James Greenblatt, MD
James Greenblatt, MD, founder and medical director, Comprehensive Psychiatric Resources, Inc., Waltham, Massachusetts, and author of Finally Focused. JamesGreenblattMD.com
Approved in June 2021, aducanumab (Aduhelm) was the first new drug for patients with Alzheimer’s disease (AD) in 18 years, but the promise of a breakthrough was short-lived. The controversial drug had no compelling evidence supporting its effectiveness. In fact, clinical trials showed that it appeared to cause harm.
This isn’t the first time that experts have questioned the efficacy of drugs for AD. Researchers reviewed all the Alzheimer’s disease drugs on the market and reported in Pharmacy & Therapeutics that they have “limited effectiveness for most patients.” They’re used only because there aren’t “any better alternatives,” the authors added.
But there is an alternative for dealing effectively with AD: prevention. The neurochemical changes that lead to AD—principally, the neuroinflammation that drives the disease—develop over the course of 30 to 40 years. By then, it’s too late to repair the damage. Preventing or minimizing those changes—even in middle and old age—is the optimal way to deal with the disease.
Prevention may be possible through anti-inflammatory lifestyle habits like a healthy diet, brain-protecting nutritional supplements, regular exercise, good sleep, and mental stimulation.
The classic Mediterranean diet, which is rich in vegetables, fruit, beans, whole grains, fish, and olive oil and low in processed foods, red meat, and dairy products, is highly protective against cognitive decline and AD.
In a study published in the British Journal of Nutrition on Dec. 23, 2021, scientists studied nearly 1,000 people for three to 10 years. The researchers traced participants’ “subjective cognitive decline” (their own estimation of decline in memory, decision-making, and other mental skills) and gave each participant a Mediterranean Diet Score, ranking their adherence to the diet from 0 to 55. For every yearly 10-point increase in the score, there was a reduction in subjective cognitive decline of nearly 8 percent.
In another study published in January in The American Journal of Clinical Nutrition, researchers analyzed the diets of 512 people ages 70 and older. Those who ate more foods typical of the Mediterranean diet had less atrophy in the hippocampus section of the brain (the hippocampus shrinks early and severely in Alzheimer’s disease) and lower levels of tau protein and beta-amyloid protein, two hallmarks of Alzheimer’s. They also performed better on memory tests.
Three vitamin supplements—B12, folate, and B6—protect against mental decline and AD. That’s because low levels of these nutrients increase levels of homocysteine, an amino acid that is neurotoxic in elevated amounts.
Studies link elevated homocysteine levels to memory loss and dementia. A study in the journal Life Sciences showed that people with the highest levels of homocysteine have a 31 percent higher risk of developing dementia. And research published in the New England Journal of Medicine showed that high homocysteine doubles a person’s risk of progressive brain atrophy. The evidence linking homocysteine and AD is so strong that in 2018, a group of experts published a consensus statement about homocysteine and AD in the Journal of Alzheimer’s Disease: “We … conclude that elevated plasma total homocysteine is a modifiable risk factor for the development of cognitive decline, dementia, and Alzheimer’s diseases in older persons.”
High levels of homocysteine are also linked to heart disease, osteoporosis, depression, and kidney problems.
To modify this risk factor, take a vitamin supplement that includes folate, B6, and B12. Follow the dosage recommendations on the label.
Many studies link regular exercise with the prevention of AD. In a study published in Frontiers in Neuroscience, researchers analyzed health data from more than 163,000 people, comparing those with the lowest levels of physical activity to those with the highest. They found that physical activity reduced the risk of AD by 45 percent and dementia (non-Alzheimer’s) by 28 percent. Try to engage in at least 20 minutes of walking, dancing, gardening, or any physical activity you enjoy five days a week.
Chronic sleep deprivation causes chronic neuroinflammation—and chronic neuroinflammation is a risk factor for AD. In a 20-year study published in the journal Nature Communications on April 20, 2021, scientists analyzed the sleep patterns of more than 8,000 people ages 50 and older. They found that those who slept six hours or fewer a night were 30 percent more likely to develop dementia than those getting seven hours.
Daily habits for deeper sleep include going to bed and getting up at the same time every day, keeping the bedroom cool and dark while you’re sleeping, turning off all screens (cell phones, computers, TVs, video games) one hour before bedtime, and taking a warm bath 30 minutes before bed.
Keeping your brain active is protective against mental decline. A recent study from scientists at Rush University Medical Center in Chicago followed nearly 2,000 people ages 80 and older for seven years. Those who had the highest level of cognitive activity—they regularly read books or played games like checkers, board games, cards, or puzzles—developed dementia an average of five years later than those with the lowest level.
