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.

MEMBER QUESTION:
So are you saying that there is not a set amount of these vitamins to take and it could be different for everyone? What kind of doctor should I see to set this vitamin regimen?

SHANKLE:
There probably isn't a doctor that can tell you what to take. This is why we have developed, as a companion to Preventing Alzheimer's , an automated online prevention program that tailors the treatment to each person based on a comprehensive review of his or her risks. Once you have that knowledge you can go to your doctor and they can look at what medications you're taking and see if they are safe to take as the prevention treatment. That's why Dr. Amen and I worked so hard to create a quality book to give people the kind of evidence they need to really reduce their risks.

For those who are interested, the prevention program that complements what the book provides, and tailors a prevention program, is preventad.com.

MEMBER QUESTION:
What about ginkgo biloba?

SHANKLE:
Ginkgo has been rather widely studied, and it shows benefits in areas of heart disease and in diabetes, and most of the studies show that it reduces the progression of memory loss in various causes of dementia, such as Alzheimer's and other conditions. It's not clearly established like vitamin E, though, for example.

MEMBER QUESTION:
I was reading in a Time magazine recently that inflammation is one cause or sign of Alzheimer's. My grandmother on my Dad's side has Alzheimer's. My dr. informed me that my hips and sternum were inflamed and that I just needed to do yoga to stop the pop, pop, popping. Basically I want to stop it before it happens to me. What can I do?

SHANKLE:
Inflammation is not an early change of Alzheimer's; it is a late change. When the plaques of Alzheimer's start to appear in the brain, it attracts inflammatory cells, and that is the inflammation people speak of. But that is a later change rather than an earlier change

AMEN:
Inflammation from any cause is not helpful to brain function, but ibuprofen and aspirin calm inflammation. So taking care of the inflammation in your body is useful, probably for your brain, as well.

SHANKLE:
It's interesting, to amplify that point, that the anti-inflammatory medications reduce the risk of Alzheimer's by about 50 to 75 percent. But the effect is not due to reducing inflammation, because the doses required are so low that they don't exert an anti-inflammatory effect in the brain. We know, for example, that ibuprofen, which is also known as Motrin or Advil, blocks the production of the beta-amyloid, which is one of the primary causes of Alzheimer's. So even though inflammation is a pathological process, a disease process itself, the anti-inflammatories are protecting against Alzheimer's in some other way.

It's also very interesting that in general the studies show that aspirin reduces the risk of Alzheimer's by about 33 percent. But there is a group of people where aspirin doubles the risk of Alzheimer's in persons who do not have the apo-lipo protein E4 gene. That gene, the E4 gene, is the major genetic risk for the most common form of Alzheimer's disease, and yet in people without the E4 gene, if they take aspirin the risk of Alzheimer's doubles. That's a very recent study, and it points out the importance of truly knowing your risks so you can select the proper treatment

MEMBER QUESTION:
Do you advise taking a gene test?

AMEN:
Yes, we do. We think that people should know their apo E genotype; if they have the E4 gene they are at two-and-a-half times the risk for getting Alzheimer's disease. If they have two copies of it, because we get one copy from our mom and one from our dad, they are at five to 10 times the risk.

Having the E4 gene does not necessarily mean that you're going to get Alzheimer's disease, but it means that you're at greater risk and you should take prevention more seriously.

MEMBER QUESTION:
What does a gene test entail, and what kind of doctor does them and reads them?

AMEN:
It's just a blood test your family doctor can have done at any lab. They then send it off to a special lab. It's becoming more and more common.

"Having the E4 gene does not necessarily mean that you're going to get Alzheimer's disease, but it means that you're at greater risk and you should take prevention more seriously."

MEMBER QUESTION:
Tell us more about the online prevention program. Is it a study or experiment?

AMEN:
At preventad.com people can take an online screening test that is highly sensitive to uncovering early memory loss, and then based on the test and questions it will help you assess your risk and give you specific things to do about it.

MEMBER QUESTION:
I have been struggling with anxiety and depression for the last three years and since then have been taking different antidepressants. Does this mean I will have a higher risk of getting Alzheimer's disease as I get older?

AMEN:
Great question. It is really untreated depression that increases people's risk, not only for Alzheimer's disease, but also for heart disease. So getting the anxiety and depression treated is absolutely critical to continued mental health and cognitive health.

MEMBER QUESTION:
With the recent release of information indicating a tie between diabetes and Alzheimer's, I am concerned with my situation. I'm a 46 year old with diabetes on insulin treatment for 11 years now. I was in the Army then and allowed to be retained until 2002. In Nov. of 2001 I had a serious memory loss episode. It started with short-term memory and got to the point where my family took me to the hospital for treatment when I woke up crying because I couldn't remember how much insulin to take. The hospital wrote it off as out of control diabetes and released me when my memory began to improve. What is your opinion?

AMEN:
Diabetes does increase the risk for Alzheimer's disease, and doing everything you can to get it under control is critical. In addition, it's important to do the prevention strategies we outline in the book so you can work to keep your brain healthy as you age. The right diet, exercise, and supplements that are appropriate to you are all very important. It also means since diabetes increases the risk, it means you have to work closely with your doctor to get the diabetes under control for you.

MEMBER QUESTION:
What is the difference between memory loss and signs of Alzheimer's?

AMEN:
I don't really want people to think about "regular" memory loss, because it's a little bit of a myth that we lose our memories as we age. In the studies we've done of older people, when you start to lose your memory, your brain is becoming significantly less active and putting you at risk for greater problems. Alzheimer's disease is a progressive loss of memory, so if you notice, or people in your family notice, because they often notice first, that your memory is getting worse and worse, that's the point to be concerned and to get an evaluation.

MEMBER QUESTION:
Is there a test to determine if you have Alzheimer's? My mother had it; are my chances greater than others? I have some memory problems now.

AMEN:
If your mother had it you are at greater risk to get it. We know having a family history of Alzheimer's disease or other forms of severe memory loss increases one's risk. A good evaluation is essential. Start with the checklist in the book or go to preventad.com and do the test.

In my four clinics across the country we do a study called Brain SPECT imaging that looks at blood flow and activity patterns on the brain. We use it to help us diagnose people with Alzheimer's disease and other forms of dementia.

MEMBER QUESTION:
Where are your clinics located and does insurance cover costs?

AMEN:
My four clinics are located in Newport Beach and Fairfield, CA,
Tacoma, WA, and Reston, VA.

It's hard to say about insurance, because there are so many types of companies it's variable. I often recommend if you're going to get screened for the E4 gene and screened for Alzheimer's disease that you pay for it yourself. It's possible that you could be discriminated against with the information, so I recommend people pay for it themselves.

"I don't really want people to think about 'regular' memory loss, because it's a little bit of a myth that we lose our memories as we age."

MEMBER QUESTION:
What about minor clots discovered in head scan?

AMEN:
Was there a history of a head injury?

MEMBER:
Yes.

AMEN:
This is a good opportunity to talk about brain injuries and the risk of Alzheimer's disease. People who have the apo E4 gene who also have a brain injury have a significantly higher risk of developing Alzheimer's disease. So if you have a brain injury, find out your apo E4 genotype, and if you have the E4 gene be very diligent about using the prevention techniques we discussed. I think anyone who has a brain injury needs to be diligent about keeping their brain healthy because they are at more risk for developing problems.

MEMBER QUESTION:
Is it true that Alzheimer's is inherited from the maternal parent rather than the paternal?

AMEN:
No. It can come down either side.

MEMBER QUESTION:
About a decade ago there was a lot of talk about the relationship of aluminum (eg. food prepared in aluminum cookware) and Alzheimer's. Is there any truth here?

AMEN:
Aluminum is not healthful for the brain, and I think we should be cautious about it.

On that same thought, there's a recent study that suggests that people who get flu vaccines are at increased risk for Alzheimer's. One of the preservatives in many vaccines is mercury, and one has to ask ones self what's the need to put a neurotoxic preservative in, because mercury is clearly toxic to the brain.

MEMBER QUESTION:
What is the latest about Aricept effects and side effects?

AMEN:
Aricept has been out for a number of years now. It works by increasing the availability of a neurotransmitter called acetylcholine in the brain. There are a couple of other medicines that work like Aricept. They tend to be helpful early in the disease and not terribly helpful late in the disease. Many of my patients over the years have found them to be helpful, especially early on.

Aricept is usually well tolerated; sometimes it's associated with muscle cramps or GI symptoms. I have one patient I'm thinking about whom, when put on Aricept, said "it was like going from 8 megabytes of RAM in my head to 128." So clearly it is helpful for some people.

MEMBER QUESTION:
I am 72, in good health, and my wife says I am getting forgetful. My only fear is Alzheimer's. What should I be doing to reduce my risk of contracting this disease?

AMEN:
First thing: take your wife's concerns seriously. Get screened, and if the screening shows there's a problem, get a good evaluation. Women usually see problems significantly before men do. And then I would obviously read the book and eat in a healthy way. Consider taking regular supplements, depending on your situation, exercise four or five times a week, and engage in life-long learning.

"People don't think about the brain, yet it runs absolutely everything we do. But we spend more money on our skin and on our behinds than we do our brain."

MODERATOR:
How about crossword puzzles?

AMEN:
Crossword puzzles are good if you like them.

MODERATOR:
We are almost out of time. Do you have any final words on Alzheimer's for us?

AMEN:
We now have some very exciting imaging tools that help us actually look at brain function. I think they're dramatically underutilized, and in the right context they can help people understand what their risk of Alzheimer's might be, and help people intervene as soon as possible.

Probably the most exciting part of writing this book was to really understand and lay out that people can take control over their own brain health. People don't think about the brain, yet it runs absolutely everything we do. But we spend more money on our skin and on our behinds than we do our brain. That's really silly. So taking brain health seriously will allow you the quality of life that keeps the golden years golden and not put your families under tremendous stress.

MODERATOR:
Thanks to Daniel Amen, MD, and William Rodman Shankle, MD, for sharing their expertise with us. For more information please read Preventing Alzheimer's .

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