Researchers have been working on the area of dementia prevention for many years and we now have a large body of information on the subject.
Because dementia develops slowly, the diagnosis is rarely made at a very early age. Yet we know the changes in the brain associated with Alzheimer’s and vascular dementia precede the development of symptoms, often by many, many years. Alzheimer’s is a form of dementia where abnormal proteins are laid down in the neurones of the brain. When a neurone is damaged by these proteins, the 20000 connections it has with other neurons are disrupted. As the damaged neurones accumulate with time, eventually the functions of the brain increasingly simplify. Some forms of Alzheimer’s are inherited but the majority is related to age. The earliest area affected is the Hippocampus, the area that deals with memory, specifically the form of memory that records the most recent five minutes to two weeks of information. Thus, the earliest symptom is difficulty remembering things that have recently occurred. This is not the tendency to walk into a room and forget why you are there; we have all done that since our twenties. It is the inability to recall recent events.
Vascular dementia or small vessel disease is very much related to age but also risk factors such as smoking, high blood pressure, diabetes, obesity, atrial fibrillation and raised cholesterol levels. Vascular dementia often follows a stepwise decline related to small strokes, rather than the steady decline seen in Alzheimer’s disease.
How can we diagnose Alzheimer’s in the very early stages when we can delay its progression? Sophisticated screening tools can often pick up subtle changes before symptoms become evident. A specialised MRI will often show changes in the area of the hippocampus and blood testing can detect the apolipoprotein E4 gene which increases risk of Alzheimer’s by two and a half times if one gene is inherited and five times if two genes are inherited. Having detected evidence of early Alzheimer’s we can initiate treatment that reduces the production of the abnormal proteins. In addition, a series of antioxidant medications can reduce the natural death of nerve cells in the brain. There is evidence that we can significantly delay progression of early Alzheimer’s, potentially delaying the disease for the remainder of our natural lives.
Vascular dementia is not a hereditary disease but many of the causes listed earlier are hereditary such as high blood pressure and diabetes. If we can treat the causes effectively, we can prevent or delay progression of the disease. We can effectively treat blood pressure, treat or prevent diabetes, stop smoking, reduce cholesterol, reduce homocysteine levels, reduce alcohol consumption and reduce caffeine intake.
So how can we reduce the risk of development or progression of these diseases and the other forms of dementia?
There are a number of simple things we can do to reduce risk. We cannot change our age or genes. However, Africans living in the USA who carry the E4 allele that increases Alzheimer’s risk have the expected rate of Alzheimer’s for carriers of the gene. Africans with the E4 allele who live in sub- Saharan Africa, where they have high levels of exercise and a low fat diet have a reduced risk of Alzheimer’s. It is estimated that regular exercise reduces the risk of Alzheimer’s by half.
Other things that will reduce the age of onset and progression include;
Reducing Homocysteine levels
High homocysteine levels increase LDL cholesterol levels which in turn increase risk of clogging of the arteries to the heart and brain. Homocysteine levels which can be detected in a blood test, are reduced by taking folic acid, vitamin B12 and pyridoxine.
Reducing alcohol consumption can reduce dementia risk although small amounts of alcohol ( 1-2 small glasses of wine on 3 or 4 days in each week) actually reduce the risk.
Stopping smoking reduces the risk of both Alzheimers and vascular dementia
Detecting and treating atrial fibrillation, an irregular heart rate, can significantly reduce the risk of vascular dementia as can lowering blood pressure and cholesterol. Atrial fibrillation can be detected on an ECG. Modern watches like the Apple watch now have an app where you can perform a simple ECG to detect possible atrial fibrillation.
There are also a number of other preventative therapies for dementia. These include Vitamin C if taken with Vitamin E. Acetyl-L-Carnitine, aspirin, Coenzyme Q10, and a diet restricted in calories but high in Omega 3 are also associated with a reduced risk. Fruit and vegetables high in antioxidants are protective. Correcting reduced oestrogen in women who have been hysterectomised, mental exercise, taking statins, folic acid and vitamin B are all associated with reduced risk of dementia.
There are also a large number of medications which are commonly taken that can cause memory problems and worsen dementia. Stopping and changing these can significantly improve symptoms. We review your medication in our memory appointment.
If you have concerns about memory, you can arrange an appointment in our memory clinic. Here we will offer a review of your history and medication, a medical examination to include skin colouration, blood pressure and pulse sitting and standing, eye movements, throat, heart and lung examination, breast, abdominal, muscle reflexes and if appropriate a genital examination.
This is followed by an extensive series of blood tests linked to memory loss and can include an optional apolipoprotein E genetic test. Urine is dipped to look for blood or protein. An ECG is performed to exclude atrial fibrillation or any heart abnormality.
Tests of memory function are used to assess evidence of significant memory changes.
Depression or anxiety which can impact memory are investigated with further tests. This is a very extensive process taking an hour or more. The initial appointment charge is £250 for the hour-long consultation, memory checks, examination and ECG. Blood test charges depend on whether the Apolipoprotein E genotype is included as this is an expensive test (£185). It is not essential, but some people may find it helpful to know if they carry a gene with increased risk in order that they can take early steps to minimise the risk of developing Alzheimers. The gene does not indicate you WILL get Alzheimers, it tells you if you have an increased risk. The remainder of the blood tests which include a very extensive list of tests including testosterone for men or oestrogen for women, Vitamin B12, folic acid, homocysteine, liver, kidney and thyroid function, cholesterol profile, glucose, full blood count, ESR, iron studies, muscle enzymes, and bone markers are charged at an additional £420. If you have recent (within two months) results for some of the blood tests we may be able to reduce the price of the blood tests further. An MRI scan be requested, if you are insured your insurer may insist that you see a specialist to agree the MRI request. If you are self-funding, we can request an MRI of the brain for you with a specialist with an interest in dementia. An MRI or when available a SPECT scan can detect early changes associated with dementia.
If you would like to book a memory appointment please call us on 01233 885257
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