January 2009
Protecting your memory
Advances in treating (and avoiding) Alzheimer's disease.
Alzheimer's shrinks areas of the brain involved in thinking, planning, and remembering.
© 2007 Alzheimer's Association. All Rights Reserved. Illustration by Stacy Janis.
© 2007 Alzheimer's Association. All Rights Reserved. Illustration by Stacy Janis.
After years of dashed hopes and diminished expectations, researchers now have guarded optimism in the battle against Alzheimer's disease. Two drugs typically used separately against the disease, for example, show unexpected benefits when taken together, a 2008
study has found. And advances in understanding how Alzheimer's develops is helping researchers zero in on new ways to combat
the disease. At least as critical, they've identified lifestyle changes that might help prevent cognitive decline in the first
place. "There is every reason to be optimistic and excited about the momentum of Alzheimer's research," says Gary Kennedy,
M.D., director of geriatric psychiatry at Montefiore Medical Center in New York City.
Better treatment options
Standard treatment for Alzheimer's has been limited mainly to either cholinesterase inhibitors (CIs) such as donepezil (Aricept) and galantamine (Razadyne), or another drug, called memantine (Namenda). CIs and memantine regulate different brain chemicals, which are important to memory. Taken separately they slow the progression of the disease in only about 10 to 20 percent of patients, and even then only modestly.
But the new study, published in the journal Alzheimer Disease and Associated Disorders, found that over the course of three years the combination therapy, on average, cut the rate of decline in half compared with a CI alone. And the longer the patients took the drugs, the more dramatic the benefits.
"The combination won't cure the disease," said Alireza Atri, M.D., Ph.D., lead author of the study and a memory disorders specialist at Massachusetts General Hospital. "But if you want the best chance of preserving as much cognitive and functional ability as you can, my advice for patients with Alzheimer's disease is to get on combination therapy and stay on it until we have more powerful treatments." Experts not involved in the study agree. "I've been treating people with Alzheimer's since the 1980s," Kennedy says. "Now I routinely have patients on a CI and memantine, and I think they're doing much better."
If you're considering the drugs for yourself or someone you care for, remember that even the combination won't reverse the disease, just slow its progression. They're also expensive, ranging from about $1,700 to $2,600 a year per drug. Side effects can include constipation, diarrhea, and headache, but they're usually mild. Our consultants think it makes sense to try the drugs for a year or more under the scrutiny of a doctor and family members.
Researchers hope that other drugs being tested in clinical trials may go further to actually reverse cognitive decline. For example, in a study published in the July 19, 2008, issue of the journal Lancet, 183 people with Alzheimer's were given a placebo or an antihistamine used in Russia, called Dimebon, which might also help prevent the death of nerve cells. After six months, those on the drug showed improved cognition, function, and behavior. The most common side effects were dry mouth and depression. For information about enrolling in a trial of the drug, go to http://www.clinicaltrials.gov.
Diagnosis vs. denial
Because current drugs only slow the progression of Alzheimer's, it's important to identify the condition before problems become severe. Prompt diagnosis is crucial for other reasons as well. Detecting it when patients still have fairly good mental function allows them to participate in making treatment decisions. And memory problems can stem from reversible causes, such as depression, thyroid problems, vitamin deficiencies, and side effects from certain medications. But people commonly deny or cover up early signs of Alzheimer's for fear of being stigmatized, according to a 2008 report by the Alzheimer's Association. That leads to lengthy delays in diagnosis. A recent Harris Interactive survey found that when symptomatic people or their caregivers worried about stigma, diagnosis occurred up to six years later.
A standard diagnostic workup should include a complete physical including lab tests and often an MRI, to rule out other causes, as well as cognitive tests to assess mental status. "The accuracy of diagnosis is best at centers that specialize in Alzheimer's disease or geriatrics,"says Samuel Gandy, M.D., a professor at the Mount Sinai School of Medicine in New York City. To get a referral, go to the Geriatric Mental Health Foundation or the American Geriatrics Society or contact a local teaching hospital.
Prevent mental decline
Of course, prevention is even better than early diagnosis or treatment. And recent research suggests several helpful strategies. For example, a 2008 Swedish study of about 2,200 men found that those at increased risk for type 2 diabetes in midlife were more likely to later develop Alzheimer's. And a Brazilian study of some 420 older adults, presented at the 2008 International Conference on Alzheimer's Disease, showed that those with multiple heart-disease risk factors had a higher level of cognitive impairment compared with a similarly aged group of healthy people.
In general, anything that protects the heart and blood vessels, thereby facilitating blood flow to the brain, might help fend off Alzheimer's. That makes it doubly important to adopt a heart-healthy lifestyle and to work with your doctor to control cardiovascular risk factors. Other evidence indicates that the following measures might also help.
Stay fit. "Physical activity increases the maturation of nerve cells in the hippocampus, the area that's responsible for forming new memories," Kennedy says. In another study presented at the same conference, researchers from the University of Kansas measured brain size and cardiovascular fitness in 63 people with early Alzheimer's. Those who were more fit had greater volume in brain regions that are important for memory. In another 2008 study, researchers assigned 170 older people at risk for Alzheimer's to increased exercise or standard care. After six months, the exercisers showed improved cognitive function compared with the control group.
Recommendation: Aim for 30 minutes of moderate-intensity aerobic activity, such as brisk walking, daily or most days.
Flex your brain muscles. Socially and intellectually stimulating activities might also increase brain function. For instance, MRI scans revealed that regions of the brain responsible for learning were enlarged in London cab drivers, who train for up to two years to memorize thousands of streets and locations. And in a 2008 study, researchers from Johns Hopkins and Duke University found that men who participated in mentally and socially engaging activities in midlife had a lower risk of dementia.
Recommendation: Stay connected with family and friends, join a hobby group, or do volunteer work. Cultivate a variety of mental pursuits, such as playing chess or bridge, doing crossword puzzles, or learning a language.
Feed your brain. Several 2008 trials failed to find cognitive benefits in fish oil or ginkgo biloba supplements. But people over the age of 50 might benefit from more B12, from fortified foods or supplements, since many lack an enzyme needed to digest that brain-boosting vitamin when it comes from food. And research suggests that regular consumption of fish and fruits and vegetables might support brain health.
Recommendation: Include fish in your diet and aim for at least five servings a day of fruits and vegetables. Avoid saturated and trans fats, which may hasten cognitive decline and consider extra vitamin B12 if you're older than age 50.
This article first appeared in the January 2009 issue of Consumer Reports on Health.
Better treatment options
Standard treatment for Alzheimer's has been limited mainly to either cholinesterase inhibitors (CIs) such as donepezil (Aricept) and galantamine (Razadyne), or another drug, called memantine (Namenda). CIs and memantine regulate different brain chemicals, which are important to memory. Taken separately they slow the progression of the disease in only about 10 to 20 percent of patients, and even then only modestly.
But the new study, published in the journal Alzheimer Disease and Associated Disorders, found that over the course of three years the combination therapy, on average, cut the rate of decline in half compared with a CI alone. And the longer the patients took the drugs, the more dramatic the benefits.
"The combination won't cure the disease," said Alireza Atri, M.D., Ph.D., lead author of the study and a memory disorders specialist at Massachusetts General Hospital. "But if you want the best chance of preserving as much cognitive and functional ability as you can, my advice for patients with Alzheimer's disease is to get on combination therapy and stay on it until we have more powerful treatments." Experts not involved in the study agree. "I've been treating people with Alzheimer's since the 1980s," Kennedy says. "Now I routinely have patients on a CI and memantine, and I think they're doing much better."
If you're considering the drugs for yourself or someone you care for, remember that even the combination won't reverse the disease, just slow its progression. They're also expensive, ranging from about $1,700 to $2,600 a year per drug. Side effects can include constipation, diarrhea, and headache, but they're usually mild. Our consultants think it makes sense to try the drugs for a year or more under the scrutiny of a doctor and family members.
Researchers hope that other drugs being tested in clinical trials may go further to actually reverse cognitive decline. For example, in a study published in the July 19, 2008, issue of the journal Lancet, 183 people with Alzheimer's were given a placebo or an antihistamine used in Russia, called Dimebon, which might also help prevent the death of nerve cells. After six months, those on the drug showed improved cognition, function, and behavior. The most common side effects were dry mouth and depression. For information about enrolling in a trial of the drug, go to http://www.clinicaltrials.gov.
Diagnosis vs. denial
Because current drugs only slow the progression of Alzheimer's, it's important to identify the condition before problems become severe. Prompt diagnosis is crucial for other reasons as well. Detecting it when patients still have fairly good mental function allows them to participate in making treatment decisions. And memory problems can stem from reversible causes, such as depression, thyroid problems, vitamin deficiencies, and side effects from certain medications. But people commonly deny or cover up early signs of Alzheimer's for fear of being stigmatized, according to a 2008 report by the Alzheimer's Association. That leads to lengthy delays in diagnosis. A recent Harris Interactive survey found that when symptomatic people or their caregivers worried about stigma, diagnosis occurred up to six years later.
A standard diagnostic workup should include a complete physical including lab tests and often an MRI, to rule out other causes, as well as cognitive tests to assess mental status. "The accuracy of diagnosis is best at centers that specialize in Alzheimer's disease or geriatrics,"says Samuel Gandy, M.D., a professor at the Mount Sinai School of Medicine in New York City. To get a referral, go to the Geriatric Mental Health Foundation or the American Geriatrics Society or contact a local teaching hospital.
Prevent mental decline
Of course, prevention is even better than early diagnosis or treatment. And recent research suggests several helpful strategies. For example, a 2008 Swedish study of about 2,200 men found that those at increased risk for type 2 diabetes in midlife were more likely to later develop Alzheimer's. And a Brazilian study of some 420 older adults, presented at the 2008 International Conference on Alzheimer's Disease, showed that those with multiple heart-disease risk factors had a higher level of cognitive impairment compared with a similarly aged group of healthy people.
In general, anything that protects the heart and blood vessels, thereby facilitating blood flow to the brain, might help fend off Alzheimer's. That makes it doubly important to adopt a heart-healthy lifestyle and to work with your doctor to control cardiovascular risk factors. Other evidence indicates that the following measures might also help.
Stay fit. "Physical activity increases the maturation of nerve cells in the hippocampus, the area that's responsible for forming new memories," Kennedy says. In another study presented at the same conference, researchers from the University of Kansas measured brain size and cardiovascular fitness in 63 people with early Alzheimer's. Those who were more fit had greater volume in brain regions that are important for memory. In another 2008 study, researchers assigned 170 older people at risk for Alzheimer's to increased exercise or standard care. After six months, the exercisers showed improved cognitive function compared with the control group.
Recommendation: Aim for 30 minutes of moderate-intensity aerobic activity, such as brisk walking, daily or most days.
Flex your brain muscles. Socially and intellectually stimulating activities might also increase brain function. For instance, MRI scans revealed that regions of the brain responsible for learning were enlarged in London cab drivers, who train for up to two years to memorize thousands of streets and locations. And in a 2008 study, researchers from Johns Hopkins and Duke University found that men who participated in mentally and socially engaging activities in midlife had a lower risk of dementia.
Recommendation: Stay connected with family and friends, join a hobby group, or do volunteer work. Cultivate a variety of mental pursuits, such as playing chess or bridge, doing crossword puzzles, or learning a language.
Feed your brain. Several 2008 trials failed to find cognitive benefits in fish oil or ginkgo biloba supplements. But people over the age of 50 might benefit from more B12, from fortified foods or supplements, since many lack an enzyme needed to digest that brain-boosting vitamin when it comes from food. And research suggests that regular consumption of fish and fruits and vegetables might support brain health.
Recommendation: Include fish in your diet and aim for at least five servings a day of fruits and vegetables. Avoid saturated and trans fats, which may hasten cognitive decline and consider extra vitamin B12 if you're older than age 50.
This article first appeared in the January 2009 issue of Consumer Reports on Health.
