GLOBAL HEALTH AGING

The McMaster Health Forum, with support from the Labarge Optimal Aging Initiative, recently hosted a public talk to examine the latest research and evidence into risks, prevention and treatment of Alzheimer’s disease. This talk featured presentations by Jay Ingram, one of Canada’s best-known and most popular science personalities, and Dr. Christopher Patterson, an expert on the diagnosis and treatment of dementia.

“My experience is that when you talk to people about Alzheimer’s, they have three questions,” said Ingram. “The first one is always ‘am I going to get it?’ The second is ‘If it looks like I’m likely to get it, what can I do to lower that risk?’ And the third question is ‘if that doesn’t work and I do get it, what are the prospects?’”

Will I get Alzheimer’s?

Early-onset familial Alzheimer’s

“There are two kinds of Alzheimer’s disease – early onset familial Alzheimer’s, which you inherit and is a dominant gene. If you had a parent with this kind of Alzheimer’s, you have a 50/50 chance of getting it yourself,” said Ingram.

But, he cautioned, “That’s so not the norm. There’s really only three genes that have been absolutely identified as early onset familial genes. They represent something less than 1% of all Alzheimer’s.”

Also, not every case of early-onset Alzheimer’s is genetic.

“Yes, there’s a risk but it’s a very tiny risk. For the most part, I think you could set that aside,” said Ingram.

Late-onset Alzheimer’s

“There’s really only one gene that has been unambiguously associated with late-onset Alzheimer’s (that is 65-70 years old and older),” said Ingram. “It comes in three varieties. One is bad, one is neutral and one is actually beneficial.”

“Let’s say, worst case scenario, I’m carrying two copies of the bad gene called APOE4. The most pessimistic of studies would say that that my risk is now 15-fold greater than it would have been. So you might think I’m terrified, but there are some other facts to consider. About half of the people who have the two bad genes never get Alzheimer’s. Plus, a good percentage doesn’t have those genes and do get it.”

“As far as late-onset, it’s so ambiguous for my money, it’s not worth worrying about.”

What can I do to prevent Alzheimer’s?

“There’s this whole constellation of effects, but when you put them together, I think they boil down to some pretty commonsense things,” said Ingram. “Exercise, watch your weight, watch your blood pressure, engage socially and keep your mind active. These are all sort of commonsense things that one should do in life.”

Education

“Education has been shown to be clearly related to your risk of dementia. The further you go in school, the less likely you are to become demented,” said Ingram. “If you continue on in what is defined as a mentally stimulating job, you’re also better off.”

Exercise

The single most important thing that older adults can do to prevent dementia is to walk 35 or 40 minutes a day.

“Exercise. Why is that important? Cardiovascular health, the health of your circulatory system and, maybe most importantly, your blood pressure are all risk factors, if they’re in decline, for Alzheimer’s disease,” said Ingram.

Be social

“There have been studies that show that it’s not even the kind of activities you do, its the number of them that you engage in and the number of people with whom you engage,” said Ingram.

Other factors

• There is good epidemiological evidence that people who adhere to a Mediterranean-type diet are least likely to develop Alzheimer’s.
• People who watch a lot of TV are more likely to become demented.
• Obesity and diabetes are risk factors for Alzheimer’s

Does having diabetes increase the risk for Alzheimer’s disease?

“If you have diabetes, your risk of developing dementia is about twice that compared to if you don’t have diabetes. Certainly, management of blood sugar is important. Whether that actually changes the progression of the disease, I don’t think we know but we would suspect that it would because appropriate management delays other vascular complications,” said Dr. Patterson.

Can cognitive exercises help improve brain function?

“The evidence for enhancing your memory by doing those memory exercises is not nearly as solid as the evidence for physical activity,” said Ingram.

“The evidence is that, in earlier stages of cognitive impairment, you see improvements in those domains in which you practice. If you do memory tests, it may not necessarily improve executive function,” said Dr. Patterson.

How does dementia impact the quality of life for caregivers?

Dr. Patterson commented that in a research project, in which he was involved, quality of life did not diminish in individuals over different stages of the disease whereas for caregivers it clearly did.

“While we talk about memory loss so much , the most disturbing change to families is not the memory loss but the change of mood or affect or personality. That’s where people feel they’ve lost the person,” added Ingram.

If I do get Alzheimer’s, what can I do about it?

Education 

“Understanding the disease and what’s going to happen to that person overtime is extremely important,” said Dr. Patterson. “Also, learning how to deal with some of the behaviors that may evolve as the disease progresses is by far the most important part of management of individuals with dementia.”

Support

Dr. Patterson highlighted that it is important to recognize “that being a caregiver for an individual with dementia is extremely stressful.”

Case management is a way of supporting families through this journey.

Medications

“Of the whole management of individuals with dementia, medications really play the least part.”

“The single medication that is commonly prescribed these days, will stabilize cognition for 9-12 months,” said Ingram. “As the cells generating neurotransmitters die, to a degree, you can replace them chemically. But, the cells are still dying and eventually you can’t make it up chemically.”

Patients may be prescribed medications to help with other symptoms of the disease.

“In the future, there may be medications that can literally interrupt the sequence of the disease,” said Dr. Patterson.

“So what do we do in the meantime? We can do lots of things that make us healthier and happier people. We hope that with increasing general health, reduction of diabetes, and daily exercise slow down the obesity train. That may be, at least in the short-term, the most effective thing we can do,” said Ingram.

The rest of the summary is available here and the video below presents highlights from the event.