By Keith Sinzinger, for U.S. News
More than 5 million Americans have Alzheimer's disease, and the nonprofit Alzheimer's Association projects that, barring major advances, 11 million to 16 million will have it by 2050--at an annual cost of $1.1 trillion in today's dollars. In May, the government announced the first national plan to combat Alzheimer's, and one focus is the role of beta-amyloid plaques in the brain, a leading suspect in this form of dementia. U.S. News spoke about progress against the disease with a leading researcher in the field, Reisa Sperling, head of the Center for Alzheimer Research and Treatment at Brigham and Women's Hospital in Boston and an associate professor of neurology at Harvard Medical School. Excerpts:
What do you see unfolding over the next couple of decades?
What we have now is what I would term "symptomatic therapy." Drugs that are FDA-approved for Alzheimer's disease help people stay functional a bit longer, but they're not really slowing the underlying disease process. I actually am optimistic about the outlook over the next 10 to 20 years, because I think we are realizing that Alzheimer's disease can be detected a decade before people have symptoms. That will allow us to move into the same type of prevention strategy that has been successful in cancer and heart disease.
Has anything proven effective yet in either staving off or slowing the disease?
Unfortunately, no. There are several anti-amyloid agents in large-scale trials that are due to report out this fall. However, those trials are being done at what we now recognize is probably the late stage of a 20-year disease process. And I'm afraid that may be too late for these particular mechanisms. The good news is that the agents are increasingly showing evidence that they have biologic activity, that they can lower amyloid in the brain and even affect what we call downstream processes, such as another key protein called tau. The issue is that we need to start both of those types of therapies, anti-amyloid and anti-tau, much earlier.
One of your specialties is early diagnosis. Are you seeing some important gains there?
We now have both imaging markers and biological markers in spinal fluid that can indicate the disease process very early, perhaps even before there are any symptoms. This is a huge advance. We screen for cholesterol and blood pressure before people have symptoms. We now have the ability to do that in Alzheimer's. The problem is we don't yet have large-scale studies to link these biomarkers to eventual clinical outcomes.
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Given that there isn't any cure, might there be a downside in being able to make early diagnoses?
I don't believe that people who don't have symptoms yet should go out and get a PET scan or a spinal fluid test or even a genetic test, because it wouldn't change what I would recommend they do. I'd still recommend that they live a healthy lifestyle. What I'm working on is trying to do a prevention trial in people who have biomarker evidence of Alzheimer's disease but don't yet have any symptoms, and see if we could prevent the emergence of symptoms. That's what I think will be exciting over the next five years.
What are significant early warning signs of the disease?
For example, people worry they have Alzheimer's disease because they can't remember the actress's name in a film. That is not worrisome. But if they forget that they went to the movies at all, or forget what they were trying to remember, then I get worried. I also think that people losing interest in their hobbies and in social interaction is often a very concerning early sign. When people get lost driving even to familiar places, or get lost in an unfamiliar setting but can't figure out how to ask for help or reorient themselves, that's a real concern. One symptom that's very common is repeating questions multiple times.
Do you have advice for how people can best protect themselves, at any stage of life?
Physical exercise is showing more and more promise. I don't think there are definitive studies yet, but research does suggest that being in shape throughout life is helpful. And similarly, some exercise studies in patients who already have dementia show it seems to slow the rate of decline. There is some evidence that lower midlife cholesterol may be protective. And there's more and more evidence that early-life cognitively stimulating activities may be helpful. So one thing we can do is make sure we stay intellectually, socially, and physically active throughout our lives and help our kids start these habits early.
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Daily Chores And Exercise
A recent study in the <a href="http://www.neurology.org/content/early/2012/04/18/WNL.0b013e3182535f0e.extract" target="_hplink">journal <em>Neurology</em></a> showed that simple activities like <a href="http://www.huffingtonpost.com/2012/04/20/chores-alzheimers-exercise-_n_1440969.html" target="_hplink">cooking, cleaning and washing the dishes</a> -- as well as good, old-fashioned exercise -- is associated with a decreased Alzheimer's disease risk, even among people who are age 80 and older. <br> <br> Researchers found that the people who were the least active each day -- in the bottom 10th percentile in the study -- were two times more likely to go on to develop Alzheimer's disease, compared with people who were in the top 10th percentile for daily activity. <br> <br> The results were even more marked when evaluating the intensity of physical activity: Those who were in the bottom 10th percentile for physical activity intensity were three times more likely to develop Alzheimer's, compared with those in the top 10th percentile.
Speak Two Languages
Being bilingual could strengthen your brainpower and protect against dementia, according to a recent study published in the <a href="http://www.cell.com/trends/cognitive-sciences/" target="_hplink">journal <em>Trends in Cognitive Sciences</em></a>. <br> <br> HuffPost Canada Living <a href="http://www.huffingtonpost.ca/2012/04/02/benefits-of-being-bilingual_n_1396671.html" target="_hplink">explains why</a>: <br> <br> <blockquote>The anticipation of having to speak one of two language at any given time forces the brain to run continually, and results in an experience that helps avoid a mental conflict between languages.</blockquote> <br> <br> "It is rather like a reserve tank in a car. When you run out of fuel, you can keep going for longer because there is a bit more in the safety tank," study researcher Dr. Ellen Bialystok <a href="http://www.guardian.co.uk/science/2011/feb/18/bilingual-alzheimers-brain-power-multitasking" target="_hplink">told <em>The Guardian</em></a>.
Research in flies suggests that the main compound in turmeric, called curcumin, could have powers against Alzheimer's. <br> <br> <em>The Telegraph</em> reported on a study in the journal <em>PLoS ONE</em>, which suggested that <a href="http://www.telegraph.co.uk/health/healthnews/9084973/Having-a-curry-could-help-ward-off-dementia.html" target="_hplink">curcumin may work</a> by reducing the amount of oligomers, which are the "precursor" forms of amyloid plaques in the brain. <br> <br> A previous study in the journal <em>Annals of Indian Academy of Neurology</em> discussed the possible <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2781139/" target="_hplink">effects of curcumin on Alzheimer's</a>. Researchers wrote: <br> <br> <blockquote>Due to various effects of curcumin, such as decreased Beta-amyloid plaques, delayed degradation of neurons, metal-chelation, anti-inflammatory, antioxidant and decreased microglia formation, the overall memory in patients with AD has improved.</blockquote>
<a href="http://www.huffingtonpost.co.uk/2011/12/01/puzzles-and-exercise-help-beat-dementia-symptoms_n_1122502.html" target="_hplink">Doing some puzzles</a> and playing games every day could ward off mental decline, according to a recent study in the journal <em>BMC Medicine</em>. <br> <br> Researchers from the University of Erlangen conducted a study in dementia patients in nursing homes, and had the study participants do exercises like bowling and solving puzzles together, the Press Association reported. They also spent some time doing things like woodwork and gardening. <br> <br> The researchers found that all of these activities seemed to have the same effect on the study participants' <a href="http://www.huffingtonpost.co.uk/2011/12/01/puzzles-and-exercise-help-beat-dementia-symptoms_n_1122502.html" target="_hplink">brain functioning</a>, compared with the typical dementia medication, the Press Association reported. <br> <br> Another recent study in the journal <em>Archives of Neurology</em> showed that life-long reading and game-playing could <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=153901" target="_hplink">decrease beta amyloid levels</a> in the brain, which are considered a "hallmark of the condition," MedicineNet reported. <br> <br> "Staying cognitively active over the lifetime may reduce the risk of Alzheimer's by preventing the accumulation of Alzheimer's-related pathology," study researcher Susan Landau, a research scientist at the Helen Wills Neuroscience Institute at the University of California, Berkeley, <a href="http://www.medicinenet.com/script/main/art.asp?articlekey=153901" target="_hplink">told MedicineNet</a>.
Elderly people who <a href="http://www.bbc.co.uk/news/health-11537068" target="_hplink">walk six to nine miles a week</a> could decrease their risk of dementia and brain functioning problems, BBC News reported. <br> <br> The 2009 study in <em>Neurology</em> included 299 people whose average age was 78. Researchers found that people who walked the most in the study -- six to nine miles a week -- had a halved risk of developing the brain problems as people who walked the least in the study, according to BBC News. <br> <br> Similarly, a 2007 study that also appeared in the journal <em>Neurology</em> showed that people age 65 and older who regularly exercise have a <a href="http://www.eurekalert.org/pub_releases/2007-12/aaon-wam121107.php" target="_hplink">decreased risk of vascular dementia</a>. That study included 749 people.
Eat Your Fish And Nuts
Researchers from Columbia University Medical Center found that eating a <a href="http://www.huffingtonpost.com/2012/05/06/omega-3-fatty-acids-alzheimers-memory-brain_n_1475806.html" target="_hplink">diet high in omega-3 fatty acids</a> -- such as fish, nuts and chicken -- is linked with lower levels of of beta-amyloid protein, which is linked with Alzheimer's disease. <br> <br> The study, published in the journal Neurology, included 1,219 people age 65 and older who didn't have dementia. The researchers found that the higher their consumption of the omega-3 fatty acids, the lower the beta-amyloid in the blood.
Drink Green Tea
That refreshing green brew could have powers against Alzheimer's disease, according to research from Newcastle University. <br> <br> WebMD reported that when <a href="http://www.webmd.com/alzheimers/news/20110106/green-tea-may-help-prevent-alzheimers-disease" target="_hplink">green tea is digested</a>, the released compounds have protective effects against Alzheimer's. <br> <br> "When green tea is digested by enzymes in the gut, the resulting chemicals are actually more effective against key triggers of Alzheimer's development than the undigested form of the tea," study researcher Ed Okello <a href="http://www.guardian.co.uk/society/2011/jan/06/green-tea-alzheimers-cancer" target="_hplink">told <em>The Guardian</em></a>.
Find out if there are any quick and easy brain training exercises you can do in order to prevent dementia.