Alzheimer’s is afflicting a growing population today and is currently catching up to cardiovascular disease and cancer having a real impact on one’s longevity and health span ( not just how long we live but more importantly how healthy we age). Compared to atherosclerosis we have less understanding how and why it begins and how to slow or prevent it. And unlike type 2 diabetes and metabolic dysfunction it does not appear to be reversible. Yet, new research is shining a light on how we can slow and even possibly prevent the ravages of this disease.

Genetic testing shows there is a gene related to Alzheimer’s called APOE e4. If this is present there’s a greater likelihood that an individual will develop the disease but as to exactly when is not yet known. What we do know from epigenetic research is that there are many factors that can influence whether this gene is activated or can it be turned off. Bottom line: our best strategy to date is trying to prevent this neurodegenerative disease from taking hold.

Alzheimer’s develops slowly over decades. It is sometimes diagnosed when a patient is in their 30’s or 40’s ( early onset) but mostly is observed in the 60’s and beyond.

Amyloid – beta is a peptide that has been found in plaque of many Alzheimer’s patients. Amyloid can also trigger the aggregation of another protein called tau. Tau leads to neuronal inflammation and, ultimately, brain shrinkage. On scan it can be seen as neuronal tangles. Scientists have identified several genetic mutations that can facilitate rapid amyloid- beta accumulation, all but assuring early onset. These mutations are called APP, PSEN1 and PSEN2. The interesting questions for researches is what causes this plaque to form in the brain? Drugs on the market today seem ineffectual at reducing this plaque, so it seems that we need to understand what is driving the plaque formation?

Can this neurodegenerative disease be prevented ? Much research has focused on multidimensional lifestyle- based interventions and has shown good data improving cognitive performance among at- risk adults. The hope is that as with other diseases ( ex: cardiovascular disease and cancer ) that have a genetic component that by addressing specific behaviours ( nutrition, sleep, exercise, stress management) we can slow down or possible prevent this disease from taking hold. Interestingly, this disease has a greater impact on females than males. Scientists believe there is something connected to menopause and the abrupt decline in hormonal signaling that triggers a greater risk of neurodegeneration in older women ( the rapid drop in estradiol in women with the APOE e4 gene is a likely driver of risk). Additionally, women seem be more prone to accumulate tau, the neurotoxin protein that is found in the Alzheimer’s patient’s brain.

Testing for Alzheimer’s can be tricky. Genetic testing is a good starting place to look for the APOE-e4 gene. Blood tests for specific markers can be easily performed – testing for amyloid in the cerebral spinal fluid. Imaging of the brain – specifically the temporal lobes that influence memory, language and auditory processing. Gait analysis has become a popular tool as well.

Prevention with clinical benefits.

1. Exercise and nutrition: aerobic and strength training might be the single best tool in your fight against this disease. Anti inflammatory benefits seem to impact the build up of amyloid- beta and tau proteins. It turns out a brain protein called BDNF which is turned on by exercise can neutralise the plaque formation. Additionally exercise helps to maintain glucose homeostasis and metabolism. The brain’s of Alzheimer’s patients become less able to utilise glucose but their ability to metabolise ketones does not. Hence a ketogenic diet ( lower in carbs and refined sugars ) which also helps to regulate insulin and glucose metabolism, seems to be a powerful tool in lowering inflammation – which likely is a prime driver in plaque formation.

2. Oral health: Brushing and flossing which prevents gum disease might be another factor. Researchers have found a pathogen – a microbe called P. gingivalis that often causes gum disease, is related to high levels of a specific inflammatory marker IL-6. P.gingivalis has shown up in the brains of Alzheimer’s patients. Bottom line: floss and get regular dental cleanings.

Sleep: During sleep our brains literally heal themselves – specially during deep sleep our brains detox and clean house. Poor sleep also is associated with disrupted cortisol rhythms and levels which can contribute to insulin resistance and damage to the hippocampus- area the brain associated with memory and processing. Additionally hypercortisolemia (excess cortisol) directly impacts release of melatonin – the hormone that signals to our brain it’s time to sleep.

Bottom Line:

– What is good for the heart and body is good for the brain. Low inflammation and oxidative stress is critical to brain health.

– Metabolic health ( liver and pancrease ) is critical to brain health.

– Play the long game. Start early with your prevention strategies, especially if you are genetically predisposed.

– Stay active. Exercise which impacts vascular and metabolic function has profound impact on brain health.

– Keep your brain challenged and engaged. Brain games, reading and starting a new hobby pay huge dividends.