“Is it Alzheimer’s?” That’s the common first question whispered by people who see their parents develop confusion, garbled speech and loss of memory. A fair concern, since Alzheimer’s is at the root of 60 percent to 80 percent of dementia cases. A frequent second question: “Will I get it, too?”
That’s what Shayna McClelland of Brooklyn wants to know – and prevent if she can. The public relations consultant is only 32. But her grandmother had Alzheimer’s, and she is now caring for her father, who suffers from dementia. She is determined to do her utmost to avoid heading down the same track. Her first step: an appointment at the new Alzheimer’s Prevention Clinic at New York-Presbyterian/Weill Cornell Medical Center in New York. “Let’s be clear,” says Richard Isaacson, a neurologist and the clinic’s director. “We don’t yet know how to prevent Alzheimer’s. But lifestyle changes may slow the onset of symptoms.”
The reality that leads experts to be hopeful about that possibility is that Alzheimer’s develops over two to three decades, giving those who start early years to make a difference. And “it’s never too late,” Isaacson argues. “Incremental changes do make a difference.” The clinic, which launched in 2013 with the dual goals of taking care of patients and gathering data on how well prevention strategies work, has people coming in aged 27 to 91. Given that the current number of Americans with Alzheimer’s – 5.3 million – is expected to triple by 2050, the fact that prevention (or at least delay) may be possible is a message that public health experts would like heard.
McClelland’s first visit began with a review of her medical and family history, medications and nutritional habits. Then came cognitive testing to establish a baseline, and bloodwork to assess her general health and whether she carries a gene predisposing her to Alzheimer’s. Those who carry the gene, which spurs a protein called ApoE4, are three times more likely than the average person to develop the disease. McClelland does not carry it.
She left the clinic with an assignment: For six months, implement a set of lifestyle changes that research shows may reduce risk of the disease. “Exercise and nutrition are two components that are known to have an effect,” says Isaacson. McClelland was advised to limit processed foods and follow the Mediterranean diet, which is characterized by dark green leafy vegetables, whole grains, fruits, nuts, fish and olive oil and is low in saturated fats. She will bump up her intake of Omega-3 fatty acids and vitamins B12, B6, D and folic acid. She was also counseled to “find a new hobby – learn a foreign language or to play an instrument,” McClelland says. And she was advised to exercise at least two to three times a week for 30 to 45 minutes, building up to 45 to 60 minutes three to four times a week. After six months, McClelland will return to see if there are any changes to her bloodwork and cognitive skills. Either new recommendations will be made, or she’ll continue on the same path.
Although the clinic’s focus is on prevention strategies, it also offers treatment for the disease that may mirror McClelland’s prescription. With treatment, however, “expectations are tempered,” Isaacson says.
What is the relationship between diet and Alzheimer’s? Cardiovascular disease and diabetes are both risk factors, and the theory is that heart-healthy nutrition is also a brain-healthy diet. A diet that minimizes sludge in the rest of the cardiovascular system may do the same for the brain’s blood vessels. Likewise, high blood sugar, which causes inflammation in blood vessels, can do the same in the brain. “The totality of the evidence is that you are what you eat when it comes to Alzheimer’s,” says Isaacson. One epidemiological study revealed that people who followed a Mediterranean diet had a 28 percent lower risk of developing mild cognitive impairment and a 48 percent lower risk of progressing from MCI to Alzheimer’s disease.
At the same time, “there is no magic thing you can add or subtract” at a certain point, cautions Jessica Langbaum, principal scientist at the Banner Alzheimer’s Institute in Phoenix. Genetics may cause you to develop the disease no matter what you eat, she says. But a healthy diet and lifestyle may help delay or slow the effects.
Isaacson also recommends minifasts. Studies have shown that fasting for 12 hours or more overnight can increase the production of ketones, an alternative energy source to the simple sugars in carbohydrates. Ketones, created when glucose levels run low and fatty acids break down to take over fueling the body, may have an anti-aging effect on the brain when combined with lower calorie intake. So give up those late night snacks, he advises. Another possible benefit of fasting is the increase in a protein called brain-derived neurotrophic factor that affects learning and memory. When people fast for 16 to 18 hours, it appears that the nerve cells in the brain go into overdrive and levels of BDNF increase.
As with diet, there are no firm answers about how keeping active affects the brain. Besides the fact that exercise is good for cardiovascular health, scientists have discovered that it reduces beta-amyloid protein that can clump in the brain and may slow normal function. Studies have shown that 150 minutes of moderate exercise a week can improve memory performance after 12 weeks. And researchers at the University of Maryland School of Public Health who looked at brain scans of volunteers at high risk for Alzheimer’s found that after 18 months, the area responsible for memory in physically active volunteers had not changed, while in couch potatoes it had atrophied.
Staying mentally engaged may also help delay the onset of disease, says Laurie Ryan, chief of the dementias of aging branch at the National Institutes of Health. But an occasional crossword puzzle is not enough. It’s important to try new things, experts stress. The brain’s synapses become less active or die away during the aging process, says Ronald Petersen, director of the Alzheimer’s Disease Research Center at the Mayo Clinic. “Intellectual stimulation may help maintain synapses or form new ones,” he says. Research at the Mayo Clinic found that taking up knitting and crocheting may reduce Alzheimer’s risk significantly, for instance. Shayna McClelland signed up for French lessons and took a storytelling class. And Isaacson has started playing bass guitar.
Calling For Study Subjects
Want to help advance research? In 2012, the Banner Alzheimer’s Institute in Phoenix launched the Alzheimer’s Prevention Registry (endalznow.org) to connect healthy people with scientists seeking volunteers to help them explore ways to slow or prevent the disease. Registering requires an email address and some demographic information, and then volunteers will be linked up with research activities in their area. Besides controlled clinical trials that require coming in for regular physical examinations or lab tests, for example, there are online and observational studies that might explore memory performance or track at-risk adults.
Excerpted from U.S. News’ “Best Hospitals 2016,” the definitive consumer guidebook to U.S. hospitals. Order your copy now.