Still much to learn in Alzheimer`s

Although we've had a name for the disease for more than a century, there is still a lot to be learned about what causes Alzheimer's as well as how to prevent and treat it. A recent report put out by the National Institute of Health in the US was pretty pessimistic about our level of understanding of this devastating condition.

Roughly 500,000 Canadians currently live with Alzheimer's disease. According to Alzheimer Society, more than 103,000 Canadians will develop the condition this year and the numbers continue to rise as our population ages. It currently accounts for 63 percent of all cases of dementia in Canada.

Unfortunately, although the report (Preventing Alzheimer's Disease and Cognitive Decline) examined relevant studies on nutrition, medical conditions, medication, social, economic, behavioural, environmental and genetic factors, it found the science is inconclusive as to the causes of cognitive decline and Alzheimer's disease.

Not only do we not know what causes Alzheimer's, we also have no reliable evidence to show that anything can prevent it or stop it from progressing.

Report authors examined available data from studies performed on humans aged 50 or older in developed countries. They limited their examination to studies with a sample size of at least 50 and of at least 300 for observational studies, and they required a minimum study duration of one year.

Authors concluded we have no valid evidence to suggest that anything we currently do, nutritional supplements, herbal preparations, dietary factors, prescription or non-prescription medication, social or economic factors, medical conditions, toxins or environmental factors, will reduce the risk of a person developing Alzheimer's disease. We do know that the presence of a particular DNA variation (apolipoprotein E) is strongly linked to Alzheimer's, but this is not something we can do anything about.

Some weak data exists to suggest certain things can increase our risk of developing Alzheimer's. These include diabetes, elevated blood cholesterol during midlife, depression, smoking, loss of a spouse, never being married or having a limited social support system.

A new study published in early May in the Journal of American Geriatrics Society has found a strong correlation between caring for a spouse with dementia and developing the condition. Caring spouses have six times the likelihood of developing dementia themselves. It is unknown why this is the case, whether it is due to the intense stress of caring for a loved one or whether it is related to the couple's shared environment or lifestyle.

Weak data also supports a few factors which may reduce the risk of developing Alzheimer's. These include: enough folic acid; a diet low in saturated fats and high in fruits, vegetables, grains, nuts, fish and olive oil; use of statins, consumption of alcohol in moderate amount; more years of education; mental engagement; and physical activity.

Some evidence also suggests omega-3 fatty acids can prevent cognitive decline (but not necessarily Alzheimer's). Several studies show the omega 3 fatty acids from eating fish reduce risk, but another study found fish oil supplements did not help.

All in all, the report's author's said there are currently no studies to confirm people can ward off Alzheimer's. Even current treatments such as donepezil (Aricept), cannot prevent the disease.

This report dealt mostly with prevention rather than treatment, but there is currently not much good news in this department either.

One exception could be the use of intravenous immunoglobulin. A new preliminary study showed this treatment slowed cognitive decline and also decreased ventricular enlargement in the brain, which is associated with brain atrophy in dementia. These findings are very preliminary, but could mark the beginning of an exciting new direction for Alzheimer's research.

Research is ongoing in several other areas and hopefully the next few decades will yield better results in figuring out this complex disease.


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