Let Me Remind You: Key Factors in Alzheimer's Disease

Overview

Forgetting where you put your keys can be a normal part of a busy life with an inattentive mind, or it could signify the normal minor cognitive impairments that can occur with age.1  For 44 million people worldwide,1 however, the sense of forgetfulness can signify the progression of Alzheimer’s disease.  AD is a progressive form of cognitive decline that affects a person’s memory, language and living skills1 as well as the commonly known symptom of forgetfulness.   AD is the most common form of dementia, with an estimated nearly 10 million American diagnoses by the year 2040.1

We have long understood that this cognitive disease is caused by lesions on the brain, through which cell signaling becomes interrupted, striking an inflammatory response in the immune system.1  This inflammation is a clear factor in the pathology of AD as it deadens nerve cells in the brain,1 taking with them the functions associated there.  Inflammation influencing Alzheimer’s disease consists of a web of interacting chemical mediators including high plasma levels of C reactive protein, and interleukin 1, both known to be notably higher in adults with Alzheimer’s.2   Lives with chronic low grade systemic inflammation, like in the case of type 2 diabetes,2 lends to heightened production of interleukin 1 and tumor necrosis alpha, both of which may be indicative of a future Alzheimer’s risk.3

A person’s genetic makeup has been suggested as a possible factor in the potential development of AD as genetic polymorphisms like APOE4, and MTHFR, C677T and A1298C which slow down the usage of folate, a complex cascade which assists methylation, and is responsible for a wide variety of biochemical reactions required for proper health of the nerves and mitochondria.1  Nutritionally, this inability to convert and utilize folate and b vitamins effectively, as well as low dietary intake of these nutrients could lead to elevated homocysteine and inflammatory markers.1,2

Exposure to environmental toxins like lead, pesticides and electromagnetic fields have also been suggested, though not proven, to increase the risk of AD.4,5

Therapeutic Foods

Aptly named, the MIND diet(Mediterranean/Dash Intervention for Neurodegenerative Delay) has proudly withstood the rigors of research to demonstrate a 53% lowered risk of developing AD in a study with over 923 mature adults aged between 58 and 98 years old utilizing MIND over a time span of 4.5 years.6  The diet plan is a hybrid of the Mediterranean and Dash diets, and puts an emphasis uniquely on green leafy vegetables and berries, which are neuroprotective, in addition to  whole grains, low quantities of fish, nuts, beans and olive  oil, at the same time decreasing red meat products, fast and fried foods, cheese, butter, pastries and sweets.6

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Berries are particularly promoted due to their neuroprotective properties.1  Berries like raspberries, blueberries, blackberries and strawberries are recommended at least twice weekly.1  In a study involving over 2800 participants, those with the highest flavonoid intake from berry fruits were 40% less likely to see cognitive decline associated with AD and/or dementia.7

Brazil nuts have also been indicated as a recommended source of nutrition for someone at risk of developing AD, as they have a high concentration of selenium.  In a study where participants were given one brazil nut per day for 6 months, interestingly, noticeable decreases in cognitive decline were related to specific gene type.8  The study concluded with the notation that brazil nuts and specifically selenium were supportive but that more research needs to be done according to individual variations and that in the future, therapy could be assigned based on genetic typing.8

Some of the known side effects from medications approved for AD include bradycardia, syncope, diarrhea, headaches, and nausea.1,9  The elements of the MIND diet advertising adequate fiber, essential fatty acids, and quality proteins on a low glycemic index platform could be an important complement to medication therapy. 

Potential negative aspects of this dietary plan are that the user, being in the risk category for cognitive decline and lifestyle function would need someone to help them understand and implement the diet.  To combat this, it could be suggested that family and care support members could attend the nutritional education sessions to learn how to properly support their loved one with the MIND diet.

Supplements to Consider

When it comes to AD, nutrients that facilitate nerve health and phospholipids for healthy cell membranes become of prime importance.  One such nutrient, Aceltyl-L-carnitine,(ALCAR) is made in the brain, liver and kidneys.  It helps oxidize fatty acids for use and enhances acetylcholine and phospholipid synthesis.1  It also seems to assist the nourishment of mitochondria with Acetyl CoA.  In one study, patients were given 2g for 255 days.10  While the study specifically was to determine the association of ALCAR and nerve regeneration in diabetics, the fact that significant nerve conduction was noted indicates the potential for use in AD and needs further study.10  Significant side effects are uncommon and ALCAR is generally considered safe.1

Complementary to ALCAR would be Alpha-lipoic acid (ALA), most well-known for its antioxidant properties10 and its ability to activate the oxidative stress response.1  ALA has shown oxidative protection against lesions, diabetes, and neurodegeneration.10  It has been shown to improve glucose handling as well as initiate Phase 2 Detox, with particular use in the detoxification of certain heavy metals.1   A dosage of 600mg daily for 12 months demonstrated a slowed progression in patients with AD.11

People to Add To Your Team

In complex disorders, it is wise to collaborate with multi-disciplinary practitioners that can understand all the unique aspects of AD.  Light physical exercise and particularly those that engage the mind together with the body like yoga and tai chi, helps to remind the neuromuscular systems of their connections, a benefit for individual with AD.  A 2014 review suggested that practicing tai chi positively altered cognition in people with mild forms.12  Joining up with an instructor that is skilled in working with the elderly and mind body methods like tai chi can be one way to meet goals of physical activity, stress release and optimized vascular functions.1

Conclusion

Much is still being researched when it comes to neuropsychiatric disorders like Alzheimer’s disease.  Let this be a reminder of the importance of proper nutrition, sugar handling and functional processes as neuroprotective early on in life.

References

1. Rakel D. Integrative Medicine. In: Integrative Medicine. 4th ed. Elsevier; 2018:320-333.

2. Bozluolcay M, Andican G, Fırtına S, Erkol G, Konukoglu D. Inflammatory hypothesis as a link between Alzheimer’s disease and diabetes mellitus. Geriatr Gerontol Int. 2016;16(10):1161-1166. doi:10.1111/GGI.12602

3. Tobinick EL. Inflammatory markers and the risk of Alzheimer disease: The Framingham study. Neurology. 2008;70(14):1222. doi:10.1212/01.wnl.0000307660.86647.7b

4. Feychting M, Jonsson F, Pedersen NL, Ahlbom A. Occupational magnetic field exposure and neurodegenerative disease. Epidemiology. 2003;14(4):413-419. doi:10.1097/01.EDE.0000071409.23291.7B

5. Qiu C, Kivipelto M, Von Strauss E. Epidemiology of Alzheimer’s disease: occurrence, determinants, and strategies toward intervention. Dialogues Clin Neurosci. 2009;11(2):111-128. doi:10.31887/DCNS.2009.11.2/CQIU

6. Morris MC, Tangney CC, Wang Y, Sacks FM, Bennett DA, Aggarwal NT. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimers Dement. 2015;11(9):1007-1014. doi:10.1016/J.JALZ.2014.11.009

7. Berries and Fruits Protect Against Alzheimer’s Disease. Accessed February 2, 2022. https://www.pcrm.org/news/health-nutrition/berries-and-fruits-protect-against-alzheimers-disease

8. Cardoso BR, Busse AL, Hare DJ, et al. Pro198Leu polymorphism affects the selenium status and GPx activity in response to Brazil nut intake. Food Funct. 2016;7(2):825-833. doi:10.1039/C5FO01270H

9. Medicines TN. Natural Medicines Database. https://naturalmedicines-therapeuticresearch-com.scnmlib.idm.oclc.org/#A

10. Nascimento OJM, Pessoa BL, Orsini M, et al. Neuropathic Pain Treatment: Still a Challenge. Neurol Int. 2016;8(2):36-38. doi:10.4081/NI.2016.6322

11. Hager K, Kenklies M, McAfoose J, Engel J, Münch G. Alpha-lipoic acid as a new treatment option for Alzheimer’s disease--a 48 months follow-up analysis. J Neural Transm Suppl. 2007;(72):189-193. doi:10.1007/978-3-211-73574-9_24

12. Tai Chi and Qi Gong: In Depth | NCCIH. Accessed February 2, 2022. https://www.nccih.nih.gov/health/tai-chi-and-qi-gong-in-depth