PreventionMany companies are examining compounds that can contribute to a neuroprotection
format. Forest and Lundbeck are expanding beyond memantine, and Ceregene,
Allon Therapeutics, Johnson & Johnson, and Memory Pharma are all working
on this. Somewhat overlapping are the other efforts to find agents that
enhance memory. There are a number of companies working in this area:
Helicon, Sention, NeuroSearch, Memory Pharmaceuticals, Abbott, and Schering-Plough.
However, as Bart De Strooper, a major plaque researcher in the Netherlands,
said (2/1/05), "The main purpose of a medicine will be to salvage
as many brain cells as you can by halting the progress of the disease
in the areas of the brain where it has already developed, and by preventing
plaque from forming in the parts of the brain they have not yet affected." Many people overlook very basic prevention by protecting the brain. Wear your seatbelt (and a helmet for speed sports such as biking or skiing). Head injuries increase the risk of Alzheimer's. Make your living space safe with respect to the chance of falling down. As with many disease prevention regimes, manage your diet and exercise. Regular physical exercise may be the most powerful risk-reduction correlate. Rovio, Kivipelto and others at the Aging Research Center's Division of Geriatric Epidemiology, in the Karolinska Institutet, Stockholm, Sweden concluded that "Regular physical activity [through mid-life, at least twice a week] may reduce the risk or delay the onset of dementia and AD, especially among genetically susceptible individuals." (Lancet Neurol. 2005 Nov;4(11):705-11.). Even if you don't have diabetes there may be good reason to limit the peaks of insulin so that they don't over-burden the insulin-degrading enzymes involved in limiting the accumulation of beta-amyloid in the brain. Some people think that timing a bit of exercise with those peaks (such as after dinner) gives an extra advantage to exercise. Please. Just exercise. It is possible that the relationship between physical exercise and risk reduction is mediated by the general (or other specific) habits, such as mental activity, that characterize the people who do a lot of physical exercise. (Update: In their more recent work, published in Lancet Neurology, the Kivipelto group used logistic regression statistical methods to determine that the risk of dementia in middle aged people is related to 7 factors (age, male sex, low education level, obesity, hypertension, high cholesterol, and lack of exercise). Recent research on the "Mediterranian diet" indicates some protective effect (See research by Nikolaos Scarmeas, e.g. Archives of Neurology. 2009;volume 66(2):pages 216-225). That diet involves lots of fruits and vegetables, some fish, red wine, not much dairy or red meat. A substantial portion of dietary prevention of AD may come from prevention of circulatory problems. Eat foods that have lots of antioxidants (blueberries, broccoli, beets, spinach, raisins, red grapes, kale, oranges, almonds, curry). Get your protein from foods with good fatty acids (tuna, salmon - probably all the fish with fins that swim deep in the ocean). In a prospective study with a large sample (n=2273), a 3-year follow-up indicated that moderate alcohol consumption might be protective, particularly 3-4 glasses of wine a day (Orgogozo et al Rev Neurol, 153:185-192, 1997). Take folic acid and vitamin E (and, most recently reported, Niacin) but avoid excessive vitamin use. Vitamins mostly prevent vitamin deficiency, and that usually requires trace amounts. Develop your memory abilities; practice word games, crossword puzzles.
There are now many sets of special, supposedly
specific mental training practice tools; these may be valuable, if
you need the structure and don't get out socially (e.g. Keep
Your Brain Alive: 83 Neurobic Exercises by Lawrence Katz or Reversing
Memory Loss by Vernon Marks), but don't expect them to be better
than any other routine of very active mental activity. Many forms
of brain training exist and some are intended to help prevent the progression
of cognitive decline before and during Alzheimer's Disease. We have observed
that many people who exhibit cognitive decline have worries and emotions
that are interfering with the full use of their available cognitive resources.
This emotional interference constitutes the primary impediment
to their cognitive skills. All the crossword puzzles and mental
muscle flexing in the world will do less for your abilities than putting
aside your mental clutter so you are free to think and remember as clearly
as you wish*. There are brief relaxation programs that can help by giving
people a way to signal themselves to relax when any of the thousands of
stress triggers stimulate worry and anxiety. Our favorite here in Seattle
is the brief "NeuroTherapy"
work of the North American Institute of Neurotherapy. Understanding one's
stress triggers (e.g. analysis) or thinking differently when triggered
(cognitive behavioral therapy) are other, less direct, approaches. Estrogen replacement therapy
*(Reference: Wilson RS, Barnes LL, Bennett DA, Li Y, Bienias JL, Mendes de Leon CF, Evans DA. Proneness to psychological distress and risk of Alzheimer disease in a biracial community. Neurology. 2005 Jan 25;64(2):380-2 |