Alzheimer's Risk Cut With Healthy Lifestyle

Studies Provide New Evidence

< July 21, 2004 > -- Can staying trim, eating lots of leafy greens, and maintaining healthy blood pressure and cholesterol levels - all while doing a little gardening or concert-attending - stave off Alzheimer's?

Increasingly, the evidence seems to suggest "yes."

Three studies presented this week at the International Conference on Alzheimer's Disease and Related Disorders in Philadelphia indicate that modifiable lifestyle factors such as physical activity and social networking can help reduce the risk of cognitive decline including Alzheimer's.

"This really represents the beginning of more research in this area," says Dr. Marilyn Albert, chairwoman of the Alzheimer Association's Medical and Scientific Advisory Council.

"The Alzheimer's Association's ultimate goal is to prevent the disease entirely," adds Dr. Albert, who is director of the division of cognitive neuroscience in the department of neurology at Johns Hopkins University School of Medicine. "Now is the time to think about risk."

"It seems like common sense, but there's some evidence that these are the important things to do," adds Dr. Neil Buckholtz, chief of the Dementias of Aging Branch at the National Institute on Aging.

Obesity, Related Problems a Major Threat

After following a group of nearly 1,500 elderly subjects for more than 20 years, researchers in Sweden and Finland found those who were obese in middle age were twice as likely to develop dementia when they were older. "Obese" was defined as a body mass index (BMI) of more than 30.

High cholesterol and high blood pressure each also increased the risk twofold. All three of these factors had an additive effect, increasing risk six times when they were all present in one person, says study author Dr. Miia Kivipelto, who is with the Karolinska Institute in Stockholm, Sweden.

Obesity, high cholesterol, and high blood pressure are also risk factors for cardiovascular disease, and there is increasing evidence that dementia and cardiovascular problems are somehow linked.

Not only can cardiovascular disease lead to certain types of dementia, it now seems plausible that separate factors such as cholesterol could contribute to Alzheimer's as well.

This is a good news-bad news scenario. While the prevalence of obesity is increasing globally, "BMI is easy to monitor, so it represents as modifiable risk factor," Dr. Kivipelto said. "It seems possible that by reducing obesity, we can modify vascular risk factors and modify the risk for Alzheimer's disease."

Healthy Lifestyle, Healthy Diet Encouraged

Researchers at Harvard Medical School found women who ate cruciferous or other green, leafy vegetables in middle age had better cognitive abilities as they aged.

More than 13,000 women ages 70 to 81 who were part of the Nurse's Health Study filled out 116-item questionnaires on what foods they ate and how often.

Overall, there was no association between fruit and vegetable intake and cognitive decline. There was, however, an inverse association between green, leafy vegetables (such as romaine lettuce and spinach) and cruciferous vegetables (such as cabbage), both of which have high levels of antioxidants and folates.

Women who ate at least eight servings (one-half cup each) per week were essentially 1.7 years younger in terms of cognitive aging compared to women who only ate three servings a week. Similarly, women who ate five servings a week of cruciferous were about 1.3 years "younger" in terms of cognition than those who ate only two servings, says study author Dr. Jae Hee Kang.

"We're talking really modest differences," Dr. Kang says. "But it could be a significant public health benefit."

While both of these studies looked at the effects of activities undertaken in middle age, a third study looked at the effects of activities undertaken in old age.

The study, led by Dr. Laura Fratiglioni, also of the Karolinska Institute, found that leisure activities that combine social, mental, and physical components are the most likely to prevent dementia.

"Combination activities are important," Dr. Fratiglioni says. Such activities could include gardening, walking, or taking a course.

While there are no answers to the big question of whether nature or nurture is more important in the onset of Alzheimer's, environment does seem to be taking a more prominent role.

"Even subjects with a genetic predisposition [to Alzheimer's] can have modulation of genetic susceptibility," Dr. Fratiglioni speculates.

Dr. Kivipelto added that the risk associated with high blood pressure and high cholesterol was, in fact, higher than that associated with the apoE (a protein which helps carry cholesterol in the blood) genes.

"The pathology for Alzheimer's disease develops over a very long period of time, 10 years or longer," Dr. Albert says. "If they are going to be concerned, they should start as early in life as possible, but certainly by middle age."

Always consult your physician for more information.

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For more information on Alzheimer's disease, please visit health information modules on this Web site.

What Causes Alzheimer's Disease?

According to the National Institute on Aging (NIA), scientists do not yet fully understand what causes Alzheimer's disease (AD). There probably is not one single cause, but several factors that affect each person differently.

Age is the most important known risk factor for AD. The number of people with the disease doubles every five years beyond age 65.

Family history is another risk factor. Scientists believe that genetics may play a role in many AD cases.

For example, familial AD, a rare form of AD that usually occurs between the ages of 30 and 60, can be inherited.

However, in the more common form of AD, which occurs later in life, no obvious family pattern is seen. One risk factor for this type of AD is a protein called apolipoprotein E (apoE).

Everyone has apoE, which helps carry cholesterol in the blood. The apoE gene has three forms. One seems to protect a person from AD, and another seems to make a person more likely to develop the disease.

Other genes that increase the risk of AD or that protect against AD probably remain to be discovered.

Scientists still need to learn a lot more about what causes AD, the NIA states. In addition to genetics and apoE, they are studying education, diet, environment, and viruses to learn what role they might play in the development of this disease.

The NIA describes the following seven warning signs:

• Asking the same question over and over again.
  
  
• Repeating the same story, word for word, again and again.
  
  
• Forgetting how to cook, or how to make repairs, or how to play cards - activities that were previously done with ease and regularity.
  
  
• Losing one’s ability to pay bills or balance one’s checkbook.
  
  
• Getting lost in familiar surroundings, or misplacing household objects.
  
  
• Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
  
  
• Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.

Always consult your physician for more information.

Online Resources

Alzheimer's Disease Education & Referral Center

Centers for Disease Control and Prevention (CDC)

HealthierUS.Gov

National Institute of Neurological Disorders and Stroke

National Institute on Aging

National Institutes of Health (NIH)

National Library of Medicine

National Women's Health Information Center