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| Increased Risk of Alzheimer's / Dementia |
Last updated: Apr 28, 2008 |
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Increased Risk of Alzheimer's / Dementia |
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Signs, symptoms and indicators | Conditions that suggest it | Contributing risk factors | Recommendations
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What causes Alzheimer's disease? No one knows. Scientists are increasingly finding that it is a combination of many interrelated factors that seems to strongly influence a person's genetic predisposition to develop this devastating degenerative condition. The top two risk factors of the disease - age and genetics - are beyond people's control, yet decisive forces in the Alzheimer's epidemiology.
Rare before age 50, Alzheimer's afflicts nearly half of all people past the age of 85 - the most rapidly growing portion of the population. By the year 2001, over 4 million living Americans had been diagnosed with Alzheimer's disease and, barring scientific progress, about 14 million will have it by the middle of this century.
As the disease develops, two key structural changes are often observed in the brain:
1) The build-up of plaque, consisting mostly of beta-amyloid peptides
2) The development of neurofibrillary tangles, generated by phosphorylated tau-proteins.
Increased free radical activity (oxidative stress) appears to fuel Alzheimer's pathology - acting simultaneously as a mediator, product, and trigger for this "clogging" process and its related neural damage. Furthermore, because Alzheimer's patients often exhibit increased concentration of heavy metals such as mercury in their blood and brain, toxic exposure is also believed to play an important role.
A very important factor in the treatment of Alzheimer's is keeping active - both physically and mentally. Walking, tai chi, swimming, reading, playing games and socializing with others are all excellent ways to keep active. In China, old people who are surrounded by a loving family and have grandchildren around have better mental function than those who live alone. We are not saying that you have to live in a crowded house with an extended family to be healthy, but do recommend having a hobby and keeping some excitement in your life.
Although a relationship between a stressful lifestyle, a low level of education and a lack of stimulation has been raised through some studies, experts say such links are not yet definitive but deserving of further study. Despite the unproven associations, what harm could fostering a healthier, less stressful lifestyle be?
Moderate alcohol consumption may reduce the risk. One study found that those drinking under one or two drinks per day had a roughly 50% lower risk of developing the disease, while people drinking more than one or two drinks had a 30% lower risk than non-drinkers. Although a protective effect may be had by consuming alcohol, the advice to drink is still premature. Some people are consuming a modest level of alcohol each day as a preventative measure against heart disease and this study appears to confirm that benefit.
Vaccinations have shown protective and reversal effects. Although promising, it is still unknown if one will be successfully developed for human use.
Results from a ‘smell’ test, though not commonly available, were predictive of who would progress to Alzheimer’s disease. A person's sense of smell is one of the first parts of the neurological system that Alzheimer's attacks. All 19 patients with mild cognitive impairment who developed Alzheimer's over the course of the study had low scores in smelling ability, the study found. None of the 30 individuals who scored well on the test developed Alzheimer's disease during the follow-up period, which averaged 20 months. These results were preliminary and more testing needs to be done.
There is no protective effect of smoking for men, but for women who are not carriers of the gene APOE 4, there appeared to be a protective effect, claim researchers. However, among women who are carriers of the gene, smoking appears to increase the risk of Alzheimer’s disease.
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 Signs, symptoms & indicators of Increased Risk of Alzheimer's / Dementia: | | | | | | Symptoms - Head - Nose |  Reduced sense of taste or smell |
Symptoms - Mind - General |
 Periods of confusion/disorientation
Counter-indicators:
 A hard-driving personality | A surprising study of elderly people suggests that those who see themselves as self-disciplined, organized achievers have a lower risk for developing Alzheimer's disease than people who are less conscientious.
A purposeful personality may somehow protect the brain, perhaps by increasing neural connections that can act as a reserve against mental decline, said study co-author Robert Wilson of Chicago's Rush University Medical Center.
Astoundingly, the brains of some of the dutiful people in the study were examined after their deaths and were found to have lesions that would meet accepted criteria for Alzheimer's — even though these people had shown no signs of dementia.
"This adds to our knowledge that lifestyle, personality, how we think, feel and behave are very importantly tied up with risk for this terrible illness," Wilson said. "It may suggest new ideas for trying to delay the onset of this illness." [General Psychiatry, Oct 1, 2007] |
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Conditions that suggest Increased Risk of Alzheimer's / Dementia: | | | | | | Hormones | Low Estrogen Levels| | Women who use hormone therapy before the age of 65 could cut their risk of developing Alzheimer's disease or dementia. This possibility is raised by research that will be presented at the American Academy of Neurology's 59th Annual Meeting in Boston, April 28 May 5, 2007.
The study found women who used any form of estrogen hormone therapy before the age of 65 were nearly 50 percent less likely to develop Alzheimer's disease or dementia than women who did not use hormone therapy before age 65.
The study was part of the Women's Health Initiative Memory Study, which is a sub-study of the Women's Health Initiative (WHI), one of the largest U.S. prevention studies of postmenopausal women. The study looked at prior hormone use in 7,153 healthy women ages 65-79 before they enrolled in the WHI Memory Study. Researchers followed the women's cognitive health over an average of five years.
In that time, 106 of the women developed Alzheimer's disease or dementia. Dementia is a general term referring to the progressive decline in a person's cognitive function. Dementia can affect memory, attention, language and problem solving abilities. Alzheimer's is the most common type of dementia.
Prior studies have shown that hormone therapy started during the WHI Memory Study increased a woman's chance of dementia. The reduced risk of dementia was seen only with prior hormone therapy, used before study enrollment. Reduced risk was not affected by other examined factors. "We found that it didn't matter how old the woman was when she started hormone therapy, how long or recently she took it or what kind of prior therapy she used," said study author Victor W. Henderson, MD, of Stanford University in Palo Alto, CA, and Fellow of the American Academy of Neurology.
Women who began estrogen-only therapy after the age of 65 had roughly a 50-percent increased risk of developing dementia. The risk jumped to nearly double for women using estrogen-plus-progestin hormone therapy. |
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Risk factors for Increased Risk of Alzheimer's / Dementia: | | | | | | Autoimmune | Diabetes Type I| | According to a new study in Neurology, diabetes mellitus may not only damage the function of the eye, limbs, kidneys, and heart - it may also impair the function of the brain and hasten the process of senile dementia.
Researchers found that diabetes mellitus nearly doubles the risk of developing both vascular dementia and Alzheimer's disease, according to the Rotterdam Study, a large prospective analysis which tracked dysglycemia and dementia in over 6000 individuals over age 55. Diagnosis of diabetes was based on World Health Organization criteria using a glucose tolerance test.
A related editorial called Alzheimer's a possible "brain-type diabetes." Besides damaging important blood vessel networks and increasing the risk of small "silent" strokes deep inside the brain, dysglycemia may be directly involved in the development of the neurofibrillary tangles, the clumping of nerves and fiber tissue inside the brain characteristic of Alzheimer's.
The researchers noted that advanced glycation endproducts (AGE), proteins damaged by chronically high blood sugar levels, are commonly found inside these tangles. "In brains of AD patients the receptor for AGE appears overexpressed," they noted. "Activation of this receptor leads to increased oxidative stress that may result in cellular damage."
Diabetes also disrupts insulin signaling to other cells in the body. This altered signaling may increase the activity of a neuronal enzyme that stimulates phosphorylated tau proteins to build up, a key trigger mechanism cited as one of the earliest signs of Alzheimer's.
NOTE: This study strongly suggests the important potential role of glycation products and insulin response, not just glucose levels, in the etiology of degenerative disease.
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Circulation |
Hypertension| | A study in Journal of Neuroimaging (July 2007) suggests that cognitively normal adults exhibiting atrophy of their temporal lobe or damage to blood vessels in the brain are more likely to develop Alzheimer's disease. Older adults showing signs of both conditions were seven-times more likely to develop Alzheimer's than their peers.
"Alzheimer's disease, a highly debilitating and ultimately fatal neurological disease, is already associated with other risk factors such as poor cognitive scores, education or health conditions," says study author Caterina Rosano. "This study, because it focused on healthy, cognitively normal adults, shows that there other risk factors we need to consider."
MRI images of participants' brains were examined to identify poor brain circulation, damaged blood vessels and/or atrophy of the medial temporal lobe. Subjects showing any one or a combination of these symptoms were more likely to develop Alzheimer's in the following years.
"Similarly to heart disease, brain blood vessel damage is more likely to occur in patients with high blood pressure, high cholesterol or diabetes," says Rosano. "Since we know that prevention of these conditions can lower risk of heart attack and stroke, it is likely that it would also lower the risk of developing Alzheimer's." |
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Environment / Toxicity |
Cigarette Smoke Damage
Mercury Toxicity / Amalgam Illness| | Part of the increase in the incidence of Alzheimer's disease may be due to mercury exposure from mercury amalgam fillings, especially those high in copper content. [Environ Contam Toxicol 2001;67. pp.800 806] |
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Family History |
Alzheimer's in family members| | By age 80, people with Alzheimer's disease in both parents had a 54% risk, 1.5 times the risk of Alzheimer's in people with just one affected parent, and 5 times the risk of people with two unaffected parents. |
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Lab Values |
Elevated Total Cholesterol| | It is thought that the connection between high cholesterol and Alzheimer's disease exists in a protein called beta-amyloid, a sticky substance that builds up in the brains of Alzheimer's patients leading to nerve cell damage and loss of cognitive function. Accumulation of the protein is believed to be related to higher cholesterol levels.
A study in Journal of Neuroimaging (July 2007) suggests that cognitively normal adults exhibiting atrophy of their temporal lobe or damage to blood vessels in the brain are more likely to develop Alzheimer's disease. Older adults showing signs of both conditions were seven-times more likely to develop Alzheimer's than their peers.
"Alzheimer's disease, a highly debilitating and ultimately fatal neurological disease, is already associated with other risk factors such as poor cognitive scores, education or health conditions," says study author Caterina Rosano. "This study, because it focused on healthy, cognitively normal adults, shows that there other risk factors we need to consider."
MRI images of participants' brains were examined to identify poor brain circulation, damaged blood vessels and/or atrophy of the medial temporal lobe. Subjects showing any one or a combination of these symptoms were more likely to develop Alzheimer's in the following years.
"Similarly to heart disease, brain blood vessel damage is more likely to occur in patients with high blood pressure, high cholesterol or diabetes," says Rosano. "Since we know that prevention of these conditions can lower risk of heart attack and stroke, it is likely that it would also lower the risk of developing Alzheimer's." |
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Lifestyle |
Absence of aerobic exercise or exercising aerobically somewhat| | Keeping an active mind and body has been shown to reduce slightly the risk of developing the disease. |
Counter-indicators:
 Exercising aerobically moderately or exercising aerobically frequently| | Keeping an active mind and body has been shown to reduce slightly the risk of developing the disease. |
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Nutrients |
Antioxidant Requirement / Oxidative Stress| | In one study, researchers found that the higher the intake of vitamins C and E, the lower the incidence of Alzheimer’s disease. The conclusion of the researchers was that “high dietary intake of vitamin C and vitamin E may lower the risk of Alzheimer disease.”
In a second study in the same journal, there was a consistent reduction in Alzheimer’s risk with increasing intake of dietary vitamin E. Those with the highest intake of dietary vitamin E showed a remarkable 70% reduction in Alzheimer’s disease incidence. [ JAMA June 26, 2002] |
Multiple Mineral, General Requirement| | Please see the link with Increased risk of Alzhiemer's and Multiple Vitamin Need. |
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Organ Health |
Diabetes Type II / Risk| | According to a study in Neurology, diabetes mellitus may not only damage the function of the eyes, limbs, kidneys, and heart - it may also impair the function of the brain and hasten the process of senile dementia.
Researchers have found that diabetes mellitus nearly doubles the risk of developing both vascular dementia and Alzheimer's disease, according to a Rotterdam Study that tracked dysglycemia and dementia in over 6,000 individuals over age 55. Diagnosis of diabetes was based on World Health Organization criteria using a glucose tolerance test.
A related editorial called Alzheimer's a possible "brain-type diabetes." Besides damaging important blood vessel networks and increasing the risk of small "silent" strokes deep inside the brain, dysglycemia may be directly involved in the development of the neurofibrillary tangles, the clumping of nerves and fiber tissue inside the brain characteristic of Alzheimer's.
The researchers noted that advanced glycation endproducts (AGE), proteins damaged by chronically high blood sugar levels, are commonly found inside these tangles. "In brains of AD patients the receptor for AGE appears overexpressed," they noted. "Activation of this receptor leads to increased oxidative stress that may result in cellular damage."
Diabetes also disrupts insulin-signaling to other cells in the body. This altered signaling may increase the activity of a neuronal enzyme that stimulates phosphorylated tau proteins to build up, a key trigger mechanism cited as one of the earliest signs of Alzheimer's.
NOTE: This study strongly suggests the important potential role of glycation products and insulin response, not just glucose levels, as being causes of degenerative disease.
A study in Journal of Neuroimaging (July 2007) suggests that cognitively normal adults exhibiting atrophy of their temporal lobe or damage to blood vessels in the brain are more likely to develop Alzheimer's disease. Older adults showing signs of both conditions were seven-times more likely to develop Alzheimer's than their peers.
"Alzheimer's disease, a highly debilitating and ultimately fatal neurological disease, is already associated with other risk factors such as poor cognitive scores, education or health conditions," says study author Caterina Rosano. "This study, because it focused on healthy, cognitively normal adults, shows that there other risk factors we need to consider."
MRI images of participants' brains were examined to identify poor brain circulation, damaged blood vessels and/or atrophy of the medial temporal lobe. Subjects showing any one or a combination of these symptoms were more likely to develop Alzheimer's in the following years.
"Similarly to heart disease, brain blood vessel damage is more likely to occur in patients with high blood pressure, high cholesterol or diabetes," says Rosano. "Since we know that prevention of these conditions can lower risk of heart attack and stroke, it is likely that it would also lower the risk of developing Alzheimer's." |
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Symptoms - Glandular |
 Poorly controlled diabetes
Reasonably controlled diabetes |
Symptoms - Mind - General |
Possible Alzheimer's disease
(Serious) past head injury| | Besides age and genetics, most experts agree the evidence is conclusive enough to name serious head injury as a strong risk factor for the disease. Inflammation in the brain can lead to the death of cells which contributes to the disease. |
Not keeping one's mind active| | Staying mentally active/stimulated appears to reduce the risk. |
Counter-indicators:
Keeping one's mind active| | Staying mentally active/stimulated appears to reduce the risk. |
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Recommendations for Increased Risk of Alzheimer's / Dementia: | | | | | | Amino Acid / Protein | Not recommended:
 Glutamine| | Glutamine accumulation has also been found in Alzheimer’s disease, Huntington’s disease and high levels of brain glutamine have been associated with a worse prognosis in Lou Gehrig’s disease. Likewise, recent studies have shown that high brain glutamine levels increase brain levels of free radicals and impair the ability of brain mitochondria to produce energy. When the brain produces low energy, excitotoxins, such as glutamate, become even more toxic. It has been shown that the reason for glutamine toxicity under these conditions is because it is converted to the excitotoxin - glutamate. Russell L. Blaylock, M.D. |
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Animal-based |
 Fish Oils| | Studies indicate eating a diet high in omega-3 fatty acids, found in fish, may fend off Alzheimer’s. To arrive at this conclusion, researchers studied older mice genetically engineered to develop the disease. The mice were divided into two groups: One group was fed a diet rich in docosahexanoic acid, or DHA, the omega-3 fatty acid found in various types of coldwater fish, and the other group was fed a low-DHA diet; such diets have been associated with impaired mental functioning.
Within five months of the study, a 70% less buildup of amyloid protein, which makes up the plaques in the brain famously attributed to Alzheimer’s, was detected in mice that were fed a diet rich in DHA-fortified foods. These results coordinate with the team’s previous findings that DHA was responsible for protecting the brains of mice from synaptic damage, enabling them to perform better on memory tests. [The Journal of Neuroscience March 23, 2005 25(12): pp.3032-40]
Scientists have discovered the mechanism by which the omega-3 fatty acids found in fish oils can help protect the brain against the cognitive decline associated with Alzheimer's disease.
Docosahexaenoic acid (DHA), preformed in fish oil, reduces the levels of a protein known to cause damage in the brains of Alzheimer's patients. They also discovered that a derivative of the fatty acid called neuroprotectin D1 (NPD1) is formed in the human brain, and is essential in protecting against brain cell death. [Journal of Clinical Investigation September 8, 2005]
Two additional studies found that in healthy individuals that a diet high in fish and fish products is associated with better cognitive performance. Higher levels of omega-3 fatty acids were associated with less decline in the speed-related cognitive domains.
It often takes decades for dementia to develop and brain volume to shrink. These studies of the benefits of omega-3 fats on brain function offer an opportunity for early intervention to maintain your brain function and slow progression to dementia. [American Journal of Clinical Nutrition, 86(5), 1259-1260, November 2007]
[Scotsman.com News April 6, 2008] Eat your omega-3's if you want to avoid getting Alzheimer's. In part, that's the moral of the story out of new research from Aberdeen University which has found that patients whose diets are high in omega-3 oils do better in mental tests than those who do not have the oils in their diet.
Calling the discovery a "major breakthrough" in the fight against Alzheimer's, the article in The Scotsman explains how the study was conducted using 58,000 Scots who suffer from the condition.
Lead researcher, Lawrence Whalley, professor of mental health at Aberdeen University, said: "Ten years ago this would have been science fiction. What we are touching on here is how nutrients can interact with specific genes in the body."
The red herring (excuse the pun) appears to be a crucial gene some individuals possess called APOE e4 that prevents the omega oils from having a healing or preventive effect. Unfortunately, those individuals must pursue other avenues of treatment.
Whalley said: "What emerges from this research is that if you don't have this gene, omega-3s can make a difference. The next big thing will be to identify what factors can influence how these genes can be switched on and off, and also what to do if you have the gene."
Maureen Thom, information manager for Alzheimer Scotland, said: "It's a very welcome and interesting piece of research, very thorough. I would like to see it developed and have results analyzed for a larger number of people. We do advise that everyone should try to stick to a healthy lifestyle and consume omega-3 oils as part of a healthy diet." |
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Botanical |
 Chlorella / Algae Products| | One study has shown that among 50 people with Alzheimer’s, aged 70-90, taking 6gm daily of chlorella for 6 months, 68% experienced either a stabilization or improvement in cognitive functions. |
Gingko Biloba| | Patients with mild to moderate Alzheimer's-type dementia have shown statistically significant improvement with Ginkgo use. One effect of Ginkgo extract is that of promoting vasodilation and blood flow, thus providing a therapeutic effect on cognitive disorders and high blood pressure. In Germany, doctors are enthusiastic about the benefits of ginkgo. A combination of ginkgo and ginseng called Gincosan is claimed to produce very good results in elderly patients.
If Ginkgo helped patients who were diagnosed with Alzheimer's [Pharmacopsychiatry 2003;36(Suppl 1): pp.S50-5], chances are good that it will help those at increased risk also. |
Marijuana| | New evidence in rats suggests that marijuana may contain compounds that slow the memory loss associated with Alzheimer's disease.
Marijuana has strong anti-inflammatory effects, and many researchers believe that there is a compelling link between chronic inflammation and the progression of Alzheimer's, said Gary Wenk, a study co-author and a professor of psychology at Ohio State University.
"Inflammation in the brain is part of aging," Wenk said. "It happens to almost all of us as we age. But in some cases, this inflammation gets out of hand and causes serious damage."
"Treatment with a synthetic compound similar to marijuana reduced inflammation in older rats in addition to making the animals "smarter," said Wenk, who is also a professor of neuroscience and molecular virology, immunology and medical genetics.
"The compound substantially improved the memories of the older rats," he said. "These animals were able to hold on to key details of a specific task. Untreated older rats, on the other hand, were not."
The researchers presented their findings October 18, 2006 in Atlanta at the annual Society for Neuroscience meeting.
Evidence suggests that people who regularly smoked marijuana in the 1960s and 1970s rarely develop Alzheimer's disease, said Wenk, adding that researchers are eager to develop a drug with the anti-inflammatory properties of marijuana, but without the drug's psychoactive effects.
The colleagues treated young and old rats with WIN-55212-2 (WIN), a synthetic drug similar to marijuana. While the compound improved memory and helped to control inflammation, it is not a candidate for use in humans because it still contains substances that could trigger a high. |
Huperzia serrata |
Diet |
Weight Loss
Sugars Avoidance / Reduction
Animal/Saturated Fats Avoidance| | Please see the link with Increased risk of Alzhiemer's and Multiple Vitamin Need. |
Processed Foods Avoidance| | Keep your weight down, and keep simple sugars and refined carbohydrates to a minimum. Researchers have found that diabetes mellitus (for which these are risk factors) nearly doubles the risk of developing both vascular dementia and Alzheimer's disease. |
 Artificial Sweetener Avoidance| | Aspartame use has been reported to trigger symptoms of Alzheimer's. |
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Drug |
NSAIDs| | At least twenty studies suggest that Ibuprofen and other NSAIDs - common non-prescription drugs - may slow or prevent the onset of Alzheimer's disease by as much as 60%. Researchers say it also opens up a new way to think about how Ibuprofen protects the brain.
"We've shown that a drug that's available, that's been in use for 30 to 40 years, and for which we know the side-effect profiles... can reduce both the inflammatory response to amyloid and the amyloid itself", says study leader Gregory M. Cole of the University of California in Los Angeles.
Note that NSAIDs can cause serious stomach problems, including bleeding. Investigators therefore hesitate to recommend widespread use of the drugs until they can develop safer versions.
Certain NSAIDs work by decreasing the levels of amyloid-beta 42 rather than by inhibiting cyclooxygenase, as was once proposed. Advil (Ibuprofen) is the most effective, requiring as little as 800mg per day to reduce the risk of Alzheimer's without serious side-effects. Other NSAIDs require much higher doses to achieve this benefit, while aspirin, Naproxen and celeloxib (Celebrex) were found ineffective. |
Conventional Drugs / Information| | Researchers found that clioquinol can almost stop the progression of Alzheimer’s disease. They believed that by absorbing the copper and zinc atoms that concentrate in the brains of Alzheimer's sufferers, clioquinol could stop the onset of dementia before it starts. That could mean that this drug might be of use by a physician who is concerned about Alzheimer's developing in a high risk patient. [Archives of Neurology December, 2003;60(12):pp.1685-91] |
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Habits |
Aluminum Consumption Avoidance| | Alzheimer's Disease has been linked to a number of risk factors, including exposure to aluminum. Now from France comes a report that drinking water with high aluminum concentrations may indeed increase the risk of developing Alzheimer's and dementia. High sources of aluminum in the diet include: aluminum cooking utensils, aluminum-containing antacids, tap water (which may have aluminum sulfate added to remove particulate and organic matter).
Researchers determined that a concentration of aluminum in drinking water above 0.1mg/liter may be a risk factor of dementia and Alzheimer's disease. Nearly 2,700 individuals were followed for an 8-year period to identify new cases of probable Alzheimer's or other dementing illness. The sample was divided into 77 drinking water areas, with surveys conducted to determine concentrations of aluminum, calcium, and fluorine in each water supply. The study authors point out that their findings support those of several other studies linking aluminum to Alzheimer's, but add that "this result needs to be confirmed using a higher number of exposed subjects." [American Journal of Epidemiology 2000;152: pp.59-66.]
One of our doctors comments: This is another reason to make sure that you limit your water intake to filtered or bottled. Aluminum is certainly an issue, but probably not as significant as chlorine exposure. Unless you have well water you will also need a filter for your shower as most of us will absorb for more toxins from bathing or showering than we ever will from drinking tap water. |
Aerobic Exercise| | Stay physically active. Patients with Alzheimer's disease have been found to have had lower levels of physical activity earlier in life. Those who exercised regularly throughout life were less likely to contract the disease than those who were inactive. Doctors caution that exercise does not guarantee immunity. |
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Hormone |
Estrogen Replacement| | Estrogen replacement therapy may help reduce risk or delay its occurrence, but does not help once disease is established. One reason for the confusion is the use of synthetic estrogens: natural estrogens should exert a protective effect. One study found that the risk of Alzheimer's disease and related dementia for women who had used estrogen was found to be about one third below that of women who had never used estrogen. The risk also decreased with increasing dosage and duration of estrogen therapy. The lowest risk was observed in long-term users taking high doses.
Suggestions that the decline in estrogen levels in women at menopause might somehow make them more vulnerable to the disease have prompted interest in the hormone as a possible treatment and research has suggested that women who take estrogen are less likely to develop Alzheimer’s.
However, a new study found that once the mind-robbing disease sets in, the female hormone offers no benefit. A year of estrogen did nothing to slow the progression of the disease or improve mental functioning in 120 older women with mild to moderate Alzheimer’s. Overall, the results of this study do not support the role of estrogen in the treatment.
In another study, women aged 60 and older were given either a low estrogen dose, a high dose or a placebo every day for a year. Instead of showing any improvement, those taking estrogen in fact fared worse than the placebo group in a rating of dementia. [JAMA February 23, 1999 283: pp.1007-1015]
[One of our doctors comments: I am really surprised that this study did not receive more widespread news coverage. When the drug companies had the initial studies published suggesting that estrogen will help protect against Alzheimer's it was all over the news. I was immediately confronted by many patients who felt my recommendation to avoid estrogens was unwise. Now the evidence is in that estrogen does NOT help Alzheimer's but actually worsens it. I am delighted that JAMA continues to take a leadership role in publishing these landmark articles which refute the drug companies' position. Unfortunately, the conventional media still appears to be sold out - hence the lack of notification of the results of this study.
There are times when estrogen is necessary. I believe if phytoestrogens are unable to stop the hot flashes then it would be wise to use small amounts of estrogens to stop them. Waking up every night with hot flashes is a surefire prescription for depression and increased risk of disease. Thus in this case the estrogen is the lesser of two evils. It should be used for the shortest time possible and always with the intent of weaning oneself off of it.] |
Testosterone| | The popular image of this sex hormone is primarily as a muscle-building machismo-inducing substance that "pumps men up", yet clinical research is uncovering important roles for testosterone in many other diverse areas of health and physiology, including the brain. New evidence suggests that testosterone may enhance memory function and protect against the development of Alzheimer's disease.
Neuroscientists from Rockefeller University and Weill Medical College of Cornell University recently discovered that when neural cells from the brains of rats are exposed to testosterone, the cells don't produce as much Amyloid beta-peptide (AB-peptide). The accumulation of AB-peptide can cause plaque deposits to form in the brain. These deposits are believed to play a major role in the development of Alzheimer's disease.
Testosterone in addition appears to improve certain cognitive abilities in men, such as verbal and spatial memory function. Levels of bioavailable testosterone are especially important, researchers emphasized, because these levels decline most rapidly as men and women age.
Since high levels of testosterone have been linked with prostate cancer in men and endometriosis in women, however, they urged caution when using replacement therapy, carefully weighing the risks and benefits for each patient.
Increasing levels of adrenal hormones such as cortisol, which rise in response to stress and aging, may also play an important role in Alzheimer's. High levels of these hormones can damage the hippocampus region in the brain, causing
learning impairment and memory loss. Testosterone, however, shows the potential to reverse some of this damage. |
Melatonin| | Ensure normal melatonin levels. Melatonin, a powerful antioxidant and heavy-metal-chelating agent, has been shown to protect against heavy metal exposure which is in turn implicated in Alzheimer's Disease.
After exposing nerve cells to inorganic mercury, neurobiologists observed a toxic reaction that reduced cellular levels of the antioxidant glutathione by 30%, triggered the release of plaque-forming ß-amyloid peptides, and spurred the hyperphosphorylation of tau-protein - all pivotal mechanisms in the development and progression of Alzheimer's.
However, they found that if the cells were first incubated with melatonin - a powerful antioxidant and heavy-metal-chelating agent - they were protected from these damaging effects. In fact, despite being exposed to toxic doses of mercury, the cells treated with melatonin often showed metabolic status comparable to that of mercury-free cells.
These results provide strong experimental evidence that mercury toxicity may be involved in Alzheimer's development and that melatonin shows a marked potential to neutralize this toxic-induced pathology, by boosting antioxidant defense and binding to heavy metals. |
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Lab Tests/Rule-Outs |
Test / Monitor Hormone levels| | Make sure estrogen and testosterone levels are normal. |
Test for Heavy Metals| | Avoid mercury, and detoxify if levels are found elevated. See discussion of Melatonin for details. |
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Mineral |
Lithium (low dose)| | There are many research findings that strongly suggest that lithium will protect against potential Alzheimer's disease and slow the progression of existing cases. Researchers have reported that lithium inhibits beta-amyloid secretion, and also prevents damage caused by beta-amyloid protein once it's been formed. Beta-amyloid peptide is a signature protein involved in Alzheimer's disease: the more beta-amyloid protein, the worse the Alzheimer's becomes. Overactivation of a brain cell protein called tau protein also contributes to neuronal degeneration in Alzheimer's disease, as does the formation of neurofibrillary tangles Lithium inhibits both of these nerve-cell damaging problems. |
Zinc| | Maintain adequate zinc status: Reduced levels of zinc are being linked to Alzheimer's disease. In one study, 38 elements were evaluated by neutron activation and mass spectrometry in the post-mortem brain tissue of eleven Alzheimer’s patients and six controls. An increase was found in aluminum, silicon and calcium; a significant decrease was found in zinc and selenium. The lower level of zinc in all areas of the tissue studied correlates with reports indicating low serum levels of zinc in other dementia studies. [Reduction of Zinc and Selenium in Brain Alzheimer's Disease: Corigan, et al., Trace Elements in Medicine, 91;8(1): pp.1-5] |
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Nutrient |
Lecithin / Choline / GPC| | Study participants received 1200mg GPC daily for six months. On a variety of assessment scales for Alzheimer's disease (AD), GPC patients scored more favorably than patients from the control group, all of whom received placebo. The mental status of patients on GPC therapy improved, while those receiving the placebo worsened. These findings are comparable to the results obtained with the use of the prescription drugs Aricept (donepezil HCl) Exelon (rivastigmine tartrate) and Reminyl (galantamine hydrochloride) in the treatment of AD patients, and with fewer side effects. [Mech Ageing Dev 2001 Nov: 122(16): pp.2041-2055] |
Essential Fatty Acids| | Please see the link from Increased Risk of Alzheimer's and Fish Oil. |
DHA (docosahexaenoic acid)| | Over 1200 patients participated in an epidemiological study which showed that people with high DHA levels were 45% less likely to develop dementia than people with low DHA levels. This suggests that proper DHA intake may reduce the risk of developing Alzheimer's. The best source of preformed DHA is fish oil. |
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Oriental Medicine |
Acupuncture| | The Chinese consider acupuncture to be an effective therapy for Alzheimer's disease. There is solid evidence that acupuncture increases certain neurotransmitters in the brain and can actually stimulate nerve regeneration. Increased serotonin levels probably explain why acupuncture is so effective in controlling pain and managing stress. Acupuncture also promotes blood circulation to the brain and improves memory and concentration so there is good reason for people who have Alzheimer's, or who are at risk for developing it, to try acupuncture. |
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Vitamins |
Vitamin E| | Ensure sufficient antioxidant intake. A study of more than 5,000 men and women found that people who consumed very high amounts of dark green, yellow, and red vegetables appear to reduce their risk of dementia by about 25%. Several studies have shown that vitamin E, an anti-oxidant, can slow progression of Alzheimer's.
Dietary vitamin E is rich in the gamma tocopherol fraction of vitamin E, whereas vitamin E supplements consist primarily of alpha tocopherol. It is the gamma tocopherol fraction of vitamin E that has been shown to be the critical factor in suppressing free radicals. The brain is especially vulnerable to the toxic effects of free radicals because of its high-energy output. Notably, in this study, only those with a genetic predisposition for contracting Alzheimer’s disease (those whose genetic structure was without the APOE epsilon 4 allele) showed the remarkable protective benefit from dietary vitamin E. [ JAMA June 26, 2002]
There is a conflicting study of Japanese men living in Hawaii that did not show any protective benefit from supplemental vitamin C or E over a period of 5.2 years. [JAMA 2002;288(18): pp.2266-8] |
Vitamin Folic Acid| | There is growing evidence suggesting that low blood folate levels can increase the risk of getting Alzheimer's.
In an ongoing study searching for new clues to the aging process, researchers took blood samples of nuns between the ages of 78-101years old living in a convent in Mankato, Minnesota. After 30 of the nuns died, researchers examined their brains for signs of atrophy and compared the results with previous blood nutrient levels.
In brain samples showing numerous Alzheimer's disease brain lesions, researchers found that significantly lower blood levels of folate corresponded with more severe atrophy of the neocortex, the region of the brain containing a rich supply of nerve cells.
Although the study was small, and did not attempt to prove a causal effect, it supports previous evidence linking defects in B-vitamin metabolism with age-related dementia and Alzheimer's. "Optimal folate concentration may in fact be higher in old age or when diseases such as Alzheimer's are present," commented the researchers.
Low folate levels can trigger a build-up of the amino acid homocysteine, which has been linked to higher risk of Alzheimer's and accelerated atrophy of the medial temporal lobe in Alzheimer's patients.
"There seems little doubt now that there is an association between the evolution of certain brain diseases associated with cognitive decline in the elderly and vitamin deficiencies associated with hyperhomocysteinemia," a related editorial resounded.
Although the full extent to which B-vitamin metabolism influences the actual causal mechanisms of dementia is still not clear, "the potential therapeutic options [implicated by these discoveries] are exciting", the authors posited.
The nuns provided a unique population sample to study because they all had similar long-term diet and exercise habits. Researchers found strong evidence of biochemical individuality among the group, despite their similar lifestyle and eating habits. Blood nutrient levels varied widely, reflecting differences in "drug-nutrient and disease-nutrient interactions or differences in the intake, absorption, and metabolism of the nutrients."
NOTE: As this study suggests, even people with similar diets may show striking differences in nutrient metabolism related to various physiological functions. Assessing each patient is the best way to gauge the effectiveness of nutrient intervention strategies.
Sources:
Snowdon DA, Tully CL, Smith CD, Riley KP, Markesbery WR. Serum folate and the severity of the atrophy of the neocortex in Alzheimer disease: findings from the Nun Study. Am J Clin Nutr 2000;71: pp.993-8.
Weir DG, Molloy AM. Microvascular disease and dementia in the elderly: are they related to hyperhomocysteinemia? Am J Clin Nutr 2000;71: pp.859-60. |
Vitamin C (Ascorbic Acid)| | Both vitamin E and vitamin C supplements reduced the incidence of Alzheimer’s disease in a 1998 study. This study followed 655 individuals over 65 years of age for an average of over 4 years. The anticipated rate of Alzheimer's did not occur in those individuals taking larger amounts of either vitamin. The lower levels of vitamin C and E found in some supplements did not provide this protection in this study. A reasonable protective benefit could be expected with 400 IU of vitamin E or 500mg or more of vitamin C. [Alzheimer Dis. Assoc. Disord.1998:12(3): pp.121-126] This was confirmed by a later study. [JAMA 2002;287(24): pp.3223-3229]
However, there is a conflicting study of Japanese men living in Hawaii that did not show any protective benefit from supplemental vitamin C or E over a period of 5.2 years. [JAMA 2002;288(18): pp.2266-8] |
Vitamin B3 (Niacin)| | A small increase in the intake of niacin was associated with a reduced risk of Alzheimer's disease in a study
of 815 elderly adults followed for an average of just over 2 years. The difference occurred with 22mg per day consumed compared to 12mg per day. The dietary intake of other B-vitamins was not associated with this reduced risk. [Gerontological Society of America 55th Annual Scientific Meeting, November, 2002] |
Vitamin B12 (Cobalamine)| | Low levels of vitamin B12 have been linked to an increased risk Alzheimer's disease. [Neurology, May 2000] It remains unclear as to whether B12 supplementation will reduce the risk.
All ages of Alzheimer’s patients have been found to have lower serum B12 levels, compared to normals and patients with other forms of dementia in several other studies.
Supplementation of B12 and/or folic acid may result in complete reversal in some patients, but there is generally little improvement in patients who have had Alzheimer’s symptoms for longer than six months. Some scientists hypothesize that prolonged low levels of vitamin B12 may lead to irreversible changes.
Researchers have known for some time that there is a genetic marker, called e4 allele, which indicates a high risk
for dementia. About 15% of the population has this marker. It's also well-known that people who have dementia or
Alzheimer's, as well as many older people in general, often have low levels of vitamin B12. Evidence points to a clear link between e4 allele and vitamin B12. People who had the high-risk genotype plus low levels of vitamin B12 had a significantly poorer memory than any other combination that was tested. Simply raising the levels of vitamin B12 showed a marked
improvement, even though the genetic condition still exists. [American Psychological Association, 5 April 2004] |
Vitamin B Complex| | Optimize your B-complex status, especially folic acid and B12. In one study, 76 Alzheimer's patients had lower blood levels of folic acid and vitamin B12 than 108 age-matched control subjects. In addition, researchers found that Alzheimer's patients had higher blood levels of homocysteine, which is already implicated in atherosclerosis. Folic acid and B12 supplementation is known to reduce homocysteine levels. |
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KEY | | Weak or unproven link | | | Strong or generally accepted link | | | Proven definite or direct link | | | Weakly counter-indicative | | | Strongly counter-indicative | | | May do some good | | | Likely to help | | | Highly recommended | | | May have adverse consequences |
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