Question: Which diet is better for reducing the risk of dementia—the MIND diet or a whole food, plant based diet?
Answer: There hasn’t been a study that has looked at the risk of dementia in a vegetarian diet. Studies in this area definitely need to be done. Perhaps a vegan diet or vegetarian diet would be effective in lowering one’s risk—we just don’t know. Fish has been shown to be effective in protecting the brain, so that would be the one beneficial component lacking from a vegetarian diet.
Question: Are there certain kinds of fish that are more beneficial to brain health than others?
Answer: Theoretically, you would think that dark meat—fattier fish—would be more protective, although there really isn’t consistent scientific evidence to support that.
Question: What is the potential benefit of taking curcumin?
Answer: Curcumin is an important ingredient in Indian food, specifically east Indian food. Curcumin and turmeric come from the same plant. They are strong antioxidants and anti-inflammatories. I’m not aware of any control trials of treatments involving this, but there might be some epidemiological evidence. The evidence so far, at least in my opinion, is not that strong. So, there needs to be more studies in that area.
Question: Is there a difference between Alzheimer’s and dementia?
Answer: Yes. Dementia is a clinical syndrome that includes the combination of having one or more cognitive problems, like memory loss, and then some associated changes in functioning like driving, or money management, or personal care. Alzheimer’s disease is one of the causes of dementia, and there are others such as stroke and Parkinson’s related conditions. One of the neat things about disentangling those is that there’s more and more evidence that we can potentially detect Alzheimer’s disease even before we get to that dementia state. Studies looking at early biomarkers could indicate that the process of Alzheimer’s disease is actually happening years, even decades, before you get to the dementia stage.
Question: Do statins cause either Alzheimer’s disease or dementia? Is there conflicting data around this?
Answer: As of right now, we do not have studies that show a casual, direct relationship. So, for patients, if you have very, very high levels of cholesterol, if they already see plaque buildup in your arteries, if you have diabetes, high blood pressure, or other things that may increase risks your risk for heart disease, they may indeed recommend a statin for you. In addition, if you’ve already had a heart attack, then it’s been demonstrated that statins can reduce your risk of death related to heart disease. So, individual discussions with your provider are important. Both heart doctors and Alzheimer’s disease researchers are thinking about how to protect the vessels overall.
Question: If we have plaque can we get rid of it?
Answer: Diet and exercise can really help the health of the vessel, but also it has been shown that for some people, if they’re appropriately selected for statin therapy, it can begin to decrease the amount of plaque buildup in the arteries over about two to three years.
Question: Can exercise remove amyloid and tau from the brain?
Answer: There’s not any evidence that exercise can reverse the amyloid or the tau that’s already in the brain. There is evidence from animal-based studies that exercise and improving blood flow might prevent amyloid accumulation. However, cognitive reserve—or making sure we have enough connections already in the brain—might be able to help us keep our cognitive abilities for longer, despite the fact there might be amyloid and tau in the brain. Even though exercise may not directly remove amyloid and tau from the brain, it can still be beneficial if there is already amyloid and tau there.
Question: What are the effects of vitamin B12 and vitamin D?
Answer: Vitamin B12 we know has a neurologic syndrome associated with it where if you are deficient in B12 it’s progressive. Everyone in their middle age and older years needs to know their vitamin B12 levels are. You can get a supplement or you can take injections on a monthly basis to keep those levels up so you don’t have neurodegenerative problems, which can be cognitive in some cases. For vitamin D, there is a very large clinical trial that’s ongoing right now, and I think that will give us a definitive answer. So far, the studies that have been done are all over the place. I’m not convinced that there’s a strong relationship there so, we have to wait for that ongoing study.
Question: Is there a difference in getting your vitamins through food versus through supplements?
Answer: Yes, there has been a lot of evidence showing the benefits of getting vitamins through food, rather than through supplements.
Question: Can we get rid of plaque through exercise?
Answer: Exercise can’t get rid of plaque, but it helps the arteries function even around that plaque. Exercise is still very important even if we can’t get rid of the plaque.
Question: If we have varicose veins, does that demonstrate that we have either bad arteries or a bad heart?
Answer: Veins are different than the arteries. As we get older, veins get looser over time. They don’t necessarily return that blood back up from our legs up to our heart as efficiently. So, we may notice some puffiness in our ankles, maybe at the end of the day, or maybe throughout the day, but your health care team might recommend reducing the amount of salt or sodium in your diet to help. It doesn’t mean that you have heart failure or necessarily a bad heart, but we need to help the body move that fluid out and not cause it to build up so much in the day. Sometimes simple things, such as those compression socks that we don’t like to wear throughout the day, can help.
Question: What is the relationship between estrogen and Alzheimer’s disease and memory?
Answer: There is some relationship between estrogen and cognitive function. The area of estrogen and Alzheimer’s disease is yet to be systematically evaluated and come to a definitive conclusion, but there is increasing evidence that after menopause there are changes with estrogen that are related to some cognitive function declines and some mood changes that are very common after menopause. A number of clinical trials have been done in regard to estrogen and cognitive function. Some of them have shown beneficial effects. They are usually for a limited amount of time. So, there is no trial data that has shown thus far that if you took estrogen during the perimenopausal period or during a few years after menopause, that it will have a long-term beneficial effect. The effects that you see, in terms of some benefit on both cognition and mood, will last as long as you take the estrogen hormone. They are not long-term beneficial effects yet, but there is a theory that it may be possible if you took estrogen say five, six, seven years after menopause, that there is a potential that it could reduce the risk for Alzheimer’s disease, but that study has not been done. There are some studies in which we’re trying to explore that very important question.
Question: Is there a relationship between Alzheimer’s and sleep?
Answer: There is increasing evidence that dysregulation of sleep and sleep-related disorders of breathing, such as sleep apnea and many other disorders in that spectrum, are related to Alzheimer’s. Perhaps the disorders do increase the risk for Alzheimer’s disease; there’s some evidence showing that sleep disorders can precipitate, or enhance, the amyloid deposition on PET scans. The evidence is getting stronger every day.
Question: What about some of the memory pill medications? Do any help?
Answer: There are four medications that have been approved by the FDA for treatment of dementia due to Alzheimer’s disease. Three of them are very similar—they’re donepezil, rivastigmine, galantamine. Donepezil, for example, is better known as Aricept. They all work on a brain transmitter called acetylcholine, which seems to be affected in people with dementia. They’re not super helpful medications, but they can potentially delay, by about six to twelve months, the progression of memory loss. There’s a fourth medication, memantine, that works on a different neurotransmitter called glutamate. This one, too, could do a little bit of delaying and that’s it—that is the extent of the evidence base.
Question: What about the over-the-counter ones that are being promoted?
Answer: They haven’t been demonstrated to work.
Question: How is an Alzheimer’s disease diagnosis made for certain—will the medical community use PET scans diagnostically at some point?
Answer: Currently, the diagnosis is mostly a clinical diagnosis, meaning that it’s a combination of symptoms and history and doing some tests to rule out other things, like making sure we aren’t missing a stroke, thyroid problems, depression, or B12 deficiency as potential causes. That’s the current state and we hope that over time we’ll be able to add biomarkers; so, that includes things like brain imaging, such as PET scan, where we can now begin to actually image the amyloid and tau in the brain—the plaques and tangles. That’s not quite ready in the terms of clinical use, but we hope eventually those will help. We can also measure tau and amyloid from a lumbar puncture and the cerebrospinal fluid obtained from that. So, not necessarily routine parts of the diagnosis, but hopefully eventually these will all be helpful to give us a more definitive diagnosis.
Question: Is it better to do intense intervals for exercise or is it better to do steady-state, longer exercise?
Answer: The answer is yes, both. Every exercise you do does not have to be the same. So, if you want to do intense, vigorous activity, sometimes it’s best to start with maybe just a minute or two at a time, while kind of walking in between. It doesn’t have to be intense all the time; it can be intense and just cycle it with maybe a little bit easier activity four times or five times over the course of the exercise that you’re doing. Doing the steady- state exercise, meaning you get to a certain intensity and you just keep that pace, that’s also good. So, both of those are very good, very helpful ways and I think it’s a really good way to mix it up a little bit so you don’t get bored of doing the same thing. It also gives you some challenges. If you have to go upstairs or walk up a hill, it gives you that intense interval and then you can quickly go back to an easier interval.
Question: If you have to stop exercising, due to a health issue or a variety of other reasons, is it starting all over again once you start exercising again?
Answer: The answer is no, not really. If you have to stop exercise and you have had to take weeks, months, or even years off from exercising, don’t feel like you’re starting at zero. Your body will remember and when you get back to moving and get back to doing some of the things that you used to be doing, your body will remember. You just have to take it slow and work with your healthcare provider to make sure you’re doing everything appropriately.
Question: Does the MIND diet help very old people or those who already have mild to moderate signs of cognitive decline?
Answer: Yes and no. We have looked at the MIND diet in relation to cognitive decline, including in people who have dementia and mild cognitive impairment, and we do see some slowing of the rate of decline. But the effect is much stronger in older people who are not demented. We really need to have clinical trials to be able to answer that question definitively in people with mild cognitive impairment.
Question: Is periodontal disease a risk factor of dementia?
Answer: Periodontal disease, or inflammation of the gum tissue, reflects inflammation in the body. So, it’s not that periodontal disease is an isolated issue, but it’s what’s causing the inflammation in the body that needs to be addressed. Some ways to address periodontal disease to help decrease that inflammation include lowering blood glucose, adapting a healthy diet, and maintaining good hygiene.
Question: What is the insurance coverage for some of these Alzheimer’s disease related tests such as a PET scan?
Answer: Medicare will pay for something known as an FDG-PET scan. This is the PET scat that estimates brain activity using glucose that is injected. However, PET amyloid scans and tau scans are not covered by any insurance or Medicare. I think that is an area that will soon be addressed. There is a large Medicare fund history called IDEAS study, which is trying to find the benefit of doing amyloid PET scans and its role in the diagnosis of Alzheimer’s disease in a clinic setting. Some of the initial results are very interesting and positive. I think as those findings become more known and definitive, Medicare may move toward covering amyloid PET scans, or even tau scan, but they are not covered at this moment.
