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Senior Life: Tips for Healthy Living - Alzheimer's Disease: How can I reduce my risk?

Pharmacy

As a consulting pharmacist in the nursing home setting, one of my primary consulting responsibilities is to review the medication lists of facility patients and make recommendations to ensure that the resident’s medication list is free of drug interactions, unnecessary medications, duplicate therapies, high-risk medications, and anything that could increase their risk of falls or cause a negative impact on existing disease states.  One of the disease states that we commonly come across in this setting is Alzheimer’s disease (AD), which affects up to 20% of individuals over the age of 80.  While we can decrease or stop certain medications to minimize their effect on AD, including worsening memory loss and confusion, remedies to actually reverse these unfortunate conditions simply do not exist at this time. The two classes of medications prescribed when a patient is diagnosed with AD, which include Aricept ® and Namenda ®, have been found to improve some of the associated symptoms of Alzheimer’s disease including cognition, behavioral concerns, and the ability to perform daily self-care activities. Unfortunately, these medications have not been found to restore memory or stop the further progression of memory loss.  This is frustrating for the individual and their families, and explains why so much attention is directed towards what can be done to help “prevent” the development of Alzheimer’s disease before it ever starts. 

Before discussing ways to prevent the development of Alzheimer’s disease, it is important to understand what it is and the difference between dementia and AD.  Dementia is not a disease on its own, but rather a group of symptoms which includes a decline in memory, reasoning, and thinking skills.  Dementia is a component of many diseases, including AD, which accounts for two-thirds of all cases.  Alzheimer’s disease is diagnosed by gathering a detailed history of the patient’s symptoms, conducting mental status testing, then combining that with brain imaging studies to rule out other causes of memory deficits such as stroke, tumors, or trauma.  Brain imaging detects plaques formed when protein pieces called beta-amyloids clump together and block nerve transmission in the brain.

So what can you do to try and prevent the development of Alzheimer’s disease?  Recent additions to the literature offer several strategies that have been found to be effective for decreasing the risk, which is especially true for those with a family history of AD.  It is important to note, that while anything you can do to promote a healthy lifestyle is beneficial to the body as a whole, changes in the biology of the brain leading to Alzheimer’s disease may begin 15 years before symptoms begin, therefore it is important to consider these strategies early on in life:

  1. Physical Activity (150 minutes of moderate exercise per week or 75 minutes of intense physical activity per week)
  2. Engage in mentally stimulating activities, such as reading, brain games, etc
  3. Quit Smoking (this is beneficial at any age!)
  4. Control the disease states that relate to heart health (diabetes, high blood pressure, atrial fibrillation, high cholesterol, etc)
  5. Maintain a healthy weight
  6. Treat depression with medications and/or counseling
  7. Reduce your risk of head injury or head trauma by identifying fall prevention strategies and wearing helmets if on bikes, etc
  8. Decrease alcohol consumption
  9. Correct hearing problems if able                                                        
  10. Address sleep issues and practice good sleep hygiene
  11. Talk to your doctor or pharmacist about any anticholinergic medications you might be taking, which can contribute to the progression of dementia or AD.  These include antihistamines, some older antidepressants, overactive bladder agents, muscle relaxers, antipsychotics, among others
  12. Find ways to decrease and manage stress
  13. Ask your provider to check your homocysteine levels, as you may benefit from taking Vitamin B and Folic Acid if it is found to be low                                                                                     

The mechanism by which most of these strategies work is either by decreasing damage to the vascular tissue in the brain or by increasing your brain’s cognitive reserve.  Some of these strategies can overlap and do both. The best approach to delaying the onset of AD is to practice a combination of multiple strategies!

Unfortunately, not many supplements have shown to be effective at reducing the risk for Alzheimer’s disease. Many people ask about the over-the-counter supplement Prevagen®, which is a protein purported to improve memory. There is no evidence to support the use of this product and actually, the manufacturer recently settled a class action lawsuit for making deceptive claims.  

In summary, while the treatment options for Alzheimer’s disease and other forms of dementia need more research, strategies to prevent its development have been studied and proven effective.  A combination of lifestyle changes and the proper management of cardiovascular diseases and diabetes are the most impactful, along with minimizing the use of medications that may worsen symptoms are all important.

Baumgart M, Snyder HM, Carrillo MC, Fazio S, Kim H, Johns H. Summary of the evidence on modifiable risk factors for cognitive decline and dementia: A population-based perspective. Alzheimers Dement. 2015 Jun;11(6):718-26.

Grossberg, George T. et al. ‘Present Algorithms and Future Treatments for Alzheimer’s Disease’. 1 Jan. 2019: 1157-1171.

Livingston G, Huntley, J, Sommerlad, A, et al. Dementia prevention, intervention, and care:  2020 report of the Lancet Commission.  Lancet 2020 396: 413–46. 

Clinical Resource, Strategies to Reduce Dementia Risk. Pharmacist’s Letter/Prescriber’s Letter. November 2020.

Yu J, Xu W, Tan C, et al. Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomized controlled trials Journal of Neurology, Neurosurgery & Psychiatry 2020;91:1201-1209.

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