Keeping Alzheimer’s at bay through diet, exercise and brain stimulation.
Sylvia Perlman lived with her daughter Zina Kramer for the last six years of her life.
“My mother was a Holocaust survivor,” said Kramer of Bloomfield Township. “She moved in with us when she could no longer live by herself. At first, we went out for lunch, attended events and visited family. I later enrolled her in the [Dorothy and Peter] Brown Adult Day Care Program two mornings a week.”
Kramer hadn’t realized she had been isolating her mother at home. At the Brown Center in West Bloomfield, a Jewish Senior Life facility for adults with Alzheimer’s disease and related disorders, Perlman interacted with others and went to her first baseball game. During the next few years, she was attending the Brown Center five days a week.
“At first, I viewed her memory as if it was rational, and that didn’t make sense,” Kramer said. “I eventually learned to get through an episode without making a judgment about her memory. I also discovered I didn’t have to do everything myself. The Detroit Jewish community has many resources and is exceptional for taking care of its own.”
The number of people with Alzheimer’s disease (AD) is expected to triple by 2050, according to research based on U.S. Census Bureau data. That means 14 million Americans will be identified as having AD in less than 40 years. These numbers are primarily the result of greater longevity among Baby Boomers.
Gary Small, M.D., described this trend as “successful longevity” at the Novi Fox Run campus in February when he spoke there about his book, The Alzheimer’s Prevention Program (Workman Publishing, 2012).
“Prevention is not a cure,” Small explained. “Prevention is using lifestyle strategies that promote brain health that are essential for quality longevity. Brain health includes more than memory. If your brain is healthy, you can think, make right decisions, be physically healthy, maintain your memory and stay focused. The prevention program, described in the book, helps people delay the onset of Alzheimer’s disease symptoms.
“Although there is no way to actually prevent AD, it is possible to delay it and increase the number of years without dementia,” Small said.
He says there is strong evidence that exercise is the right lifestyle choice associated with Alzheimer’s prevention. A recent study in the journal Neurology supports that theory and suggests working out can be more effective at protecting the brain than cognitive challenges such as games and puzzles (although they do have some benefit).
In the study, a group of 700 participants born in 1936, who participated in physical activity, showed less brain shrinkage and fewer white matter lesions, both of which can be signs of AD, than the group that didn’t exercise.
The conclusion makes sense because physical activity helps promote a healthy heart, and the well-being of the heart and brain are interrelated. An unhealthy heart isn’t as efficient at pumping blood and oxygen, which the brain requires.
One theory presented at the Alzheimer’s Association’s International Conference in July 2012 suggested that strength training could be the best exercise intervention. Another study showed that women between ages 70 and 80 who used weights showed the most improvement. In general, those participants who started with a higher cognitive baseline actually gained the most benefits from exercise.
Another new study, published in the Archives of Neurology, found that people who kept their brains active most of their lives by reading, writing, completing crossword puzzles or playing challenging games were less likely to develop brain plaques associated with AD. In other words, stimulating your mind at an early age may do more to help your brain than starting chess once you retire. People in the study who recently took up crossword puzzles did not see added benefit.
Small feels strongly that we do have the ability to influence our future brain health. He writes that “science has shown that genetics, our hereditary predisposition for Alzheimer’s disease, accounts for only part of our risk. Lifestyle choices may have an even greater impact. Therefore, we have more control than we think.”
“The word ‘senility’ simply means getting older and does not have the same meaning as the word dementia,” explained Rhonna Shatz, D.O., Clayton Alandt Chair of Behavioral Neurology at Henry Ford Health System. “Dementia is not inevitable as you age.
“More frequently, there are abnormal brain pathologies that take place in the brain that indicate that a person may be at risk for dementia,” Shatz said. “Yet there are people who live to an old age with a high burden of these brain pathologies, enough to meet pathologic criteria for Alzheimer’s, who never develop cognitive decline.
“For those individuals who do develop cognitive decline, there tends to be more than one cause, both from inside and from outside the brain. For example, in addition to Alzheimer’s changes, there are vascular pathologies and Parkinson’s-related pathologies. The brain can malfunction from stresses outside the brain itself, from diabetes, effects of depression, from poor sleep and from high body weight. Right now, we don’t know why there is such a variance in how people function with dementia.”
According to Shatz, a person’s genetics and cognitive reserve can help the body and brain fend off decline. “Cognitive reserve is a building up of many connections between brain cells. The more you build up, the harder it is to shake and break them down because as one cell or connection is damaged another takes its place.
“One of the theories about how your cognitive reserve can be expanded is based on the evolutionary concept of survival,” Shatz said. “Using that theory, there are several triggers that can help turn on the brain’s stem cells.”
The first trigger is our need for physical exercise based on the flight or fight lifestyle of our early ancestors. The second is our need to be with other people for survival through socializing and sharing fire or hunting together.
“A third is the notion of increasing mental activity and challenging your brain with new tasks,” Shatz said. “Animals learn a skill by using specific patterns, while people learn through new challenges. Do what you have a passion for, but frequently do it a little differently to stay challenged. Select a hobby or an interest and plan new things you can do with that. Think of your daily activities as if you were on a vacation and create a weekly itinerary that is different each day.”
Shatz also lists getting enough proper sleep and having a physical exam with your doctor as ways to lower your risk for dementia.
“I’m so proud of our Jewish community because they’ve provided a place where my 91-year-old mother can live with dignity in a Jewish setting with others who have the same beliefs, ethics and values,” said Susan Stettner of Huntington Woods. “My mother, who has Alzheimer’s, lives at the Coville Assisted Living Apartments located on several floors of the Prentis Apartments in Oak Park. She socializes with others in the communal dining and activities areas. There is 24-hour personal care assistance with support for families.
“There was a time when I provided services to the Jewish community at my work for the Agency for Jewish Education, now known as the Alliance,” Stettner said. “Now my family and I are recipients of services provided by the community.”
Stettner’s mother, Micki Pelzner Lipshaw, also attends the Brown Adult Day Care Program at JVS in Southfield two afternoons a week.
“This service has been very helpful to me because it provides a support group for caregivers. It’s a place where I can share my feelings, get feedback and listen to other experiences.
“My mother was very active and social and still was diagnosed with Alzheimer’s in her 70s,” Stettner said. “I’m 63, I eat healthy meals, I exercise, I keep my brain stimulated with lectures and reading, and I socialize with friends. However, I know there’s no guarantee that I won’t be diagnosed with AD at some point. We’re all lucky to be living longer, but the quality of our longer life is anyone’s guess.
“Fortunately, I can help my mother enjoy a wonderful time at a concert or join her at a Brown Center outing. She may not remember the event by the time we get home, but I know she experienced much joy.”
Peter Ostrow, director of the Brown Adult Day Care Program, said, “The Memory Club is also part of the services provided by JVS. Many seniors who live independently haven’t been diagnosed with AD, but they are anxious about their memory losses. We call this mild cognitive impairment and offer a program that provides memory-enhancing tips and techniques for those experiencing mild memory problems. When the loss is more severe, they choose to attend one of the Brown Centers, depending upon where they live.”
Ostrow described the Dorothy and Peter Brown Memory Care Pavilion at Fleischman Residence in West Bloomfield as a program specifically designed to meet the needs of older adults with severe memory impairment. Residents receive 24/7 nursing, recreational and social supports.
“We provide mental stimulation, attempting to train the brain to expand its connections and create a cognitive reserve,” Ostrow said. “The participants engage in memory exercises, participate in field trips and learn what works best to boost their memory. At the same time, they are socializing with others. Our goal is to help them continue to live independently and avoid rapid brain changes.”
Ostrow explains that at the adult day care programs, staff works with seniors who have a range of dementia problems.
“One goal is to help these men and women be more functional and include them in as much social interaction as possible,” he said. “The program is open to the broader community, depending upon need.”
The Greater Michigan Chapter of the Alzheimer’s Association collaborates in various programs and events sponsored by Detroit’s Jewish Senior Life.
“We help train staff who work with residents and provide additional resources to the programs, making programs more effective,” says Gayle Burstein, director of major gifts at the Alzheimer’s Association. “Because we’re part of a national organization, we make ourselves available 24/7 so that anyone needing help can talk to a person.
“Although we can’t stop Alzheimer’s from happening, with medication we can manage a person’s ability to function until there’s nothing left to improve,” she said. “At that point, we can help the families with counseling and programs, whether the patient is in the early or late stages of Alzheimer’s.”
Often a patient is referred to the Speech and Language Pathology Department at Beaumont Hospital in Royal Oak because they have problems speaking, although they haven’t been labeled with dementia.
“We include patients and their families in our 10-week program to show them how they can cope with their problem,” said Michael Rolnick, Ph.D., director of the department at Beaumont. “We work on their speech and show them how to live a healthy lifestyle with good nutrition and exercise. Often we inform families that a patient should be re-evaluated for AD.”
Treatments And Research
An important discovery in 2012 was the identification of a genetic mutation that protects people from developing AD. The mutation in the Amyloid Precursor Protein (APP) significantly decreases the amount of beta-amyloid a person makes, improving a resistance to developing AD. Research continues. (See sidebar below.) Treatments today work by temporarily improving symptoms of memory loss and problems with thinking and reasoning. The medications tend to boost performance of specialized biochemicals that carry information from one brain cell to another. However, they don’t stop the underlying decline and death of brain cells. As more cells die, Alzheimer’s continues to progress.
One immunization strategy had to be stopped recently because some participants developed acute brain inflammation. Another medication under investigation is taken as a nasal spray to impede the protein tau from forming tangles. Researchers also are trying to develop drugs that focus on the specific inflammatory processes. Others are researching the heart-head connection, evaluating how current drugs for heart disease may reduce risk factors for Alzheimer’s. Still other studies are exploring how much lifestyle choices may prevent AD or at least delay its onset.
According to research presented at the American Academy of Neurology’s meeting in March 2012, patients taking beta blockers for hypertension may be less likely to have brain changes associated with Alzheimer’s disease and other forms of dementia such as Parkinson’s dementia. The study findings are preliminary but promising. They emphasize the importance of maintaining healthy cardiovascular and cerebro-vascular systems through diet and exercise and regular medical attention.
If you’re looking for ways to stimulate the growth of new brain cells, research published in the Oct. 15, 2012, issue of NueroImage suggest that learning a foreign language in a condensed course may be the perfect strategy.
New research also suggests that sweets and fatty foods are not only bad for your body, but they also are very bad for your mind. The theory has to do with higher levels of LDL, the bad cholesterol, because it has a negative effect on blood vessels and reduces the flow of oxygen to the brain. On the other hand, a Mediterranean-style diet provides nutrients that are beneficial to the brain.
Start exercising. The online, October 2012 issue of Archives of Neurology, reported that a study of elderly people showed that the worse participants did on physical tests, the more likely they were to have dementia.
The first Alzheimer’s patient in the United States received a pacemaker implanted in her brain last October at the Ohio State University Wexner Medical Center. The patient was enrolled in an FDA-approved study to determine if using a brain pacemaker can improve cognitive and behavioral functioning in patients with AD. More research is needed.
Although no drug therapy or treatment regimen has been found that will prevent Alzheimer’s disease, medical authorities agree that lifestyle choices make a big difference for reducing the risk of developing AD as you age.
Dr. Gary Small, author of The Alzheimer’s Prevention Program, says it’s never too early to begin making healthy choices. Alterations in the brain associated with Alzheimer’s usually start decades before symptoms appear. Small advises thinking about prevention in your 30s and 40s. He recommends concentrating on five areas:
• Nutritional eating and a diet low in saturated fat.
• Staying physically active with aerobic exercise and strength training.
• Maintaining a healthy weight and avoiding diabetes, if possible.
• Staying mentally active by reading, socializing.
• Limiting stress.
“If we take charge of our everyday lifestyle choices, we can push back the age at which Alzheimer’s symptoms might begin, perhaps by several years, which, in some cases, can mean for the rest of our lives,” Small said. “Even if scientists one day come up with a miracle drug that can cure dementia, it will always be easier to protect healthy brain cells than to try to repair damaged ones. For now, prevention is the key to protecting our brains.”
By Ruthan Brodsky, Special to the Jewish News
Book Helps Kids Cope With Alzheimer’s
Hugging Grandma, written by Zina Kramer, was written to help families explain memory disorders to children. Kramer provides specific and effective ways for children to maintain a relationship with their relative. For information, contact Nelson Publishing & Marketing (www.nelsonpublishingandmarketing.com). The book is illustrated for children.
Don’t wait to change your diet,” warned Neal Barnard, M.D., author of Power Foods for the Brain (Grand Central Life & Style). “Avoid meat and dairy products because what you eat, even when you’re 40 and in the prime of your life, will have a bad impact on you three decades later.”
Research shows that people who eat more saturated fat and partially hydrogenated oils are at greater risk of developing Alzheimer’s. What’s more, cholesterol increases the production of beta-amyloid and plays a role in the formation of the beta-amyloid plaques that can lead to Alzheimer’s disease.
In the American diet, the biggest source of saturated fat is from dairy products — cheese, ice cream, butter and milk. Meats — chicken, sausage, burgers and roast beef — are a close second, according to Barnard, who is Jewish and will speak at 7 p.m. Monday, April 22, at Adat Shalom Synagogue in Farmington Hills. President of the nonprofit Physicians Committee for Responsible Medicine, Barnard is the author of 15 previous books on diet and health, and associate professor of medicine at George Washington University School of Medicine in Washington, D.C.
In his latest book, Barnard describes how simple diet changes can protect your brain from memory loss, stroke and Alzheimer’s. He emphasizes that saturated and transfats, the kind found in hamburgers, doughnuts and chili cheese fries, can triple the risk of developing Alzheimer’s and reduce brain functioning in the short term.
“On the other hand, eating fruits, vegetables and foods rich in vitamin E, such as almonds, may reduce the risk of Alzheimer’s by as much as 70 percent,” he said.
For those who have added fish, especially salmon, to their diet as a healthy food choice, Barnard’s response is that fish is more like beef than it is like broccoli.
“People who frequently eat salmon usually have weight problems and are at a higher risk of diabetes because Atlantic salmon, for instance, is about 40 percent fat, and it’s not all good fat,” Barnard said.
“Only 15-30 percent of the fat in fish is Omega-3, and the other 70 percent is bad fat, a blend of saturated and unsaturated fats. Besides, fish also contains cholesterol, and shellfish have more cholesterol than red meat,” he said. “I suggest taking the best of the Mediterranean diet — the vegetables, fruits, beans and grains — and skipping the fish and oil.”
He also warns against potential threats to the brain from medications, drug interactions, sleep deprivation and physical conditions that can put memory at risk.
“As we’ve seen, for example, high cholesterol levels are linked to dementia,” he said. “So you’ll want to keep a healthy, low cholesterol level. To do that, I would encourage you to focus on healthful foods and to reserve cholesterol-lowering drugs for when a healthy diet does not bring cholesterol down. So far, drugs do not seem to be able to equal the power of food choices.”
Power Foods for the Brain contains recipes from Christine Waltermyer and Jason Wyrick.
Local Research Delves Into Alzheimer’s
By Louis Finkelman|Special to the Jewish News
The Alzheimer’s research program at Beaumont Hospital’s Neurology Research Laboratory is headed by Dr. David Loeffler, who also serves on the Medical and Scientific Advisory Board of the Greater Michigan Chapter of the Alzheimer’s Association.
Since 1984, he said, physicians have diagnosed possible Alzheimer’s disease using clinical tests. They evaluate how patients perform on tests of cognitive function and other neuropsychological examinations. By the time clinical tests indicate Alzheimer’s disease, the patients have probably experienced years, or even decades, of Alzheimer’s-related brain pathology. To date, there are no valid biomarkers, chemical or mechanical tests that can diagnose Alzheimer’s with 100 percent accuracy in live patients.
Loeffler explains that AD is a “diagnosis of exclusion”; when all other causes of dementia that can be tested for are ruled out, then a clinical diagnosis of “probable dementia-Alzheimer type” is made. But, he says, a diagnosis based upon clinical findings is only about 85-90 percent accurate because using neuropathological findings (postmortem brain examination) is the “gold standard.”
“Alzheimer’s is the most common form of dementia, but other disorders also can cause dementia,” Loeffler said. “Efforts to improve the early diagnosis of AD have moved forward in recent years. Researchers now test several chemical and physical markers, hoping to improve the accuracy of diagnosis and to get earlier diagnoses.”
Though early detection may someday lead to breakthroughs in treatment, Loeffler said, “Unfortunately, at the moment, an earlier diagnosis of Alzheimer’s does not increase the chances of successfully treating the disorder.”
However, having these biomarker tests would be a blessing and a curse. If AD is discovered in apparently healthy patients, researchers could experiment on earlier intervention, but until effective treatment is developed, this news could be tragic for the patients.
“If there were a predictive test for Alzheimer’s disease, would you want to know?” Loeffler asked.
Furthermore, as Dr. Kostas Lyketsos of Johns Hopkins University has pointed out, tests for pre-clinical Alzheimer’s will also detect the disease in millions of people who have no symptoms, doubling or tripling health care costs, without, as yet, any clear benefits to the patients.
Pathologists can look through a microscope for signs of Alzheimer’s disease on brain tissue. They can see extracellular plaques of amyloid-beta proteins; and inside neurons, they can see tiny tangles of twisted tau proteins. The plaques and tangles are accompanied by brain inflammation and, to varying extents, with dementia.
A great deal of research has gone into preventing or reversing the amyloid beta build-up that leads to plaques in the Alzheimer’s brain. Unfortunately, treatments that work well in mouse models have not helped Alzheimer’s patients in clinical trials. In humans, plaque counts correlate poorly with the extent of mental impairment; some people have the plaques and lose cognitive functions, but others with plaques continue to function well.
Other researchers have been working on targeting the tau protein within tangles. Beaumont’s Neurology Research Laboratory is currently studying an immunotherapy approach to prevent the development of toxic conformations of tau in the Alzheimer’s brain. Researchers refer to the dispute between those who see more hope in work on plaques and those who see more hope in work on tangles as an argument between the BAPtists (Beta Amyloid Protein researchers) and the TAUists.
Researchers also would like to discover the mechanism or mechanisms of Alzheimer’s disease. In less than 1 percent of cases, Alzheimer’s appears in patients younger than 55 years; this early-onset Alzheimer’s has a large hereditary component due to well-defined gene mutations and is called “familial Alzheimer’s.” Heredity plays a lesser role in the more prevalent “sporadic” form of the disease, which shows up in older individuals, although it still plays a role.
Prospective studies show that Alzheimer’s is less likely to appear in people who suffer from chronic inflammatory conditions such as rheumatoid arthritis and are treated with anti-inflammatory drugs, suggesting a critical role for brain inflammation in the disorder. Alzheimer’s also seems less likely to occur — or to begin later — in people who eat a Mediterranean diet, get regular exercise, who have avoided head trauma and who have intellectual attainments such as success in education or employment.
Loeffler says the goal of Beaumont’s Alzheimer’s research program is to improve treatment. The laboratory previously conducted studies on an important inflammatory pathway in the Alzheimer’s brain — complement activation. Recently, it has studied antibodies of relevance to Alzheimer’s in intravenous immunoglobulin (IVIG) preparations, which consist of plasma antibodies from thousands of healthy individuals. Support from the Erb Family Foundation has made these immunoglobulin studies possible.
Research from Israel
• Ladostigil, an Israeli-developed drug candidate to treat mild cognitive impairment and slow the progress of AD is undergoing advanced clinical studies.
• BNeuroAD is an electromagnetic stimulation system that stimulates areas of the brain responsible for memory and learning. Developed by Neuronic; patent pending.
• ElMindA is a brain network activation (BNA) technology that was developed to improve diagnosis, treatment and monitoring of AD and other brain disorders.
IRP — Staying Active as You Age
The Institute for Retired Professionals (IRP) of the Jewish Community Center is an ideal place for retired or semiretired people who want to stay mentally and physically active. The group offers weekly and monthly study groups facilitated by members and guest speakers. IRP members are members of the JCC and can use the gym.
“IRP is a wonderful way to stay connected with others intellectually and emotionally,” says IRP President Faye Menczer Ascher. “We constantly learn from one another.”
Florence LoPatin, 85, of Bloomfield Township still works full time. She is also an active IRP member and attends cultural events such as the symphony.
IRP member Marvin Sherman, 87, of West Bloomfield, said, “My keys to staying healthy are to maintain a sensible diet, stay hydrated and have a goal and plan for something to do every tomorrow. As people approach a frightening old age, they find their friends and family are dying off, and they find it difficult to stay connected. The key is to fill up your emotional needs to make up for your persistent losses because you can’t stop the losses.”
For information on the Institute of Retired Professionals, call Sharon Levine at (248) 4030. For a schedule of events, go to www.jccdet.org/55/irp.