Demystifying Dementia – Part II

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Exercise and socializing help prevent Alzheimer’s. Relaxing after a tai chi class at Noguchi Plaza in Little Tokyo are, from left: Hong Wong, Mo Nishida, instructor Misako Tsuchiya, Ernie Fukumoto and his dog Kenu, Bill Uyehara, and Karima Boaulia. (Photo by Ellen Endo/Rafu Shimpo)

By ELLEN ENDO, Contributing Writer

There is no cure for Alzheimer’s, but can it be prevented? To this, experts say, “Put down the crossword puzzle and go for a walk.”

“I’ve liked sports all my life, so physical exercise (is important). You can’t be sedentary,” states Dr. Helena Chang Chui, an internationally recognized expert on Alzheimer’s and vascular dementia who has spent much of her 35-year career working with patients and researchers to develop preventions and better treatments.

One in five Japanese Americans is over age 65 (21.6 percent) compared to the number of people over 65 in the general population (12.1 percent), according to the 2010 Census.  Additionally, those over 80 are the fastest-growing segment of the JA population with a life expectancy estimated at 91.8 for women and 90.7 for men, say researchers.

The risk of Alzheimer’s doubles every five years after age 65. “It’s important not to wait until the dementia starts (to begin preventive steps),” says Dr. Kenneth M. Sakauye, author of “Geriatric Psychiatry Basics” and contributing co-author with Dr. Iqbal Ahmed to the “Praeger Handbook of Asian American Health.”

“Alzheimer’s is a disease. Just because something is an epidemic doesn’t mean it’s a normal part of aging,” adds Sakauye, a University of Tennessee professor of psychiatry and vice chair of psychiatry at UT’s Health Science Center College of Medicine. “Engaging in activities to improve your mental function must be started early.”

Once dementia occurs, it cannot be reversed, Sakauye notes.

Dr. Chui concurs. “Our best defense is a good offense, which (means) working with researchers to try to find better treatments for people that have symptoms and also preventions to reduce the frequency of developing symptoms.”

Chui chairs the University of Southern California Department of Neurology and is the principal investigator for the National Institute of Aging (NIA)-funded Alzheimer’s Disease Research Center.

Chui adds, “The effects of vascular dementia can be subtle … and symptoms of cognitive impairment can occur in small steps, stabilize, and then progress further. We’re interested in the health of the blood vessel system and, therefore, the health of the brain.”

These seniors get their exercise by line dancing at San Fernando Valley Japanese American Community Center in Pacoima. Credit: Linda Yamada

Gerontologist Dr. Freddi Segal-Gidan, director of the Rancho Los Amigos/USC California Alzheimer’s Disease Center and a colleague of Dr. Chui, emphasizes the importance of early diagnosis. “Many elderly people may have mild dementia that is not recognized by family members,” Segal-Gidan recently told The Rafu Shimpo.

Equally important, adds Segal-Gidan, is recognizing cultural differences and helping the family to cope. “In general, among Japanese Americans, there is a lot of deference to the physician, which can be good,” she observes.

“The individual who is experiencing memory impairment may exhibit a change in personality. That’s hard for families to deal with,” Segal-Gidan adds.

“There may also be a bit of shame associated with memory problems and behavior changes. When someone becomes agitated and aggressive, people may be embarrassed by their behavior. But these are the symptoms.

“We don’t have really good treatments (at this time), but we understand the disease more.”

So, what can individuals do to ward off Alzheimer’s and other causes of dementia?

Dr. Helen Petrovitch, who has studied men of Japanese ancestry in the Honolulu-Asia Alzheimer’s Study (HAAS) from 1991 to the present, says that doing crossword and sudoku puzzles or learning a new skill don’t hurt, but they probably don’t help much either.

Larger-scale studies and further research are needed, but there are some things that may help lower risk. The experts offer the following advice:

1) Control blood pressure. Hypertension and stroke have been linked to Alzheimer’s and other dementias.

2) Maintain a healthy cholesterol level. High cholesterol increases risk of cardiovascular disease and vascular dementia.

3) Stay socially active. It reduces the stress, a contributing factor to dementia.

4) Take fish oil every day. “I do,” Petrovitch adds. Fish oil provides omega-3 fats (salmon, tuna, trout, mackerel, sardines), which the brain needs.

5) Walk and exercise regularly. It increases blood and oxygen flow to the brain.

6) Limit tofu. It contains plant estrogens that can shrink the brain.

7) Follow a heart-healthy Mediterranean diet that includes fish, whole grains, nuts, olive oil, and fresh fruits and vegetables.

8) Treat yourself to an occasional glass of red wine, which contains resveratrol, which is also found in grapes.

9) Drink green tea regularly. A team of German researchers has found that green tea contains epigallocatechin gallate (EGCG), which helps prevent development of harmful amyloid plaques in the brain.

10) Drink caffeinated coffee in moderation. University of South Florida researchers also say that the caffeine in coffee can delay the onset of Alzheimer’s even in those who already have mild cognitive impairment.

11) Control cholesterol, blood pressure, and diabetes, all of which have been linked to cognitive decline.

12) Avoid head trauma. Fall-proof your home; wear a helmet when riding a bike or engaging in high-risk activities.

13) Cumin and cilantro, typically used to season yellow curry and Mexican food, have been found to enhance learning in test animals.

As part of the Kame Project of King County, Washington, researchers wanted to know if drinking juices would delay the onset of dementia. The study involved 1,836 Japanese American men and women age 65 and older who were deemed dementia-free when the project began in 1992. Participants were followed through 2001, comparing those who drank juices an average of three times per week versus those who drank juice less than once a week.

The collaborative study between the University of Washington and Seattle Japanese American community concluded that juices high in polyphenols contained the most health benefits. More importantly, the study determined that diet and lifestyle influenced the onset of dementia more than genetics.

Among the juices most commonly consumed, grape, apple, orange, and cranberry contained the highest levels of polyphenols. Acai, pomegranate, berry, and cherry juices had even higher levels.

Adding to the list of memory enhancers, television’s “Dr. Oz” recently invited Dr. Majid Fortuhi, chairman of the Neurology Institute for Brain Health and Fitness, to identify foods that can boost memory at any age. They are: beets, pecans, chicken giblets, clams, elderberries, and fresh vegetable juices. Fortuhi, who is also assistant professor of neurology at Johns Hopkins School of Medicine, also recommended push-ups as an ideal brain-boosting exercise.

Neurologists, gerontologists, and others who work with the elderly agree that early detection is key. If forgetting where you put your keys or glasses seems to be happening more often, or you enter a room then can’t remember why you’re there, these might just be normal distraction or an indication of something more.

Dr. Chui believes there are long-range benefits to being proactive with diet and exercise. “If we could delay the onset by just five years, we could cut the frequency, the prevalence (of dementia) by half,” she predicts.

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Ellen Endo is a 2012 National Press Foundation Alzheimer’s Issues Fellow. The final installment of this three-part series will delve into the latest scientific advances and hope for the future.

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