Program by Phone March 13, 2018 Coconut Oil, Vitamins and Alzheimer s: What Really Works? Robert L. Russell, MD Medical Director, Kindred at Home, Indianapolis, IN 1
OBJECTIVES To discuss how lifestyle choices and healthy living can aid in reducing dementia risk. To discuss the dietary components of dementia risk reduction. To discuss the various research being done in the field of preventive medicine. DISCLOSURE Paid Consultant for the Indiana State Health Department Polypharmacy Program SMART campaign Medical Director for Kindred at Home of Greater Indianapolis Assistant Medical Director for Kindred Hospice of AVON 2
OVERVIEW Worldwide the number of people with dementia is estimated to be 47 million, with 37% living in high income countries Over 5 million Americans are living with Alzheimer's dementia (AD) in 2017 1 in 10 people age 65 and older has AD African Americans are twice as likely to have Alzheimer's or another form of dementia as compared to older whites Almost 2/3 of American with AD are women Cure vs. prevention - Alzheimer s Association WE KNOW DIET & EXERCISE ARE GOOD FOR US Improves cardiovascular health Decreases obesity risk Decreases diabetes risk Improves mood Improves immunity Mayoclinic.org 3
HOW DOES EXERCISE EFFECT THE BRAIN? Improves circulation to the brain Improves memory and cognition Improves alertness Reduces stress and anxiety Improves sleep WHAT EXERCISES ARE THE BEST FOR THE BRAIN? Aerobic (sometimes called Cardiovascular Exercise) is best Ideally 20-30 minutes a day Benefits of exercising at least 10 minutes It may even increase the size of the hippocampus which is responsible for short term memory and learning. (Based on a British Study at the University of British Columbia). Aerobic Exercise includes: Walking Running/Jogging Cycling Swimming Rowing Boxing Basketball 4
THE FINNISH GERIATRIC INTERVENTION STUDY TO PREVENT COGNITIVE IMPAIRMENT AND DISABILITY (FINGER STUDY) A large, two-year trial looking at diet, exercise, cognitive training and cardiovascular risk (done between 2009-2011) Individuals were between the ages of 66yo-77yo. FINGER STUDY The primary outcome was change in cognition as measured through comprehensive neuropsychological test battery score. It proved that a multidomain intervention improves or maintains cognitive function in at-risk elderly people compared to the general population. This trial is registered at ClinicalTrials.gov ( NCT01041989 ) Tiia Ngandu et al. The Lancet Volume 385, no. 9984 p2255-2263, 6 June 2015 5
WORLDWIDE FINGER The FINGER model is now being replicated in the United States, Europe, Singapore, and Australia including populations from a variety of geographical and cultural backgrounds. Here in the US it is called POINTER U.S. Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (US-POINTER) trial (USA) World-renowned researchers, under the leadership of Drs. Laura Baker, Miia Kivipelto and Rachel Whitmer, in collaboration with the Alzheimer s Association, are initiating efforts to replicate the results of the Finnish trial in the U.S. (to test the generalizability of the FINGER findings in American older adults). http://wwfingers.com THE MEDITERRANEAN DIET Diet inspired by the healthy eating habits of the inhabitants of Greece, Spain and Southern Italy Consists of the consumption of high amounts of vegetables, fruits, olive oil, large amounts of fish over non fish sources of protein, moderate wine drinking and limited amounts of dairy In the 50s and 60s, research found that men of this region who adhered to this diet had lower rates of heart disease, strokes and type II diabetes and death from any cause Through systematic reviews of a number of studies, it has been shown those who eat this diet have lower levels of memory and cognitive deficits It is postulated this diet s benefits on the brain's health comes from the high levels of antioxidant foods that are consumed 6
SPEAKING OF ANTIOXIDANTS The Association of Antioxidant Supplement use and Dementia in the Prevention of Alzheimer's Disease by Vitamin E and Selenium Trial (PREADViSE) Kryscio RJ et al JAMA Neurol 2017 The trial initiated as a double blind study in 2002 but was converted into a cohort study from 9/2005-5/2015. It started as an offshoot of the SELECT prostate cancer prevention trail where 7500 plus men were recruited of which 3700 plus continued on to the cohort study. The participants were at least 60 years old at the start of the trial Participants were randomized to vitamin E, selenium, vitamin E and selenium or placebo PREADVISE Phone assessments were conducted with a 2 stage enhanced cognitive screen If the assessment showed evidence of possible cognitive decline participants were encouraged to visit a physician The conclusion was neither supplement prevented dementia 7
WHAT ABOUT VITAMIN D? The Vitamin D status and risk of dementia and Alzheimer's disease: A meta-analysis of dose-reponse. Jayedi A, et al. Nutr Neurosci. 2018 A systematic review of seven cohort studies and one retrospective cohort It was found a serum Vitamin D 25-OH level of 25ng/ml carried a lower risk of dementia and the risk decreased as the serum level increased to about 35ng/ml. There was no conclusive evidence found asserting a level above 35ng/ml provided any benefit FOLIC ACID AND B12 B12 had a beneficial effect cognitive function of unselected healthy and or cognitively impaired elder adults Folic acid was associated with improved response of people with Alzheimer's disease to Cholinesterase inhibitors Folic acid with or without B12 for the prevention and treatment of healthy elderly and demented people review, Malouf, R et al. Cochrane Database Syst Rev. 2008 8
THE NORDIC DIET The Nordic prudent diet reduces risk of cognitive decline in the Swedish older adults: A population-based cohort study. Shakersain B, et al. Nutrients 2018 The authors of the study were trying to find a definitive diet that slows the rate of cognitive decline when compared to other diets like the Mediterranean-DASH diet intervention for neurodegenerative delay (MIND), Mediterranean Diet for stopping hypertension and Baltic Sea Diet NORDIC DIET 2223 dementia-free adults aged 60 and older were followed for 6 yrs. A mini mental state examination was given at baseline and follow-up. They were also administered a 98 food item questionnaire to identify the Nordic Prudent Dietary Pattern (NPDP) It was found individuals who adhered to the Nordic Prudent Diet showed slowed rates of cognitive decline over time compared to other groups Diet is based on traditional Swedish cuisine, with fish being the main protein, oatmeal, non-root vegetables like cabbage, fruit like apples, pears and peaches, and drinking tea. 9
THE MIND DIET The Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) was developed by Martha Clara Morris at Rush University Medical Center Followed 923 Chicago- area seniors over 4.5 years, was founded by the NIA. 144 participants developed Alzheimer's disease, while the other participants seemed to have delayed cognitive decline as long as they stayed on the Diet. There was about a 35% lower risk of developing AD if they moderately followed diet and a 53% percent lowered risk for those who followed the diet rigorously. WHAT DO YOU EAT ON THE MIND DIET At least six servings a week of green leafy vegetables Other vegetables at least one a day Five serving of nuts a week Two or more serving of berries a week At least three servings of beans a week Three or more serving of whole grains a day Fish at least once a week Poultry twice a week Cooking with olive oil mainly One glass of wine a day 10
IN THE NEWS Just this week on CNN.com a report was done on some foods being better for your brain and memory by Lisa Drayer on March 7, 2018 https://www.cnn.com/2018/03/07/health/brain-food-drayer/index.html This report discusses many of the foods already mentioned through the aforementioned various diets, but also includes several foods not mentioned. OTHER FOODS THAT CAN IMPROVE BRAIN HEALTH Eggs - one study according to the report showed that about 1,400 men and women who were high in choline, a protein found in eggs, performed better on tests of verbal and visual memory and appeared healthier on MRIs of the brain. Choline is an important precursor to acetylcholine which is necessary for normal brain function. If you cannot eat eggs due to due to their high cholesterol levels, peanuts, fish, poultry, lean beef, broccoli, brussels sprouts and dairy are good sources as well. 11
OTHER FOODS THAT CAN IMPROVE BRAIN HEALTH Coffee - the caffeine found in coffee and other caffeinated beverages improve focus, with forming memories and in one study seemed to reduce the cognitive decline of older women over a four year period. It does have a dose dependent benefit. From most studies, it seems two 8oz cups appears to be the appropriate amount. Wine - One glass of wine a day IN SUMMARY Aerobic exercise for at least 20-30 minutes at least three to four times a week provides some preventive benefit when coupled to a diet rich in fish, antioxidants and other brain protective foods The Western Diet actually increases your risk of Alzheimer's Disease, one study says by as much as 50% We should adopt a healthy life as soon as possible, avoid smoking, illicit drugs and drink only in moderation None of these diets have large consumption of red meat or pork We should avoid overly processed food, large amounts of sugar, large amounts of butter and cheese Prevention will continue to be heavily researched and emphasized as the numbers of people over the age of 60 continue to increase 12
QUESTIONS? Resources Helpline: 800.272.3900 ALZ.org Support Groups Education Programs 26 13
Resources ALZWebinars.org ALZPhonePrograms.org 27 Thank You For the generous support that helps make these programs possible. 28 14