Alzheimer’s Disease Prevention

Alzheimer's disease research has revealed a number of factors that may be able to prevent or delay the onset of dementia in some people.

For example, studies have shown that people who maintain tight control over their glucose levels tend to score better on tests of cognitive function than those with poorly controlled diabetes. Several studies also have suggested that people who engage in intellectually stimulating activities, such as social interactions, chess, crossword puzzles, and playing a musical instrument, significantly lower their risk of developing Alzheimer's disease and other forms of dementia. Scientists believe mental activities may stimulate the brain in a way that increases the person's "cognitive reserve",  the ability to cope with or compensate for the pathologic changes associated with dementia.

Researchers are studying other steps people can take that may help prevent Alzheimer's disease in some cases. So far, none of these factors has been definitively proven to make a difference in the risk of developing the disease. Moreover, most of the studies addressed only Alzheimer's disease, and the results may or may not apply to other forms of dementia. Nevertheless, scientists are encouraged by the results of these early studies and many believe it will eventually become possible to prevent some forms of dementia. Possible preventive actions include:

Lowering homocysteine. In one study, elevated blood levels of the amino acid homocysteine were associated with a 2.9 times greater risk of Alzheimer's disease and a 4.9 times greater risk of vascular dementia. A preliminary study has shown that high doses of three B vitamins that help lower homocysteine levels, folic acid, B12, and B6, appear to slow the progression of Alzheimer's disease.

Lowering cholesterol levels. Research has suggested that people with high cholesterol levels have an increased risk of developing Alzheimer's disease. Cholesterol is involved in formation of amyloid plaques in the brain. Mutations in a gene called CYP46 and the apoE E4 gene variant, both of which have been linked to an increased risk of AD, are also involved in cholesterol metabolism. Several studies have also found that the use of drugs called statins, which lower cholesterol levels, is associated with a lower likelihood of cognitive impairment.

Lowering blood pressure. Several studies have shown that antihypertensive medicine reduces the odds of cognitive impairment in elderly people with high blood pressure. One large European study found a 55 percent lower risk of dementia in people over 60 who received drug treatment for hypertension. These people had a reduced risk of both Alzheimer's disease and vascular dementia.

Exercise. Regular exercise stimulates production of chemicals called growth factors that help neurons survive and adapt to new situations. These gains may help to delay the onset of dementia symptoms. Exercise also may reduce the risk of brain damage from atherosclerosis.

Education. Researchers have found evidence that formal education may help protect people against the effects of Alzheimer's disease. In one study, researchers found that people with more years of formal education had relatively less mental decline than people with less schooling, regardless of the number of amyloid plaques and neurofibrillary tangles each person had in his or her brain. The researchers think education may cause the brain to develop robust nerve cell networks that can help compensate for the cell damage caused by Alzheimer's disease.

Controlling inflammation. Many studies have suggested that inflammation may contribute to Alzheimer's disease. Moreover, autopsies of people who died with Alzheimer's disease have shown widespread inflammation in the brain that appeared to be caused by the accumulation of beta amyloid. Another study found that men with high levels of C-reactive protein, a general marker of inflammation, had a significantly increased risk of Alzheimer's disease and other kinds of dementia.

Nonsteroidal anti-inflammatory drugs (NSAIDs). Research indicates that long-term use of NSAIDs, ibuprofen, naproxen, and similar drugs, may prevent or delay the onset of Alzheimer's disease. Researchers are not sure how these drugs may protect against the disease, but some or all of the effect may be due to reduced inflammation. A 2003 study showed that these drugs also bind to amyloid plaques and may help to dissolve them and prevent formation of new plaques.

A study published in 2005 found that people with mild cognitive impairment who took 10 mg/day of the donepezil (Aricept) had a significantly reduced risk of developing Alzheimer's disease during the first two years of treatment, compared to people who received vitamin E or a placebo. By the end of the third year, however, the rate of Alzheimer's disease was just as high in the people treated with donepezil as it was in the other two groups.

Reference: National Institute of Neurological Diseases and Stroke

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