Stopping Alzheimer's Before it Starts

WebMD Live Events Transcript

In a perfect world Alzheimer's disease would be a distant memory, but until we have a cure, prevention is a vital step toward stopping memory loss and dementia. Daniel Amen, MD, and William Rodman Shankle, MD, co-authors of Preventing Alzheimer's, joined us on May 20, 2004, to discuss the steps you can take to reduce risk factors for this devastating disease.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome back to WebMD Live, Dr. Amen, and hello, Dr. Shankle. Tell us what brought you two together to produce Preventing Alzheimer's .

SHANKLE:
In the process of developing early detection and disease management automated online tools, we next moved into the area of reducing risks and preventing the appearance of the first symptoms of Alzheimer's and other causes of memory loss.

At that point Dr. Amen, who is an expert in brain imaging, had been referring patients to me for evaluation and treatment, and we discussed the idea of integrating the activity of the brain through imaging and the ability to prevent or delay Alzheimer's and other causes through reducing the risk factors associated with these conditions. That was the beginning of Preventing Alzheimer's , the book.

From that point, we then reviewed the world literature to identify those risks and treatments that were associated with a quality of evidence that would be accepted by the FDA to approve a new drug, for example, and that is what appears in the book -- those things that are very well established to reduce the Alzheimer's disease and other causes.

MODERATOR:
At just how young an age should we begin the prevention process?

SHANKLE:
The prevention process should begin at approximately age 40. That is because on the average, Alzheimer's disease begins 30 years before the first symptoms appear. The average age of onset of the first symptoms is approximately 67 years old, so it makes sense to begin reducing one's risk for developing these disorders that rob one's mind around the time these diseases actually begin in the brain.

This is not unprecedented; for example both diabetes and hypertension have long periods with no symptoms before the diseases actually express symptoms.

MODERATOR:
On the other side of the coin, is it ever to late, age -wise, to take preventative steps?

SHANKLE:
In practical terms it's never too late. The studies show that persons who engage in risk reduction and prevention through delay will benefit, at least if they start before the age of 80 years old. So there's a very long period in which people benefit by reducing their risks.

"The prevention process should begin at approximately age 40. That is because on the average, Alzheimer's disease begins 30 years before the first symptoms appear."

MEMBER QUESTION:
Do vitamins B, C, E, and folic acid help in reducing your chances of getting Alz.? Which amounts should be taken? Will the vitamin E cause an elevation in bad cholesterol? I had read it does and have discontinued vitamin E because my bad cholesterol stays too high. My father died with Alz. and I am 52 yrs. old.

SHANKLE:
This is an excellent question, and it points out the need to identify precisely what one's risks are, so that one knows which treatments are going to help. And once you know which treatments are going to help, you also need to know what the potential risks are for taking those treatments.

In reviewing the literature on these various supplements that are available -- vitamin C, D, E, folic acid, and others -- it is very clear that there are risks in taking each of them that need to be known. It is also very clear there are interactions with medications that are prescribed that need to be known. In optimizing one's treatment strategy to prevent Alzheimer's, you first need to know the risks and how the preventive agents interact with things you currently take. This was the goal of the online prevention program we have developed. Vitamin E, as a good example, does increase the risk of bleeding at doses above 1000 units a day, and it suppresses the immune system, so there are real reasons to know precisely how much to take.

That said, vitamin C and E do, in fact, reduce the risk of developing impairment in memory as one ages, by about 30 percent, and a recent study has shown approximately a 70 percent risk reduction for Alzheimer's.