Three tips: How to design a prevention strategy for Alzheimer's disease.
Background: Alzheimer's and Prevention
Just like heart disease and diabetes, “primary prevention” is as important as early detection in the field of Alzheimer’s disease and related disorders (ADRD).
ADRD is a term used to represent a group of diseases that affect cognitive function, and includes progressive neurological disorders such as Alzheimer’s disease (AD), vascular dementia, Parkinson’s disease, Lewy body disease, and frontal lobe dementia. ADRD also includes non-progressive or static disorders such as major depression and metabolic disorders, which ultimately affect cognitive function.
With a rapidly aging population, maintaining cognitive and physical vitality is the key to reducing personal and economic burdens on our society.
Although more comprehensive research is needed, current clinical and epidemiologic studies provide solid evidence about the relationship between risks for developing ADRD and factors that increase or decrease those risks.
Incorporating such knowledge into your daily life will help you maintain your cognitive and physical vitality as you age.
Know Your Risk Factors
The first step in preventing Alzheimer’s disease and related disorders (ADRD) is to know your risk factors. Having certain ADRD risk factors does not mean that you will develop any particular disease, but does mean that you have a higher probability of doing so.
For Alzheimer’s disease (AD), age is by far the greatest risk factor.
Most individuals with the disease are 65 or older, and the likelihood of developing AD doubles about every 5 years after age 65. After age 85, the risk reaches nearly 50 %. Another important risk factor for AD is family history. Research has shown higher risk among those with the first-degree relatives with AD. The risk increases if more than one family member has AD.
Despite the fact that certain risk factors such as age, genetic dispositions, and family history cannot be changed, there are many risk factors that you can identify and manage by choosing a healthy life style and by using appropriate risk-reducing treatments.
Risk Factors
These risk factors include but are not limited to:
• Stroke increases an individual’s risk of developing vascular dementia by 6-10 times. So maintaining good cardiovascular health and proper blood flow to the brain is important.
• Diabetes increases the risk for stroke, heart disease and hypertension, all conditions that increase the risk of vascular dementia. Additionally, diabetes also impairs cognitive function in those with AD.
• Heart diseases including heart valve diseases, coronary artery disease and atrial fibrillation reduce blood flow to the brain. Poorly controlled heart diseases lead to large or small strokes anywhere in the brain.
• High cholesterol increases the production of beta amyloid, one of the hallmarks of AD, and doubles the risk of the disease.
• High blood pressure is a major risk for vascular dementia.
• Head injury especially with loss of consciousness in individuals with a genetic disposition to AD increases the risk of the disease ten fold. Also, head injury with or without loss of consciousness increases the risk for seizure, which can begin up to several years after the injury. Seizure is a risk factor for cognitive impairment or dementia if it is not controlled well.
Additional Risks Include:
-Severe estrogen deficiency
-Severe testosterone deficiency
-Certain cancer treatment
-Alcohol or chemical abuse
-Regular tobacco use now or in the past
-Unhealthy diet
-Lack of mental and physical exercise
MCI Screen is a Pragmatic Brief Cognitive Assessment in Clinical Care Settings
The MCI Screen (MCIS) was developed in collaboration with primary care physicians and specialists in busy clinical practices who face the challenge of delivering high quality care to an ever-aging patient population. This collaborative effort has resulted in a product that fits pragmatically and economically into today’s fast-paced clinical practices.
Over the past 20 years, the MCIS has helped physicians manage patients effectively. The MCIS has been attractively reimbursed by Medicare and other insurances, further supporting physicians’ efforts to promote cognitive health. Additionally, the MCIS has been used in various academic research settings, as well as by commercial insurance companies for purposes such as long-term care and life insurance assessments.
The MCI Screen features:
- Have the highest accuracy in published medical literatures with both high sensitivity and high specificity.
- May be administered by a clinician or a trained office staff.
- Fully online guided administration of a 10-minute assessment that enforces consistency across different test administrators.
- Ensuring a longitudinal tracking of cognitive performance not unnecessarily biased by variability in the assessment process and different test administrators.
- Access accounts and test results from any internet-enabled computer, tablet, or hand-held device, at any time.
- Automatic scoring and reporting in real time, and the score adjusted based on age, gender, race, and education.
- Reimbursed for its test administration and interpretations by Medicare and other private insurances.
The MCI Screen meets all criteria for pragmatic implementation of cognitive assessment in clinical care setting.As part of your strategy to prevent symptoms of dementia, manage your risk factors.
Manage Your Risk Factors
Many known risk factors for Alzheimer’s disease and related disorders (ADRD) are extensively studied conditions that can be successfully managed. These risk factors can be mitigated by certain life style modifications and by appropriate medical treatment.
It is also important to work with your physician to establish a baseline of your overall health and to monitor it regularly. This includes an annual health exam, recommended screenings such as mammography and pap-smears for women of a certain age, and assessments for memory and other cognitive functions.
Prevent Stroke
Stroke increases an individual’s risk of developing vascular dementia by 6-10 times. By controlling existing heart diseases and optimizing cardiovascular health, stroke is a preventable disease.
Manage Diabetes
Diabetes increases the risk for stroke, heart disease and hypertension, all conditions that increase the risk of vascular dementia. Treatment for diabetes is well established, and controlling it effectively can prevent cognitive impairment.
Manage High Cholesterol
High cholesterol increases the production of beta amyloid, one of the hallmarks of Alzheimer’s disease, and doubles the risk of developing the disease. The American Heart Association recommends that total cholesterol should be maintained below 200 mg/dL with LDL cholesterol under 100 mg/dL.
Prevent Head Injury
A strong link between serious head injury and future risk of Alzheimer’s disease (AD) has been reported. Head injury with loss of consciousness in individuals with a genetic disposition to Alzheimer’s disease (the apolipoprotein E4 gene) increases the risk of the disease ten fold. It is important to protect your head by using your seat belt, wearing your helmet when participating in sports, and making homes fall-proof as appropriate.
Healthy Lifestyle
There is evidence that certain life style modifications reduce the risk of Alzheimer’s disease and related disorders. These include:
Diet
The World Health Organization recommends at least 400 g (3-4 servings) of fruits and vegetables per day to prevent chronic diseases. Other diet strategies include:
• Calorie-reduced diets have shown to control weight, heart disease, and stroke from obesity.
• Omega-3 fatty acid has been shown to reduce the risk of dementia by 33%. The correlation between omega-3 fatty acids and reduction of Alzheimer’s risk is still being studied. Omega-3 fatty acids can be found primarily in cold-water fish such as salmon, mackerel, herring and sardines. 650mg is the recommended daily intake of omega-3, an amount that is often difficult to get on a daily basis, therefore supplements are recommended. Additionally, when purchasing fish, those raised in the wild are recommended over farm-raised fish since the latter do not contain significant amounts of the acid.
• Dietary antioxidants from fruits and vegetables reduce the risk of developing Alzheimer’s by approximately 20%. Good sources of antioxidants include prunes, raisins, broccoli, berries, spinach, beets and red grapes.
Mental Exercise
A small but growing body of research suggests that mental exercise can reduce a person’s risk of developing Alzheimer’s disease (AD) by up to 33%. Activities that involve learning something new and then recalling it later are recommended since they activate the parts of the brain that are first affected by AD.
Physical Exercise
Regular physical exercise can improves the heart and strengthens the muscles, and can reduce the risk of developing dementia and AD by approximately 50%. Recommended exercises include but are not limited to swimming, cycling, jogging, skiing, aerobic dancing, and walking.
According to the latest joint American Heart Association/American College of Sports Medicine guidelines on physical activity, all healthy adults aged 18-65 should be getting at least 30 minutes of moderate intensity activity five days per week. For those 65 and older, or for those 50-64 with chronic conditions or physical functional limitations (e.g., arthritis) that affect movement ability or physical fitness.
References
1. Alzheimer’s Association. 2024 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dement 2024;20(5).
2. A Billing and Coding: Cognitive Assessment and Care Plan Service (CMS website: https://www.cms.gov/medicare-coverage-database/view/article.aspx?articleid=59036&ver=13&)
3. Cognitive Assessment & Care Plan Services (CMS website: https://www.cms.gov/medicare/payment/fee-schedules/physician/cognitive-assessment)
4. Alzheimer’s Association. 2019 Alzheimer’s Disease Facts and Figures. Alzheimer’s Dement 2019;15(3):321-87.
5. Cordell CB, Borson S, Boustani M, et al. Medicare Detection of Cognitive Impairment Workgroup. Alzheimer's Association recommendations for operationalizing the detection of cognitive impairment during the Medicare Annual Wellness Visit in a primary care setting. Alzheimers Dement. 2013 Mar;9(2):141-50.
6. Athilingam P, Visovsky C, Elliott AF, Rogal PJ. Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice. Am J Alzheimers Dis Other Demen. 2015 Sep;30(6):547-58.
7. Liss JL, Seleri Assunção S, Cummings J, et al. Practical recommendations for timely, accurate diagnosis of symptomatic Alzheimer's disease (MCI and dementia) in primary care: a review and synthesis. J Intern Med. 2021 Aug;290(2):310-334.
8. de Levante Raphael D. The Knowledge and Attitudes of Primary Care and the Barriers to Early Detection and Diagnosis of Alzheimer's Disease. Medicina (Kaunas). 2022 Jul 7;58(7):906.
