A slow leisurely pace won’t cut it
Dementia is a devastating and expensive development for an individual and his family. Most dementias are progressive and incurable. If it can be prevented, it should be. Exercise is one preventative. But how much and what kind of exercise?
Nine percent of U.S. adults over 65 have dementia. That’s 3.650,000 folks.
From The Globe and Mail:
In 2017, a team led by the lab’s director, Jennifer Heisz, published a five-year study of more than 1,600 adults older than 65 that concluded that genetics and exercise habits contribute roughly equally to the risk of eventually developing dementia. Only one of those two factors is under your control, so researchers around the world have been striving to pin down exactly what sort of workout routine will best nourish your neurons.
Heisz’s latest study, published last month in the journal Applied Physiology, Nutrition, and Metabolism, offers a tentative answer to this much-debated question. Older adults who sweated through 12 weeks of high-intensity interval training improved their performance on a memory test by 30 per cent compared with those who did a more moderate exercise routine.
This was a small study, only about 20 sedentary participants (all over 60 years old) subjected to one of three protocols for twelve weeks, exercising thrice weekly:
- Four-minute bouts of vigorous treadmill walking at 90-95% of maximum heart rate, repeated four times, with three minutes easy walking between the high-intensity spells intervals (HIIT)
- Walking at 70-75% of max heart rate for 47 minutes (burning the same number of calories as group #1
- Thirty minutes of relaxed stretching
Alex Hutchinson’s full article is well worth a couple minutes of your time if you want to avoid dementia.
Source: New study shows the right workout routine can help fight dementia – The Globe and Mail
Steve Parker, M.D.
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Most cavemen didn’t live long enough to get dementia
Several respected researchers think that Alzheimer’s dementia may primarily be an infectious disease, particularly related to gum bacteria.
LOS ANGELES — As more disappointing results emerge from anti-amyloid drug trials in Alzheimer’s disease (AD), there is growing interest in novel treatment approaches for this condition.
One such approach is based on the hypothesis that Porphyromonas gingivalis (Pg), the bacteria involved in periodontal disease, may cause AD. The biopharmaceutical company Cortexyme Inc is testing this theory with an investigational agent COR388, which targets gingipains, the toxic proteases released by Pg. Early results show the drug is well tolerated and promising in terms of biomarker findings. Organizers hope that a phase 2/3 trial of the treatment now under way will provide definitive efficacy results.
Source: Gum Disease Bacteria a Novel Treatment Target for Alzheimer’s?
Steve Parker, M.D.
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HgbA1c (hemoglobin A1c) is measure of average blood sugar levels over the previous three months. From a 2018 study:
In this community-based population, we observed a significant trend for cognitive decline over a 10 year period among individuals aged ≥50 years with normoglycaemia, prediabetes or diabetes at baseline. Additionally, HbA1c levels were linearly associated with subsequent cognitive decline in memory and executive function (but not orientation) irrespective of diabetes status at baseline.
Source: HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing | SpringerLink
h/t to Jan at The Low-Carb Diabetic
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Exercise also seems to protect against memory loss and dementia
Keep your eyes on this development, folks. Potential game-changer. And a boon to Big Pharma. From NBCnews.com…
Lowering blood pressure to recommended levels can prevent dementia and the memory and thinking problems that often show up first [mild cognitive impairment], researchers reported Wednesday.
People whose top blood pressure reading was taken down to 120 were 19 percent less likely to develop mild cognitive impairment, the loss of memory and brain processing power that usually precedes Alzheimer’s, the study found. And they were 15 percent less likely to eventually develop cognitive decline and dementia.
It may take a few more years before the study conclusively shows whether the risk of Alzheimer’s was actually reduced because of the lower blood pressure,the researchers said.
It’s the first intervention that has been clearly demonstrated to lower rates of mental decline.
The findings come from a large trial of blood pressure called the Systolic Blood Pressure Intervention Trial, or SPRINT.
It has already found that lowering systolic blood pressure — the top number in a blood pressure reading — to 120 or less can prevent stroke, heart attacks, kidney disease and other problems.
Source: Tight blood pressure control can cut memory loss, study finds
He’s not worried about adequate dietary calcium
The paleo diet is relatively low in calcium content. So is that a reason to take a calcium supplement? Probably not. Calcium supplements are problematic. They may increase the risk of heart attacks. They may raise the odds of premature cardiac death in men. High calcium consumption increased the risk of death in Swedish women.
MedicalNewsToday has a brief report on dementia in women with cerebrovascular disease and calcium supplements:
“Calcium supplements may increase the risk of developing dementia in senior women with cerebrovascular disease, finds a study published in Neurology, the medical journal of the American Academy of Neurology.
Women who took calcium supplements were twice as likely to develop dementia.Cerebrovascular diseases are conditions caused by problems that affect the blood supply to the brain. The four most common types of cerebrovascular disease are stroke, transient ischemic attack (TIA), subarachnoid hemorrhage, and vascular dementia.”
Source: Dementia risk increased with calcium supplements in certain women – Medical News Today
“More basic research is critical.”
Several scientific studies, but not all, link type 2 diabetes with Alzheimer’s disease. Some go so far as to say Alzheimer’s is type 3 diabetes.
My Twitter feed brought to my attention a scientific article I thought would clarify the relationships between diabetes, carbohydrate consumption, and Alzheimer’s dementia (full text).
Click the full text link to read all about insulin, amylin, insulin degrading enzyme, amyloid–β, and other factors that might explain the relationship between type 2 diabetes and Alzheimer’s dementia. You’ll also find a comprehensive annotated list of the scientific studies investigating the link between diabetes and Alzheimer’s.
Bottom line: We still don’t know the fundamental cause of Alzheimer’s disease. A cure and highly effective preventive measures are far in the future.
Action Plan For You
You may be able to reduce your risk of Alzheimer’s disease by:
- avoiding type 2 diabetes
- preventing progression of prediabetes to diabetes
- avoiding obesity
- exercising regularly
- eating a Mediterranean-style diet
Scientists have no idea whether a Stone Age diet prevents dementia.
Carbohydrate restriction helps some folks prevent or resolve obesity, prediabetes, and type 2 diabetes. A low-carb Mediterranean diet is an option in my Advanced Mediterranean Diet (2nd edition).
Steve Parker, M.D.
Reference: Schilling, Melissa. Unraveling Alzheimer’s: Making Sense of the Relationship Between Diabetes and Alzheimer’s Disease. Journal of Alzheimer’s Disease, 51 (2016): 961-977.
…according to an article at the Journal of the American Medical Association. The study involved Chicago-area residents who had provided information about their eating habits. After death, their brains were biopsied, looking for typical pathological findings of Alzheimers Disease.
Rich sources of omega-3 fatty acids include salmon, sardines, herring, trout, and mackerel
Participants who ate seafood at least once a week had fewer Alzheimers lesions in their brains, but only if they were carriers of a particular gene the predisposes to Alzheimers. The gene is called apolipoprotein E or APOE ε4.
You’ve heard that seafood may be contaminated with mercury, right? The seafood eaters in this study indeed had higher brain levels of mercury, but it didn’t cause any visible brain damage.
The Mediterranean diet, relatively rich in seafood, has long been linked to a lower risk of dementia.
A weakness of the study is that the researchers didn’t report results of clinical testing for dementia in these participants before they died. You can have microscopic evidence of Alzheimers disease on a biopsy, yet no clinical diagnosis of dementia.
Steve Parker, M.D.
Exercise your brain
I saw a patient at the hospital a couple years ago who had been brought in by ambulance after suffering some trauma (not to his brain). He couldn’t call any friends or relatives to let them know what was going on because he didn’t have his cellphone. His phone had all his contact numbers so he had no reason to memorize any. Would you be in the same boat?
DailyMail has an interesting article on whether our use of technology is making us dumber. If we turn over mental tasks like navigation and math to computers, do our brains waste away? Will we be seeing more and earlier cases of age-related dementia? E-mentia?
This is worth keeping an eye on.
Steve Parker, M.D.
PS: The five other members of my household all have cellphones. The only number I’ve memorized is my wife’s.
Pioglitazone (aka Actos) is a type 2 diabetes drug in the TZD class. You could call it an “insulin sensitizer.” A recent report out of Germany suggests that pioglitazone prevents dementia, but it’s not a very strong linkage. If it works, I wonder if it’s simply related to better control of blood sugar, which could be accomplished with a variety of means.
The best popular press report I’ve seen is at Bloomberg.
German researchers went fishing for associations in a huge database of patients and drug usage. Their formal report hasn’t even been published yet. A five-year study was recently initiated to further investigate the possibility that piogoitazone prevents dementia. I doubt this will pan out.
Steve Parker, M.D.
The NYT’s Well blog has the details. The brain’s hippocampus is a critical center for memory. Alzheimers disease is associated with a gene called apo-E4. Carriers of that gene who exercise regularly have less shrinkage of the hippocampus than non-exercisers.
To PROVE that regular exercise prevents dementia-related shrinkage of the hippocampus, you’d have to force some folks to exercise and stop others who wanted to exercise. A couple years later, scan their brains and compare the two groups. That study may never be done.
Another way to preserve your memory could be to keep your fasting blood sugars closer to the lower end of the normal range, rather than the higher end. That strategy may prevent degeneration of your hippocampus and amygdala.
The Mediterranean diet also seems to prevent or forestall dementia.
Steve Parker, M.D.