Alzheimer's Disease: Prevention Strategies

Alzheimer’s disease afflicts millions worldwide. It has no known cure, and the secrets to preventing it are not yet known. However, guidelines based on the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia offer hope that it can be delayed and even prevented by treating high blood pressure, avoidance of tobacco products and alcohol as well as regular exercise.

Who is at Risk for Alzheimer's?

Anyone aged above 65 or older with or without abnormal gene forms, for e.g., the apolipoprotein E gene [APOE] and the sortilin-related receptor 1 gene [SORL1] is at risk. Acquired risk factors include hypertension and diabetes, and probably many other factors yet to be defined. But there is a risk of early-onset (between ages 35 and 60) disease if one of the parents carries specific genetic mutations. The guidelines do not recommend genetic screening for asymptomatic individuals. Nonetheless, genetic testing may be offered to individuals with family history of Alzheimer’s disease.

Controlling Alzheimer's Risk Factors

Hypertension: While risk based on age and genetics is uncontrollable, preventive strategies to control high blood pressure and other stroke risk factors may help to avoid damage to blood vessels in the brain or reduction in brain’s oxygen supply. It is plausible that controlling high blood pressure could prevent damage to nerve cell circuits involved in decision-making, memory, and verbal skills. For instance, results of the Systolic Hypertension in Europe (SYST-EUR) study revealed a reduced risk of dementia among participants receiving antihypertensive treatment. Treatment with nitrendipine along with enalapril or hydrochlorothiazide reduced the blood pressure by at least 20 mm Hg in more than 3000 patients over 60 years old who had systolic blood pressures of 160–219 mm Hg and diastolic pressures below 95 mm Hg. Followed over a period of 2 years, there was a significant decrease in Alzheimer’s associated dementia. The guidelines recommend a target systolic blood pressure of less than or equal to 140 mm Hg for individuals aged above 60 years.

Other studies have linked type 2 diabetes with Alzheimer’s — the incidence of both disorders increases with age and genetic predisposition. They both involve glucose abnormalities and abnormal proteins. Neurofibrillary tangles and amyloid deposits occur in the brain cells of Alzheimer's patients. Managing glucose, blood pressure, blood lipids and proteins, therefore, may go a long way in preventing Alzheimer’s disease.

Changing Lifestyle: Current smokers are at increased risk of Alzheimer’s disease. Besides smoking cessation and reduced fat and alcohol intake, consumption of a Mediterranean-style diet and fish may decrease the risk. Some studies indicate that taking an antioxidant-rich diet may provide some protection against damage from free radicals (called oxidative damage).

High level of physical exercise (defined as 3 or more times weekly at intensity greater than walking) lowers the risk. Increased mental exercise has also been shown to delay cognitive decline. But individuals engaged in sports or activities such as bicycling predisposing them to head injuries should wear protective headgear including helmets.

Protective clothing may prevent exposure to environmental toxins such as pesticides, fertilizers, fumigants and defoliants that are associated with an increased risk.

Medications: It is still not established unequivocally that hormones, nonsteroidal anti-inflammatory drugs or vitamin E or C supplements can prevent Alzheimer’s. In any case, it is essential not to use the female sex hormones estrogen or progesterone, to reduce the risk.

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