How to prevent Alzheimer’s
 

Keith Turner and his wife Lillian used to joke about the way he muddled up words and then forgot what he had just said. ‘The stories kept the whole family amused,’ recalls the 68-year-old retired chiropodist from Portsmouth on the south coast of England. “We’d be sitting on our favourite bench looking out to sea and I’d say to her: ‘Look at the ship on the veranda’. She’d give me a look and I’d say: ‘Go on, what have I said this time?’”

The couple soon stopped laughing, however. At a routine check-up, a doctor asked Keith if there was anything particularly bothering him. ‘Give him his memory back,’ blurted out Lillian, increasingly worried now that her husband was getting lost on the way home from the local shop. The GP took the problem seriously and referred Keith to an NHS memory clinic where he was diagnosed with the progressive, degenerative brain syndrome, Alzheimer’s disease -for many people, the most terrifying prospect attached to getting old.

What is it?

Far more than simple forgetfulness, Alzheimer’s, the most common form of dementia, slowly strips away the complex connections inside the human brain. The first sign is difficulty with laying down new memories and retaining old ones. Other symptoms at this stage include depression, uncertainty, personality change and ultimately loss of connection with family, friends, environment and everything that is familiar and normal in everyday life.

How we think, how we process information, and how we remember; this is who we are, it is at the very core of our identity,' says Ian Deary, Professor of Differential Psychology at Edinburgh University and an expert in Alzheimer’s disease.

What is the impact?

The impact on quality of life of the family as well as the individual can be harsh. Nine out of ten sufferers in the developed world live at home and in the UK, where health and social services support is sparse, most carers are ‘demoralised, isolated and psychologically distressed, with six out of ten developing a serious mental or physical health problem’, according to Dr David Wilkinson, an Old Age psychiatrist at Moorgreen Hospital, Southampton.

What can be done?

Medication is available: the most effective drugs are cholinesterase inhibitors, medication that was first licensed in the late 1990s. People with Alzheimer’s suffer from a progressive and disproportionate loss of acetylcholine, a vital neurotransmitter that enables brain cells to communicate with each other; creating the building blocks of memory and cognition, the ability to retain a sense of direction, time and date.

Cholinesterase inhibitors such as Aricept, boost levels of this chemical and have been shown to delay the disease, particularly in the early stages when damage to the hippocampus, the part of the brain most involved in memory, takes place. When taken from this early stage, the effects on memory, language and cognition can be dramatic and long lasting.

Keith was one of the lucky ones. He was prescribed the drug three years ago and it brought dramatic improvements. ‘I remember sitting in a café in the sun with Keith shortly after he started taking Aricept,’ recalls Lillian. ‘I suddenly realised that I wasn’t all tensed up about what was going to go wrong next. It was a wonderful feeling. And nearly three years later, things are still just as good as ever.’

BUT the cost of around £1000 for a year’s treatment, have proved too expensive for the UK’s NHS. To the astonishment of clinicians, charities and patients, the National Institute of Clinical Excellence (NICE) has banned the prescription of Aricept and two other cholinesterase inhibitors until the disease has reached a final, severe stage.

Keith would not have been prescribed Aricept until he had deteriorated significantly. ‘It’s difficult to believe that doctors would not want me to recover in this way – and not just for my sake,’ he says.

What else is available?

• Get a referral to a memory clinic
  CANTAB PAL (Paired Associates Learning) Test, developed by Professor Sahakian, taps into the parts of the brain first affected by Alzheimer’s and can identify the disease ten or even 20 years before symptoms show. It is one of the top tests currently available at NHS memory clinics as well as in the USA and plans are afoot for it to be used throughout the world.

• Keep healthy.
  High blood pressure and cholesterol increase the risk of Alzheimer’s so maintaining a healthy heart and circulation by taking regular exercise or with medication such as statins may help to reduce your risk. There is also growing evidence that taking B vitamins to reduce levels of the toxin homocysteine may offer some protection.

• Stay active
  People who keep active physically also tend to have a better mental function – ‘though we are not sure whether one causes the other’, explains Professor Deary. He hopes to find out, however, in a new study of 1000 71-year-olds in which he will track their neurological progress since they all contributed to a one-off Scottish Mental Survey in 1947.
  Keeping active mentally is also important – and its not just Sudoku and crosswords that make the difference. It also helps to be part of a social network, getting out in the evening and engaging in activities that mix mental and physical activity such as ballroom dancing or playing chess.
  ‘People can choose to age better by taking care of their mental capital and well-being,’ says Professor Sahakian. ‘Paying attention to diet, keeping body and mind active and keeping family and friends close around you will all help.’

• Eat well
  Enjoy your food, and eat a wide variety of different foods to make sure you get a full range of vitamins and minerals. Eat lots of fruit and vegetables, and enjoy high-fat and sugary foods in moderation.
  ’Brain foods’ contain nutrients that are used to manufacture the brain chemicals that enhance memory, concentration and reaction time. According to the Alzheimer’s Society, these include: fish oils, blueberries, iron-rich food including lean beef, wholegrain cereals and breads, beans and pulses.

• Be sociable:
  Take time to go out with your friends or your partner however tired you may feel. Even a phone call or email can help you to keep in touch. There’s evidence that collapsing on the sofa in front of the television increases the risk of Alzheimer’s. – though TV programmes that are engaging and mentally strenuous can help keep you alert.
   

Be Headstrong – challenge your risk of Dementia is a new booklet from the Alzheimer’s Society is available free from local branches of the Alzheimer’s Society or from www.challengedementia.org.uk .

 

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