Alzheimer's Disease: An Avoider's Guide
by Ken Rude

A guy goes to see the doctor. The doc checks him out, then sits the man down and tells him, "You have cancer, and you have Alzheimer's." The guy says, "Hey doc, it could be worse. I could have cancer."

Maybe a bad condition lends itself to a good joke. Certainly, loss of memory vastly oversimplifies the ravages of this devastating illness. The long, drawn-out process of Alzheimer's Disease begins harmlessly enough with occasional forgetfulness or uncharacteristic difficulty doing simple arithmetic. But it progresses as the disease slowly and inexorably coats the brain with growths and tangles, gumming up the works like years of Cokes spilled into your hard drive. Bit by bit, over a decade or more, these growths destroy brain cells and rob the sufferer of memory, then cognitive abilities. Alzheimer's plays havoc with personality as its victim is plunged into a world that is unfamiliar and threatening. Rational thought processes disappear, replaced by fear and agitation. Caregivers and family members can become overwhelmed trying to protect against the ill person's wandering or uncharacteristically aggressive behavior, or against accidental fires in the kitchen. In the end, the disease finally robs the victim of motor behavior, falls lead to broken bones, and speech is lost. The sufferer fails to recognize hunger and loses the ability to eat. The disease is always fatal.

There is no known cure for Alzheimer's as of yet. We don't even know exactly what causes it.

The illness was first described in 1906 by Dr. Alois Alzheimer, a German physician who did an autopsy following the death of a woman who had suffered from an unusual dementia. On examining her brain, Dr. Alzheimer found and described arrays of growths, to which he correctly ascribed her bizarre behavior. To this day, Alzheimer's Disease can only be definitively diagnosed on autopsy. Brain growths or plaques, as well as neurofibrillary tangles, are characteristic of the disease. However, a skilled doctor can usually diagnose the disease relatively early on the basis of behavioral and neurological changes as well as laboratory tests.

The plaques that occur with Alzheimer's are composed of beta-amyloid. This by-product of the processing of a protein called amyloid precursor protein can be found widely throughout the body. According to the most widely-held hypothesis of the disease's onset, the amyloid precursor protein breaks down, and the resulting beta-amyloid collects on brain tissues and eventually leads to brain-cell destruction.

Another theory assigns a prominent role to "tau," a protein that helps give a nerve cell its shape. This theory suggests that tau becomes deformed during Alzheimer's, leading nerve cells to lose their shape and clump together into defective "neurofibrillary tangles."

Factors that Contribute to or Retard Alzheimer's
Right now you may be saying, "When I was young, I smoked a lot of stuff that tangled my neurofibrillaries. Can I take a test to see if I'm gonna get the big A?" The answer is yes, though it probably only makes sense if you have the "familial" form of the disease, an inherited form that accounts for less than 10% of cases. In the other 90-some percent of Alzheimer cases, the so called "sporadic" form, the genetic picture is so murky that testing for it is usually not a good idea. Far greater a risk factor for Alzheimer's than genetic make-up is simply advanced age. Several other factors also influence development of Alzheimer's:

— Education level. The more education you have, the better your memory and learning ability even in the presence of Alzheimer's brain abnormalities. Perhaps the better-educated brain is better able to bypass the damaged areas in order to perform its tasks. We physical therapists know that the physically-fit recover better from their injuries than the unfit, and it seems the same thing happens with the mentally fit. Maybe parents in the future will tell their kids to stop watching TV and do their homework, or they'll get Alzheimer's.

— Cognitive activity. This is similar to the above. Activities such as reading books, playing crossword puzzles, and going to museums keep the mental faculties more nimble. A carefully controlled study of Catholic nuns, priests and brothers showed that those who engaged in the greatest amount of mentally stimulating activities reduced their risk of landing Alzheimer's Disease by 47%! Speed chess, anyone?

— Leisure activity. A study of identical twins showed that the one who participated in more leisure activity was less likely to develop Alzheimer's. For my purposes here I'm presuming that "leisure activity" can be defined as "writing for About Town" or "lying on the couch, rooting for the Yankees."

— High homocysteine levels. This doubles your Alzheimer's risk. Homocysteine is an amino acid, and a necessary substance in your body. Interestingly, homocysteine levels can be reduced by increasing your uptake of folic acid and vitamins B6 and B12. So far, there's no direct evidence that taking additional folic acid and B6/B12 leads to decreased levels of dementia; however, studies are ongoing. Wanna reduce your homocysteine? Green leafy vegetables, low-fat dairy, citrus fruits and juices, whole-wheat bread and dry beans.

— Cardiovascular risk factors. There is accumulating evidence that some of the risk factors for stroke and heart disease also factor into risk for Alzheimer's. High blood pressure, high cholesterol, high homocysteine levels — betcha didn't know that's a risk factor for heart disease, too — all seem to be linked to increased frequency of Alzheimer's. Getting plenty of exercise and giving up smoking may soon become part of standard Alzheimer's prevention.

Treatment
If, as mentioned above, Alzheimer's Disease is indeed caused by a laying down of some foreign substance in the brain, why can't the doctors just scrub off the noodle in question, the way heart surgeons clean out your arteries, or housepainters use paint remover to take away cruddy paint? Unfortunately, and this is the bad news, no treatment has yet been found that can do any such thing — nothing that can definitively stop the disease or prevent it. However, there are several experimental treatments for Alzheimer's.

Several drugs — Aricept, Exelon, Reminyl — can slow the disease's progression in its early and middle stages. The Food and Drug Administration just approved a fourth drug, memantine, for middle-to-late-stage Alzheimer's, and it's expected to become available in early 2004. It has been used in Germany for twenty years, and slows down the decline in reasoning and functioning, allowing sufferers to take care of themselves longer.

Besides drugs, there are some vitamins and herbal products that could possibly have some similar beneficial effects in slowing the disease, and tend to have fewer side effects than pharmaceuticals. (Please note that I, as a physical therapist, am not qualified to give pharmaceutical or herbal advice, so I make no recommendations — except to tell my kids to eat their green leafies.) However, claims that anything will cure or prevent Alzheimer's should be taken with a strong dose of skepticism.

That said, Vitamin E is often considered one of the good guys in treating Alzheimer's. It appears to slow some aspects of the disease by about seven months, and is now frequently prescribed. Also drawing research attention is the herbal superstar drawing research attention, Ginkgo biloba, which may be of some benefit to some people in modifying the onset of dementia. Finally, there is Huperzine A, a moss extract long used in traditional Chinese medicine, with properties similar to pharmaceutical medications used to treat Alzheimer's.

Another line of possible treatment builds on the evidence that inflammation in the brain can promote Alzheimer's. Because of this, researchers have tried using the non-steroidal, anti-inflammatories Vioxx and Aleve to slow the disease's progression, but without success. Celebrex is currently getting a look for its therapeutic potential.

Finally, there is phosphatidylserine — if you can say it, you get extra mental-stimulation points which, as you will see below, may help you prevent Alzheimer's in yourself. This soy-derived substance is a structural component of your nerve cells' membranes; the hope is that using it on likely candidates for Alzheimer's will shore up the nerves' membranes so they don't degenerate. A micro-trial a few years ago showed promising results for age-related memory loss. Much more research needs to be done.

For Further Information
One of the most devastating aspects of Alzheimer's Disease is its long-term impact on families and caregivers, but I'm afraid addressing these and other concerns is beyond the scope of this article. Fortunately, there is a lot of useful information as close as the Internet, so I'm going to close with the names of some organizations and their web addresses.

• Alzheimer's Association. 1-800-272-3900. www.alz.org. A non-profit supporting families and caregivers.

• Alzheimer's Disease Education and Referral Center (ADEAR). 1-800-438-4380. www.alzheimers.org. A service of the National Institute for Aging, funded by the US Government.

• Eldercare Locator. 1-800-677-1116. www.eldercare.gov Also funded by the US Government. A service of the Administration on Aging, it helps find local services, and can provide information and referrals to respite care for exhausted caregivers. It offers contact information for local Area Agencies on Aging.

Last but not least, two local telephone numbers for the Alzheimer's Association: In Poughkeepsie, they are at 2 Jefferson Plaza. Call (845) 471-2655. In Kingston, the number is (845) 340-8474.