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Thursday, August 7, 2014

Exercise, Lower Cholesterol, and Take Vitamin D: For Alzheimer's Prevention!

Not strictly a gyno topic, but a topic such as brain function as we get older, and brain function improvement are some of the most important and common questions I get asked as a physician, so it is a topic I do like to think and write about. As a normal consequence of aging we get changes in memory and thinking. It's not all just decline of thinking function, there may be some truth to making room for new facts and new ways of thinking and just literally spring cleaning out the old ideas. For a few of us a bit of word searching and forgetfulness will eventually translate into full blown dementia. If you want to see if your memory is declining take this quiz from AARP. And we want to prevent it. We should no longer think of Alzheimer’s as an older person’s disease, but the ultimate result of brain changes that occur one to two decades before the signs of clinical symptoms. For some facts and figures on the topic of Alzheimer's go to NIH. Alzheimer's Disease was named for Dr. Alois Alzheimer who lived from Civil War days until 1915. He studied Auguste Deter who had delusions of jealousy, which progressed into full blown case of what is now known as Alzheimer's. When his now famous patient died the autopsy found a very atrophic brain. Risk of Alzheimer’s today is same as a century ago. In the 20th century was the nominative believe that senile dementia was a consequence of hardening of the brain vessels. By the 1970s the thinking was shifting from blood flow to a disease of damage to brain cells of a degenerative disease. And today 60-70% is caused by this degeneration of brain cells and small vascular disease. Norman Rockwell died of Alzheimers in 1970, as did Rita Hayworth in 1987, and given the devastation of this condition her family members targeted this disease for awareness. Barry Goldwater and Ronald Regan each had Alzheimer's. Charlston Heston died of this disease in 2008, actor Peter Falk succumbed just this year. Alzheimer’s Association founded in 1980. The first most important discovery of the pathology was that beta-Amyloid protein was discovered by George Glenner and Caine Wong. Next in 1976 Tau Protein was identified as also being in the damaged nerve cells. Microtubular structure in neurons (brain cells) are destroyed by the tau protein, which is is normally destroyed as it appears. The first genetic link was found in 1987, showing that there is a mutation of the amyloid precursor protein (APP). We cannot yet use this knowledge to treat patients, but we are hoping it will lead to a cure. Now we know at least 5 genes are involved in the development of this disorder in patients. APOE-e4 allele variant copy in 50% of all cases. The thought is that both age and genetic predisposition work in the affected brains to accumulate amyloid –B. Once enough of these abnormal substance accumulate then the brain cells cannot fire as well, some inflammatory reactions are set in motion, and eventually what happens is neuronal death. If you have enough brain cells that have died off the full blown clinical syndrome of Alzheimer's occurs. And once again we think that anything that clogs the brain blood flow can set this process in motion. Keeping your cholesterol low and eliminating extra plaque build up in the brain is important, and normal levels of vitamin D are required as well, but if the process will occur anyway one thought is to fight it by having a better brain to start with! So brain teasers are important! There has been some progress in the testing for the early stages of disease, but mostly with MRIs and spinal taps and not really tests we can order in the gyno office! For more information on Alzheimer's research check the Scripps Research Institute. So for now, we have to be as proactive as we can and eating right, sleeping well, and exercising, are all part of that! And the best way to get exercise in you ask: the morning. Research at Northwestern University noted that early morning exercisers are more likely to get their workouts in. 

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