Treating and Preventing Alzheimers

What can we do to treat Alzheimers disease? I watched again a great talk by Dr. Frank Longo MD/PhD at Stanford, a rock star if there ever was one in the Alzheimers research and treatment field. It’s a great little talk and I recommend watching it if you’re a practitioner, researcher, or even just an interested caregiver or patient – there’s a lot here.

We all know about the medications available – there are the FDA approved medication treatments basically in two groups: the so-called cholinesterase inhibitors, such as Donepezil (Aricept), Galantamine (Reminyl, Razadyne), and Rivastigmine (Exelon). And then there are the “NMDA receptor antagonists,” of which there is one medication currently approved and on the market, Memantine (e.g., Namenda).

Basically all of these medications can help, but they are only treatments. Generally a patient who is helped but Aricept or Namenda can expect maybe 6 months where the progression of their dementia (as Alzheimers is a disease of progressive cognitive decline) is effectively halted. In rare cases some improvement in cognitive functioning can occur. However, these drugs all treat the symptom of the disease (e.g., the cognitive dysfunction) and they do not treat the underlying issue – the underlying brain damage that causes the cognitive deficits in the first place. Also, these drugs (like all drugs) have side effects.

So, drug therapies are interesting and as a psychologist who has worked almost exclusively in inpatient medical settings for the past several years, I like to keep abreast of what’s happening in the world of the somatic therapies. There are a lot of research treatments out there as well that we can talk about… I may go into that in a later post. Needless to say, a lot of research is currently going on in the Alzheimers disease treatment front as far as medical treatments go.

However, as a psychologist what I’m personally most interested in are health-related behaviors, like diet, exercise, coping behaviors, et cetera. Are there things that people could be doing to prevent Alzheimers disease or even treat it after it’s taken hold?

The answer is, yes. I was greatly impressed when I heard Dr. Longo speak at last year’s Updates on Dementia in Foster City (which I try to attend every year… pamphlet on the 2013 conference is here if you want to attend). He basically gave the same lecture that I linked to above (although at the conference he included a lot more information about current research on drug therapies and diagnostic techniques). In both lectures, he spoke at length about the nexus of research that relates to the subject of health behaviors and how they relate to Alzheimers disease and prevention. He focused on three areas – diet, exercise, and so-called brain games or brain training activities.

First, there’s the so-called “Mediterranean diet.” This relates to the idea that a diet rich in monounsaturated fats (such as olive oil), low in saturated fats, and high in lean proteins like fish (and low in red meat, which I don’t like to hear), and plenty of vegetables and fruit, somehow imparts a protective effect on people when it comes to development of progressive dementia. There does seem to a significant body of research that indicates that adherence to such a diet can reduce the risk of several forms of dementia, including Alzheimers disease – eating fish two to three times a week probably helps reduce risk of Alzheimers disease, and this probably relates to the positive effects of the Omega-3 fatty acids (which you can also get from flaxseed or chia seeds as well). It may or may not help people who currently suffer from Alzheimers.

Then, there’s exercise and maintaining a proper body weight. One of the things that impressed me is that Dr. Longo cited several studies, both with humans and animal (rat) models that people with excessively high Body Mass Index (BMI) tended to develop higher levels of amyloid plaques than those of normal BMI (which maybe has something to do with the fact that beta-amyloid serves a function in the body of metabolizing cholesterol, and is also related to oxidative stress). So, maintaining a normal BMI may be a critical way to prevent (or treat) Alzheimers disease.

Regarding exercise: Frank Longo cited several studies, including the 2012 EXCEL study (which focused on weight training) and the 2011 study of Erickson et al., both of which demonstrated nothing short of “striking” effects. In the EXCEL study, subjects essentially reversed the effects of their Mild Cognitive Impairment syndrome (often a precursor to full-blown dementia) by engaging in weight training twice per week for six months, and in Erickson et al., subjects engaged in some brisk walking several times per week – and on average subjects increased their hippocampal volumes (the hippocampus being a brain structure crucial to learning and memory) by on average, two percent. In neither case were these exercise programs particularly taxing.

So, both cardiovascular exercise and progressive resistance training appear to impart significant benefits. Engaging in a regular exercise program may not only prevent the onset of Alzheimers disease, but may actually be a treatment as powerful as some of our current FDA approved therapies (!!!). Think about this as a treatment – what if you went to a doctor and they told you they could offer you a treatment that could potentially reverse the shrinkage of your hippocampus, reverse your cognitive impairment issues, and the side effects are all positive, e.g., reversing of your diabetes, healthy weight loss, increased muscle tone, decreased depression, better sleep…. Would you take that treatment? I would!!!

Finally, there’s the question of brain exercises. I’m sure you’ve seen the ads for computer software such as from the companies Posit Science and Luminosity. The idea here is based on some reasonable logic – the idea is when it comes to Alzheimers disease, “use it or lose it” is the watchword. Also, people who have a lifetime history of being intellectually engaged seem to run a reduced risk of developing frank cognitive impairment (based on the well-known observation that higher levels of educational attainment seem to impart a protective effect against Alzheimers disease).

So, here’s the idea: if instead of spending one’s retirement watching reruns of “Gilligan’s Island,” one instead plays these games, or does crossword puzzles… does that prevent or treat Alzheimers or MCI? Unfortunately, Dr. Longo, as well as I, have to give you the bad news. Amongst the three areas outlined here (diet, exercise, and ‘brain exercises’), the literature on this seems to be the poorest. While I would certainly tell you that it’s better to remain intellectually engaged and challenged in late life, and it probably helps, at best the positive effects of playing these “brain games” or making a point of doing the New York Times crossword puzzles on a daily basis, is likely vanishingly small. If active engagement in life truly is an Alzheimers disease preventative – it’s not to be found in brain games, it’s to be found in having a purpose in life, a hobby, social activities, stuff like that.

But do we need research to tell us that? Think about what the boosters of these software packages are telling us – that somehow it’s a good thing for an older adult to sit in front of their computer for even more time in their average day (which an average Baby Boomer does probably enough of anyways) and play computer games as a way to forestall the onset of dementia, INSTEAD of getting out of the house and going to the gym, or just going on a walk?

This is me on my soapbox here – I think the reason why these companies are making so much money based on such a flimsy premise is that it appeals to people in the same way drug therapies do. “Here,” they say, “treating or preventing your Alzheimers disease or dementia is as easy and effortless as taking a pill or playing some computer games (and doesn’t require the hard work and effort involved in making healthy dietary choices or getting a regular exercise program)!” The problem is, pills have side effects, these software programs likely don’t do much, and exercise is essentially free – and it works. So, save the potentially hundreds of dollars you might spend on expensive brain training software and maybe hit Costco and lay up a few filets of salmon, and then use the rest to buy that gym membership you were thinking about (or, maybe just save your money and instead go out and walk!!!!).

(BTW, just wanted to say – before you start any exercise program, it’s probably smart to check with your physician first. Never hurts.)

2 thoughts on “Treating and Preventing Alzheimers

  1. yes, I agree with you! As a board-certified music therapist, there is evidence that the use of music therapy as applied by a qualified professional, can help motivate individuals to move more, as well as other more healthy behaviors. I work with people who are already well into their disease process, and the research shows, as does my own experience, that depression and anxiety are decreased, mood elevated, and more social behaviors are influenced, and supported through the use of music therapy. The rhythm and elements of melody, timbre, tempo all arouse the motor cortex and activate movement, access memory, and normalize situations that otherwise would not be. Self-expression is supported. I have many otherwise non-verbal clients who sing a phrase, or whole verse of a song that had meaning from their past. The smiles and the connection we experience together is priceless. Music can access parts of the brain that is still intact, and the music draws out what is still functional. I love working with this population!

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