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Aging
Well Alzheimer's
research is starting to shed light on prevention February 11, 2003 Avoiding stress
could be one of the simplest ways to protect yourself against Alzheimer's
disease. Then again, a glass of red wine could help ward off dementia. And
cutting back on red meat might help as well. Finding it hard
to keep up? So are most people. The trickle of
research about Alzheimer's has turned into a deluge, making it tough to
track the latest thinking about what you should or shouldn't do to fend
off the disease, from which four million Americans suffer, according to
the Alzheimer's Association. Nearly half of all people 85 and older are
said to be affected. The confusion,
however, hasn't stopped people from taking precautionary steps, such as
consuming complex cocktails of vitamins and working crossword puzzles to
stimulate the brain. Whether any of these measures are truly effective
will be better understood in coming years. "It's just
in the past 10 or 20 years that we've thought this isn't a normal part of
aging, that this can be treated," says Neil Buckholtz, chief of the
dementias-of-aging branch at the National Institute on Aging in Bethesda,
Md. "Now we're looking at treatments for the disease, and we have
enough basic science that we're looking at ways to prevent it." No one knows
exactly what triggers Alzheimer's. Scientists have observed that it
develops as connections between brain cells wither and the cells die,
eventually chipping away at parts of the brain controlling memory,
learning and judgment. Many believe a few proteins are involved, including
beta amyloid, which promotes plaque buildup in the spaces between cells;
and tau, which creates tangles inside cells. Other potential culprits:
Oxygen damage to brain cells and inflammation in the brain. As recently as
five years ago, there were no research trials funded to study Alzheimer's
prevention and no means to identify people at high risk. Now, scientists
are making strides. Magnetic-resonance and other diagnostic images are
being studied as potential tools to pinpoint the disease in early stages. And the federal
government has bankrolled several areas of clinical study, with trials
lasting several years apiece, to examine ways to prevent the illness. The
substances being investigated as possible Alzheimer's blockers include
vitamin E, anti-inflammatories, estrogen and ginkgo biloba. Beyond such
potential help in your medicine cabinet, here's a look at other new
findings that could shape preventive efforts to come: The blues may
hurt your mind. A long-term study of 651 nuns, priests and brothers across
the U.S. found last summer that those with the most symptoms of depression
also had the greatest risk of developing Alzheimer's. At the study's start
in 1994, the religious volunteers were all 65 or older and free of
Alzheimer's. The scientists asked them annually about 10 symptoms of
depression, such as "whether you felt sad during the past week,
whether you felt lonely, or whether people seemed unfriendly," says
Robert S. Wilson, a neuropsychologist at the Rush Alzheimer's Disease
Center in Chicago who led the study. After seven
years, 108 of the religious volunteers had Alzheimer's, with the odds of
developing the illness increasing about 20% for each symptom of
depression. "It was a much stronger effect than we were
expecting," Dr. Wilson says. Now, the
researchers are studying the brains of participants who have died in an
attempt to better understand the connection between Alzheimer's and
depression. One possible link: The symptoms of depression that the
researchers pinpointed may reflect chronic stress, says Dr. Wilson, which
has been found in animal studies to have "a deleterious effect on
brain function -- especially memory." Although Dr.
Wilson says it's "probably a little early to go out and start taking
antidepressants" for mild symptoms, the findings certainly provide
good reason to keep tabs on depression -- often a tough sell for doctors
treating older patients. It's also
important for adult children to notice signs of depression in their
parents, then encourage their parents to have it treated, particularly
since it's often tough for family members to distinguish between
depression and the beginnings of dementia, says Cindy Little, director of
long-term-care benefit administration for MetLife Inc. in New York.
"You have to fight against this idea that it's normal aging,"
she adds. It is brain
surgery. A pilot study published last October found promising results in
using experimental shunts to drain fluid from patients' brains. The
theory, says Gerald D. Silverberg, a Stanford University neurosurgeon who
led the research, is that declining circulation of spinal fluid lets the
proteins at work in Alzheimer's collect in the brain. "By flushing
this stuff out and increasing the turnover of spinal fluid," the
disease's progression was slowed in 12 patients implanted with shunts over
the course of a year, he says. In comparison, 11 patients without the
shunts became sicker. To be sure, the
numbers are too small to be statistically significant. Some scientists
were also skeptical because a few patients with shunts were dropped from
the results when they stopped taking medications. But a larger trial now
is trying to enroll about 250 patients. The first
experiments treating Alzheimer's patients with shunts were performed back
in the 1960s, but sudden drops in fluid pressure caused bleeding. The new
shunts use a low-flow valve that constantly dumps small amounts of spinal
fluid into the blood stream in an attempt to clear proteins and increase
brain-fluid production. If the shunts
are proven to slow Alzheimer's in the larger trial, "it will be the
very first clinical intervention that actually changes the course of the
disease," says Dr. Silverberg. What's good for
your heart is good for your head. Increasingly, scientists are discovering
that high blood pressure, high cholesterol, lack of exercise and other
contributors to heart disease are also present in Alzheimer's patients.
The latest coincidence: high blood levels of homocysteine, an amino acid
that is a byproduct of red meat -- already believed by many scientists to
contribute to atherosclerosis. In Sydney,
Australia, scientists studying 36 healthy elderly people found last year
that those with greater brain atrophy were twice as likely to have high
homocysteine levels as those with less atrophy. Other researchers at the
University of California-Davis found that people with high levels of
homocysteine were 10 times as likely to have vascular disease, which,
along with brain atrophy, is related to the development of dementia,
including Alzheimer's. "You can
control high homocysteine levels" by eating foods with vitamins B-6
and B-12 and folic acid, which help break down the amino acid, says James
Toole, a neurologist at Wake Forest University School of Medicine in
Winston-Salem, N.C. "You shouldn't eat steak," he adds. Drink to your
health. People who drink an occasional glass of wine may have a lower risk
of developing Alzheimer's and other forms of dementia, according to a
study of elderly Europeans published in November. Researchers in
Copenhagen examined the drinking patterns of 1,709 people in the 1970s,
then assessed them for dementia in the 1990s, when they were 65 or older.
Over that period, 83 participants developed dementia. People who drank
wine weekly or monthly were significantly less likely to develop dementia
as those who didn't. In contrast, those who drank beer once a month were
more than two times as likely to develop dementia as those who hardly ever
drank beer. Wine,
especially red wine, contains flavonoids, a type of antioxidant believed
to neutralize or prevent brain damage. The results don't mean people
should necessarily start drinking more, notes Thomas Truelsen of Denmark's
Institute of Preventive Medicine. But they could mean that an agent in red
wine could become an important weapon in fighting dementia, he adds. One final note:
Make sure your parents and other older loved ones know there are glimmers
of hope. Most elderly people still believe that memory problems are an
inevitable part of aging about which nothing can be done. That was the
conclusion reached last summer by Perla Werner, an associate professor of
gerontology at the University of Haifa in Israel, after extensive
interviews with 79 elderly people about their perceptions of memory
problems and their decisions to seek -- or not to seek -- help. Copyright
© 2002 Global Action on Aging
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