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Cognitive health: Alzheimer’s disease

Cognitive health: Alzheimer’s disease

Cognitive health: Alzheimer’s disease

Alzheimer’s disease is often mistakenly used as an alternative word for dementia. But Alzheimer’s is actually a type of dementia. In fact it’s the most common type, with the second most common being vascular dementia. Indeed according to the Alzheimer’s Society, of the 850,000 people in the UK who are currently affected by dementia (i), 520,000 have dementia caused by Alzheimer’s (ii).

Dementia itself describes a set of symptoms that are caused when the brain is damaged by a disease – Alzheimer’s, for example – or a series of strokes (as with vascular dementia). You could also say it’s an umbrella term for a number of conditions that affect the brain, just one of which is Alzheimer’s (in fact according to Dementia UK there are more than 200 different types of dementia (iii)).

Dementia is also progressive, which means its symptoms become worse over time. Experts believe Alzheimer's symptoms progress slowly over a period over seven to 10 years (iv) – though this can vary from one affected person to the next. Scientists also believe that the degeneration in the brain thought to be involved in the development of Alzheimer’s probably begins at least 10 years before any clinical symptoms start to appear (v).

Alzheimer’s and memory loss

Each person diagnosed will experience dementia in their own way, but one of the most common symptoms is memory loss. This may include things like:

Forgetting what happened earlier in the day while having no difficulty remembering things from long ago
Misplacing or losing things more frequently
Forgetting important events or numbers
Forgetting where everyday things are kept (people with Alzheimer's and other types of dementia also often put things in unusual places)
Asking someone to repeat things over and over, or relying on memory aids a lot (written notes, for instance).

Many people with Alzheimer's may also develop language difficulties. This means they may struggle with written or spoken words, so they may have problems following or joining in a conversation or watching and following the radio or TV. These types of problems include not being able to find the right words or forgetting what they said when they’re in the middle of a sentence, or repeating what they said just a few moments ago. They may also not be able to keep track while reading a book, magazine or newspaper.

Confusion about things you’ve been familiar with is also common in Alzheimer’s, including having difficulties with driving to familiar places and going shopping and using money. People with Alzheimer’s may also find it hard to learn new things or make decisions, and may become less flexible, and may also experience things like mood changes, anxiety and agitation.

All of these are early symptoms of Alzheimer’s, with the main one being memory problems. But because these symptoms usually develop very gradually, it can be difficult for someone who’s affected – or their loved ones – to realise there’s a problem. With memory problems, for instance, people often think it’s just a part of getting older.

What are the other symptoms?

Then as Alzheimer’s progresses, not only do memory problems get worse but other symptoms can appear too, including:

Sleep problems
Increasing confusion (such as not knowing what time of day it is)
Feelings of paranoia and being suspicious of other people (including carers and family members)
More frequent mood swings as well as anxiety, frustration, agitation and depression
Problems with judging distances and other spatial tasks

If you or someone you love is affected by one or more of these signs, it doesn’t necessarily mean that you or they have dementia. But if these changes have been happening for a while and are getting worse, it may be time to see a GP. One good reason for seeing a GP is that there are lots of other things that could be causing these symptoms. So getting medical advice might help put your mind at rest.

What causes Alzheimer’s?

Exactly what causes Alzheimer’s isn’t known yet, but it’s thought the symptoms are triggered by progressive physical changes in the brain.

The general area of the brain that becomes damaged is called the cerebral cortex. When this happens the affected brain cells don’t communicate and function properly – this is known as cortical atrophy. Two proteins are thought to be involved in this process, called amyloid and tau. For some as yet unknown reason these proteins build up inside brain cells and form abnormal structures called plaques and tangles (twisted fibres), with more and more brain cells becoming affected over time.

Experts also believe that people with Alzheimer’s may have lower levels of certain chemicals in the brain that help send signals between brain cells (also called neurotransmitters, these include acetylcholine, glutamate, serotonin and dopamine). Because the levels of these chemicals are lower than they should be, the affected brain cells may not communicate as well as they should.

However, right now we still don’t know whether any or all of these processes actually cause Alzheimer’s directly or are a result of it.

What are the Alzheimer's risk factors?

Currently there’s no known reason why some people develop Alzheimer’s while others don’t. But we do know that some things increase your risk for the condition:

Getting older: The biggest risk factor for Alzheimer’s and other forms of dementia is age, which means the older you are, the more likely you are to develop it (though it’s not inevitable, even if you live to a ripe old age). According to the NHS, dementia is most common in people aged 65 and older, affecting an estimated one in 14 people over 65 and one in six over 80 (vi). But it doesn’t affect older people exclusively, with one in 20 cases found in people aged 40 - 65 (this is called early-onset Alzheimer’s) (vi).

Family history: Having a parent or grandparent with Alzheimer’s means your risk may be slightly higher than someone who doesn’t have a family history of dementia. Some genes can run families and make people more vulnerable to developing dementia, though according to the Alzheimer’s Society, this is very rare (i).

So if Alzheimer’s does run in your family it doesn’t automatically mean dementia is inevitable for you. Meanwhile according to the NHS, if several of your family members have developed dementia over the generations – particularly when they were young – it may be a good idea to speak to your GP about genetic counselling. This can offer you access to advice about your chances of developing Alzheimer’s in the future too (vii).

Men vs women: Alzheimer’s is more common in women than in men. In fact, the Alzheimer’s Society claims there are about twice as many women as men over the age of 65 with Alzheimer’s (i). This could be because women, on average, live longer than men. Or there may be a link between dementia and the loss of the hormone oestrogen after the menopause.

Heart problems: According to the NHS, several lifestyle factors and conditions linked with cardiovascular disease may also increase your risk of developing Alzheimer’s (vii). These include smoking, obesity, diabetes, high blood pressure and high cholesterol. In fact health experts often say that what’s good (or bad) for the heart is also good (or bad) for the brain.

Other things that are thought to increase the risk of Alzheimer’s include being born with Down’s syndrome, having a severe head injury, hearing loss, untreated depression (though depression may be a symptom of Alzheimer’s rather than a risk factor), a sedentary lifestyle, and loneliness or social isolation.

Can Alzheimer’s be treated?

There may not be a cure for dementia yet, but there are treatments that often help to slow it down and help some of those affected maintain mental function. Getting the condition diagnosed by your GP in the early stages could mean you’ll get the right treatment and support, which could help you carry on leading an active, fulfilled life for as long as possible.

During the early stages of dementia many people can live independently in their own home and enjoy life as they did before they were diagnosed. As the illness progresses, however, they may need more help with day-to-day tasks such as housework and shopping, as well as adaptations to their home to make life easier.

Medicines

Several types of prescription medicines are prescribed for Alzheimer’s that aim to help to improve some of the symptoms temporarily, including:

Acetylcholinesterase inhibitors. These are medicines that help boost the level of acetylcholine in your brain, which may help your brain cells communicate more effectively. These medicines include donepezil, galantamine and rivastigmine, and are usually prescribed for people in the early to mid stages of Alzheimer’s.
Memantine works by blocking the effects of too much glutamate in the brain, and is typically used for moderate or severe Alzheimer’s disease (though it may also be prescribed for people who cannot take acetylcholinesterase inhibitors).
Medicines to treat behavioural and psychological symptoms in the later stages of Alzheimer’s, including antidepressants and medicines that can help with aggression and distress.

Therapies and activities

Besides medicines, people with Alzheimer’s may be offered other support in the form of cognitive stimulation therapy (which may help improve memory and problem-solving skills); cognitive rehabilitation (often carried out by occupational therapists, this aims to help with everyday tasks); and reminiscence work, which involves talking about the past and using props such as favourite possessions, photos and music.

If diagnosed with Alzheimer’s you may also be eligible for further support from social services, including having visits from carers to help with everyday activities.

How to reduce your risk

There are some things that increase your risk for Alzheimer’s you can’t do much about – your age, for instance, your gender and your family history. But according to the Alzheimer’s Society, there’s evidence to show there are things you can do yourself to help reduce your risk too (viii).

Changing your lifestyle to make it as healthy as possible is arguably the best thing you can do, including:

Quitting smoking
Drinking less alcohol
Eating a healthy, balanced diet that includes at least five portions of fruit and vegetables every day
Maintaining a healthy weight (including losing weight if you need to)
Staying physically and mentally active
Keeping up with your regular health checks, especially as you get older
Reducing heart risks – find out more about how to have a heart-healthy lifestyle, including ways to keep your blood pressure and cholesterol healthy

If this all sounds a bit overwhelming, just remember: making one small change every now and then is easier to achieve than trying to overhaul your entire lifestyle at the same time. Here are a few little things you could start to do right now:

Eat more fish: According to the Alzheimer’s Society, eating fish regularly as part of a balanced diet could help reduce your risk of age-related cognitive decline and improve other aspects of your health (ix). The NHS recommends eating at least two portions of fish a week, including one portion of oily fish, as part of a healthy, balanced diet (x).

Stick to the limits: According to the Alzheimer’s Society, drinking too much alcohol increases your risk of developing dementia (viii). Try to stick to current UK government guidelines, which recommend drinking no more than 14 units of alcohol per week on a regular basis. There’s one unit in a single small shot of spirits, two units in a can of lager/beer/cider (ABV 4.5%) or a pint of lower-strength lager/beer cider (ABV 3.6%), 1.5 units in a small glass (125ml) of wine (ABV 12%), and three units in a large (250ml) glass of wine (ABV 12%).

Drink tea: Experts from the National University of Singapore believe drinking just one cup of tea a day – such as ordinary black tea, oolong or green – may help reduce the risk of cognitive impairment in older people by 50 per cent and by as much as 86 per cent in people who have a genetic risk of developing Alzheimer’s (xi). The scientists behind the study suggest there are compounds in tea that may protect the brain from vascular damage and neurodegeneration.

Learn something new: Education and learning is associated with better mental functioning as you get older, and the longer you keep learning, the longer your brain may stay mentally active. In fact it’s never too late to learn, since learning at any age can help make fresh connections in your brain.

Try taking opportunities that come your way to learn new skills, or if you’re retired and have time on your hands you may want to consider doing some voluntary work that will help keep you mentally active. You could also think about taking up a new hobby, learning how to speak another language or learning to play a musical instrument (even listening to music could be good for your brain).

Whatever you decide to learn, try to make sure you find it meaningful and interesting, as the more serious you are about learning and the more you look forward to it, the more your brain may benefit.

Be more playful: There are lots of games that may help keep your mind and memory active by encouraging your brain to make fresh connections. For instance, jigsaw puzzles, board games such as Scrabble or chess or card games such as bridge may all help keep your brain active. This popular memory card game may also help improve your memory and concentration:

Shuffle a full pack of playing cards and spread them face down on a table.
Take turns with the person you’re playing with to turn over any two cards. Make sure you’ve both seen the cards, then turn them back over again.
Try to remember what each card is and where it is. The aim of the game is to find pairs, so keep going until you find one. If you find a pair, pick the cards up and keep them.
When all cards have been paired and removed from the table, the player with the greatest number of cards is the winner.

Research lead by the University of Exeter and King’s College London also suggests older people who regularly do word and number puzzles have sharper brains than those who don’t (xii). “We’ve found that the more regularly people engage with puzzles such as crosswords and Sudoku, the sharper their performance is across a range of tasks assessing memory, attention and reasoning,” said researcher Dr Anne Corbett.

“We can’t say that playing these puzzles necessarily reduces the risk of dementia in later life, but this research supports previous findings that indicate regular use of word and number puzzles helps keep our brains working better for longer.”

Go for a walk: Exercise is good for your brain in many ways, as it helps increase oxygen levels and blood flow throughout the body. Staying active could keep your memory in shape, as regular physical activity is thought to help increase the number of cells in the hippocampus, which is your brain’s memory centre.

According to the NHS, to stay healthy adults should do 150 minutes of moderate-intensity activity every week (xiii). Any type of physical activity is better than none, even doing the housework or gardening. Walking may be particularly beneficial, as it’s an example of a type of activity that may help prevent brain shrinkage. Dancing may also be useful for your memory because it’s not only a form of physical exercise but also an opportunity to learn something new – new dance steps, for instance. Gentler forms of exercise such as yoga and t’ai chi may also have a positive impact on your memory and concentration.

However if you have an existing medical condition or you haven’t been very active lately, always speak to a healthcare professional before taking on any new exercise regime.

Sleep well: If you’re having sleep difficulties there’s a good chance you won’t be able to think as clearly as you should, and you may find your memory is affected too. Sleep is important not just for memory but it also helps you learn and perform skills. Find out more about the steps you can take to get a better night’s sleep in our guide to sleep and insomnia.

Learn to destress: If you’re under stress more often than not, it could be affecting your brain – and probably not in a positive way (xiv). Try to limit stress as much as you can – for tips on destressing read our guide to stress symptoms and signs.

Meanwhile if you’re currently experiencing low mood or depression, don’t ignore it – instead find out what you could do to manage it and keep it under control. Some experts believe depression and the risk of dementia are linked (xv), with some thinking depression may in fact be an early symptom of dementia and others suggesting depression could play a part in the development of dementia (xvi). Read about what you could do to help manage depression naturally in our guide to depression signs and symptoms.

What natural supplements help with Alzheimer’s?

A healthy lifestyle is arguably your best weapon against cognitive problems. But there may also be other things you could do to support your brain, such as taking natural supplements. Here are some of the supplements you may want to consider trying – read more about them and the scientific evidence that supports their use for cognition support in our guide to nutrition for the brain.

High-strength fish oils: Supplements made from oily fish that contain the omega-3 fatty acids EPA and DHA are thought to be good for your brain, so they may be particularly beneficial if you don’t like eating fish. If you’re a vegetarian or vegan you can now get these important omega-3s in a veggie/vegan-friendly formulation – look for omega-3 supplements that contain algae, which supply fish with omega-3s in the first place.

Turmeric (curcumin): Curcumin is one of the many active ingredients found in the curry spice turmeric, and may be helpful for cognitive decline. You can add turmeric to your food, or take a turmeric supplement if that’s more convenient. Consider trying a good-quality supplement that provides a high percentage of curcuminoids (curcumin is a type of curcumninoid).

Ginkgo biloba: Nutritional therapists often use the herb ginkgo biloba to treat memory problems and cognitive function in older people.

B complex: Some of the B vitamins – including vitamin B6, B12 and folate (or folic acid) – may help slow down cognitive decline. B vitamins are widely available in our diet, but many people may not get enough of them. You can take individual B vitamin supplements, but it’s often considered more convenient to take a B complex supplement or a multivitamin formula with good levels of the Bs.

Astaxanthin: Antioxidants may be helpful in supporting cognitive health, especially if your levels are already less than decent. A particularly potent antioxidant found in a type of freshwater algae, astaxanthin can be found in supplement form as well as in foods such as salmon, lobster, crawfish, rainbow trout and crab. As a supplement it is usually suitable for vegetarians and vegans (check the label – some capsules can contain non-vegetarian and non-vegan ingredients).

Iodine: If you’re deficient in this essential mineral it can lead to an underactive thyroid, which can affect your cognition. You can get iodine in fish, eggs and other dairy products, as well as in nutritional supplements such as multivitamins.

Rosemary: Both the scent and compounds found in rosemary may be beneficial for memory problems. Add some of this fragrant herb to your food, or look for a nutritional supplement that contains it. You can also release the smell of rosemary essential oil in a heat-based diffuser.

Iron: This essential nutrient helps with blood flow, including blood flow to the brain, and is thought to help with cognitive health especially in those who are deficient in it. If you don’t eat a lot of iron-rich foods – such as red meat, liver, beans and nuts – you can get it in a single supplement or as part of a multivitamin formulation.

Zinc: This essential nutrient is found in high levels in the brain. You can get it in foods such as meat, nuts and dairy products, or if you don’t get much in your diet try a zinc supplement or multivitamin that has good zinc levels.

Phosphatidyl serine: Found in foods such as egg yolks, soya beans, fish and meat, phosphatidyl serine is often sold as a brain health supplement, as some experts think it may help boost memory and cognition.

Ashwagandha: One of the most widely used herbs in Indian Ayurvedic medicine, ashwagandha contains compounds called withanolides that some think are good for the brain. It’s widely available as a supplement, though not all brands contain beneficial levels of withanolides (look for a product that contains at least 1.5 per cent withanolides).

Vitamin C: Like the B vitamins, vitamin C is widely found in foods – yet some people may not be getting enough of it in their diets. Some scientists even believe it may help with cognitive functioning. You can get vitamin C supplements in many forms, including tablets, capsules and powder.

Magnesium: Found in foods such as dark chocolate, nuts, seeds, legumes, milk, oily fish, red meat and leafy green vegetables, magnesium may be beneficial if you want to give your brain a boost. However, despite the fact that it’s in many different foods, some people may have low levels of magnesium. If you want to try a supplement, look for magnesium in a more absorbable form, such as magnesium citrate.

Green tea: If you like drinking green tea, your brain may already be getting a supply of certain helpful compounds. If you’re not a fan of the taste, however, you can try a green tea supplement – choose a product with a good level of active antioxidant ingredients called polyphenols.