Alzheimers

Overview: Alzheimers

• Renowned gerontologist Ken Dychtwald, PhD, has stated, “It's easy to overlook the remarkableness of aging.” According to Dychtwald, throughout 99% of human history, the average life expectancy at birth was less than 18years of age.

• In the past, people did not age; they died. Infectious diseases, accidents, violence, and other hazards often brought life to an early close. Until very recently, therefore, people were much more likely to die young than to live into old age.

• Beginning in the last century, however, something unprecedented happened.

• Thanks to advances in sanitation, public health, food science, pharmacy, surgery, medicine, and, more recently, wellness-oriented lifestyles, the number of people in the United States who were more than 65years old multiplied 11-fold during the twentieth century, from 3 million to 33 million.

• According to the U.S. Bureau of the Census, by the year 2035 some 70 million people—60 million of whom will be older baby boomers—will be 65years old and older.

• Although we should applaud the increase in life span enjoyed by many people, a major problem is associated with it: with increasing longevity comes an increasing incidence of cogni- tive decline, dementia, and Alzheimer disease (AD).

Warning Signs of Alzheimer Disease

• Recent memory loss that affects job skill

• Difficulty performing familiar tasks

• Problems with language

• Disorientation to time and space

• Poor or decreased judgment

• Problems with abstract thinking

• Misplacement of important objects

• Changes in mood or behavior

• Changes in personality

• Loss of initiative

Mini-Mental State Examination

Prevention Prescription

• Recommend a low-fat diet (15% to 20%). Most of the fat should be rich in omega-3 fatty acids

• Encourage stress management. Meditation, deep breathing, prayer, and various other relaxation techniques are shown to lower cortisol levels, improve memory, and lower blood pressure.

• Exercise. Physical, mental and mind-body exercises all are essential for a healthy body and a healthy mind.

• Consider measuring hormone levels:

  • Dehydroepiandrosterone

  • Estrogen

  • Pregnenolone

  • Replace hormones to keep at optimal levels.

Therapeutic Review: Integrative Medicine

Facets of Psychological Wellbeing that improve Telomere Length

1. Self-confidence

2. Self-acceptance

3. Personal growth

4. Purpose and meaning

5. Positive relationships

6. Sense of independence

Nutrition

• Recommend a diet containing 15% to 20% fat based on patients' preferences.

• Include organic fruits and vegetables, and fish or seeds rich in omega-3 fatty acids, such as salmon or flaxseed oil.

Supplements

• Vitamin E: 2000 units/day

• Ginkgo biloba: 240 mg/day

• Phosphatidylserine: 100 to 300 mg/day

• Fish oil (docosahexaenoic acid [DHA] and eicosapentaenoic acid): 500 to 1000 mg/day

• Huperzine A: 50 to 100 mcg/dayVinpocetine: 2.5 to 10 mg/day

• Coenzyme Q10: 100 to 300 mg/day

Note: Be aware of the rare possibility of increased clotting time in patients taking maximum doses of ginkgo, vitamin E, and DHA, especially with warfarin and aspirin.

Mind-Body Therapy

• Control stress: Perform daily morning meditation for at least 12-20 minutes.

• Exercise: Physical, mental, and mind-body exercise should be part of the integrative prescription.

Pharmaceuticals

• Deprenyl, 5 mg twice daily, slows progression.

• Rivastigmine is the most effective acetylcholinesterase inhibitor available.

• Start with 2.5 mg twice daily and work up per package insert.

• Memantine is usually started with 5 mg in the morning for 2 weeks and then is often increased to a maximum of 40 mg/day slowly over a 2-week period

Caution: Do not use deprenyl with antidepressant medication because fatal reactions can occur. Deprenyl can be used in conjunction with anticholinesterase drugs

Hormone Replacement Therapy

• Dehydroepiandrosterone (DHEA): 25 to 100 mg/day, depending on blood level

• Pregnenolone: 10 to 100 mg/dayMelatonin (for sleep): 3 mg/day at bedtime.

• A proper dose allows a complete night's sleep without morning grogginess.

Note: When using DHEA in men, measure and follow the prostate-specific antigen level. If it is elevated, do not use DHEA. Also consider using saw palmetto with DHEA.

Key Web Sources

• Alzheimer's Research & Prevention Foundation. www.alzheimers- prevention.org.

• Alzheimer's Foundation of America. www.alzfdn.org.

• Alzheimer's Association. www.alz.org.

• Alzheimer's Disease Education and Referral Center. www.nia.nih. gov/alzheimers.