Q- My family seems to be plagued by Alzheimer's disease and dementia, although I'm unclear about what the difference is between the two. First my father's brain started to deteriorate quite quickly. My sister and I looked after him in turn at our homes, but when that became impossible, we put him in a home. Then my mother started to show signs and, because she was argumentative in the earlier stages, we ended up having to put her in a home too. Sadly, my husband's mother went the same way. It was quite dreadful.
Now my husband and I are concerned about our own chances of getting Alzheimer's or dementia. How can we find this out, and is there anything we can do to protect ourselves?
A- Dementia isn't a disease-it's a medical term for a cluster of symptoms that affects mental tasks like memory and reasoning. Dementia can be due to a variety of conditions but, by far, the most common cause is Alzheimer's disease. Alzheimer's is a chronic neurodegenerative disease responsible for about 60-70 per cent of dementia cases.
Becoming forgetful is not the only tell-tale sign of Alzheimer's. You may notice that you reach to pick something up like a cup of tea and miss, or you misjudge the distance when walking towards the pavement. Reading a map may suddenly become confusing, or you misplace your belongings, like putting your eyeglasses in the freezer.
Another early important indicator of the onset of Alzheimer's disease is a marked deterioration of your sense of smell.
Make yourself aware of such signs because the earlier you spot them, the more successful you're likely to be with preventative measures.
If you do suspect a problem, you and your husband should visit an osteopath to establish your ankle-brachial index (ABI). This test measures your blood pressure at the ankle and in the arm while at rest. A low ABI score (< 0.90) can be considered a marker of cognitive impairment.
According to one review, the ABI test "provides independent and supplemental information on subjects' susceptibility to develop cognitive disorders, along with its usefulness to predict cardiovascular diseases (CVD). Given its availability, easiness, safety to patients and low cost, the ABI could be useful in clinical practice and research in the field of cognitive diseases".
Getting your homocysteine levels tested is also helpful for predicting your risk of Alzheimer's, as reported in last month's issue (see Brain twisters in WDDTY April 2015 for more information and what to do to lower your levels).
A home-testing kit is available from YorkTest Laboratories (www.yorktest.com; tel: 0800 074 61850800 074 6185 FREE) for lb149.
If your ABI score is low or if your homocysteine levels are high, ask to be referred to a laboratory to undergo the ApoE4 gene test to reveal your ApoE4 genotype. This test will firmly establish whether you have a genetic predisposition for Alzheimer's.
And even if this is the case, there's plenty you can do to reduce your risk. Here are some simple steps you can take to help slash your risk of dementia and keep your brain healthy for years to come.
Eat plenty of fruit and veg
Plant polyphenols, found mostly in fruit and vegetables, are potent antioxidants that can offer protection against the development of neurodegenerative diseases, particularly Alzheimer's, and other illnesses as well. Berries, plums, green olives and globe artichokes are good sources, as are dark chocolate, cocoa, coffee and red wine (see right).
Avoid trans fats
Believe it or not, the type of fat you consume can alter your brain's function for better or for worse. Saturated fats can cause brain cells to lose their efficiency, and trans fats are the worst kind of dietary fat for brain (and bodily) health. One review found that trans fats in most studies did indeed increase the risk of cognitive disorders like Alzheimer's, dementia and mild cognitive impairment.
You can work out whether a food contains trans fats simply by looking at the ingredients list on the label. If the list includes words like 'shortening', 'partially hydrogenated vegetable oil' or 'hydrogenated vegetable oil', then that item contains trans fats and should be avoided.
As ingredients are listed in decreasing order of their quantity in the food, smaller amounts are present when the ingredient is listed towards the bottom of the list.
Never stop learning
Every human brain starts to shrink in volume from around the age of 35, so after that, it takes longer to learn. However, we now know that we can actually increase the size of the brain through learning new skills.
London black-cab drivers, who go through the arduous task of memorizing all of London's ever-changing street networks and physical features (known as 'acquiring the knowledge'), have been found, in post-mortem examinations, to have larger brains than usual.
So, try learning something new, such as playing a musical instrument, beanbag juggling or a language, and widen your circle of friends, as this will help keep your brain stimulated and engaged.
According to a review of long-term studies, "physical activity may prevent cognitive decline and dementia". And it doesn't have to be strenuous-even simply walking regularly can bring benefits for body and mind.
Go for cocoa
Cocoa, the key ingredient in chocolate, is chock-full of antioxidant polyphenols known as flavanols, known to have strong brain-protecting properties. More important, drinking cocoa increases blood flow to the brain, stimulation that leads to "maintenance of healthy brain function and cognition".
Cocoa powder has twice as many flavanols as dark chocolate, which in turn has twice as many flavanols as milk chocolate. White chocolate has zero flavanols (as it contains no cocoa whatsoever).
Up your 'good' cholesterol
It's well known that high levels of high-density lipoprotein (HDL, the 'good' cholesterol) protects against heart disease. But it's less well known that HDL cholesterol can help save your brain too. Researchers have found that it blocks the buildup of amyloid plaques-abnormal proteins that accumulate between nerve cells (neurons) in the brain, so blocking important processes that keep neurons healthy and functioning properly.9 HDL also acts as an anti-inflammatory to lessen brain damage.
Ways to ramp up HDL levels in your blood include exercising regularly, drinking only moderate amounts of alcohol and losing weight if need be.
Drink wine in moderation
Light to moderate drinking-especially of wine-appears to reduce the risk of dementia and cognitive decline.10 Red wine is an especially good choice as it's rich in brain-protecting polyphenols like resveratrol. Moderate alcohol consumption is generally defined as no more than one drink a day for women and one to two drinks for men, or no more than seven to 14 drinks per week. A drink is defined here as 5 oz of wine, a 12-oz beer, or 1.5 oz of vodka or other spirits (1 L = 33.8 fl oz).
Several studies suggest that caffeine has a protective effect against dementia, possibly because of its polyphenol (antioxidant) actions. In a study of middle-aged adults, drinking three to five cups of coffee a day was associated with a 65 per cent lower risk of developing dementia or Alzheimer's in later life.
Look after your gut
The nature of your intestinal microbiota definitely influences the permeability of the blood-brain barrier. Even more exciting, there's now evidence to suggest that people with Alzheimer's and other forms of dementia may benefit from taking probiotics as a preventative, while the use of other measures to improve the gut microbiome may help to manage such conditions.
Consider consulting a naturopath with an established reputation for fixing gut problems (such as irritable bowel syndrome, Crohn's disease, inflammatory bowel disease, diverticulitis and pancreatitis) to ensure you're getting the right support for your gut flora.
Keep your weight in check
Being either over- or underweight can increase your risk of Alzheimer's, so try to maintain a healthy weight. One pooled analysis of 10 studies revealed that being underweight increases the risk of general dementia by 36 per cent, while being obese boosts the risk by 42 per cent. Obesity was also found to increase the risk of Alzheimer's by 80 per cent and vascular dementia by 73 per cent.
Adopting a Mediterranean-style diet-rich in fresh fruit and vegetables, olive oil and fish-is one way to help keep your body and mind in good health. Not only can it help you lose weight, but it's also been found to slow cognitive decline and lower the risk of developing Alzheimer's and other dementias too.
Get a good night's sleep
Lack of sleep is thought to increase the risk of dementia by increasing beta-amyloid plaque deposition and neurofibrillary tangles-clumps of tau protein, considered a primary marker of Alzheimer's-in the brain. Aim to get seven to eight hours of uninterrupted sleep each night, and seek help if you have trouble falling or staying asleep.
1 Biol Psychiatry, 1986; 21: 116-8; www.alz.org/aaic/releases_2014/sun-830am-smell-eye-tests.asp
2 Atherosclerosis, 2011; 216: 251-7
3 BMC Neurol, 2013; 13: 44
4 Oxid Med Cell Longev, 2009; 2: 270-8
5 Neurobiol Aging, 2013; 35 Suppl 2: S65-73
6 Neuroscientist, 2010; 16: 566-77
7 BMC Public Health, 2014; 14: 510
8 Int J Med Sci, 2007; 4: 53-8
9 JAMA Neurol, 2014; 71: 195-200
10 Neuropsychiatr Dis Treat, 2011; 7: 465-84
11 Sci Transl Med, 2014; 6: 263ra158
12 Front Cell Neurosci, 2013; 7: 153
13 J Alzheimers Dis, 2010; 20 Suppl 1: S167-74
14 Obesity Rev, 2008; 9: 204-18
15 Epidemiology, 2013; 24: 479-89
16 JAMA Neurol, 2013; 70: 1544-51