Menachem, a client of mine who was in his early 70’s, used to come to his sessions with his wife. As he had a history of severe cardiovascular disease, including a serious heart attack, I didn’t find it unusual that he had moments of forgetfulness and confusion. Sometimes, he would tell me the same things he told me at his previous session only a few days earlier. The main problem was that over time, I was finding the problem to be getting slightly worse. I was worried that some of the symptoms I saw, including what I thought was some cognitive decline, might be the beginnings of some type of dementia. One day I pulled his wife aside and suggested he see a neurologist for a full workup and conversation about his memory issues.
Alzheimer’s disease (AD), also just Alzheimer’s, accounts for 60% to 70% of cases of dementia. It is a chronic neurodegenerative disease that usually starts slowly and gets worse over time. The most common early symptom is difficulty in remembering recent events (short-term memory loss). As the disease advances, symptoms can include problems with language,
disorientation (including easily getting lost), mood swings, and loss of motivation, not managing self-care, and behavioral issues. As a person’s condition declines, they often withdraw from family and society. Gradually, bodily functions are lost, ultimately leading to death. Although the speed of progression can vary, the average life expectancy following diagnosis is three to nine years. There is a perception that we can’t do anything to prevent the onset of Alzheimer’s, but more and more, we are seeing research that says that modifiable lifestyle factors could be responsible for 20%-40% of Alzheimer’s disease risk. Primary prevention through lifestyle intervention must be made in order to combat this terrible disease. Evidence suggests that the disease begins forming 20-30 years before the first symptoms, so it is never too early to begin preventative measures.
Anything that we can do to prevent this ailment not only helps us, but those around us who would have to bear the burden of caring for someone without normal cognitive function and a progressively worsening memory. What are the risk factors for getting Alzheimer’s? Just like in heart disease and cancer, there are certain risk factors that are indeed beyond our control:
Age: The greatest known risk factor for getting Alzheimer’s is advancing age. For example, while one of nine people age 65 or older has Alzheimer’s, nearly one of three people age 85 or older has the disease. One of the greatest mysteries of Alzheimer’s disease is why risk rises so dramatically as we grow older.
Family history: Those who have a parent, brother, sister or child with Alzheimer’s are more likely to develop the disease. The risk increases if more than one family member has the illness. When diseases tend to run in families, either heredity (genetics) or environmental factors, or both, may play a role.
Genes are involved in Alzheimer’s. There are two types of genes that can play a role in affecting whether a person develops a disease—risk genes and deterministic genes. Alzheimer’s genes have been found in both categories.
Women are more likely to get Alzheimer’s than men.
But many if not most of the risk factors are things we can do something about.
- Lack of exercise
- Lack of adequate and quality sleep
- High blood pressure
- High blood cholesterol
- Elevated homocysteine levels
- Poorly controlled diabetes
- A diet lacking in fruits and vegetables
Obviously the solution to lack of exercise is to begin exercising. Brisk walking is a good start, although one should progress into doing other forms of exercise as well. It is probably a good decision, if you are older, to take a personal trainer for a short time to show you how to exercise properly. Most people who need to quit smoking need help doing it. There are multiple methods that can be successful, particularly if coupled with Cognitive Behavioral Therapy. Exercise and proper diet including weight loss can help your blood pressure and cholesterol before you turn to drug therapy.
In order to lower high homocysteine, lifestyle changes are also necessary. What raises your homocysteine? Many factors contribute to high homocysteine levels:
- Insufficient folate, vitamin B6, vitamin B12, betaine, vitamin B2, and magnesium
- Prescription drug use of certain drugs, some used as common treatments for diabetes but others also
- Diets that are high in red meat and dairy products
- Alcohol consumption
- Advancing age
- A genetic variant that causes an impaired ability to metabolize active folate from folic acid
In order to lower the homocysteine, make the following dietary and lifestyle changes which will also reduce chronic inflammation.
- Avoid methionine-rich foods like red meat and dairy products
- Exercise! Patients in a cardiac rehabilitation program showed a reduction in homocysteine from exercise alone
- Decrease or eliminate alcohol and smoking
- Supplement with a Vitamin B complex.
In part two of this article, we will examined the very pronounced effects that improper nutrition and lack of sleep can have and can cause Alzheimer’s disease. We will also see how Menachem’s visit to his neurologist went and what diagnosis he received. Preventing Alzheimer’s will give you quality of life in old age, ease the burden of others and will “add hours to your day, days to your year and years to your life.”