By using a little detective work, you can usually locate the cause of dementia and start improving it, says Dr Harald Gaier
Q When my father died in 2009, my elderly mother moved in with us. She is now 71 and apart from her eyesight, which is rather poor (and which she won't admit), and a lifelong gluten sensitivity (which she periodically tries to ignore), she is physically quite fit and well, although she has quite a high body mass index. But she is now showing worrying signs of dementia or Alzheimer's (I don't know which it is). I have reading glasses that lie around and the other day, I couldn't find them. They turned up two days later in my freezer! My husband's car keys were buried in our rubber-tree houseplant pot. She insisted he had buried them there himself . . . and even recalled seeing him do it! It would be funny if it weren't so annoying. Her short-term memory has become appalling. What can we do to help her?
I am a registered nurse and know a bit about the drug Aricept (donepezil) and its many horrible adverse effects (such as the need to keep increasing the dose to maintain effectiveness, loss of appetite, fatigue, insomnia, hallucinations, aggressive behaviour, urinary incontinence, stomach ulcers, hepatitis, muscular twitching, tremors, and rigidity of hands, face, legs and tongue). Can you please help us?
Lucille D., Lowestoft, Suffolk
A Surprisingly, researchers at the Mayo Clinic in Rochester, Minnesota, have discovered a strong link between coeliac disease and dementia starting at around age 64.1 Also, bad eyesight seems to boost the risk of Alzheimer's disease (AD).2 This Michigan University study analyzed the Medicare records of 625 elderly people for an average of 10 years, using a scale that ranked vision from excellent (1) to totally blind (6). The researchers discovered that the odds of dementia increased by around 52 per cent with each step up the scale.
Happily, a simple eye test may be a big help in diagnosing early AD. When blood vessels in the retina are photographed, abnormal vessel widths in pre-AD patients are revealed, according to researchers in Australia.3
And if your mother has any cardiovascular problems, these can double the risk of AD and dementia.4
As you, like most people, can't tell AD and dementia apart, here are the current standard definitions: AD is a progressive mental deterioration arising in middle or old age due to generalized degeneration of the brain, and is the most common cause of premature senility; and dementia is a loss of mental ability severe enough to interfere with normal activities of daily living and lasting more than six months, but not present since birth, and not associated with any loss or alteration of consciousness.
Have these definitions helped make the distinction clear? If not, console yourself with the fact that about half of post-mortem examinations of patients diagnosed with AD by medical consultants are found to have dementia instead.
Modifying non-genetic risk factors
It's an established fact that people with high homocysteine levels (greater than 11 umol/L) are prone to develop AD. A randomized placebo-controlled study showed that lowering raised homocysteine levels in AD patients by giving high-dose B vitamins (folic acid: 0.8 mg; vitamin B6: 20 mg; vitamin B12: 0.5 mg) prevented AD-related grey matter atrophy and shrinkage of the whole brain over two years.5
Yet another study has shown that high-dose B vitamin supplementation can reduce, by up to seven times, the grey matter (GM) damage in regions especially affected by AD changes, such as the medial temporal lobe. In the placebo group, while higher homocysteine levels at the start of the study were associated with faster GM atrophy, this deleterious effect was largely prevented by the B vitamins.6
Choline and betaine are dietary nutrients associated with low homocysteine levels and essential for the proper development of neural and brain function. The link between cognitive function and blood levels of choline and betaine was examined in a cross-sectional study of 2,195 elderly people. A significant relationship was found between low choline/betaine and low vitamin B12 and cognitive performance.7 This suggests that taking choline, betaine and vitamin B12 (under the tongue for better absorption) may be beneficial.
In addition, elderly people who take vitamins E and C together may well reduce their risk of AD. Researchers assessed the prevalence of dementia (200 cases were found) and AD in 4,740 people aged 65 years or older for two years and also collected information on supplement use. The patients were then followed for a further three years and 104 new cases were found, an increase far lower than average for the population. The greatest reductions in AD were found in those who took separate vitamin E and C supplements in combination, with or without a multivitamin, whereas no improvement was seen with taking either vitamin C or vitamin E alone.8
I should also mention, Lucille, that carrying excess weight (your mother's high BMI score) may also be a factor in AD, as obese subjects appear to have higher levels of homocysteine than non-obese controls.9 So the introduction of a weight-loss regimen may offer your mother extra benefits.
Modifying genetic risk factors
As iron overload can contribute to the development of AD in patients with a genetic predisposition, its treatment (usually via chelation therapy, whereby chelating agents are used to remove heavy metals from the body) may be protective in certain cases.10
Low levels of vitamin D have frequently been associated with mental decline and can also contribute to diseases of the nervous system. Vitamin D receptors (VDRs) are found throughout the human brain, and vitamin D may be protective by regulating inflammation. When researchers looked at two VDR variations, Apa1 and Taq1, in the DNA of 255 AD cases and 260 controls from the Oxford Project to Investigate Memory and Ageing (OPTIMA), they found a link with AD, especially in those aged under 75.11 So, taking vitamin D3 supplements may also help your mother.
Dealing with dementia
As it may be difficult to get some of the high-dose vitamins mentioned here, I suggest you seek the help of a naturopath or other suitably qualified natural healthcare practitioner, who can prescribe them for your mother.
She should also have a complete medical (including complete blood count, blood pressure, body temperature, pulse rate, ECG and Babinski reflex) and also, ideally, undergo the following tests:
o Folic acid level
o 30-point Mini-Mental State Examination (takes about 10 minutes)
o Vitamin B12 level
o Homocysteine level
o C-reactive protein level
o Antineuronal antibodies
o Test for APOE (E4) gene
o Clock drawing test (she will be asked to draw a clock face with the hands denoting a certain time and then asked to say what time it is)
o Tests of primitive reflexes (snout reflex, glabellar tap, palmomental reflex).
Early intervention is crucial, and a short cognitive function test can help you and your husband identify early signs of cognitive decline in yourselves. To see whether you or your family and friends are at risk, visit: www.foodforthebrain.org/alzheimers-prevention/take-the-test.aspx.
1 Arch Neurol, 2006; 63: 1440-6
2 Am J Epidemiol, 2010; 171: 728-35
4 PLoS One, 2013; 8: e68741
5 Int J Geriatr Psychiatry, 2012; 27: 592-600
6 Proc Natl Acad Sci U S A, 2013; 110: 9523-8
7 Br J Nutr, 2013; 109: 511-9
8 Arch Neurol, 2004; 61: 82-8
9 Turkish J Endocrinol Metab, 2004; 3: 107-11
10 Neurobiol Aging, 2012; 33: 202.e1-13
11 Neurosci Lett, 2011; 504: 79-82