify their life to prevent it completely. There are so many indications that Alzheimer’s disease might be prevented that there is hope mounting that we may be able to end this disease in the near future.