Dear Dr. Eva,

All the women on my mother’s side of the family have ended up with dementia from strokes and Alzheimer’s disease. It starts to be noticeable in their 70s and they end up in nursing homes by 80. I recently turned 60 and I’m wondering if there’s anything I can do to avoid this happening to me.

Bad Genes?

 

Dear Genes,

Your question is interesting because you’ve mentioned two different causes of dementia. Dementia is the current name for memory loss and mental deterioration in old age, which was previously called “senility” or “senile dementia.”

There are many causes of mental decline associated with aging. The two you mentioned, Alzheimer’s disease and vascular dementia, are by far the most common. Alzheimer’s disease accounts for at least 50% of cases. Vascular dementia, which is brain damage due to lack of blood flow to the brain, accounts for about another 30%. Although these are two different diseases, it is not unusual for an elderly person to have both. Many less common causes of dementia make up the remaining 20%.

Alzheimer’s is a progressive disease of the brain as a whole, with gradual loss of memory. Memory loss is the main sign of Alzheimer’s disease, which does not affect a person’s ability to move, speak, or walk until the very late stage of the disease. Because vascular disease is caused by a series of strokes, each one damaging a different small part of the brain, the memory loss is more stepwise. In vascular dementia, a person has a sudden loss of memory function, such as losing the ability to absorb new information. Depending on what part of the brain is injured, other physical signs of brain damage, such as inability to move one side of the body, problems speaking or walking, or sudden one-sided loss of vision or hearing, may happen at the same time. The person stabilizes as they recover from the stroke, but in most cases they eventually will have more strokes, with more brain damage.

Making the distinction between Alzheimer’s dementia and vascular dementia is important because, even though there is no proven way to prevent Alzheimer’s or slow its progression, there are treatments and behavior changes that will reduce the risk of vascular dementia and stroke.

Despite much research, no medication, supplement, exercise or diet has been found to prevent or slow down Alzheimer’s disease. In studies of acetylcholinesterase inhibitors such as donepezil (Aricept) and memantine (Namenda) – including 512 patients with early signs of mental decline who were followed for three years – these medications did not slow progression to Alzheimer’s disease. Also, medication did not improve test scores on memory or other tests of brain function when compared with placebo (sugar pills.) Many other treatments – including blood pressure medicines, diabetes medicines, cholesterol-lowering medicines (statins), nonsteroidal anti-inflammatory drugs (such as ibuprofen and naproxen), estrogen, progesterone, and testosterone – have all been tried and found to have no benefit in preventing mental decline.

On the other hand, there are several ways to prevent vascular dementia by maintaining good blood flow in the brain. Steps to maintain good blood flow to the brain and prevent strokes are similar to those needed to maintain good blood flow in the heart and prevent heart attacks. Avoiding smoking, controlling diabetes, controlling high blood pressure, and controlling high cholesterol all decrease the risk of both heart attacks and strokes. In people at high risk for stroke, which includes all diabetics, low-dose aspirin is recommended to reduce the risk of both stroke and heart attack as long as there are no conditions causing risk of bleeding. Atrial fibrillation is a fairly common abnormal heart rhythm in older people which increases the risk of stroke. Some people can feel that their heart rate is irregular, but others do not notice it. However, atrial fibrillation is easy to detect on an EKG or Holter monitor (24-hour EKG recording) and it can be treated to reduce stroke risk. For people who have already had a stroke or TIA (transient ischemic attack, sometimes called “mini stroke” or “pre-stroke”), sonogram of the neck arteries is useful to measure blood flow to the brain. If there is a severe blockage, surgery (carotid endarterectomy) can be done to decrease the risk of a major stroke. The risk of a serious complication from the surgery is about 6%.

Lifestyle factors that lower the risk of stroke and heart attack include regular physical activity, weight control, eating a variety of fruits and vegetables, and drinking small amounts of alcohol, especially red wine. In the Nurse’s Health Study, a large study of over 120,000 female nurses followed for over 20 years, women who ate a healthy diet, exercised regularly, avoided weight gain and did not smoke cigarettes had an 84 percent lower risk of stroke.

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