Tag Archives: Alzheimer’s disease

Insane Medicine – Lowering Dementia Risk


Research is demonstrating that treating multiple risk factors for dementia results in better outcomes than treating each factor individually. Risk factors include:

  1. Poor nutrition
  2. obesity’smoking
  3. physical inactivity
  4. cardiovascular risks
  5. depression
  6. social isolation
  7. lack of mental stimulation

Strategies to help deal with these risks have been shown to help improve cognitive performance. Just treating single variables such as high blood pressure or lack of exercise has less effect than hitting multiple factors at once. A study in Lancet Neurology (August 2014) revealed that one-third of Alzheimer’s Disease (AD) cases are attributable to modifiable factors and thus AD may be reduced in prevalence by improved education , treatment of depression, and management of vascular risk factors such as physical inactivity, smoking, hypertension, obesity, and diabetes.

  • Get regular exercise: this reduces stress, improves blood flow to the brain, strengthens connection of neurons in the brain, improves medical health and balance, thus reducing falls. The goal is 30 minutes of aerobic activity five times a week (walking, dancing, biking as examples) and strength training twice a week.
  • Challenge your brain: Demanding brain activities utilizing different aspects of your intellect help protect against cognitive decline, making your mind more efficient and able to focus. So expose yourself to new ideas and challenges mentally, so that you can maintain your memory skills and concentration abilities. Things like cross-word puzzles, checkers or cards help build up your brain as do math problems. Research shows that staying intellectually engaged may prevent AD. These types of brain challenges add to your cognitive reserve. Social interaction also plays a role in preventing cognitive decline. It has been found that those who play more games or puzzles were more likely to perform better on test of memory, learning, and information processing. They also have greater brain volume in areas associated with memory. Mental workouts enhance brain blood flow and promote cell growth, stronger neuron connections, and keep the brain efficient. It makes the brain less sensitive to trauma such as drugs, stroke, or disease. The internet has resources to help:  http://brainworkshop.sourceforge.net/  or http://sporcle.com/  or http://syvum.com/teasers/  or http://www.braingle.com/  or http://www.billsgames.com/brain-teasers/   So consider crossword puzzles, jigsaw puzzles, word searches, math problems, an brainteasers to exercise your mind!
  • Treat mental illness, especially depression: Sadness, hopelessness, and lack of energy may signal depression. Depression is associated with a high risk of cognitive decline. See your doctor to help get treatment.
  • Eat a healthy diet: Eat complex carbohydrates such as whole grains, legumes, fruits, and vegetables. Avoid sodas, sweets, and excess sugars. Protein is essential for growth and cell maintenance, so consider lean meats, fish, poultry, eggs, low fat dairy,  nuts, and beans. Chose healthy fats such as omega-3 fatty acids found in flaxseed oil, fish, and nuts. Monounsaturated fats are also healthful and is present in olive and canola oils. Polyunsaturated fats from corn, safflower, and sunflower seeds are fine as well. Avoid trans-fats. Remember to include your micronutrients and phytochemicals (found in plant sources).
  • Treat cardiovascular risks: Stop smoking, lose weight, be physically active, treat high blood pressure and diabetes, take your prescribed medications.

Avoid Trans-fats in your diet. It is found in many junk foods, especially fast foods, processed foods, baked goods, margarine, and other sources. These products and trans-fats perform about 10% worse on cognitive tests than those who consumed minimal amounts. Trans-fats promote oxidative stress and damage the memory center of the brain, the hippocampus.

Magnesium is essential for brain functioning. It is found in green leafy vegetables, whole grains, nuts, legumes, and hard water. Magnesium helps in energy production, needed especially in the brain. It helps in the formation and release of neurotransmitters as well as functioning of connections in the brain (synapses) to process new information. Studies in Molecular Brain (September 2014) demonstrated that magnesium L-threonate (MgT) supplementation prevented memory decline and prevented synapse loss in mice prone to AD. It also reduced the deposition of beta-amyloid protein in the brain (a cause of AD) Risk factors for magnesium depletion include chronic alcoholism, diabetes, excessive coffee intake, inflammatory bowel disease such as Chrone’s disease, diuretic intake, liver and kidney disease,  and excessive soda and salt intake.The RDA is 400 mg a day – http://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/  This link points to sources of magnesium for your diet. Foods included are Almonds, spinach, cashews, peanuts, shredded wheat cereal, soy milk, black beans, whole wheat bread, avocado, baked potato, brown rice, plain yogurt, and others.

This sounds dumb but avoid head injury – it has been shown that older adults who have a head injury are at higher risk of dementia, especially over the age of 65. The main reason for these injuries are falls, many of which are preventable and may be due to deconditioning and weakness from lack of exercise. Remember that exercise increases strength and balance.

Remember to not be anxious over your health – don’t become a hypochondriac. Maintain your health through proper eating, exercise, risk management of cardiovascular problems (high blood pressure, high cholesterol, smoking cessation), taking your prescribed medications, and regular physician check-ups will maximize your health. Don’t get preoccupied with health matters and fears of disease such that they interfere with your daily activities and enjoyments in life. Keep yourself busy and distracted by learning new tasks and volunteering. Consider meditation, relaxing your body and mind, concentrating on the present moment. Exercise your body to reduce stress and reduce your anxiety. This will build your physical strength and increase your feelings of well-being. Keep your head up with positive feeling and be grateful for the good things in your life and those things you can control. Don’t stress out!!




Insane Medicine – Obesity increases your risk of Alzheimer’s disease.

  • Obesity increases your risk of diabetes, hypertension, stroke, and cancer. It also increases your risk of cognitive decline. It has been shown, however, that weight loss can reverse some of the cognitive decline! This was shown in patients with gastric bypass who were found to have improvements in their executive functioning after surgery and weight loss. Executive functioning includes the processes of organizing, planning, an decision-making. Also improved is attention and memory.
  • Also linked to this cognitive decline in obese people is lack of physical activity, poor inflammatory-type diet, and depression.
  • Increased fat causes problems in executive functioning, decreased memory, and  decreased processing speeds, all of which worsen with age as well. The high content of simple sugars and saturated fat cause a disruption in the blood-brain barrier that allow inflammation to occur in the brain, especially from the passage of Interleukin-1, which is secreted by fat and passes through this disrupted brain barrier. The hippocampus is the target that is affected, thereby diminishing memory by disrupting the connections in the brain called synapses. In the lab, lowering the brain’s level of interleukin-1 results in improved cognitive performance.

What to do? Emphasis on healthy choices and then weight loss:

  • Exercise regularly
  • Decrease stress through relaxation, meditation, or other routes.
  • Get plenty of sleep
  • From Harvard's healthy eating plate - one-half the plate is for fruits and vegetables, one-fourth with whole grains, the rest is devoted to fish, beans, nuts, or chicken - all unprocessed.
    From Harvard’s healthy eating plate – one-half the plate is for fruits and vegetables, one-fourth with whole grains, the rest is devoted to fish, beans, nuts, or chicken – all unprocessed.


  • Eat a proper diet, less processed food, for example, use whole wheat bread and avoid processed meats such as hot dogs or salami. Choose low fat dairy products. Avoid additives or flavorings.Chose healthy plant oils such as canola and olive oils. Eat smaller portions of food.
  • Caffeine intake can  be safe in adults up to 400 mg a day and can increase wakefulness, better recall of spatial information, improved attention, faster reaction time,  and decrease feelings of fatigue.  It may also enhance memory and cognition as well. One study linked drinking three to five cups of coffee a day with a 65 % decrease in dementia. Caffeine was noted to decrease the formation of tau protein in the hippocampus of rats. Tau protein deposition is a hallmark of Alzheimer’s disease.  Caffeine enhances the brains’s memory and allows the consolidation of information for the long term.

Insane Medicine – Key factors to prevent cognitive decline and dementia.

Insane Medicine -Preserve your mind to prevent cognitive decline
Insane Medicine -Preserve your mind to prevent cognitive decline.
  • Alzheimer’s disease results from accumulation in the brain of aberrant proteins (amyloid-beta and tau). This results in faulty connections in the brain and brain cell death. With that, memory and skills are lost over time.
  • 30 million people are affected by Alzheimer’s disease in 2010. One-third of these cases are attributable to modifiable risk factors such that there is a chance to prevent cognitive decline in some people. (Lancet Neurology, 2014)

There are controllable risk factors: What are they?:

  1. A lack of exercise.
  2. Smoking
  3. Poor diet
  4. Low level of education
  5. Depression
  6. Poor lifestyle
  7. Obesity
  8. High Blood pressure
  9. Uncontrolled diabetes.
  • Keeping a healthy hear may prevent dementia, in that reduced blood flow to the heart due to no exercise or poor diet also impacts flow to the brain as well. The above factors overlap in that depressed people may smoke more and get less exercise. They gain weight and also eat poorly.
  • Per the JAMA (July 2014) there has been a 24 % drop in first time strokes and a 20% drop in death from strokes. This is due to better control of risk factors causing strokes such as treating elevated blood pressure, stopping smoking, and statin use to control cholesterol levels.
  • It is important to stimulate your brain with mental activities and mental challenges such as cross-word puzzles or card playing. This resulted in greater brain volumes, especially in the hippocampus and better memory and executive functioning.
  • Moderate exercise in the 50-65 year range decreases the risk of cognitive decline significantly. The same was true for even older individuals (70 and above). SO be certain to exercise 30 minutes a day at least 5 days a week!

Insane Medicine – A manual for care of your Brain: Part 1

Insane Medicine - Brain matters
A chimpanzee Brain in a jar.
  • Alzheimer’s disease presents with plaques and tangles in the brain, the plaques being clumps of a protein fragment, beta-amyloid, and the tangles being misshaped ‘tau’ proteins. These can be present in people and yet the individual does not show signs of dementia. Thirty percent of people over age 70 have elevated beta-amyloid but are cognitively normal.
  • Neurofibrillary tangles damage neurons and synapses, disrupting the architecture of the brain. It may take more than 10 years before amyloid deposition begins and symptoms of dementia start.
  • Damaged blood vessels in the form of small strokes add on to the problem of dementia. Some 20 percent of the elderly have had ‘silent’ strokes and do not have any knowledge of it. These small strokes further the destruction of the brain’s architecture, leading to vascular dementia.
  • Risk factors for vascular damage include smoking, high blood pressure, and diabetes.
  • Watch your blood pressure!
  • High blood pressure is a huge risk factor for later cognitive impairment. Why? Small strokes cut off blood flow to brain tissue due to uncontrolled blood pressure and diabetes, destroying brain architecture and function. On an MRI, bright white matter areas of hyper-intensities represent areas of damage, in which neurons cannot connect well with one another. Patients with uncontrolled blood pressure tend to have more hyper-intensities, representing compromised brain functioning.
  • Control your diabetes and sugar intake.
  • Type 2 diabetes in a strong risk factor for dementia. People with this problem are insulin resistant, mostly due to obesity. High levels of insulin in the blood correlate with more rapid cognitive decline, possibly due to less brain insulin as a result of decreased receptors for insulin in the blood-brain barrier. This results in less insulin entry into the brain. Insulin may help clear the toxic beta-amyloid from the brain.
  • Insulin receptors in the brain seem to localize in areas that are important for the formation of new memories. When the receptors decrease, memory seems to get impaired. Intranasal insulin may have a positive effect on cognitive abilities in patients with memory impairment, but studies are ongoing.
  • What to do: Lose weight and exercise more. Evidence from studies show that patients  who had a diet low in saturated fats and carbohydrates with a low glycemic index had lower beta-amyloid levels in the brain CSF, which surrounds and bathes the brain) So eat less saturated fats and sugars!
  • Exercise! Executive functioning (the ability to plan and make decisions, correct errors, and respond to new information) is improved by exercise. Executive functioning is lost in cognitive impairment and Alzheimer’s disease. People who move and exercise, especially over their lifetime, have a lower risk of dementia. Sedentary people have less blood flow to the distant blood vessels in their brain and that makes them vulnerable. Exercise may expand brain volume and protect blood vessels in the brain. It helps with stress, insulin levels, and many other parameters in good ways.
  • Keep your brain active! People who are involved with mentally stimulating activities, like reading, going to classes, playing games) have a lower risk of dementia. This cognitive reserve may protect against the onset of symptoms.
  • Caffeine may protect your brain! There is evidence that up to 500 mg of caffeine a day was helpful in preservation of memory. Caffeine may reduce amyloid burden.
  • Blueberries and strawberries may reduce memory decline. Aim for at least one serving of blueberries a week and two of strawberries.
  • Increase the amount of fish in your diet! Dark-meat fish, such as swordfish, salmon, mackerel, sardines,) are excellent in certain measures of cognition. Omega-3 fats  alone (which are present in high amounts in fish)  have not been shown to help dementia.
  • Avoid sleep restriction! Get plenty of sleep! Sleep seems to expand the area between brain cells making it easier to clear beta-amyloid and toxins from the brain, sleep disruption impairs this capability.
  • DASH diet: A healthy diet that includes fruit, vegetables, fiber, low sugar content, and low saturated fat, helps with blood pressure and overall health. The American Heart Association recognizes this diet as being effective in a number of health scores.
  • Consider the Mediterranean Diet. More on this diet later.
  • Antioxidant vitamins, such as vitamin E/C/beta-carotene, B vitamins, phosphatidyl serine, ginkgo, huperzin-A, and other supplements have been found to be ineffective in preventing memory decline and dementia.
  • Insane Medicine - Plaques in the brain - what a pain
    Insane Medicine – Plaques in the brain – what a pain!
  • http://dashdiet.org/    – this is a link to the DASH diet – a heart-healthy option
  • http://www.nhlbi.nih.gov/health/health-topics/topics/dash/
  • http://www.mayoclinic.org/healthy-living/nutrition-and-healthy-eating/in-depth/dash-diet/art-20048456  – Mayo clinic presents the DASH diet

Alzheimer’s Disease – new screening tests in the near future?



Alzheimers disease brain tissue

Insane Medicine -Alzheimers disease
Alzheimer’s disease – neurons affected by plaques.
  • 5 million people are affected by Alzheimer’s Disease (A.D.) in the U.S., with a 1% incidence in the age group of 60-70 and 6-8% in the 85 year old category.
  • It is a progressive disease leading to eventual functional incapacity. There is a resulting loss of retention of recent memories at first with a progression to loss of remote memories in later stages. Language, abstract reasoning, and executive or decision making functions are impaired. Patients become household and work impaired. Some become delusional or psychotic.
  • This disease is the result of hyperphosphorylated Tau proteins that form neurofibrillary tangles inside the neurons. Also there are plaques of beta-amyloid that deposit in the brain, disrupting neuronal function.
  • Family history plays a role in the disease, with an individual having twice the average risk of disease if a first degree relative has Alzheimer’s.
  • Genetic changes, such as the presence of Apolipoprotein E4 mutation, increases the risk of A.D. by 2-5 times average risk by the age of 60-80.
  • Other causes of dementia must be ruled out before Alzheimer’s Disease is diagnosed. Reversible causes especially must be looked for, such as B12 deficiency, infections such as syphilis, thyroid disorders, autoimmune disorders, medication side effects, and drug abuse, especially alcohol.
  • A.D. results in difficulty in performing sequential tasks with poor decision-making skills eventually. This results in an at-risk population of elders, who are easy prey for con-artists looking to make money off impaired individuals.
  • Neuropsychiatric testing can help determine a person’s capabilities.
  • Cedar-Sinai Medical Center is developing a retinal imaging device that may identify A.D. 15-20 years earlier than other tests, such as PET scanning. Using curcumin, a compound found in the spice Tumeric, researchers discovered that the curcumin bound the Alzheimer’s plaques and could be seen in the retina. This resulted in 100% detection of the disease. Some people without the disease, however, tested positive with this testing.
  • Another retinal test is being evaluated by the Banner Alzheimer’s Institute using Fluorescent Ligand Eye Scanning (FLES). Researchers could detect beta-amyloid in the retinas of A.D. patient 85 % of the time.
  • Such retinal scans will allow for earlier detection of A.D.
  • There is no specific treatment for Alzheimer’s Disease, so there are a lot of ethical considerations that need to be evaluated in performing such tests. However, earlier detection may allow an individual to protect their financial and personal well-being from poor decision-making by allowing  specified power-of-attorneys to help make decisions when executive functioning starts to fail.
  • Other A.D. findings: Recently, a new protein, TDP-43, also seen in Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) ,has been associated with A.D. Additionally, A.D. patient can be screened for impairment through an inability of smell detection as well, using a 40-item smell detection test, called the University of Pennsylvania Smell identification Test.