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October 23, 2014

Alzheimer’s: What can you do to prevent it?

New cases of Alzheimer’s disease in America are diagnosed at a rate of one per minute. One in every 10 people over age 65 will develop this incurable condition, and half of people over age 85 will have Alzheimer’s.

If Alzheimer’s disease can’t be cured, can it be prevented? Joseph Maroon, clinical professor of neurological surgery, says in many cases, it can.

As for advanced age as a risk factor, “that’s one thing we really can’t do much about,” he said. However, other risks such as a history of cardiovascular disease, high blood pressure, history of mild cognitive impairment, or traumatic brain injury (TBI), can be minimized, he said in an Oct. 15 talk at the Hill House Kaufmann Center, part of the Alzheimer Disease Research Center’s Walter Allen Memorial Seminar series.

Studies have found some genetic risk factors for Alzheimer’s disease, but genetic causes underlie only about 5 percent of cases, Maroon said.

So, for the 95 percent of patients who are not going to acquire Alzheimer’s disease through genetic causes, how can it be prevented?

“The critical thing to realize is you have a choice,” Maroon said.


beans“Our lifestyle and its actions account for 70 percent of our ideal lifespan, and genes about 30 percent,” he said. “It is true, 30 percent of the things that happen to us, we’re not going to have much control over; it’s programmed into our DNA.”

But genes do nothing unless they’re acted upon, Maroon said. “The factors that tell the genes what to do are called epigenetic factors,” literally “above the genes.”

walnutsResearchers are finding that even prenatal epigenetic factors can have long-term effects on health. “What happens to the infant in utero in terms of the epigenetic factors of drugs, diet, nutrition, vitamins, can have a very powerful impact much later in development, in terms of diseases that one may acquire, including obesity, diabetes and other factors,” he said.


Trying to prevent Alzheimer’s? Diet is one of the factors that we control, says Joseph Maroon, who advocates avoiding junk food and excessive carbohydrates in favor of beans, certain  nuts and broiled fish, and food high in polyphenols, including red raspberries, blueberries and strawberries.

Trying to prevent Alzheimer’s? Diet is one of the factors that we control, says Joseph Maroon, who advocates avoiding junk food and excessive carbohydrates in favor of beans, certain nuts and broiled fish, and food high in polyphenols, including red raspberries, blueberries and strawberries.

Inflammation is a common factor in cancer, heart disease, arthritis and Alzheimer’s disease, Maroon said, describing four controllable elements that are linked to inflammation: a diet high in junk food laden with “bad” fats, lack of exercise, exposure to pollution and stress.

“The most important thing is: in each one of those things you have a choice,” he said. “We have a choice in what we eat, whether we exercise,” as well as in our environment and how we manage stress.

Maroon noted that some research has shown that patients who have taken ibuprofen long-term have less inflammation and a lower incidence of Alzheimer’s disease. However, long-term use of ibuprofen comes with the risk of ulcers. “It’s not innocuous, “ he cautioned.


salmonA person who eats a typical fast-food meal — Big Mac, a soda made of high-fructose corn syrup and a big order of fries covered in salt — is consuming food that will be turned into inflammatory compounds. “These compounds go throughout our bodies and then enter the cells and they tell the cells to make various proteins. Some of these proteins are very inflammatory,” Maroon said.

“If we eat junk, it tells our genes on our chromosomes throughmixed fruit various transcription factors to make inflammatory molecules, which cause these particular problems,” he said.

Conversely, with a calorie-restricted diet, a Mediterranean diet, high consumption of polyphenols (an antioxidant found in grapes and many vegetables), and appropriate nutritional supplements, “the transcription factors tell our genes to make proteins that are anti-inflammatory. So it reduces the plaque in our arteries, and probably also in our brains and also, to some extent, in the flexibility of our joints,” Maroon said.

Excessive carbohydrates should be avoided. “Sugar is probably the biggest poison in our diet. Most of the diseases we get are related to excessive carbohydrates,” he said.

So what is brain food? Eating baked or broiled fish several times a week has been found to increase brain size. “An increase in brain volume can protect against Alzheimer’s disease,” he said, adding that smaller fish should be consumed as opposed to larger fish, such as tuna, which have higher levels of mercury.

Also healthful for the brain are such foods as extra-virgin olive oil, avocados, flax seed oil, nuts — walnuts and almonds in particular —all of which are full of “good” fats.

He also recommended a diet that includes lean protein, fruits and vegetables, beans and “superfoods,” most of which are high in polyphenols: blueberries, strawberries, raspberries; spinach, fish oil, red grapes, dark chocolate (70 percent cacao) and modest amounts of caffeine.

Maroon, who has authored books on fish oil and on resveratrol, also is a proponent of dietary supplements. “The regular use of fish oil is associated with a significant reduction in cognitive decline and brain atrophy,” he said. And resveratrol, a polyphenol antioxidant found in red wine, has been found to activate longevity genes in animal studies.

“I think there is a role for selected agents in contributing to health,” he said, noting that there is “strong science” behind such supplements as folic acid; vitamins B-12, C and D; magnesium, fish oil and high-potency multi-vitamin and mineral capsules; and “good science” behind supplements such as co-enzyme Q10, alpha lipoic acid and ginkgo biloba.


“If there were a drug that could prevent heart attack, stroke, cancer and treat everything from fragile bones to constipation while staving off dementia, it would be a miracle elixir,” Maroon said. That elixir? “It is exercise.”

Excess fat tissue releases inflammatory molecules. Exercise, however, not only combats weight gain, it increases BDNF (brain-derived neurotrophic factor), a chemical that increases formation of new brain cells and enhances synaptic activity, communication among brain cells.

Exercise increases synapses as well as neuroplasticity, the ability to synthesize information, Maroon said.

In addition, walking 30 minutes a day will reduce the incidence of diabetes — the leading cause of blindness, kidney failure, kidney transplantation and amputations — by about 40 percent, he said. For those who can’t walk, water aerobics or swimming can substitute.

“If you can walk 30 minutes a day and decrease that risk, why wouldn’t you?” he said, adding that despite the benefits, eight out of 10 senior citizens forgo exercise.

Pitt studies have shown that walking 72 blocks per week actually increases the size of your brain, Maroon noted. “They’ve measured this with MRI and seen that your brain can increase in size with physical activity.”


Factors such as poor air quality, pesticides, chemicals and pollutants “all activate our genes to create problems,” and should be avoided, Maroon said.

Lead exposure in children may contribute to the later development of Alzheimer’s disease.

Smokers have a 45 percent greater risk of developing dementia than nonsmokers, Maroon said. “And 14 percent of all Alzheimer’s cases are potentially attributed to smoking.”

Exposure to radiation through X-rays and CT scans should not be taken lightly, Maroon said, urging patients to ask questions before undergoing CT scans.

Maroon urged extra caution with children.

“We see in our concussion clinic 10,000 new patients a year with cerebral concussion, primarily from sports.”

Many of those are children who have hit their head in falls from a swing or a skateboard. Typically, the first test recommended in the emergency room is a CT scan.

“One CT scan of the brain is equivalent to taking 200 chest X-rays and directing that radiation to the brain,” Maroon said.

“We do know that kids who are exposed to high doses of radiation as a baby have a higher incidence of malignant brain tumors later on,” he said. Before undergoing a diagnostic procedure, patients should ask what difference it would make in their treatment. “If it’s needed, by all means, there’s nothing better. But you really need to question it,” he stressed.

Emotional factors

Emotional health is one of the factors that most people don’t consider, Maroon said. “Religion, relationships, meditation, spirituality are extremely important.” Stress, worry and family turmoil can have a negative effect.

“People who are under excessive stress literally destroy their brain cells: We know this,” Maroon said.

“People who are under chronic stress make an excessive amount of cortisol, which is a stress hormone. Cortisol is death chronically to cells in our hippocampus, in the temporal lobe, which serves memory, which is the first area that gets destroyed in Alzheimer’s disease.”

Maroon pointed out that the areas known for high numbers of centenarians among them — Okinawa, Japan; the Mediterranean island of Sardinia; Nicoya, Costa Rica, and Loma Linda, California (which has a large Seventh-day Adventist population) — have in common such factors as prayer and relationships, exercise and hard work, a good diet and relatively clean environments. “They don’t smoke. If they drink it’s in moderation and it’s usually wine, not hard liquor, and they live the longest.”

They also have the lowest incidence of cardiovascular disease, Alzheimer’s disease and other diseases of aging, Maroon said.


What about traumatic brain injury? Maroon, who is the team neurosurgeon for the Pittsburgh Steelers, noted the high-profile cases of NFL players Junior Seau, Mike Webster, Terry Long and Justin Strzelczyk, whose deaths were linked to brain damage attributed to their football careers, and the recent criticism of University of Michigan coaches who in a game last month against Minnesota allowed quarterback Shane Morris to return to the field after he suffered a concussion.

“Clearly you can have cognitive impairment if you get hit in the head, or have a bad car accident or fall. And these are the major causes in the older patients,” Maroon said.

Severe head injury can result in neurodegeneration and Alzheimer’s-like syndromes and questions remain, he admitted. But the fear of developing chronic traumatic encephalopathy after a single concussion is “overrated,” based on a review of the literature back to the 1950s, he said. “Millions and millions of kids have played football and have had concussions without developing neurodegeneration of their brain,” he said.

“Chronic traumatic encephalopathy in athletes is not Alzheimer’s disease. There are unique changes that occur in the brain that are actually different from Alzheimer’s,” he said, adding that the link between Alzheimer’s and trauma is extremely complex.

“The best thing: Don’t get hit in the head.”

—Kimberly K. Barlow

Filed under: Feature,Volume 47 Issue 5