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Alzheimer’s

Alzheimer’s in the most common kind of dementia. Alzheimer’s disease is a progressive, degenerative brain disease that results in loss of memory and mental function. Dysfunctional cellular processes result in neuron death. It progresses in stages, and people with Alzheimer’s experience gradual memory loss as well as loss of judgment, difficulty concentrating, loss of language skills, personality changes, and a decline in the ability to learn new tasks. In advanced stages, people with Alzheimer’s can lose all memory and mental abilities.

About 5 million Americans have Alzheimer’s and this number is expected to increase as the population grows older. How it progresses is different for each person. If Alzheimer’s develops rapidly, it is likely to continue to progress rapidly. If it has been slow to progress, it will likely continue on a slow course.

The effects of Alzheimer’s come because the disease kills brain cells. In a healthy brain, billions of neurons generate chemical and electrical signals that are relayed from neuron to neuron and help a person think, remember, and feel. Neurotransmitters — brain chemicals — help these signals move from cell to cell. In people with Alzheimer’s, neurons in certain places start to die, causing lower levels of neurotransmitters to be produced. That causes the brain to have problems with its signals.

There is no cure for Alzheimer’s, but there are some medications that can help slow the progression of the disease in some people. Some herbs and supplements, and lifestyle adjustments, may help reduce the risk or improve quality of life.

PREVENTIVE CARE

No one knows exactly how to prevent Alzheimer’s disease, but eating a healthy diet and exercising regularly help.

  • Eating more fatty, cold-water fish (such as tuna, salmon, and mackerel) may be associated with a lower risk of dementia. This may be because these fish have high levels of omega-3 fatty acids, which benefit the heart and the brain. Eating fish at least two to three times per week provides a healthy amount of omega-3 fatty acids.
  • Coconut oils are showing to provide the medium chain fatty acids needed for proper brain health. Watch this video on some amazing rapid improvements in memory believed to have derived from small doses of coconut oil rather quickly.
  • Antioxidants, such as vitamins A, E, and C (found in darkly colored fruits and vegetables), may help prevent damage caused by free radicals.
  • Maintaining normal blood pressure levels may reduce the risk for Alzheimer’s.
  • Some studies suggest that certain medications may prevent Alzheimer’s, including statin drugs (such as pravastatin or lovastatin, used to lower cholesterol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen. More research is needed to see how effective these medications are in reducing risk of the disease as recent studies suggest natural remedies may be as or more effective.
  • Keeping mentally and socially active may help delay the onset or slow the progression of Alzheimer’s.

NUTRITION

People with Alzheimer’s may need help with nutrition. They often forget to eat and drink, and, as a result, can become dehydrated.

Follow these tips for a healthy diet:

  • Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
  • Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables such as kelp and dulce.
  • Eat more high-fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
  • Avoid refined foods such as white breads, pastas, and especially sugar.
  • Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
  • Use healthy oils in foods, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
  • Avoid caffeine, alcohol, and tobacco.
  • Drink 6 – 8 glasses of filtered water daily.
  • Exercise.

NUTRIENTS SHOWN TO HELP

These supplements may help with some symptoms of Alzheimer’s, although further study is needed:

  • Phosphatidylserine, an important neurotransmitter naturally occurring in the brain, shows promise in several studies. Studies have shown it increases acetylcholine and decreases inflammation. This supplement increases levels of brain chemicals that deal with memory, according to several studies. Do not take phosphatidylserine if you are taking anticoagulants (blood-thinners), and use caution if combining it with ginkgo for the same reason. There are great differences in quality among phosphatidylserine supplements. You should consider spending more for a more expensive brand, as they tend to be better than cheaper brands.
  • Antioxidants may protect against the development of dementia. They may even slow the progression of dementia. In some, but not all, studies, vitamin E combined with Aricept may slow cognitive decline in people with Alzheimer’s disease. Another antioxidant, coenzyme Q10, may also help the brain get more oxygen. The skins of dark berries also provide valuable antioxidants. Many naturally-oriented physicians recommend eating half a cup of frozen blueberries daily — freezing makes the antioxidants in the berries’ skin more easily absorbed.
  • Vitamins: biotin (300 mcg); B1 (50 – 100 mg), B2 (50 mg), B6 (50 – 100 mg), B12 (100 – 1,000 mcg), folic acid (400 – 1,000 mcg). No scientific evidence shows a direct benefit, but B12 and folic acid lower the levels of an amino acid in the blood that is often elevated in Alzheimer’s patients. Injections of B12 may have the best results.
  • Zinc (30 – 50 mg per day) is often deficient in elderly people, and may help improve memory.
  • Alpha Lipoic Acid (ALA), fatty acid found in all cells, is a  powerful antioxidant that passes the blood brain barrier, chelates metals, reduces inflammation, and increases acetylcholine, the brain’s main memory nuerotransmitter.
  • Omega 3 Fatty Acids – DHA in particular, appears to help brain function.
  • Acetyle-L-Carnitine - helps mitochondria performance and brain cell energy production. It leverages ALA’s benefits.
  • Lithium, a mineral that helps increase neuroprotective proteins.
  • Melatonin, a powerful natural hormone with brain antioxidant characteristics.

HERBS

Herbs are generally a safe way to strengthen and tone the body’s systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 – 10 minutes for leaf or flowers, and 10 – 20 minutes for roots. Drink 2 – 4 cups per day.

  • Ginkgo (Ginkgo biloba), standardized extract, shows the best evidence for treating early Alzheimer’s disease and vascular dementia. If you are taking blood-thinning medication, use ginkgo only under the supervision of your doctor. It has antioxidant and anti-inflammatory properties. Recent studies confirm it improves cognitive function.
  • Huperzine A, a chemical made from the Chinese moss plant Huperzia serrata, may improve memory in both vascular and Alzheimer’s dementia, according to several studies in China and recent US and European studies.
  • American Ginseng (Panax quinquefolium) increases endurance and improves blood flow to the brain. Use with caution if you have high blood pressure, and talk to your doctor before combining ginseng with gingko.
  • Curcumin, derived from Turmeric plant, readily penetrates the blood brain barrier with a wide range of brain benefits.
  • One study showed that lemon balm (Melissa officinalis), 60 drops per day, helped improve cognitive function in people with mild-to-moderate Alzheimer’s.
  • Bacopa (Bacopa monnieri) leaf extract, called Brahmi, is used in Ayurvedic or Indian medicine to improve brain function and learning. However, no scientific studies have looked at bacopa to see whether it might help lessen symptoms of dementia. One study found that 300 mg per day for 12 weeks seemed to improve cognition in healthy people.
  • Vinpocetine (isolated from Vinca minor), increases blood flow to the brain and help the brain better use oxygen. However, most of the studies done so far have been of poor quality. More research is needed.
  • Ashwaganda, used in India for thousands of years medicinally, has shown to have antioxidant and anti-inflammatory properties and is rich in polyphenols.

SIGNS AND SYMPTOMS

The early symptoms of Alzheimer’s disease can be missed because they resemble signs that many people attribute to “natural aging.” The following are the most common signs and symptoms of Alzheimer’s:

Psychological Symptoms

  • Increasing memory loss, starting with forgetting recent events and new information, and progressing to not recognizing friends and family members
  • Difficulty concentrating
  • Difficulty understanding words, completing sentences, or finding the right words
  • Getting lost in familiar surroundings
  • Restlessness
  • Depression
  • Aggression, agitation, anxiety, restlessness
  • Distrusting others
  • Withdrawal, disinterest, hostility, loss of inhibitions

Physical Symptoms

  • Impaired movement or coordination
  • Muscle stiffness, shuffling or dragging feet while walking
  • Insomnia or change in sleep patterns
  • Weight loss
  • Incontinence
  • Muscle twitching or seizures

CAUSES:

Researchers aren’t sure what causes Alzheimer’s disease. Both genetics and the environment may combine in some cases. Recent research indicates that free radicals (molecules that can cause oxidation, and damage cells and DNA) may play a role in the development of Alzheimer’s.

Alzheimer’s is characterized by the buildup in the brain of two types of proteins. Clumps of abnormal cells are called plaques, made of beta-amyloid protein. These plaques build up between neurons and may prevent them from communicating with each other. Inside nerve cells are tangles, made of twisted tau protein. Tau protein is necessary for the brain to function, but in people with Alzheimer’s the protein becomes twisted, which may cause damage to neurons (brain cells).

People with the APOE-e4 gene are more likely to develop Alzheimer’s — it’s known as a “risk gene” for the condition. But scientists think there may be many more genes involved. And even people without inherited genes for the disease can get Alzheimer’s.

RISK FACTORS

The causes and risk factors associated with Alzheimer’s disease are not entirely clear, but include:

  • Family history of Alzheimer’s
  • Older age — the risk of developing Alzheimer’s doubles every five years after age 65
  • Long-term high blood pressure
  • Heart disease
  • History of head trauma — one or more serious blows to the head may put a person at an increased risk.
  • Down syndrome
  • Education level — people with higher levels of education are less likely to develop Alzheimer’s

DIAGNOSIS

There is no single test for Alzheimer’s disease. A true diagnosis can be made only after a person dies and an autopsy is performed on the brain.

However, Alzheimer’s usually has a characteristic pattern of symptoms. A doctor will start by ruling out other possible causes. The doctor will ask questions about medical history and symptoms and do a physical exam (including a neurological exam).

The following tests may also be used:

  • Mental status evaluation, to test memory and attention span. It can also reveal difficulties in problem-solving, social, and language skills.
  • Genetic test, using a blood test for the APOE-e4 gene. The presence of the gene in the blood may suggest Alzheimer’s, but it does not always make an accurate diagnosis.
  • Imaging tests such as CT, MRI, or PET scans.

In the early stages of dementia, brain scans may be normal. In later stages, an MRI may show a decrease in the size of certain brain areas. While the scans do not confirm the diagnosis of Alzheimer’s, they rule other causes of dementia such as stroke and tumor.

TRADITIONAL TREATMENT

The goals in treating Alzheimer’s disease are to:

  • Slow progression of the disease.
  • Manage behavior problems, confusion, and agitation.
  • Change the home environment to be safe.
  • Support family members and other caregivers.

There is no cure for Alzheimer’s. The most promising treatments include lifestyle changes and medications.

LIFESTYLE

Research indicates that the following lifestyle changes may help improve behavior in people with Alzheimer’s disease:

  • A regular walk with a caregiver or trusted companion may improve communication skills and lessen the chance of wandering.
  • Bright light therapy may reduce insomnia and wandering.
  • Calming music may reduce wandering and restlessness, boost brain chemicals, and improve behavior.
  • Pets can increase appropriate social behaviors.
  • Relaxation training and other exercises that require focused attention can improve social interaction and the ability to perform tasks.

The Safe Return Program, implemented by the Alzheimer’s Association, encourages identification bracelets, wallet cards, and clothing labels for patients with Alzheimer’s. Information is stored in a national database and distributed to authorities when a person is reported missing.

TRADITIONAL MEDICATIONS

Several drugs are available to try to slow the progression of Alzheimer’s and possibly improve mental function.

  • Cholinesterase inhibitors — increase the amount of acetylcholine in the brain. Side effects can include nausea, fatigue, and diarrhea. This class of drugs includes:
    • Donepezil (Aricept)
    • Rivastigmine (Exelon)
    • Galantamine (Razadyne, formerly called Reminyl)
  • Memantine (Namenda) — This drug works by regulating a chemical messenger called glutamate, which is involved in information storage and retrieval in the brain. Side effects can include headache, constipation, confusion, and dizziness. It is currently the only drug approved for treatment of moderate-to-severe Alzheimer’s disease.

The following medications also may ease the symptoms related to AD:

  • Selective serotonin reuptake inhibitors (SSRIs) increase activity of a brain chemical called serotonin. They are used to treat depression that often occurs in the early stages of Alzheimer’s.
  • Methylphenidate (Concerta) is a stimulant that is often prescribed for attention deficit hyperactivity disorder. It is sometimes used to treat withdrawal and apathy in Alzheimer’s patients.
  • Carbamazepine is an anti-seizure drug that stabilizes sodium levels in the brain. It is sometimes used to treat agitation in Alzheimer’s patients.
Acupuncture

Small studies have shown that transcutaneous electrical nerve stimulation (TENS), a technique used in physical therapy and certain types of acupuncture, may improve memory and daily living skills in people with Alzheimer’s. Further studies are needed.

Massage and Physical Therapy

People with Alzheimer’s disease become frustrated and anxious because they cannot communicate well with language. Using touch, or massage, as a form of nonverbal communication has been shown to benefit those with Alzheimer’s. In one study, people with Alzheimer’s who received hand massages and were spoken to in a calming manner had a reduction in pulse rate and in inappropriate behavior. Health care professionals speculate that massage may be good for people with Alzheimer’s not only because it is relaxing, but because it provides a form of social interaction.

Mind-Body Medicine

Music Therapy

Music therapy, the use of music to calm and heal, cannot slow or reverse dementia. But it may improve quality of life for both a person with Alzheimer’s disease and their caregiver. Clinical reports suggest that music therapy may reduce wandering and restlessness and increase chemicals in the brain that enhance sleep and ease anxiety. For example, the chemicals melatonin, norepinephrine, and epinephrine increased in the brains of people with Alzheimer’s after they listened to live music regularly. Mood also improved after listening to the music.

Support for the Caregiver

Studies suggest that caregivers who receive emotional support have better quality of life, and those they are caring for benefit as well.

Alzheimer’s disease can lead to many complications, including:

  • Falls
  • “Sundowning” (withdrawal or agitation in the evening)
  • Malnutrition and dehydration
  • Infection (from urinary tract infections or pneumonia)
  • Asphyxiation (stopped breathing)
  • Harmful or violent behavior toward self or others
  • Suicide
  • Poor health and support due to caregiver burnout
  • Physical and emotional abuse, including neglect
  • Heart disease

Alzheimer’s disease gets worse over time. However, people with the disease may survive for many years. Those with a long-standing history of high blood pressure are more likely to get worse faster.

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