PREVENTION By Dr. Elliot O. Douglin

PREVENTION By Dr. Elliot O. Douglin

INTRODUCTION Ca Alzhei er s disease (AD) be prevented? This is a controversial question Some say that all you can do is hope for the best and wait for a cure However, promising research indicates that primary prevention strategies can reduce risk Researchers have broadened their scope from treatment to prevention strategies Autopsy specimen showing large ventricles (coronal section).

IX PILLA OF ALZHEIME P EVENTION According to the Alzhei er s Research and Prevention Foundation there are 6 evidence-based pillars of a brain healthy & Alzhei er s prevention lifestyle 1) Regular physical exercise 2) Mental stimulation 3) Healthy diet 4) Quality and quantity of sleep 5) An active social life 6) Stress management

OTHER EVIDENCE BASED PRINCIPLES In addition to the 6 primary pillars there are other evidencebased CNCD prevention principles relevant to AD prevention Smoking cessation Prevention or tight control of HT, DM, CHOL Prevention or reversal of obesity Avoid alcohol or use in strict moderation Avoid head injuries

CNCDs INCREASE RISK OF DEMENTIA J Am Geriatr Soc.2015;63;1783-90 Researchers assessed 2176 cognitively normal participants,average age 78.5 yrs, followed for 4 yrs. Those with one chronic disease were 38% more likely to develop dementia Those with 4 or more conditions had a 61% increased risk. A study presented at the European Assoc. for the Study of Diabetes shows that poor blood sugar control results in a 5o% higher risk for dementia.

Research indicates that consistent physical exercise a redu e Alzhei er s risk up to 50%. It can also slow progression in those who have started to develop cognitive problems Aim for at least 30 mins/day, 5 days/week A combination of cardio exercise and strength training is ideal Include balance and coordination exercises EXERCISE

Walking & Dementia in Older Men Cases per 1000 person-years 20 18 16 14 12 10 8 6 4 2 0 Total Dementia AD VaD Mixed & Other Miles/da y <0.25 0.25-1.0 >1-2 >2 N = 2257; mean age 77; BMI 23; 6-yr F/U Abbott et al (2004) JAMA 292:1447-1453 [Honolulu-Asia Aging Study]

HEALTHY DIET Several epidemiological studies show that eating the Mediterra ea diet a redu e the risk for AD Vegetables, beans, peas, olive oil, fish (reduce dairy and animal flesh) Eat foods rich in anti-oxidant and anti inflammatory molecules Ginger, Turmeric,(curcumin is powerfully anti inflammatory), Berries, especially blueberries, Green tea bioflavonoids, cruciferous vegetables, carotenoid rich foods, flavonoids.

HEALTHY DIET Co t d Avoid trans-fats and animal fats Get plenty omega 3 fats (especially DHA) Eat a variety of fruits and vegetables Avoid packaged and processed foods Avoid the intake of refined sugars and white flour

JUNK FOODS AND BRAIN ATROPHY An article in BMC Medicine 2015;13:215 on a study done in Australia reports that older people who eat an unhealthy Western Diet of sweet drinks, salty snacks and processed meats have smaller brains, in particular smaller left hippocampi. Older adults who ate healthier foods such as vegetables, fruits and fish have larger left hippocampi.

MENTAL STIMULATION Those who continue to learn new things and continue to challenge their brains are less likely to de elop de e tia a d Alzhei er s disease Learn something new Practice memorization Enjoy strategy games, puzzles, riddles Explore new routes of travel Mental exercises have long lasting benefits for those over 65.

Leisure Activities & Dementia Board games 0.26* Reading 0.65* Playing a musical instrument 0.31* Crossword puzzles 0.59 Writing 1.00 Group discussions 1.06 Dancing 0.24* Housework 0.88 Walking 0.67 Climbing stairs 1.55 Bicycling 2.09 Swimming 0.71 Team games 1.00 Babysitting 0.81 asterisks indicate statistical significance

o ial Net orks & Alzhei er s Disease Pathology Cognitive Performance Prior to Death 2 1 0-1 -2-3 -4 High Network (90th%) Low Network (10th%) N = 89 Mean age at enrolment 84.3 years Mean age at proximate assessment prior to death 87.2 years Female 55.1% Education 14.4 years Social networks 6.9-5 0 10 20 30 40 90 th % = 13 people; 10 th % = 2 people Neurofibrillary tangles Bennett et al. (2006) Lancet Neurology 5: 406-412

QUALITY SLEEP An increasing number of studies have linked poor sleep to higher levels of beta amyloid 7-8 hours of uninterrupted sleep

STRESS MANAGEMENT Stress, when chronic or severe, causes shrinkage in the hippocampus-a key memory area Practice stress-coping strategies Deep breathing sessions Periods of relaxation Nurture inner peace Studies link spirituality (prayer, worship, meditation) with better brain health Classical music Have wholesome fun Keep a sense of humour:laughing is therapuetic

SOCIAL ENGAGEMENT We are social creatures Neither we nor or brains thrive in isolation Studies show that the more socially connected we are the better will be our cognitive functions Be involved in church, community groups, professional groups, exercise groups Maintain friendships

RECENT RESEARCH PAPERS Older age at retire e t is asso iated with de reased risk of de e tia y Carole Dufouil et al. Eur. J. Epidemiology 2014;29:253-61 The study showed strong evidence of a significant decrease in risk of developing dementia associated ith older age at retire e t i li e ith use it or lose it. Results indicated the importance of maintaining high levels of cognitive and social stimulation throughout work life and into retirement years.

RECENT RESEARCH o t Higher levels of serum vitamin D3 linked to lower risk of dementia.(jama Neurology.2015 Sep.14) Higher levels of plasma mixed tocopherols (vitamin E) linked to reduced risk Higher levels of omega 3 fats, especially DHA, linked to reduced risk. Resveratrol shown to be protective.(neurology.2015 Sep. 14.)

TAURINE For years neuroscientists believed brain shrinkage was inevitable and irreversible. Cutting-edge research has shown that brain cells can regenerate An amino acid called taurine plays an important role here. Researchers found that taurine increased the growth of brain cells by activating dormant stem cells

TAURINE Animal studies show that taurine triggers new brain cells to grow in the hippocampus, the area of the brain most concerned with memory(gebara E et al: Stem cell Res 2015; Pasantes-Morales H:Adv Exp Med Biol.2015) Taurine levels fall significantly with age. Supplementation can certainly benefit.

PROMISING BUT INCONCLUSIVE STUDIES Vitamins B6, Folate, B12. Magnesium Ginkgo biloba. Selenium Acetyl l carnitine Lio s Ma e E tra t Extra- virgin coconut oil Huperzine A

PHYTO CHEMO PREVENTION In addition to healthy life style,some prevention experts recommend supplementation for those at higher risk. Vitamins D3, E; Resveratrol; Omega 3 fish oil; Carotenes; Decaff. green tea extract; Folate; Curcumin; Acetyl l carnitine, among others.

PROTECT YOUR BRAIN