How To Slow the Progression of Alzheimer’s Disease

If you think this way, fortunately, you’re wrong on several fronts.

Today we have a number of medications that can slow the progression of the disease, and a vaccine under development. We’re also making great strides in understanding the possible causes of Alzheimer’s. We now know lifestyle plays a role, which means there are concrete steps you can take to reduce your risk.

One key discovery: The same conditions that increase your risk of heart disease, including high cholesterol, high blood pressure, high levels of the amino acid homocysteine, and being overweight, also increase your risk of Alzheimer’s.

Why? We’re not quite sure. But it may have to do with the importance of healthy blood flow to the brain. If that blood flow is compromised because of clogged or narrowed blood vessels, less oxygen gets to the brain and fewer waste products leave it. Detritus builds up, possibly leading to the abnormal clumps (called amyloid plaques) and tangled bundles of fibers (called neurofibrillary tangles) found in the brains of Alzheimer’s patients.

Cholesterol may also play a role. In animals, high cholesterol leads to extra plaque in the brain, as well as extra plaque in the arteries. And sure enough, people who regularly take statin drugs to lower their cholesterol are less likely to develop Alzheimer’s than people who don’t.

So if you’re worried about developing Alzheimer’s, or even if you’ve recently been diagnosed, taking steps to reduce your risk factors for heart disease can also reduce your risk of Alzheimer’s and, quite possibly, slow the progression of the disease if you have it.

Alzheimer’s is a disease ideally suited for integrative medicine. In one study of 35 people with mild dementia and depression, an approach using antidepressants, drugs for Alzheimer’s, and nutritional supplements, along with some changes in diet and mild physical exercise, not only significantly slowed mental decline for two years, but even improved memory and other cognitive functions.

Our Best Advice

The earlier you’re diagnosed with Alzheimer’s, the earlier you can start treatment. This, in turn, not only slows progression of the disease, but also buys you time to benefit from new treatments that may be just around the corner.

1. Start taking a cholinesterase inhibitor such as Aricept (donepezil) along with the NMDA inhibitor Namenda (memantine) as prescribed by your doctor.
2. Begin taking 80 milligrams ginkgo two or three times a day.
3. Take 400 IU vitamin E and 1,000 milligrams vitamin C daily.
4. Take a daily B vitamin supplement containing at least 800 micrograms folic acid, 400 micrograms vitamin B12, and 250 milligrams niacin.

Why It Works

As of late 2005, there were two classes of drugs for Alzheimer’s: cholinesterase inhibitors, including Aricept (donepezil), Exelon (rivastigmine) and Reminyl (galantamine), and NMDA (N-methyl-D-aspartate) inhibitors, in which one drug, Namenda (memantine), has been approved.

Cholinesterase inhibitors work by increasing the amount of the neurotransmitter acetylcholine in the brain, which helps brain cells communicate. These drugs work best when prescribed early in the disease (which is why early diagnosis is so important). Studies find they can slow the progression of the disease, freeing up caregivers and reducing their stress.

Namenda is thought to work by regulating the activity of glutamate. This brain chemical affects learning and memory, helping the brain process, store, and retrieve information. Studies find Namenda can also slow mental decline when used either alone or in combination with Aricept, and it seems to work even in people in the moderate to severe stages of the disease.

Ginkgo seems to work just as well as cholinesterase inhibitors in slowing mental decline. Studies find the herb could delay the loss of abilities needed to cope with everyday life by 10 months after 26 weeks of treatment and by 21 months after a year of treatment. The herb probably works by protecting brain cells from oxidative damage, strengthening blood vessels, and, possibly, preventing the formation of amyloid plaques, one of the hallmarks of the disease.

Remember oxidative stress, Super Threat #2 from Part 2 of this book? Today the evidence is clear that oxidative stress damages brain cells, contributing to Alzheimer’s. In fact, many people with Alzheimer’s and other forms of dementia have low levels of antioxidants in their blood. That’s why we recommend the antioxidant vitamins E and C.

One major study published in the New England Journal of Medicine gave 341 people with moderately severe Alzheimer’s disease either Cognex (tacrine)-an older drug rarely used these days-vitamin E, the drug plus the vitamin, or a placebo for two years. Treatment with either the drug or the vitamin slowed progression of the disease significantly more than treatment with the placebo. Other studies find that taking vitamins E and C together significantly reduces the risk of Alzheimer’s in healthy people.

Why the B vitamins? Because they help control levels of the amino acid homocysteine, a heart disease risk factor and also an Alzheimer’s threat. Elevated homocysteine levels double the risk of developing Alzheimer’s disease. B vitamins break down homocysteine so there’s less of it in your body. If you don’t get enough B vitamins, you may have too much homocysteine. Studies find that lowering homocysteine levels with vitamin B12, folic acid, and vitamin B6 can not only reduce the risk of Alzheimer’s but also improve the mental status in people who have Alzheimer’s and high levels of homocysteine.

Other Medicines

Herbs and Supplements

Phosphatidylserine (PS). This is a naturally occurring fat we get as part of our normal diet. It’s particularly important in enabling the membranes of brain cells to transmit electrical signals within the cell and to other brain cells. Although most positive studies have been conducted on people with mild memory problems-not Alzheimer’s-we still think it’s a good option for Alzheimer’s patients, along with traditional medical treatment. Take 100 to 300 milligrams a day.

Vinpocetine. This supplement, derived from the Madagascar periwinkle, was developed in Hungary about 20 years ago. It’s mainly used to treat people with a loss of blood flow to the brain, a key contributor to memory and learning problems. Although there aren’t many human studies on its use, three studies show that taking vinpocetine can improve attention, concentration, and memory in people with memory problems more than a placebo. Take 5 milligrams three times a day, increasing to 10 milligrams three times a day if necessary.

Acetyl-L-carnitine. This amino acid is often included in “brainpower” and “memory boosting” supplements sold in drugstores. It plays many roles in helping to maintain the health of brain cells, and may also improve production of the neurotransmitter acetylcholine. In studies on Alzheimer’s patients, there is some evidence that high daily amounts like those we recommend here can help slow the inevitable decline. Take 1,500 to 3,000 milligrams in two or three divided doses throughout the day. Note: this not the same thing as L-carnitine. Also, avoid products with “D” carnitine.

Melatonin. Evening doses of melatonin can improve two common symptoms of Alzheimer’s: sleep problems and “sundown syndrome,” in which the person becomes agitated as darkness arrives. A review of four studies in which people with Alzheimer’s were given 3 milligrams melatonin a day for 21 days as the sun set found that most people who took the supplement showed less “sundowning” behavior and slept better. Start with 1 milligram a day at sunset, gradually increasing the dose (up to 3 milligrams) until you see a benefit.

Other Approaches

Cognitive activities. Keep exercising your brain as long as possible. We know more intellectually active people are less likely to develop Alzheimer’s in the first place, so we think that maintaining that activity as long as possible may help delay the disease’s progression. In Europe, there are “memory clinics” that use this approach on people with various forms of dementia, and a program in Florida brings together people in the early stages of dementia for a college-level course covering nutrition, mental fitness, stress reduction, communication, and information about the course of the disease. The course provides people more control over their disease, helps them learn to make lifestyle changes that could slow the disease’s progression, and improves their mood, self-esteem, and independence.

Massage and therapeutic touch. Many people with Alzheimer’s go through stages in which they become very agitated, wander, and exhibit disruptive behavior. Several studies suggest that massage therapy and therapeutic touch (in which practitioners hold their hands close to a person without making physical contact in an effort to correct imbalances in the person’s “energy field”) can soothe this agitation and reduce the disruptive behavior. One study found that they also reduced levels of the stress hormone cortisol.

Aromatherapy. Aromatherapy won’t slow the progression of the disease, but it can help calm agitated behavior. In one study involving 15 severely demented and agitated people in a nursing home, researchers filled the air of the Alzheimer’s unit with the scent of either lavender oil or a placebo for two hours a day. After the aromatherapy, 9 of the 15 patients were significantly less agitated. Another study using lemon balm oil applied to the face and arms twice a day showed similar results. Try a room diffuser plugged into the wall, or mix 10 to 20 drops of either oil in a 6-ounce bottle of filtered water with a tablespoon of plain vodka or grain alcohol. Shake, then spray the room and/or the bedclothes prior to sleep.

Prevention

Get 30 minutes of physical activity a day. Doing so could reduce your risk of Alzheimer’s by 50 percent-even more if you increase the amount of activity.

Take a baby aspirin every day. This can protect you against cardiovascular disease; studies also suggest that regular use of nonsteroidal anti-inflammatories like aspirin or ibuprofen can cut your risk of Alzheimer’s by about one-third. A baby aspirin, or 81 milligrams, a day is all you need.

Exercise your mind. Certain activities that stretch your mind, like chess or crossword puzzles, actually help rewire your brain, increasing the number of synapses, or connections, between brain cells. One study found such activities could lower your risk of developing Alzheimer’s disease or any other form of dementia by as much as 75 percent.

Maintain a healthy weight. One long-term study of 1,500 adults found those who were obese in middle age were twice as likely to develop dementia in later life.

Get your cholesterol under control. See the entry on high cholesterol for specific tips and advice.

Follow a brain-healthy diet. That means no more than 30 percent fat, with little or no trans and saturated fats, plenty of foods rich in vitamins E and C and beta-carotene (like dark green leafy and brightly colored vegetables), lots of fish, flaxseed oil, walnuts, and other sources rich in polyunsaturated fatty acids, and regular consumption of foods high in antioxidant flavonoids, such as tea, berries, pomegranates or pomegranate juice, and dark chocolate.

Take this vitamin trio. Take a B vitamin complex to maintain normal homocysteine levels. Also take 400 IU vitamin E and 1,000 milligrams vitamin C a day. One study of 4,740 Utah residents ages 65 and older found taking both vitamins daily for three years reduced the prevalence of Alzheimer’s 78 percent.

Take 1 to 2 grams fish oil daily. When researchers followed 815 people ages 65 to 94 for several years, they found that those who ate fish once a week or more were 60 percent less likely to develop Alzheimer’s than those who never or rarely ate fish. Fish oil capsules ensure you get the omega-3 fatty acids found in fish.