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Glenn D. Braunstein, M.D. Headshot

Alzheimer's Disease Risks, Signs and Prevention

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So, the good news is that Angelenos are dying less frequently. The fact that we're not getting any younger is partially responsible for the significant increase in Alzheimer's disease rates.

Recently released statistics from the Los Angeles County Department of Public Health showed a 300 percent increase in deaths from Alzheimer's disease between 1998 and 2007. The spike, attributed to both better diagnosis and the aging of the population, underscores that this is a disease that is going to become an increasingly pressing public health problem.

Alzheimer's disease was the seventh-leading cause of death in Los Angeles County in 2007, and killed twice as many women as men. It was the fifth-leading cause of death for women, with 1,194 deaths, but the 12th-leading cause of death for men, with 586 deaths.

Alzheimer's disease is one of the most serious and progressive forms of dementia, as well as the most common type of dementia affecting older people in the United States. It impacts the part of the brain that controls cognitive function, including memory, comprehension and language. Scientists have not been able to pin down an exact cause for Alzheimer's, but it is probably due to a combination of genetic and other factors. What we do know is early recognition of the symptoms, accurate diagnosis and early care, including medication, are vital to improving the quality of life and mental function of those living with the disease.

In fact, new recommendations from the National Institute on Aging and the Alzheimer's Association update the criteria for diagnosing the disease and suggest changing the thinking about Alzheimer's. Instead of considering it dementia that affects older people, the disease should be considered a brain disorder that begins years before symptoms occur. Researchers are hopeful that study into the earliest phases of the disease through the use of biomarkers and advances in medical imaging will lead to intervention strategies, and eventually prevention.

In the meantime, we can arm ourselves with information to recognize the disease early, better understand who is at risk and take what measures we can to prevent it.

What are the risk factors?

-- Age is one of the predominant risk factors, as most people who develop Alzheimer's disease are 65 or older. After age 65, the likelihood of developing the disease doubles every five years.

-- Family history also seems to play a role in Alzheimer's risk. There are at least two genes that seem to be linked to the disease, and there may be others. One known gene is linked to a higher risk for the disease, but is not thought to cause it. It is one of three genes that control the production of proteins that carry cholesterol in the blood. A less common gene that runs in families does seem to contribute to the cause of Alzheimer's, but these genes account for fewer than 2 percent of cases.

-- Serious head injuries increase the future risk for Alzheimer's and other forms of dementia.

-- Poor cardiovascular health is another contributing factor, as brain cells use 20 percent of the nutrients and oxygen we carry in our blood. High blood pressure, heart disease, stroke, diabetes and high cholesterol all indicate higher risk of Alzheimer's and other forms of dementia.

What are the Signs?

The earlier Alzheimer's disease is detected, the more potential there is for medical interventions to be successful in improving quality of life in patients living with the disease. There are 10 warning signs the Alzheimer's Association suggests recognizing and watching for in ourselves and in loved ones.

An important distinction to note in these warning signs is that these are changes that are disruptive to daily life, and cannot be attributed to another medical problem. For example, it's important to watch for memory changes - but take into account that sometimes forgetting names or appointments, and remembering them later, is normal (as is mixing up yin and yang as I did in last week's blog on acupuncture). What's more concerning is forgetting recently learned information, important dates or events, asking for the same information repeatedly or a sudden reliance on memory aids. This kind of forgetfulness is one of the common signs evident in the earliest stages of the disease.

Other signs to be aware of if they are new, occur with greater frequency or more intensity include:

-- Difficulty in planning or problem solving, such as following a familiar recipe or tracking monthly bills.

-- Difficulty completing familiar tasks, like remembering the rules of a favorite game, or driving to a usual location like work or church.

-- Losing track of dates, seasons and passage of time.

-- Difficulty understanding images and spatial relationships, such as passing a mirror and thinking someone else is in the room, or trouble judging distance.

-- Problems with words in speaking and writing that did not previously occur. Some Alzheimer's patients have difficulty following conversation, or struggle with vocabulary.

-- Misplacing things, losing the ability to trace one's steps, or putting things in unusual places. Sometimes, an Alzheimer's patient may accuse others of stealing.

-- Considerable lapses in judgment and decision-making.

-- Withdrawal from work or social activities.

-- Changes in mood and personality, such as confusion, suspicion, depression, fear and anxiety.

Of course, Alzheimer's disease is not the only cause of memory impairment. Other considerations are vascular disease affecting the brain (e.g. mini-strokes), low pressure hydrocephalus, hypothyroidism, cancer, vitamin B12 deficiency, infections, substance abuse, and, especially, overmedication with sleeping pills, sedatives and antidepressants.

Tips for Alzheimer's Prevention

As our understanding of Alzheimer's disease grows, so do our tools for fighting and preventing it. New research is finding more biomarkers to aid in recognizing the disease, as well as looking into causes for it. For example, my colleague Keith Black, M.D., chairman of the Department of Neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai, recently blogged about a potential link between pesticides and Alzheimer's disease.

In addition to scrubbing your produce, some other good habits to embrace to protect against Alzheimer's include:

-- Eat right and maintain a healthy weight. Obesity, diabetes, high cholesterol and heart disease have been identified as risk factors for Alzheimer's. Developing healthy habits to combat these health problems may also stave off Alzheimer's. A Harvard University study of women age 70 and older indicated diets high in vegetables, especially leafy greens, cauliflower and broccoli are connected with slower rates of cognitive decline. According to a UCLA study, turmeric seems promising: In an animal study, Alzheimer's-like brain plaques disappeared after being treated with compounds found in this spice.

-- Get active. Studies have shown that in as little as six months, regular exercise can improve memory and cognitive function in older adults. One study found that seniors age 65 and older who exercised three or more times weekly cut their risk of developing dementia by 35 percent.

-- Exercise your mind. Reading, working crosswords, enrolling in classes and puzzling out the daily Sudoku are fun - and may be effective in preventing Alzheimer's. Mentally nimble folk were more than twice as likely as less mentally active people to avoid Alzheimer's, according to a Rush University study. Just as weight lifting can build muscle, learning new information, problem-solving and making new memories help maintain existing brain circuits and create new ones.

-- Finally, although there are currently no medications that can prevent Alzheimer's disease, there are four FDA-approved drugs that have been shown to decrease the rate of cognitive decline. This may buy some patients more time while waiting for the breakthroughs that will truly prevent or reverse the disease process.