Alzheimer’s disease is scary. While pharmaceutical treatments exist, their effectiveness is minimal at best, and with the headlines about fraud in one of the early studies on the nature of the disease, you may be feeling like dementia is more mysterious than ever, or that there is nothing you can do about it.
MedShadow’s Medical Advisory Board Member, George Grossberg, MD, works with people who have Alzheimer’s and their families at the St. Louis School of Medicine in Missouri. He explains that, while we may not have effective drugs, we do know a lot about the lifestyle factors such as diet, exercise, and stress reduction that can prevent Alzheimer’s and delay its progression. In fact, a 2023 study published in BMJ showed that people who avoiding drinking and smoking and maintained health diets, along with regular physical, cognitive and social activity experienced slower cognitive decline than people with less healthy habits, even if they had a genetic predisposition for Alzheimer’s disease.
Here’s what he had to say.
This interview has been edited for clarity and brevity.
MedShadow: What are the risk factors for developing dementia?
Dr. Grossberg: There are many known risk factors for Alzheimer’s, some are modifiable, and some, unfortunately, are not.
You’ve probably heard this saying that what’s good for the heart is good for the brain. The first group which is really, really important, are what we call cardiovascular, heart, and blood vessel-related risk factors.
A major risk factor [for Alzheimer’s disease] is high blood pressure, especially if it’s not well controlled. Smoking is a huge risk factor for cardiovascular disease, heart attacks, and strokes, as well as Alzheimer’s disease.
Poor control of cholesterol is one. Conditions like diabetes that aren’t well-controlled would be another major risk factor. Obesity is another risk factor for both heart attacks and strokes, as well as Alzheimer’s.
Unfortunately, another major risk factor is genetics or family history. We don’t yet know how to change our genes, although we are working on that.
Another risk factor, which often we don’t have much control over, which is really starting to move up and become better understood, is air pollution or toxic chemicals in the polluted air that we breathe.
MedShadow: What are some of the things people can do to reduce their risk of developing Alzheimer’s?
Dr. Grossberg: We always tell our patients, “don’t be a couch potato.” I talk about activity in four spheres with all of my patients and their families. Of course, we talk about physical activity, the importance of regular exercise.
The current guidelines call for a minimum of 150 minutes a week or more of exercise. That could be 20 minutes a day. It could be 30 to 40 minutes every other day. But again, you want at least 150 minutes or more of total physical activity. Walking is the most common exercise for all ages.
Then we talk about the importance of mental activity. So you should challenge the brain throughout life. Reading, playing cards, computer games, puzzles, jigsaw puzzles, crosswords, whatever the person enjoys doing, that keeps their brain active. We think it is very helpful to delay or decrease the risk of brain diseases like Alzheimer’s disease.
The third area of activity, which is a bit hard to do with COVID, is social activity. It’s important for people not to be alone but to be social and to engage with others. We think that has brain-related benefits.
We think spiritual activity is beneficial. If someone has a religious belief system, if they go to church regularly, we encourage those kinds of things. If they’re not particularly adherent to any particular religion, we talk about the importance of kind of inner spirituality or mindfulness can be very, very helpful.
Another area that we talk about would be avoidance of stress. The more you stress the brain, the more likely it is that it’s going to deteriorate.
Another important piece here is the importance of quality sleep. Older adults, especially older women, are at the highest risk for sleep apnea, or obstructive sleep apnea, which is often not diagnosed and consequently not treated. It’s usually treated with what’s called CPAP [continuous positive airway pressure machines] at night. Undiagnosed and untreated sleep apnea can cause cognitive impairment that can look very much like Alzheimer’s disease in its early stages, but is reversible.
MedShadow: How does exercise limit the risk of developing Alzheimer’s?
Dr. Grossberg: We know it increases blood flow, and it also may increase nutrient flow to the neurons, the brain cells. We think it also enhances what we call “neural connections,” the ability of neurons to communicate one with another and that makes the brain more resilient.
MedShadow: What kind of exercise should we do?
Dr. Grossberg: A lot of my patients are older adults in their 70s, 80s, and 90s, who definitely don’t want to get Alzheimer’s disease. They may be having physical limitations and can’t do power walking or running or bicycling.
So recent studies are showing that regular walking, for example, is just as good as power walking, as far as its preventative and therapeutic benefits. That means that any kind of exercise is a good idea.
For patients who can’t walk, let’s say they’re in a wheelchair or they’re at risk for falls or using a walker, we usually recommend isometric exercises [a type of strength/resistance exercise]. No matter what your limitations are physically, there are exercises that you can do, and they all are beneficial.
MedShadow: What kind of diet helps prevent Alzheimer’s?
Dr. Grossberg: We recommend what’s called the MIND [Mediterranean-DASH Intervention for Neurodegenerative Delay] diet, which is a combination of the Mediterranean diet and the DASH [Dietary Approaches to Stop Hypertension] diet for hypertension. So it’s basically the Mediterranean diet with low salt, low sodium intake.
The Mediterranean diet emphasizes to a great extent, fruits and vegetables. But it is not a vegetarian diet. You are allowed to have lots of fish, particularly oily fish, like salmon and mackerel and sardines, that have the healthy fats or omega three fatty acids.
Lean meats are part of it, as well. Vegetables and fruits have a lot of protective factors. There may be antioxidants in certain vegetables or fruits.
The more we load up on these good fats, and these protective factors from fruits, vegetables, and whole grains, the better chance we have of protecting our neurons and our brain cells.
MedShadow: What types of hobbies can a person pursue to prevent or delay dementia?
Dr. Grossberg: The brain is a muscle, and the more you challenge it, the more you exercise it, the better the connections become among the neurons. It will make them more resilient and more resistant to diseases like Alzheimer’s disease.
The idea is to find something that the patient likes. So if they really, really like crossword puzzles, that’s what we recommend that they do. If they hate crossword puzzles, we wouldn’t say, “well, you need to start doing crossword puzzles.”
I just ask a family “what does mom or dad like to do? What have they always liked to do?” And they’ll say, Well, you know, they, you know, they like to play chess. And if you don’t play chess, but you have an interest in it, a really good activity would be to learn to play something new, challenging the brain.
If you’re going to watch TV, watch the game shows, because at least to get you thinking along with the contestants. One of the all time favorites of many of my patients is Wheel of Fortune, where they try to guess the puzzle before the contestant does.
We think by challenging the brain, you develop more neural connections, making the brain more resilient to things like Alzheimer’s disease.
MedShadow: How much can lifestyle factors, like diet, exercise, and not smoking really impact a person’s risk for Alzheimer’s?
Dr. Grossberg: There’s very good evidence that people who are strict adherence to the MIND diet, especially when they combine it with exercise, and all the things that we talked about, are at maybe 40%—that’s huge—40% lower risk of developing Alzheimer’s disease. So that’s very exciting news.
We don’t often think about the power of nonpharmacologic interventions. Given the failure of many different drug treatments, to either delay or prevent Alzheimer’s disease, I think it behooves all of us to refocus on the utility of lifestyle modification.
MedShadow: What about if you’ve already been diagnosed? How can these habits help you?
Dr. Grossberg: It’s harder to measure, but we think if you’re already diagnosed and you’re doing the right kinds of things, the kinds of things that we talked about, you will remain more functional, increasing your chances of having a slower rate of decline.
And there’s no downside to any of these things. That’s the other thing. I point out that you know, these are these things that are good for your cardiovascular system. They’re good for your brain. There’s no downside to employing any of the activities or the dietary recommendations of any of the things that we recommend.
MedShadow: If you haven’t been exercising or eating a MIND diet, how can you get started?
Dr. Grossberg: One of the things that’s really important with exercise is that you don’t want to injure yourself. Start slow and work yourself up gradually. And it does help to have a professional give you some guidance.
There are exercise physiologists who go to people’s homes, and they do an assessment and then begin to work out with them and do the kinds of activities that they’re still able to do relatively easily. But that’s expensive and not everybody can afford that.
A cheaper option is a membership at the YMCA or YWCA. You could go there and work with a trainer that can see what your physical limitations are and can prescribe exercises for you that you’re able to do safely on a regular basis.
For inexperienced cooks, you can start by buying a MIND diet guide and cookbook and trying out some of the recipes. But even if you eat out, it is possible to eat healthy, if you communicate with the chef and the kitchen, through your server.
[Editor’s note: you can download MedShadow’s Dining Out on a Low-Sodium Diet guide, prepared by Cindy Tenner, who is living with heart failure as a side effect of successful cancer treatment years ago.]
MedShadow: Who can benefit most from these concepts?
Dr. Grossberg: I would emphasize that this is not just for older adults who are in high-risk years for conditions like Alzheimer’s disease. This is also for their family members, their adult children, because they now know they have a mom or a dad with Alzheimer’s disease.
They’re coming to me and they’re saying, “What about us? What do you recommend for us so that we can delay or decrease our chances of developing Alzheimer’s disease?”