Malaz M. Boustani, MD, MPH, on Alzheimer's, Dementias, and Prevention

Alzheimer's disease is nearly surpassing cancer as the disease Americans are most fearful of getting, according to a survey commissioned by the MetLife Foundation. A larger number of older adults combined with longer lifespans ensure that more of us are and will continue to be affected by Alzheimer's disease, whether as patients or caregivers. According to the survey, 44% of adults in the U.S. have a family member or friend with Alzheimer’s disease. Dr. Malaz Boustani, a 2005 recipient of the Paul B. Beeson Career Development Award in Aging Research, answers some questions about Alzheimer’s disease and memory disorders.

My mother had Alzheimer's disease. How likely am I to develop it?
Children with one parent who has had Alzheimer’s are twice as likely as those in the general population to develop the disease. If both parents had Alzheimer’s disease, the risk increases five-fold.

Though your family history may increase your risk, it is not the only risk factor. The development of Alzheimer’s disease is influenced by a complex interplay of genetic, environmental, and lifestyle factors.

Is there any way to prevent Alzheimer's disease? What roles do diet and exercise play?
While there are no proven interventions to prevent Alzheimer’s disease, we are seeing evidence that a healthy lifestyle could help reduce your risk.

Diet – There is no downside to eating healthy. A Mediterranean diet consisting of whole grains, fresh fruits and vegetables, healthy protein sources such as fish, nuts, and seeds, and healthy fats such as those found in olive oil will help your head as well as your heart.

Chronic conditions such as hypertension, high cholesterol, and diabetes affect brain health. They contribute to the development of both Alzheimer’s disease and vascular dementia (stroke-induced dementia). By eating a healthy diet and preventing high blood pressure, high cholesterol, and high blood sugar, you retain some control over possibly developing Alzheimer's disease and other dementia syndromes. There is no data to support the use of vitamin supplements to protect against Alzheimer’s and other cognitive disorders.

Physical Exercise – Fifteen minutes of moderate exercise three to five times per week is probably one of the healthiest things we can do for our brains. It helps improve mood, increases mental alertness, and preliminary research suggests that it could be beneficial in preventing or delaying the onset of Alzheimer’s disease.

Brain Exercise – The old adage to use it or lose it should be the rallying cry for the importance of keeping your brain engaged. Just as we need physical activity to keep our bodies healthy, we need mental activity to keep our brains sharp. Here are a few things you can do:

• Learn something new: a hobby, a language, a sport.

• Keep socially active – see friends, participate in the community, join a reading group.
• Play word games, computer games, cross-word puzzles.
• Change your routine. Take a different route to the store. Try a new fitness class at the gym.

Stress Management – Stress is the bane of modern life and with it comes a greater likelihood of developing heart disease, depression, and Alzheimer’s disease, among other illnesses. It is critically important to reduce stress. In addition to physical exercise, ways to reduce stress include massage, yoga, aromatherapy, meditation, music therapy, cognitive behavior therapy, and spending time with a good friend.

Another thing we are learning a little bit more about is the role of prolonged use (more than 60 days) of over the counter or prescription anticholinergic drugs and the risk of Alzheimer’s disease. Discuss with your physician whether any of the medications you are taking in combination with your family and health history could pose a risk.

What is the difference between Alzheimer's disease and dementia?
Every Alzheimer’s disease patient has dementia but not every dementia patient has Alzheimer’s disease, meaning that Alzheimer’s is a form of dementia, in this case the most common form. Vascular dementia is the second.

So dementia is not a specific disease but rather an overall term to describe any mental decline that affects memory.

My memory is not as sharp as it used to be. When should I become concerned?
There is a saying that it’s normal to forget where you put your car keys but if you forget what your car keys are for then you should be concerned that you might have the beginnings of Alzheimer’s disease. It is important to realize, however, that there are quite a range of memory disorders from mild cognitive impairment to late stage Alzheimer’s disease.In addition, the symptoms of some neurological disorders such as Lew body disease are often mistaken for Alzheimer’s disease so it is important to get a full medical workup from a memory care physician.

02/08/12