Preventing dementia

Reducing the risk of developing Alzheimer's disease

Josh Mitteldorf, Preventing Dementia Translated by Evgenia Ryabtseva, portal "Eternal Youth" http://vechnayamolodost.ru
For links, see the original article.

Dementia (dementia) develops unexpectedly. People suffering from it feel helpless hostages of their genes. However, this is a misconception. How much does the fear-inducing ApoE4 gene increase the risk of developing dementia? This cannot be found out with the help of precise mathematical calculations, since this correlation depends on many lifestyle factors that are no less important than genetic features. For women who inherited ApoE4 from one of their parents, the risk of developing Alzheimer's disease is doubled, but this effect is easily corrected by diet, exercise and dietary supplements. For men, the effect of one copy of ApoE4 is so small that it has virtually no effect on the level of risk. For women and men with two copies of ApoE4, the risk of developing Alzheimer's disease is very high, but even in this case, human-controlled factors can significantly improve the situation.

The following factors are listed, which, according to the author's opinion based on the analysis of literary sources, can significantly reduce the risk of developing senile dementia even if there is a genetic predisposition.

1) physical activity (they are the most important);

2) mental stimulation and social factors;

3) metabolic syndrome / insulin sensitivity;

4) diet;

5) drugs and dietary supplements that selectively affect the brain.

Physical activity

At the beginning of the analysis, the author assumed that the most important factor would be No. 2 from the above list. Social contacts are more important for longevity than anything else, so we can assume that this pattern is even more relevant for maintaining brain health in old age.

However, it unexpectedly turned out that mental stimulation and social factors are effective in some studies, but ineffective in others. Factor No. 1 turned out to be the undisputed leader in the processing of literary sources.

There is strong evidence that physical activity reduces the risk of developing dementia. The meta-analysis published in 2011 and the review of literary sources published in 2017 are the most indicative. A moderate amount of physical activity is much better than lying on the couch. Regular attendance at the gym is even better, but the severity of the positive effect is not proportional to the increase in the intensity of loads.

Social relationships and mental stimulation

The most convincing study, which revealed the relationship between social factors and slowing the decline of cognitive function, was conducted in 2001. A group of scientists from the University of California at Los Angeles observed 1,200 women and men for more than 7.5 years and came to the conclusion that the most important of the social factors is "emotional support".

However, in subsequent studies, the importance of emotional support was not confirmed. In the 2010 review, not a single social variable was included in the list of protective factors. And a 2016 study showed the existence of a relationship between social connections and basic levels of cognitive function in middle age and its absence for changing the level of cognitive activity over a 20-year period.

Diet

Of the several diets tested for neuroprotective effects, the MIND (Mediterranean-DASH Intervention for Neurodegenerative Delay diet), developed by Martha Morris from Rush University in Chicago, is the best described. According to Morris, this diet reduces the risk of developing Alzheimer's disease by 50%. The MIND diet is a variant of the Mediterranean diet (the letter M in the name is taken from the English word Mediterranean – Mediterranean). The main components of the Mediterranean diet are leafy greens, berries, nuts, fruits, vegetables, olive oil, whole grains and fish as a source of protein and omega-3 fatty acids. In the case of the MIND variant, the emphasis is on blueberries (blueberries) and walnuts, which are supposedly especially useful for the brain. [Detailed information can be obtained on WebMD.]

Regular coffee consumption is associated with a moderate increase in risk, but tea, especially green tea, has a much better reputation. A study conducted in Japan demonstrated a pronounced positive effect of drinking a large amount of green tea on cognitive function. Apparently, caffeine has a moderate neuroprotective effect, however, for the most part, the benefits of tea are due to the catechins or polyphenols contained in it, which are also contained in decaffeinated tea. Green tea is a component of the MIND diet.

Metabolic syndrome

20 years ago, the association between metabolic syndrome and Alzheimer's disease was first identified. Observations have shown that insulin therapy worsened the risk, and indeed, excess insulin seems to be a key factor in this relationship. Metformin is a standard drug for the treatment of diabetes mellitus and in one study it was demonstrated that taking metformin reduces the risk of developing Alzheimer's disease in patients with diabetes to levels comparable to those for non-diabetic people of the same age. However, another study showed that metformin actually increases the risk of developing Alzheimer's disease. According to a fairly convincing hypothesis, metformin depletes vitamin B12 reserves. This vitamin is necessary for the functioning of neurons and is therefore concentrated in the brain tissue. Many people suffer from B12 deficiency even without taking medications, so metformin should always be used in combination with B12. Whether there is a residual risk of developing Alzheimer's disease due to taking metformin even with the use of B12 remains to be seen, however, it is possible that B12 should be prescribed not only to patients taking metformin. Low-protein diets protect about many aspects of aging and the MIND diet is also predominantly vegetarian. B12 is an important compound that can be obtained from plant products.

Medications, hormones and dietary supplements

The most common pharmaceutical approach is to increase the concentration of the neurotransmitter acetylcholine. Acetylcholine is found wherever there are nerves, and is necessary for cognitive function, sensitivity, motor function control and, in particular, for memory. Alpha-glycerylphosphorylcholine is a precursor to acetylcholine that can be taken orally. A study was conducted in which 132 patients with Alzheimer's disease who took the drug of this compound, after 90 and 180 showed an improvement in symptoms compared to the period of onset of the disease, compared with the deterioration observed in patients of the placebo group. However, it is not yet clear exactly what effect alpha-glycerylphosphorylcholine has: nootropic or neuroprotective. A bibliography on this subject can be found at Examine.com .

Another potential anti-aging agent is drugs of the angiotensin receptor blocker class. The most famous of them is losartan. There is scientific evidence that taking drugs of this class reduces the risk of developing Alzheimer's disease by 25%, and in experiments on mice they have demonstrated the ability to increase life expectancy. The mechanism of action of these drugs consists in relaxing the walls of the arteries and lowering blood pressure, which weakens the severity of the processes leading to the development of all diseases of the cardiovascular system. However, people do not like to take these drugs, as their intake is often accompanied by apathy and weakness. Some patients develop a cough. Telmisartan has the least number of undesirable side effects from drugs of this class.

Both male and female sex hormones have a protective effect against dementia. A moderate way to use this effect without taking sex hormones is to take dehydroepiandrosterone. The levels of this hormone decrease with age, and its serum content is lower in patients with Alzheimer's disease, which indicates a possible positive effect of the drug, but does not prove it.

Pregnenolone is another precursor of hormones, in fact, dehydroepiandrosterone is synthesized from pregnenolone in the body. Its concentration in the body also decreases with aging. Studies in mice have shown that pregnenolone increases memory retention in the anticipation model. However, there is no evidence of its neuroprotective effect.

Poor sleep quality, sleeping for more than 8 or less than 7 hours a day, and sleep apnea are risk factors for dementia. Their effect is great, but there is little data on this issue. In Alzheimer's disease, sleep is usually disrupted, with melatonin levels reduced and out of sync with the circadian cycle. Naturally, it comes to mind to check the effectiveness of melatonin-containing dietary supplements, and there is already evidence of limited success of the use of melatonin in the treatment of Alzheimer's disease. It was not possible to find data on the possible preventive effect of melatonin, however, the use of alternative pharmaceutical sleeping pills is associated with an increased risk of developing the disease.

"Incentive Award"

It is believed that the dietary supplements listed below have neuroprotective or nootropic effects, or a combination of them.

Predominantly nootropic effect

• Bakopa

• Gingko biloba

• Ginseng

• Gotu Kola (Centella asiatica)

• Guperzin

• Pyracetam

• Lion's mane mushroom (combed hedgehog)

Predominantly neuroprotective

• Acetyl-L-Carnitine

• Ashwagandha

• Black cumin

• Curcumin

• Ginger

• Omega-3 fatty acids

• Alpha Lipoic Acid

Hope for the twice unlucky

One in 50 people has 2 copies of the ApoE4 gene. Adjusted for age, their risk of developing dementia is more than 10 times higher regardless of gender. There is a theory that maintaining a low cholesterol level in the blood can completely eliminate this risk. This theory is based on the results of a mechanistic analysis and extrapolation of the strange fact that in Nigeria, against the background of the highest occurrence of the ApoE4 gene, there is no increase in the frequency of dementia. Not so long ago, it was suggested that carriers of the ApoE4 gene should eat more omega-3 fatty acids than other people.

According to the author, the most significant study of Alzheimer's disease was conducted by Dale Bredesen from the Buck Institute, who applied the most personalized treatment protocols to 10 patients with Alzheimer's disease, which allowed radically improving the level of cognitive function in 9 out of 10 participants. This impressive example demonstrates the possibilities of medical science provided that bureaucratic barriers are eliminated and doctors are given enough time to work individually with patients.

In this case, Breseden's work gives promising hope that the positive effects of the approaches described above are cumulative and that carefully selected individual programs that include them can delay the development of Alzheimer's disease for many years.