In-Depth Evaluation of a Meta-Analysis: Lifestyle Choices & Their Effect on Alzheimer's

Meta-analysis Proves Daily Habits Can Raise or Lower the Risk of Alzheimer’s

Evelyn Smith

M.S. in Library Science, University of North Texas (2012)

In the past week, many news sources have reported that lifestyle choices made in early and in midlife directly or indirectly influence whether individuals develop Alzheimer’s later in life.  However, they all stem from the same source:

Xu, W., Tan, L., and Wang, H. F., et al. (2015, August 20). Meta-analysis of modifiable risk factors for Alzheimer's disease. Journal of Neurology, Neurosurgery, and Psychiatry. pii: jnnp-2015-310548.  doi: 10.1136/jnnp-2015-310548. [Epub ahead of print].  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26294005

Researchers affiliated with Qingdao University, in Qingdao, China, and the University of California, San Francisco, evaluated the association between Alzheimer’s and its modifiable risk factors by searching the PubMed and Cochrane databases, identifying 323 article with 93 factors that met their inclusion criteria for meta-analysis.  

Xu, et al, identified four pharmacological factors and four dietary factors that protected users from Alzheimer’s.  They also found a biochemical exposure, homocysteine, and a psychological condition, depression, that increase the risk of Alzheimer’s. 

Meta-data showed how pre-existing diseases, like hypertension and low-diastolic blood pressure as well as type 2 diabetes mellitus in Asians—increase the risk for Alzheimer’s. Finally, lifestyle choices, such as those evidenced by either a high body mass index (BMI) in midlife as well as low BMI later in life intensify the probability of developing Alzheimer’s.  However, cognitive activity, currently smoking among Westerners, light-to-moderate drinking, stress, and high BMI late in life decrease the risk of developing Alzheimer’s. 

Conclusions:  Effective dietary and medical interventions, biochemical exposure, psychological conditions, and pre-existing diseases and life styles may decrease the risk for Alzheimer’s.

For an easy to follow review of these findings, Alice Walton has summarized this meta-data analysis as follows:

Walton, Alice. (2015, August 22).  The Lifestyle choices that affect Alzheimer’s risk.  Forbes.  Retrieved from http://www.forbes.com/sites/alicegwalton/2015/08/22/the-lifestyle-choices-that-affect-alzheimers-risk/

University of California, San Francisco researchers after surveying 323 studies on Alzheimer’s containing “high quality data” have determined that most causes of Alzheimer’s are within each individual’s power to avoid (Walton, 2015, August, 22, para. 1).

Protecting against Alzheimer’s are seven common sense factors as well as links between medications and a reduced risk for Alzheimer’s:

• Eating a healthy diet;

• Healthy intake of folate; 

• Vitamin C, and vitamin E;

• Coffee consumption;

• Fish consumption;

• Light moderate drinking;

• Staying cognitively active;

• Estrogen;

• Cholesterol lowering drugs (statins); 

• Blood pressure meds;

• Anti-inflammatory drugs (NSAIDs).

 (Walton, 2015, August 22, para. 2)

Surprisingly, exercise isn’t mentioned, even though it protects against some of the negative factors that researchers have coupled with a high risk of developing Alzheimer’s:

• Obesity;

• Depression;

• Carotid artery narrowing;

• Low educational attainment;

• High levels of homocysteine (a compound that builds up, in part when B vitamin levels are low);

• High blood pressure and low blood pressure;

• Frailty;

• Currently smoking (in Asians);*

• Type 2 diabetes (in  Asians);*

(Walton, 2015, August 22, para. 3)

Walton concludes that if everyone avoids these nine risk factors, this would cut the incidence of Alzheimer’s by two-thirds (Walton, 2015, August 22, para. 4).

*Read more about this advice, later.  But for now, realize that smoking and Type 2 diabetes can raise the risk of dementia in all ethnic backgrounds.

Now you know what to do, no excuses are acceptable!

All of which leads to the following blog that fills in some of the blanks:

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To-do List of Ways to Avoid Alzheimer’s:

Eat a healthy [Mediterranean, MIND, DASH, or traditional Asian] diet:

A heart-healthy diet and 30 minutes of aerobic exercise daily prevent & delay dementia.

Diners can pick from several different style diet to find delicious, heart and brain-healthy food that helps them prevent or delay dementia:

Cohen, Paula. (2015, March 30).  The MIND diet: 10 foods that fight Alzheimer's (and 5 to avoid).  CBS News. Retrieved from http://www.cbsnews.com/media/mind-diet-foods-avoid-alzheimers-boost-brain-health/

Martha Clare Morris and her fellow researchers at the Rush University Medical Center in Chicago have developed the MIND diet, claiming that faithfully following its tenets delays or prevents the risk of dementia by 53 percent (Cohen, 2015, March 30, para. 2-4).  Participants aged 58 to 98 in the Memory and Aging Project filled out food questionnaires and underwent neurological testing whereupon those that strictly followed its proposals upon testing had the cognitive function of individuals 7.5 years younger than their chronological age (Cohen, 2015, March 30, para. 5). 

The MIND diet combines the Mediterranean and DASH diet as well as emphasizing those foods, like blueberries, that have been proven effective in fighting Alzheimer’s (Cohen, 2015, March 30, para. 7 & 13).

The MIND diet recommends six or more servings of green leafy vegetables weekly, eating a green salad with at least one other vegetable daily, adding some nuts to a diet five days a weekly, three servings of beans or legumes weekly, three serving of whole grains daily, fish at least once weekly, poultry twice weekly, cooking with olive oil, and a glass of red wine daily (para. 19, Cohen, 2015, March 15, para. 9-18). It also limits red meat, butter, and sweets, but not as severely as the Mediterranean diet does, and allows cheese, fast food, and fried food to only once a week (Cohen, 2015, March 15, para. 18).

Morris, M. C., Tangney, C. C., and Wang, Y., et al. (2015, June 15).  MIND diet slows cognitive decline with aging.  Alzheimer’s & Dementia. (15)00194, 6S1552-5260. doi: 10.1016/j.jalz.2015.04.011. [Epub ahead of print].  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26086182

Researchers tested the MIND diet, which emphasizes neuro-protective components, finding it helped 960 participants in the Memory and Aging Project lower their rate of cognitive decline over 4.7 years.

Mediterranean Diet—Topic overview.  (2015). Heart Disease Health Center.  WebMD.  Retrieved from http://www.webmd.com/heart-disease/tc/mediterranean-diet-topic-overview

A Mediterranean diet features fish, fruit, vegetables, beans, high fiber, whole grains, nuts, and olive oil while rationing meets, cheese and sweets.  Approximately 35 to 40 percent of all calories come from fish and olive oil and nuts (Mediterranean Diet, 2015, para. 1-3).

What are the benefits? Adhering faithfully to a Mediterranean diet might prevent heart disease, Type 2 diabetes, stroke, Alzheimer’s depression, Parkinson’s disease, and metabolic syndrome (Mediterranean Diet, 2015, para. 7).

How can you make the Mediterranean diet part of your eating plan?  Check out the foods that are part of a Mediterranean diet and incorporate them in a personal diet plan (Mediterranean Diet, 2015, para. 8).

• On the menu:  Choose daily from a variety of fresh fruits and vegetables, whole-grains, unsaturated fats for mostly vegetarian meals, including Omega-3 fatty acid fish in meals at least twice weekly, but limiting poultry and eggs to only a few times a week and beef to only a few times a month and restricting sweets to only a few times a week (Mediterranean Diet, 2015, para. 9).

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Scarmeas, Nikolaos, Stern, Yakov, Tang, Ming Xin, et al.  (2006, June). Mediterranean diet and risk for Alzheimer’s disease.  Annals of Neurology.  59 (6), 912-921. doi:  10.1002/ana.20854.  [Full text]. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3024594/

After evaluating the diet of 2,258 cognitively healthy, community-based New Yorkers and adjusting for cohort, age, gender, education, apolipoprotein E genotype, caloric intake, smoking medical comorbidity, and BMI, researchers concluded that strictly adhering to a Mediterranean diet lowered the risk for Alzheimer’s disease (2006, June, Abstract, p. 912).

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Curinga, Karen. (2015). Why is an Asian diet more healthy than an American diet?  Live Healthy.  Houston Chronicle.  Retrieved from http://livehealthy.chron.com/asian-diet-healthy-american-diet-6022.html

Adopting a traditional Asian diet is a healthier way to eat than the standard American diet (Curinga, 2015, para. 1):

• Higher Vegetable Consumption:  Only 20 percent of an Asian diet’s calories come from meat (Curinga, 2015, para. 2).

• Healthier Cooking Techniques: Asian cooking uses low-fat cooking methods like stir-frying and steaming, substituting ginger, garlic, fresh herbs and chilis for salt while cooking foods quickly with very little oil (Curinga, 2015, para. 3).

• Less Red Meat Consumption:  Asian cookery substitutes Omega-3 fatty fish, like tuna and salmon, for red meat—an option that reduces the risk for some cancers as well as heart disease.  Tofu, a soybean product, also reduces cholesterol levels (Curinga, 2015, para. 4).

McCarron, Joshua. (2015, January 28).  Asian diet to lose weight.  Livestrong.  Retrieved from http://www.livestrong.com/article/316334-asian-diet-to-lose-weight/

• Features:  Traditionally Asian diets avoid processed and refined foods, substitute green and black teas instead of sodas, and rely primarily on plant-based foods Consequently, Asian diets are higher in fiber than typical American diets but lower in calories (McCarron, 2015, January 28, para. 3).

• Typical Food:  Steamed rice, vegetables, tofu and miso, fresh fish, eggs, and chicken make up the Asian diet (McCarron, 2015, January 28, para. 4).

• Asian Pyramid:  Asians typically eat meat only about once a month while having a sweet, an egg, or some poultry only once a week.  Daily components of the Asian diet are fish, shellfish, dairy products, vegetable oils, fruits, nuts, seeds, vegetables, legumes, and rice, noodles, and other grains (McCarron, 2015, January 28, para. 5).

• Considerations: Walking, stretching, and performing tai chi and taking part in the martial arts go along with an Asian diet (McCarron, 2015, January 28, para. 6).

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Stay Active:  Get in at least two and a half hours of moderate aerobic exercise weekly.

Both aerobic exercise & strength training build strong minds.

Admittedly, this factor doesn’t appear on the list prepared by Xu, et al, but a lack of daily exercise does influence cardiovascular health, which, in turn, is a risk factor for Alzheimer’s.  It’s also the wise health choice that busy working adults in midlife are most likely to skip. Indeed, 80 percent of all American adults don’t get enough exercise, although not doing so leads to obesity and Type 2 diabetes, and exercise reduces the risk for cardiovascular disease (Ryan, 2013, May 3, para. 2 & 6).

Ryan, Jason. (2013, May 3).  CDC: 80 percent of American adults don’t get recommended exercise.  CBS News.  Retrieved from http://www.cbsnews.com/news/cdc-80-percent-of-american-adults-dont-get-recommended-exercise/

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Ahlskog, J. E., Geda, Y. E., and Graff-Radford, N. R., et al.  (2011, September). Physical exercise as a preventive or disease-modifying treatment of dementia and brain aging.  Mayo Clinic Proceedings, 86(9), 876-84. doi: 10.4065/mcp.2011.0252.  [Full text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21878600

Using PubMed keywords “exercise” and “cognition”, researchers looked for studies that associated a reduced risk of dementia with midlife exercise.  Meta-analysis confirmed that exercise in middle age “significantly” reduced the risk of Mild Cognitive Impairment and dementia. Moreover, in patients already diagnosed with dementia or MCI, randomized controlled trials documented better cognitive scores in those who participated in six to 12 months of aerobic exercise compared to their sedentary controls, and one year of aerobic exercise in a large randomized clinical trial of senior adults resulted in “significantly” larger hippocampal volumes and improved spatial memory.  Similarly, animal studies show that exercise improves learning outcomes.  Aside from protecting the neurons in the brain, physical exercise may also mitigate cerebrovascular risk.

Paillard, T. (2015). Preventive effects of regular physical exercise against cognitive decline and the risk of dementia with age advancement. Sports Medicine Open, 1(1):4. Epub 2015 April 17.  [Full text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26284161

Regular physical exercise increases the creation and synthesis of neurotransmitters in the parts of the brain involved in thinking and reasoning, and there is an inverse proportion between the amount of physical activity and the risk of cognitive decline or the development of neurodegenerative disease.  The synthesis of cerebral tissue under the influence of regular aerobic exercise possibly increases the gray and white matter in the prefrontal and temporal cortex areas as well as the volume of the hippocampus. Additionally, coordination exercise stimulates cognitive function. 

Petersen, Ronald. (2014, October 22).  Can exercise prevent memory loss and improve cognitive function?  Diseases and Conditions: Alzheimer’s Disease.  Mayo Clinic.  Retrieved from http://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/alzheimers-disease/faq-20057881

Possibly. Researchers know that regular aerobic exercise reduces the risk of comorbidities for Alzheimer’s like cardiovascular diseases and Type 2 diabetes while strengthening bones and muscles and reducing stress, but studies also verify that physically fit middle and older age adults are less likely to experience a decline in mental performance (Petersen, 2014, October 22, para. 1-2).

Accordingly, aerobic exercise several times a week for 30 to 60 minute intervals may help healthy older adults retain their thinking and reasoning skills; improve memory, reason, judgment and thinking skills for those individuals diagnosed with Mild Cognitive Impairment and in the beginning stages of Alzheimer’s; delay the onset of Alzheimer’s for individuals at risk for developing dementia (Petersen, 2014, October 22, para. 3).

Physical exercise keeps an adequate supply of blood flowing in the brain, but it also increases the chemicals that protect it, counteracting the natural brain shrinkage that occurs with aging.  More research is necessary to understand how much physical activity improves memory or slows gradual cognitive decline, but researchers do know that “regular exercise is important to stay  physically and mentally fit” (Petersen, 2014, October 22, para. 4-5).

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Think dark green--as in leafy vegetables!

Get enough folate and Vitamin C and E 
But put on hold on taking a Vitamin E supplement! By choosing a wise diet, most adults can receive their recommended daily allowance of folate, Vitamin C and E.

Folic acid in diet. (2015, August 3).  Medline Plus.  US National Library of Medicine.  Retrieved from https://www.nlm.nih.gov/medlineplus/ency/article/002408.htm

Folate is found naturally in dark green leafy vegetables, dried beans and peas, citrus fruits and juices, and enriched breads, and cereals (Folic acid, 2015, August 3, para. 9-10).

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Morris, Martha Savaria. (2012, November).  The role of B vitamins in preventing and treating cognitive impairment and decline.  Advances in Nutrition. 3(6), 801-812.  doi:  10.3945/an.112.002535.  [Full text]. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3648704/

Researchers extended the homocysteine theory of cardiovascular disease to Alzheimer’s when they discovered a link between vascular dementia and Alzheimer’s (Morris, 2012, November, Abstract, p. 801).

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Harrison, F. E. (2012).  A critical review of Vitamin C for the prevention of age-related cognitive decline and Alzheimer’s disease. Journal of Alzheimer’s Disease:  JAD.  29 (4), 711-26.  doi: 10.3233/JAD-2012-111853. [Full text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22366772

Maintaining a healthy Vitamin C level can protect against age-related cognitive decline; moreover; deriving an adequate supply of Vitamin C from  diet is more effective  than taking supplements to improve a diet low in Vitamin C (Harrison, 2012, Abstract, p. 711).

Zelman, Kathleen M. (2010, January 7).  The benefits of Vitamin C.  WebMD.  Retrieved from http://www.webmd.com/diet/the-benefits-of-vitamin-c

Experts recommend taking a 500 milligram supplement of Vitamin C daily to achieve health results on top of eating five serving of fruits and vegetables since only 10 to 20 percent of all adults consume the nine recommended servings of fruits and vegetables daily (Zelman, 2010, January 7, p. 1).

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Grimm, M. O., Stahlmann, C. P., and Mett, J., et al.  (2015, June).  Vitamin E: Curse or benefit in Alzheimer's Disease? A systematic investigation of the impact of α-, γ- and δ-Tocopherol on Aß generation and degeneration in neuroblastoma cells. The Journal of Nutrition, Health and Aging. 19(6), 646-56. doi: 10.1007/s12603-015-0506-z. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26054501

Although Vitamin E provides beneficial anti-oxidative effect, as a tocopherol, it also has the potency to increase amyloid-β levels, so researchers recommend that more studies are needed to find a form of Vitamin E that can act both as an antioxidant and not increase beta amyloid plaque.

Whitbread, Daisy.  (2015). Top 10 foods highest in Vitamin E you can’t miss. HealthAliciousNess.com.  Retrieved from http://www.healthaliciousness.com/articles/vitamin-E.php

• Tofu (Light, silken)

• Spinach (cooked)

• Nuts (almonds)

• Sunflower seeds (roasted)

• Avocados

• Shellfish (shrimp)

• Fish (Rainbow trout)

• Plant oil (Olive oil)

• Broccoli (cooked)

• Squash and pumpkins

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Lower high levels of homocysteine (which builds up when Vitamin B levels are low):

Fish, lean meat, poultry, egg, & dairy products all contain Vitamin B12.

Fish, lean meat, poultry, and dairy and egg products and fortified foods all are sources high in Vitamin B12 (Fear, 2015, January 18, para. 4-9).

Fear, Georgie. (2015, January 18).  List of foods high in Vitamin B12. Livestrong.  Retrieved from http://www.livestrong.com/article/25392-list-foods-high-vitamin-b12/

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Chen, H., Liu, S., and Ji, L., et al. (2015). Associations between Alzheimer's disease and blood homocysteine, vitamin B12, and folate: a case-control study. Current Alzheimer Research.  12(1):88-94.  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25523421

Evaluating the association between Alzheimer’s and levels of homocysteine (Hcy), Vitamin B12, and folate,  Chinese researchers conducted a case study that matched 115 patients with Alzheimer’s and 115 cognitively-health controls, measuring their serum folate and Vitamin B12 using an automated immunoassay analyzer, and measuring plasma Hcy with high-performance liquid chromatography.  They then analyzed the link between Alzheimer’s and homocysteine, Vitamin B12 and folate, using binary logistic regressions while adjusting for age and gender.  Researchers correlated low vitamin B12 in subjects with normal Hcy levels with Alzheimer's, high Hcy and low folate levels with normal Vitamin B12 with Alzheimer’s, and high hcy levels, low vitamin B12 levels, and any folate level with Alzheimer’s. They concluded that a combination of high Hcy, low Vitamin B12 and any folate level  signified the weakest association with Alzheimer’s.

Shen, L. and Ji, H. F. (2015, April 8).  Associations between homocysteine, folic acid, Vitamin B12 and Alzheimer's Disease: Insights from meta-analyses.  Journal of Alzheimer’s Disease: JAD. [Epub ahead of print].  [Abstact only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25854931

Performing a search using Medline and Scopus databases, using Stata 12.0 statistical software, a search identified 68 studies linking homocysteine (Hcy), folic acid, and Vitamin B12 levels and Alzheimer’s.  This meta-analysis associates Alzheimer’s with higher levels of hcy and lower levels of folate acid and Vitamin B12 in plasma than occurs in cognitively-healthy controls. Age-subgroup evaluation also shows no age effect for hcy levels in plasma between Alzheimer’s patients and controls, but it reveals that  their differences in folate and Vitamin B12 levels increase with age.  Data additionally suggests that high hcy levels and low folate levels correlate with an increased risk of Alzheimer’s.

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Daily drink three cups of coffee:

Enjoy coffee and tea without regret.

Numerous studies suggest that caffeine may postpone the onset of Alzheimer’s.

Mann, Denise. (2012, June 7).  Drinking coffee may delay Alzheimer’s disease.  Alzheimer’s Disease Health Center.  WebMD. Retrieved from http://www.webmd.com/alzheimers/news/20120607/coffee-may-help-turn-tide-on-alzheimers-disease

Drinking three cups of coffee daily may slow the progression of Alzheimer’s in older adults already starting to show signs of memory loss.  Starting at age 30, adults should average drinking three eight-ounce cups of coffee daily (Mann, 2012, June 7, p. 1).

Panza, P., Selfrizzi, V, and Barulli, M. R., et al. (2015, March).  Coffee, tea and caffeine consumption and prevention of late-life cognitive decline and dementia:  A systematic review. The Journal of Nutrition, Health, & Aging. 19(3), 313-28. doi: 10.1007/s12603-014-0563-8. [Abstact only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25732217

Some case-controlled and cross-sectional and longitudinal population-based studies provide evidence that coffee, tea, and caffeine consumption may protect against late life cognitive decline.  However longer, follow up studies are necessary to establish a distinct dose response.  Additionally, findings on whether caffeine keeps Mild Cognitive Impairment from progressing to Alzheimer’s are too limited to draw conclusions.

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Eat broiled, baked, or grilled [Omega 3, oily] fish a minimum of at least once a week*: 

Substitute fish for beef as a diet's major protein source.

*The  Mayo Clinic and the American Heart Association, however, call for eating fish twice a week (Mediterranean diet, 2015, p. 2; Omega 3 fatty acid, 2015, para. 21):

Mediterranean diet:  A heart-healthy lifestyle:  Nutrition and Healthy Eating.  Mayo Clinic.  Retrieved from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801

Fish and Omega-3 fatty acid. (2015, June 15). American Heart Association http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jsp

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Addendum

August 31, 2015

However, please note that eating too much Omega-3 fish or overdoing fish or krill oil supplements might have a disastrous effect:

Fish and Omega-3 fatty acid. (2015, June 15). American Heart Association.  Retrieved from http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Fish-and-Omega-3-Fatty-Acids_UCM_303248_Article.jsp
 
Omega 3 fatty acids. (2015).  University of Maryland Medical Center.  Retrieved from http://umm.edu/health/medical/altmed/supplement/omega3-fatty-acids

The American Heart Association recommends that healthy adults eat two servings of Omega-3 fatty fish weekly, although the University of Maryland Medical Center cautions that eating three servings of Omega-3 fish per week may raise the rise of hemorrhagic stroke.  The Website also warns that it’s important to consult a physician before taking more than three grams of Omega-3 fatty fish or krill oil capsules daily (Omega 3 fatty acid, 2015, para. 8 & 21). 

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Cole, G. M. and Frautschy, S. A. (2010, April). DHA may prevent age-related dementia.  The Journal of Nutrition. 140 (4), 869-74.  doi: 10.3945/jn.109.113910. Epub 2010 Feb 24.  [Full Text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20181786

The risk of developing Alzheimer’s doubles every five years after age 65—a statistic that necessitates a need for a “safe, effective and affordable preventive” approach.  Here the (n-3 fatty acid docosahexaenoic acid (DHA) comes to the rescue since it “appears to slow the onset of Alzheimer’s and possibly vascular dementia”: Clinical trials hint that DHA or fish oil on its own can delay the early stages of dementia, but larger trials are necessary to prove its effectiveness.  DHA moderates some of the enzymes that slow the division of tau-protein, increases brain levels of neuroprotective brain-derived neurotrophic factor and reduces the (n-6) fatty acid arachidonate as well as possibly helping suppress insulin/neurotrophic factor signaling deficits, neuroinflammation, and oxidative damage that contribute to synaptic loss and neuronal dysfunction in dementia (Cole, 2010, April, Abstract, p. 140).

Morris, Martha Clare, Evans, Dennis A., Bienias, Julia L. (2003, July).  Consumption of fish and n-3 fatty acids and risk of incidence of Alzheimer’s Disease. JAMA Neurology. 60 (7), 940-46. doi:10.1001/archneur.60.7.940.http://archneur.jamanetwork.com/article.aspx?articleid=784412.  [Full text].  Retrieved from http://archneur.jamanetwork.com/article.aspx?articleid=7844124

In a longitudinal study of Chicago-area older adults, aged 65 to 94, from 1993 to 2000, researchers found that those who ate fish once a week were 60 percent less likely to show signs of Alzheimer’s than those who never or rarely ate fish (Morris, 2003, July, Abstract, p. 940).

Thomas, J., Thomas, C. J., and Radcliffe, J., et al. (2015).  Biomed Research International. 172801. doi: 10.1155/2015/172801.  Epub 2015 Aug 2. Omega-3 fatty acids in early prevention of inflammatory neurodegenerative disease: A focus on Alzheimer's Disease. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26301243

Normal physiological changes of the brain caused by aging include the depletion of long chain omega-3 fatty acids; moreover, the brains of Alzheimer’s patients have lower docosahexaenoic acid (DHA) levels. Accordingly, this study supports the role that long chain, Omega-3 fatty acids play in the prevention or delay of cognitive decline in its earlier stages, although it also calls for longer trials.

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Drink a glass of red wine daily:

Drinking a glass of red wine protects against cardiovascular disease.

Ma, T., Tan, M.S., and Yu, J. T., et al.  (2014).  Resveratol as a therapeutic agent for Alzheimer’s disease.  BioMed Research International.  doi: 10.1155/2014/350516. Epub 2014 Nov 26. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25525597

Resveratol, a polyphenol found in red wine and many plants, displays neuro-protective properties, although its low bioavailability limits its effects.

Pasinetti, G. M. (2012, October).  Novel role of red wine-derived polyphenols in the prevention of Alzheimer's disease dementia and brain pathology: experimental approaches and clinical implications. Planta Medica, 78(15): 1614-9.  doi: 10.1055/s-0032-1315377. Epub 2012 Sep 21. [Full text]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23023952

Recent epidemiological and experimental evidence supports the hypothesis that grape-derived polyphenols interfere with the generation and assembly of β-amyloid peptides into neurotoxins, reducing tau accumulation (Pasinetti, 2012, October, Abstract, p. 1614).

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Stay cognitively active:

Continually challenging the mind keeps it sharp.  Hence, storing up a cognitive reserve delays some of the effects of Alzheimer’s while also lessening the impact of beta amyloid plaque.

Older adults can stay cognitively active all their lives.

Boots, E. A., Schultz, S. A., and Almedia, R. P., et al. (2015, July 8). Occupational complexity and cognitive reserve in a middle-aged cohort at risk for Alzheimer's Disease. Archives of Clinical Neuropsychology. pii: acv041. [Epub ahead of print].  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26156334

For individuals at risk for Alzheimer’s Occupational Complexity (OCC) may confer resilience to the adverse effects of neuropathology on cognition.  326 Middle-aged study participants underwent a structural MRI, cognitive  evaluation, and a work history assessment. 

Sobral,  M., Pestana, M. H., and Paúl C.  (2015, June).  Cognitive reserve and the severity of Alzheimer's disease.  Arquivos de Neuropsiquiatria. 73(6):480-6. doi: 10.1590/0004-282X20150044. [Full text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26083882

Alzheimer’s patients with higher levels of Cognitive Reserve, or the ability to cope with the effects of the neurodegenerative process, are more likely to have a slower rate of cognitive decline, or so researchers determined after examining two questionnaires, one of which detailed their participation in leisure activities throughout life, filled out by 75 outpatients diagnosed with probable Alzheimer’s (Sobral, 2015, June, Abstract, p. 480).

Yang, Sarah. (2012, January 23). Lifelong brain-stimulating habits linked to lower Alzheimer’s protein levels.  Mind and Body.  Berkeley News.  Retrieved from http://news.berkeley.edu/2012/01/23/engaged-brain-amyloid-alzheimers/

Yang and her fellow University of California, Berkeley researchers have discovered that older adults who have taken part in cognitively stimulating activities throughout their lives had fewer deposits of beta-amyloid plaque than those who didn’t challenge themselves (Yang, 2012, January 23, para. 1-2).  Yang, et al asked 65 cognitively normal adults age 60 and old how often they took part in “mentally engaging” activities from age six to their present age. Researchers then gave the participants neuro-psychological tests as well as PET scans, finding a “significant association” between high levels of cognitive activity throughout a lifetime and low levels of beta amyloid plaque (Yang, 2012, January 23, para. 10-11).

Yeung, S. T., Martinez-Coria, H., and Ager, R. R., et al.  (2015, July 7). Repeated cognitive stimulation alleviates memory impairments in an Alzheimer’s disease mouse model. Brain Research Bulletin, 117, 10-15. doi: 10.1016/j.brainresbull.2015.07.001. [Epub ahead of print].  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26162480

Researchers subjected 3xTg-AD mice to a “rigorous” training routine starting at three months of age, consisting of training in a new spatial recognition task in a Morris water maze every three months, ending at 18 months of age.  At this time, the mice underwent testing in another hippocampus-dependent spatial task, using a Barnes maze and in a cortical dependent novel object recognition memory task. Data showed that periodic enrichment throughout the mice’s lives improved the memory performance in aged 3xTg-AD mice when compared to “naïve aged matched 3xTg-AD mice”. Researchers noticed the effects of this “cognitive enrichment” as early as six months of age.  Thus, they have hypothesized that “repeated cognitive enrichment can mitigate the diverse cognitive deficits observed in Alzheimer's disease”.

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Take estrogen, cholesterol-level drugs (statins), blood pressure medications, and anti-inflammatory drugs (NSAIDs), or include natural sources of estrogen in your diet:

DeMarco, Bob (2010, July 24).  The estrogen dilemma and Alzheimer’s disease revisited.  Alzheimer’s Reading Room. Retrieved from http://www.alzheimersreadingroom.com/2010/07/estrogen-dilemma-and-alzheimers-disease.html

Taking estrogen supplements might possibly guard against Alzheimer’s since researchers theorize that before menopause women are naturally protected against cognitive decline, but after menopause, they are at risk (DeMarco, 2010, para. 4).  Indeed, 68 percent of all Alzheimer’s cases are women (DeMarco, 2010, para. 1).

14 foods that fight inflammation. (2015).  Health Media Ventures.  Retrieved from http://www.health.com/health/gallery/0,,20705881,00.html

Additionally,  while foods high and sugar and saturated fats “spur” inflammation, some foods and herbs are naturally anti-inflammatory: fish, whole grains, dark leafy greens, nuts, soy, low fat dairy, peppers, tomatoes, beets, ginger and turmeric (or curcumin), garlic and onions, olive oil, beans, and tart cherries (14 foods, 2015), 

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Aim for a happy medium when improving blood pressure levels: 

Blood pressure chart: What your reading means. (2015, February 21).  High Blood Pressure (hypertension).  Mayo Clinic.  Retrieved from  http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/blood-pressure/ART-20050982

Blood pressure that is too high or too low puts adults at risk for brain damage:

High Blood Pressure & Low Blood Pressure

Normal Blood Pressure:

Normal systolic blood pressure:  Below 120

Normal diastolic blood pressure:  Below 80

Prehypertension:

Systolic blood pressure:  Between 120 and 139

Diastolic blood pressure:  Between 80-89

High Blood pressure:

Systolic high blood pressure: 160 or higher

Diastolic high blood pressure: 100 or higher 

The DASH diet lowers blood pressure.

 ________

Kruyer,  A., Soplop, N., and Strickland S., et al.  (2015, July).  Chronic hypertension leads to neurodegeneration in the TgSwDI mouse model of Alzheimer's Disease. Hypertension. 66(10, 175-82. doi: 10.1161/HYPERTENSIONAHA.115.05524. Epub 2015 May 4. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25941345

“Hypertension, specifically, is an important modifiable risk factor for late-onset Alzheimer’s” that researchers examined by chemically inducing chronic hypertension in the TgSwDI mouse model of Alzheimer’s in early adulthood, whereupon hypertension accelerated cognitive deficits in the Barnes maze test a well as causing the deposits of microvascular deposits of β-amyloid plaque and vascular inflammation. Moreover, hypertension causes hippocampal neurodegeneration at an earlier age than normal in mice.

Meng, X. F., Yu, J. T., and Wang, H. F., et al. (2014). Midlife vascular risk factors and the risk of Alzheimer's disease: A systematic review and meta-analysis. Journal of Alzheimer’s Disease. 42(4), 1295-310. doi: 10.3233/JAD-140954. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25024338

In a systematic review and meta-analysis of published cohort studies, researchers found “positive and significant” associations between vascular risk factors, such as high blood pressure, hypercholesterolemia, obesity, and diabetes mellitus in midlife and the eventual risk of developing Alzheimer’s.

Norton, S., Matthews, F. E., and Barnes, D. E., et al. (2014, August; Erratum 2014, November).  Potential for primary prevention of Alzheimer's disease: an analysis of population-based data. The Lancet: Neurology, 13 (8), 788-94; Erratum (11), 1070. doi: 10.1016/S1474-4422(14)70136-X. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25030513

Researchers estimated the population-attributable risk of seven potentially modifiable risk factors for Alzheimer’s worldwide as well as in the United States, the United Kingdom, and Europe: Diabetes, midlife hypertension, midlife obesity, physical inactivity, depression, smoking, and low educational attainment. The highest estimated PAR was for physical inactivity in the US while all the risk factor PAR estimates were about 30 percent for the US, the UK, and Europe.  Assuming a causal relation and intervention at the appropriate age, these seven risk factors could be reduced by 8.3 percent worldwide by 2050 by improved access to education and targeting vascular risk factors for improvement like physical activity, smoking, midlife hypertension and obesity, diabetes, and depression.

10 ways to control high blood pressure without medication.  (2015, May 30). Diseases and Conditions:  High Blood Pressure (Hypertension).  Mayo Clinic. Retrieved from http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/high-blood-pressure/art-20046974

• Loose extra pounds and watch your waistline:  Loosing just ten pounds or 4.5 kilograms can reduce blood pressure.  Generally, a man is at risk if his waist measures more than 40 inches, or 102 centimeters, while a woman is at risk if her waist measure more than 45 inches, or 89 centimeters (10 ways, 2015, May 30, para. 4-9).

• Exercise regularly: Exercising 30 minutes daily can lower blood pressure by 40 to 9 millimeters, but once someone stops exercising, his or her blood pressure goes up again.  The Mayo Clinic suggests walking, jogging, cycling, swimming, and dances as the best ways to bring down blood pressure, although strength training can also reduce it (10 ways, 2015, May 30, para. 10-12).

• Eat a [heart-] healthy diet can lower blood pressure by 14 mm. Hg.  The Mayo Clinic suggests keeping a food diary, boosting consumption of potassium, and shopping smart (10 ways, 2014, May 30, para. 12-17).

• Reduce sodium to bring down blood pressure by 2 to 8 mm. Hg., a task perhaps made more necessary for African Americans, adults over age 51, anyone already identified with high blood pressures, diabetes, or chronic kidney disease.  This can be accomplished by reading food labels, eating less processed foods, not adding salt to dishes, and gradually reducing sodium intake (10 ways, 2014, May 30, para. 18-24).

• Limit alcohol intake:  More than one drink daily in women and two drinks daily in men can raise blood pressure as well as reducing the effectiveness of blood pressure medication (10 ways, 2014, May 30, para. 25-27).

• Quit smoking:  Stopping smoking helps blood pressure return to normal (10 ways, 2014, May 30, para. 28).

• Cut back on caffeine:  To see if caffeine is raising one’s blood pressure, check it within 30 minutes of drinking a caffeinated beverage.  Regularly drinking coffee only slightly raises blood pressure, however (10 ways, 2014, May 30, para. 29-31).

• Reduce stress: Chronic stress raised blood pressure, so the stressed out need to change their expectations, making plans to solve their problems that they can solve themselves, avoiding stress triggers, taking time out to relax, and being grateful for their blessings (10 ways, 2014, May 30, para. 32-39).

• Monitor blood pressure and regularly visiting a physician (10 ways, 2014, May 30, para. 40-41).

• Get support:  Asking for and receiving support from family and friends as well as joining a support group can help bring down high blood pressure (10 ways, 2014,, May 30, para. 42-43).

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Steer Clear of Obesity:  Exercise & diet away a high Body Mass Index

You are what you eat!

Obesity in midlife increases the risk of Alzheimer’s in late life, but a higher BMI in the elderly doesn’t necessarily increase the risk for the older adults.

Anstey, K. J., Cherbuin, N., and Budge, M., et al. (2011, May).  Body mass index in midlife and late-life as a risk factor for dementia: A meta-analysis of prospective studies.  Obesity Reviews, 12(5), e426-37. doi: 10.1111/j.1467-789X.2010.00825.x. Epub 2011 Feb 23. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21348917

A meta-analysis of 16 articles detailing the relationship between Body Mass Index in mid and late life and dementia, evaluating 25,624 participants of Alzheimer’s, 15, 435 participants for vascular dementia, and 30,470  participants for other types of dementia, suggests either being underweight in midlife or overweight and obese increases the risk of dementia.

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Defining adult overweight and obesity. (n. d.).  Division of Nutrition, Physical Activity, and Obesity.  Centers for Disease Control and Prevention.  Retrieved from http://www.cdc.gov/obesity/adult/defining.html

If BMI is 25.0 to 29.9, an individual is overweight; if it is 30.0 or higher, he or she is obese (CDC, n. d., para. 3).

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Christensen, A. and Pike, C. J. (2015, July 7). Menopause, obesity and inflammation: interactive risk factors for Alzheimer's disease. Frontiers in  Aging Neuroscience. 7, 130. doi: 10.3389/fnagi.2015.00130. eCollection 2015. [Full-text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26217222

The onset of menopause in women elevates their vulnerability of Alzheimer’s disease, a risk associated with the depletion of estrogen, increased central adiposity, and inflammation.

Naderali, Ebrahim, Ratcliffe, Stuart H., and Dale, Mark C.  (2009, October 2).  Review:  Obesity and Alzheimer’s Disease: A link between body weight and cognitive function in old age.  American Journal of Alzheimer’s Disease and Other Dementias. 24 (6), 445-449.  doi:  10.1177/1533317509348208.  [Full text]. Retrieved from http://www.researchgate.net/profile/Ebrahim_Naderali/publication/26867791_Obesity_and_Alzheimer’s_disease_a_link_between_body_weight_and_cognitive_function_in_old_age/links/5411a7fb0cf264cee28b4bf4.pdf

Obesity’s role in cardiovascular disease and diabetes may also contribute to the development of Alzheimer’s while obesity might also impair glucose transport to the brain (Naderali, 2009, October 2, Abstract, p. 445).

Whitmer, R. A., Gustafson, D. R., and Barrett-Connor, E. (2008, September).  Central obesity and increased risk of dementia more than three decades later. 30; 71(14): 1057-64.  doi: 10.1212/01.wnl.0000306313.89165.ef. Epub 2008 Mar 26.  [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18367704

A longitudinal analysis conducted on 6,583 Northern Californians enrolled in Kaiser Permanente’s health plan had their sagittal abdominal diameter measured from 1964 to 1973, and diagnoses of dementia in 15 percent of the patients occurred on average 36 years later from 1994 to 2006.  After adjusting for age, gender, race, education, marital status, diabetes, hypertension, hyperlipidemia, stroke, heart disease, and medical utilization, compared with those patients with the lowest quintile of SAD, those with the highest Body Mass Index were the most likely to be diagnosed with dementia: 50 percent of those individuals diagnosed with dementia in old age also were obese in the middle in midlife.

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Treat and prevent depression:

It's important not to fight depression alone.

Family members and friends should watch for signs of depression in older adults particularly when they withdraw from others:

Baquero, M. and Martín, N. (2015, August). Depressive symptoms in neurodegenerative diseases. World Journal of Clinical Cases. 16; 3(8): 682-93. doi: 10.12998/wjcc.v3.i8.682.  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26301229

Patients diagnosed with cognitive decline, whether they suffer from Alzheimer’s, Parkinson’s, Lewy body dementia, vascular dementia, or frontal temporal degeneration, exhibit the symptoms of depression at some point during their presence.  A large number of patients are depressed during the early stages of neurologic disease without clear evidence of neurological decline, although depressive symptoms can occur later in neurodegenerative disease. In turn, depression further decreases cognitive abilities and everyday functioning. Since depression is treatable, their early detection is important in those individuals at risk for developing dementia.

Qiu, W. Q., Zhu, H., and Dean, M., et al. (2015, August 6). Amyloid-associated depression and ApoE4 allele: longitudinal follow-up for the development of Alzheimer's disease. International Journal of Geriatric Psychiatry. doi: 10.1002/gps.4339.  [Epub ahead of print].  [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26250797

Qiu, et al followed 223 cognitively-healthy older adults at baseline, giving them repeated cognitive evaluations for the incident AD. Fifteen individuals, or seven percent of the sampling, developed Alzheimer’s after an average follow-up time of 6.2 years. While no one with non-amyloid depression developed Alzheimer’s, nine percent of the individuals diagnosed with amyloid-associated depression developed Alzheimer’s.  Additionally, ApoE4 carriers tended to have a much higher risk of developing Alzheimer’s than ApoE4 non-carriers (40% vs. 4%, p = 0.06).  By way of contrast, eight percent of those who did not have depression at baseline developed Alzheimer’s, but ApoE4 carriers and non-carriers did not show a difference in Alzheimer’s risk.

 ___________

Ease carotid artery narrowing:

Are you at risk for cardiovascular disease?

An inadequate blood supply to the brain causes cognitive decline.

Claassen, J. A. (2015, May 15).  New cardiovascular targets to prevent late onset Alzheimer disease. European Journal of Pharmacology. (15)00455-0, pii: S0014-2999doi: 10.1016/j.ejphar.2015.05.022. [Epub ahead of print].  [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25987416

Therapeutic strategies for reducing cardiovascular disease may also reduce the incidence of dementia caused by Alzheimer’s Disease. Longitudinal studies show a correlation between high blood pressure, vascular stiffness, and the accumulation of beta amyloid plaque.

Hohman, T. J., Samuels, L. R., Liu D., et al. (2015, September). Stroke risk interacts with Alzheimer's disease biomarkers on brain aging outcomes. Neurobiology of Aging. 36(9), 2501-8. doi: 10.1016/j.neurobiolaging.2015.05.021. Epub 2015 Jun 6. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26119224

Although medical science has long known that Alzheimer’s disease biomarkers and stroke risk factors have predicted cognitive impairment independently, no researchers had evaluated the interaction between stroke risk and AD markers on hippocampal volume and cognitive performance.  Consequently, researchers analyzed data from the Alzheimer’s Disease Neuroimagining Initiative, autopsy data from the National Alzheimer Coordinating Center, and stroke risk from the Framingham Stroke Risk Profile.  In the first two studies, stroke risk interacted with tau and amyloid levels to influence cognitive performance. However, stroke risk factors were greatest in the absence of AD biomarkers or neuropathology, thus providing evidence that Alzheimer’s Disease and stroke risk factors influence the ability to think and reason independently.

Saito, S., Yamamoto, Y., and Ihara, M. (2015). Mild Cognitive Impairment: At the crossroad of neurodegeneration and vascular dysfunction.  Current Alzheimer Research. 12(6):507-12.  [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26027811

Not only do most individuals diagnosed with Mild Cognitive Impairment possess amyloid plaques and neurofibrillary tau tangles, but at the same time, their cerebral vascular pathology shows signs of arteriosclerosis and cerebral amyloid angiopathy (CAA). Because severe CAA is an independent risk factor for dementia, clearing the brain of Aβ is a potential treatment for both Alzheimer’s Disease and MCI.  Moreover, controlling the risk factors for both cardiovascular disease and dementia reduce the risk of MCI developing  into Alzheimer’s.

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 Upgrade the effects of low education: 

It's never too late to learn new skills!

Not only do years of schooling influence an older adult’s risk for Alzheimer’s, but the quality of that schooling also influences whether individuals experience cognitive decline.  Please note, however, that it’s never too late to learn new, challenging skills, such as learning a foreign language or taking up Web design.

Chin, A. L., Negash, S., and Xie, S. (2012, March).  Quality, and not just quantity, of education accounts for differences in psychometric performance between African Americans and white non-Hispanics with Alzheimer’s disease. Journal of the International Neuropsychological Society: JINS, 18(2):277-85. Doi: 10.1017/S1355617711001688. Epub 2012 Feb 3. [Full text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22300593

Chin, et al examined the extent to which quality of education after controlling for years of formal education accounted for the differences in cognitive performance in African Americans and non-Hispanic, white Americans in 244 Alzheimer’s patients who self-identified as either African American or white by using the Wechsler Test of Adult Reading to estimate their quality of education.  After controlling for age, gender, and years of formal education, African Americans scored “significantly lower” than whites on the Mini-Mental State Examination and on neuropsychological tests assessing memory, attention, and language.  However, after adjusting for the patients’ reading levels, all differences “significantly” diminished.  Researchers thus inferred that that quality, and not just quantity, of education” needs to be considered when assessing cognitive performance in African Americans with Alzheimer’s. 

Mehta, K. M., Stewart, A. L., and Langa, K. M., et al. (2009, September). “Below average” self-assessed school performance and Alzheimer’s disease in the Aging, Demographics, and Memory Study.  Alzheimer's and Dementia, 5(5): 380-7. Doi: 10.1016/j.jalz.2009.07.039. [Full text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19751917

Researchers examined whether a self-assessed low-academic performance correlates with Alzheimer’s beyond the effects of the Alzheimer’s patient’s education level when they asked 725 Aging, Demographics, and Memory Study participants whether their academic performance was above average, average, or below average:  11 percent of those with “above-average performance had Alzheimer’s, 12 percent of the formerly average students had Alzheimer’s, and 26 percent of the below average students had Alzheimer’s.  After controlling for years in school, a literacy test score, age, gender, race/ethnicity, apolipoprotein E-epsilon 4 status, socioeconomic status, and self-reported co-morbidity, those who regarded themselves as “below average” academically were four times more likely to have Alzheimer’s compared with those who were average.  Accordingly, improving school performance in addition to increasing the years of formal school may reduce the risk of Alzheimer’s later in life. 



P. S. -- As a semi-retired, former college English professor, I'd like to add that non-traditional older students from all ethnic and economic backgrounds were almost always my best--and most dedicated--students simply because they were more focused on their studies than the average 18 to 21-year-old even while working, keeping up their family responsibilities, and going to school.  So don't be afraid to go back to school at any age.  You may be pleasantly surprised!

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Prevent frailty’s effect upon cognitive ability:

Old age doesn't necessary correlate with frailty.

Addendum

August 28, 2015

Morley, John E., Morris, John C. Berg-Weger, Marla, et al. (2015, September 1).  Brain Health: The Importance of Recognizing Cognitive Impairment: An IAGG Consensus Conference. Journal of Post-Acute and Long-term Care Medicine. 16(9), 731-739. doi: http://dx.doi.org/10.1016/j.jamda.2015.06.017 [Abstract only].  Retrieved from http://www.jamda.com/article/S1525-8610%2815%2900438-7/abstract
Early diagnosis of cognitive decline is a right owed every mentally-impaired older adult.  Moreover, recognizing early symptoms of Mild Cognitive Impairment allows for appropriate diagnosis and treatment that also allows for individual to participate in the decision-making process about his or her future:  Additionally, 1) screening tests take only three to seven minutes to administer;  2)  consultation with both individual and family member or friends who suspect that his or her cognitive powers are declining is an appropriate approach to take; 3) MCI may have treatable aspects, and 4) a combination of medical and lifestyle interventions may delay or prevent cognitive decline.

Bottom Line:  At the first sign of mental impairment, schedule an appointment for your loved one with a neurologist.  Preventive actions taken when older adults are first diagnosed with Mild Cognitive Impairment may prevent or delay Alzheimer's.  Also, during this stage of cognitive decline, the MCI patient and his or her family can make financial planning decisions and living arrangements together should he or she eventually be diagnosed with Alzheimer's.  Remember, Mom, Dad, or Aunt Susie is still an adult and deserves to be treated like one!

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Buchman, A. S., Boyle, Patricia, A., Wilson, Robert S.  (2007, June).  Frailty is associated with incident Alzheimer’s disease and cognitive decline in the elderly.  Psychosomatic Medicine. 69, 483-489.  doi: 10.1097/psy.0b013e318068de1d.  [Full Text].  Retrieved from http://www.researchgate.net/profile/Patricia_Boyle3/publication/6279551_Frailty_is_associated_with_incident_Alzheimer's_disease_and_cognitive_decline_in_the_elderly/links/0c96052853de735245000000.pdf

In a longitudinal study of 823 elderly conducted by the Rush Memory and Aging Project analyzing possible links between frailty, cognition, and Alzheimer’s, both at baseline and annually, frailty correlated with an increased risk of incident Alzheimer’s (Buchman, 2007, June, Abstract, 483).

Canevelli, M., Cesari, M., and Van Kan, G. A. (2014, January).  Frailty and cognitive decline: how do they relate?  Current Opinion in Clinical Nutrition and Metabolic Care. 18(1), 43-50. doi: 10.1097/MCO.0000000000000133. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25405314

Physical frailty predicts the incidence of cognitive impairment and dementia in longitudinal studies while cross-sectional studies indicate that the frail elderly have a lower cognitive performance than their non-frail peers.  Even so, randomized, controlled trials are necessary for treatment to improve the cognitive abilities of older patients in poor health.

__________

The next two factors supposedly apply only to Asians, although the Centers for Disease Control notes that smoking contributes to cardiovascular disease (CDC, 2014, para. 3), which, in turn, contributes to the risk for developing Alzheimer’s, and  Swedish researchers have determined that prediabetes increases one’s risk of Alzheimer’s by 70 percent (Mann, 2006, para. 7).

Mann, Denise. (2006, July 17).  Diabetes: New links to Alzheimer’s.  Diabetes Health Center.  WebMD.  Retrieved from http://www.webmd.com/diabetes/news/20060717/diabetes-link-alzheimers

Smoking & tobacco use.  (2014, February 6).  CDCL  Centers for Disease Control and Prevention.  Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/index.htm

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Stop [or never taking up] smoking (among Asians):

Why the researchers listed smoking as a poor lifestyle choice specifically for Asians* rather than for everyone on Earth must have gotten lost in translation since smoking is linked to chronic heart and cardiovascular disease (Smoking, 2013, para. 5).

List of smoking-related diseases expanded. (2013).  NBC News.  Associated Press.  Retrieved from http://www.nbcnews.com/id/5077308/ns/health-addictions/t/list-smoking-related-diseases-expanded/

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Cho,  H., Kim, C., Kim, H. J. (2015, August 11). Impact of smoking on neuro-degeneration and cerebrovascular disease markers in cognitively normal men.  European Journal of Neurology.  doi: 10.1111/ene.12816. [Epub ahead of print]. [Abstract only].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26264353

Korean researchers surveyed the results after 977 cognitively normal men received medical check-ups, including a 3.0T magnetic resonance imaging at a health promotion center, and the results placed them in the following categories: Never smoked, smoked in the past, and current smokers.  Current smokers exhibited a cortical thinning in their frontal and temporo-parietal lobes when compared with those men who had never smoked. However, no links existed between smoking and the severity of white matter hyper-intensity or in the number of lacunes.  Researchers therefore concluded that smoke might influence neuro-degeneration in cognitively health man rather than worsening their cerebrovascular health. They then inferred that the impact of smoking on Alzheimer’s might be modifiable.

Durazzo, T. C., Meyerhoff, D. J., and Mon, A. et al.  (2015, April 9). Chronic cigarette smoking in healthy middle-aged individuals is associated with decreased regional brain n-acetylaspartate and glutamate levels. Biological Psychiatry. (15), 00283-8. pii: S0006-3223.  doi: 10.1016/j.biopsych.2015.03.029. [Epub ahead of print].  [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25979621

Chronic smoking in young and middle-aged individuals correlates with “significant age-related neurobiological abnormalities” in the brain’s anterior frontal regions linked to the development and maintenance of addictive disorders.  After comparing N-acetylaspartate (NAA), choline-containing compounds, creatine-containing compounds (Cr), myo-inositol (mI), and glutamate (Glu) levels in the anterior cingulate cortex and the right dorsolateral prefrontal cortex of young and middle-aged smokers and nonsmokers using 4-tesla proton single volume magnetic resonance spectroscopy, researchers examined their decision-making, risk taking, and self-reported impulsivity.  The smokers exhibited lower DLPFC, NAA, Cr, mI and Glu concentrations than their non-smoking peers.  They also showed poor decision-making skills and greater impulsivity.

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Prevent  Type 2 diabetes (among Asians):

Again, it’s a mystery why researchers singled out Asians* as being particularly at risk if they have diabetes.  After all, anyone with Type 2 diabetes is at greater risk for heart attack and stroke (Complications, 2015, January, para. 2).

What complications (problems) care caused by diabetes.  Department of Health.  New York State.  Retrieved from http://www.health.ny.gov/diseases/conditions/diabetes/problems_caused_by_diabetes.htm

___________

Sridhar, G. R., Lakshmi, G., and Nagamani, G. (2015, June 10). Emerging links between type 2 diabetes and Alzheimer's disease.  World Journal of Diabetes. 6(5), 744-51. doi: 10.4239/wjd.v6.i5.744.  [Full-text].  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/26069723

Indian researchers emphasize that epidemiological, clinical, biochemical, and imaging studies link Type 2 diabetes mellitus and Alzheimer's disease with increasing age and note that being diagnosed with either disease increases the risk of developing the other.  While cross sectional studies undoubtedly confirm this association, cross sectional studies, however, reveal the many complex ways diabetes and Alzheimer’s interact with each other.  Additionally, Sridhar, et al recognize that they share certain life style risk factors, such as obesity, dyslipidemia, insulin resistance and sedentary habits, as well as certain pathogenic factors, so lifestyle changes and pharmacological agents should be able to prevent  or delay their develpment.  Paradoxically, not only do life style choices protect against Alzheimer’s disease, but the drugs used in the treatment of diabetes, such as intranasally-delivered insulin, also guard against dementia.  Furthermore, since a Type 2 diabetes is a recognized risk factor for Alzheimer’s, clinicians must take the responsibility for preventing or postponing Alzheimer’s after a  Type 2 diabetes diagnosis.

Zhang, Z., Fang, P., and Shi, M., et al. (2015, August 4). Elevated galanin may predict the risk of type 2 diabetes mellitus for development of Alzheimer's disease.  Mechanisms of Ageing and Development. 150, 20-26. doi: 10.1016/j.mad.2015.08.001. [Epub ahead of print]. [Abstract only].

Developing evidence indicates that galanin defects perform a central role in type 2 diabetes mellitus, a risk factor for Alzheimer’s. Current data also supports the hypothesis that activating central GalR2 weakens insulin resistance in animal models.

The study finds a correlation between these factors and Alzheimer’s; however, it doesn’t prove that any one of them directly causes Alzheimer’s (Walton, 2015, August 22, para. 3-4). 

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The links furnished on this Web page represent the opinions of their authors, so they complement—not substitute—for a physician’s advice. 

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Mayo Clinic Publicizes Tests for Alzheimer's

Petersen, Ronald. (2015). Alzheimer's test: Detection at the earliest stages. Mayo Clinic. Retrieved from https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/alzheimers-test/faq-20057850

New Alzheimer's tests, not yet widely available, detect the pathological components of Alzheimer's:

• Biomarker Test: Assessment examines the spread of beta-amyloid patterns within the brain;

• Brain Imaging (neuroimaging): Procedure records changes within the brain;

• Cognitive Assessment: Computer-based assessment may detect early cognitive changes.

Early detection allow for intervention with medication that slows the advance of Alzheimer's.