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Alzheimer's in the family.

We know. Your memory isn't what it used to be. But then ... whose is?

We all forget thing. And the older we are, the worse it seems to get. But there's forgetting ... and there's forgetting.

If you can't remember where you put your house keys, that's one thing. If you can't remember where your house is, that's another.

It's the second kind of forgetting that terrifies many older people, because it could signal the onset of Alzheimer's disease.

What causes Alzheimer's? Is it inherited? What role does diet--and especially aluminum--play?

Here's what researchers know ... and don't know.

What is Alzheimer's disease?

It's an irreversible deterioration of the areas of the brain that control reasoning and memory. The brain cells atrophy and die, and with them goes the ability to think and remember.

About four million Americans have Alzheimer's. And as the baby boomers start to hit the senior circuit over the next 25 years, the number is expected to leap to 14 million.

What are the symptoms?

"The process is so gradual that a lot of the early signs are confused with the memory loss that happens as a person ages normally," says Sheryl Williams, director of scientific information at the Alzheimer's Association in Chicago.

Often, the bill collector is the first person to notice a change. "A lot of elderly people don't live with their children," says Williams, "so nobody notices that the bills aren't being paid until the lights get cut off."

One of the first things to go is a loss of memory for recent names and events. People get lost in what should be familiar territory.

Family members often notice sharp changes in personality: A neat and tidy person may become sloppy or an ordinarily calm person may easily become enraged.

People constantly have to be reminded to do the most basic things --like eating and washing. In the final stages, most patients lose weight and control of their bodily functions. Eventually, they become totally helpless.

Once they become bedridden, Alzheimer's sufferers become more prone to infection. The average patient dies within nine years of being diagnosed--often from pneumonia.

Does everyone with these symptoms have Alzheimer's?

No. "There are other forms of dementia, as well as infections, small strokes, depression, or dozens of other processes that can mimic Alzheimer's and that may be reversible with proper treatment," says JoAnn McConnell, former vice president for medical and scientific affairs at the Alzheimer's Association.

Who gets Alzheimer's?

It strikes both sexes and all races. The one thing that most Alzheimer's victims have in common is that they are elderly. A detailed survey of residents of East Boston, Massachusetts, in 1989 found Alzheimer's in about three percent of people between the ages of 65 and 74, 19 percent of people aged 75 to 84, and 47 percent of people over 84.(1)

Are there any people who are less at risk?

Researchers have identified three groups:

* People with more education. That's what studies in China, Finland, France, Israel, Italy, Sweden, and the United States show.(2)

"Your brain is just like the rest of your body," says JoAnn McConnell. "If you give it a little bit of exercise every day, you stimulate your cells to work harder and become stronger."

Learning may give us a "brain reserve," adds Robert Katzman of the Department of Neurosciences at the University of California, San Diego.

Of course, there could be an entirely different explanation. People with more education have better diets, access to better medical care, and other advantages that could delay the onset of the disease.

* Users of non-sterlidal anti-inflammatory drugs (NSAIDs). Last year, researchers in Arizona gave 14 patients with mild to moderate Alzheimer's 100 mg to 150 mg a day of the NSAID indomethacin. After six months, the patients scored slightly better on mental tests than they did when the study began. Fourteen similar patients who were taking placebo (inactive) pills scored significantly worse.(3)

Also, in a study of elderly identical twins, the twin who was taking anti-inflammatory drugs was less likely to get Alzheimer's than the twin who wasn't.(4)

What could NSAIDs have to do with Alzheimer's? Some researchers believe that inflammation is a key component of the disease. Common, over-the-counter NSAIDs like aspirin or ibuprofen haven't yet been tested.

* Women taking estrogen after menopause. Estrogen appears to be necessary for the survival of brain cells. According to a still-unpublished study by Alzheimer's expert Victor Henderson of the University of Southern California, women taking estrogen seem to have about half the risk of developing the disease.

Estrogen could help explain why women are more likely to suffer from Alzheimer's. With menopause, women's bodies produce far less estrogen, while a man's testosterone level stays relatively constant over the years. (Since testosterone is converted into estrogen in the brain, there's no sharp drop-off in the hormone as men age.)

What causes Alzheimer's?

Nobody knows. "In the past, it was just accepted that old people got funny and weird and senile," says JoAnn McConnell.

"We now understand that if they get senile, there's a disease going on.

But we don't know what causes it. We know the symptoms. We know that brain cells die. But we don't know why."

Is Alzheimer's genetic?

In up to 15 percent of the cases, it may be. But not everyone who inherits a bad gene gets Alzheimer's. And most people who get Alzheimer's don't have the bad genes that have been linked to the disease.

Last year, Allen Roses of Duke University discovered that people who inherit a gene from each parent that makes a protein called apoE4 are up to eight times more likely to develop Alzheimer's.

These people also produce too little of two other proteins--apoE2 and apoE3--says Roses. And those proteins may help stabilize the framework of nerve cells in the brain. Without them, Roses suggests, the frameworks collapse and become tangled, and the cells die.

Does aluminum cause Alzheimer's?

"The jury is still out," says Zaven Khachaturian, director of the Alzheimer's Disease Research Program at the National Institute on Aging.

Some researchers have found high levels of aluminum in the brains of Alzheimer's patients. Others haven't. And while the disease is more common in communities with more aluminum in the drinking water, the millions of people who take aluminum-containing antacids like Gaviscon, Maalox, and Mylanta don't seem to have higher rates of the disease.

"It's not clear whether aluminum causes the damage to the brain cells or is a result of it," concludes Khachaturian.

Can any supplements help prevent or treat Alzheimer's?

In several European studies, a substance called acetyl-l-carnitine, which is found naturally in our bodies' cells, appeared to slow down the mental deterioration of Alzheimer's. While it's available by prescription in Europe to treat the disease, a just-completed large clinical trial in the U.S. came up empty.

"We don't understand how a study could be so positive in one country and [not] in another," said a spokesperson for the Italian pharmaceutical firm Sigma-Tau, which carried out both the European and U.S. studies.

Another supplement, choline (or lecithin, which contains choline), flopped when tested in Alzheimer's patients.(5)

Are any drugs effective?

A new drug called tacrine (which is sold under the brand name Cognex) slows deterioration, but only modestly, only in some patients, and only for six months or so.

Where can I find out more?

Call the Alzheimer's Association at (800) 272-3900, or the National Institute on Aging's Alzheimer's Disease Education and Referral Center at (800) 438-4380.

(1)Journal of the American Medical Association 262: 2551, 1989.

(2)Neurology 43: 13, 1993.

(3)Neurology 43: 1609, 1993.

(4)Neurology 44: 227, 1994.

(5)Clinical Pharmacy 10: 447, 1991.
COPYRIGHT 1994 Center for Science in the Public Interest
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1994, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Author:Schardt, David
Publication:Nutrition Action Healthletter
Date:Jun 1, 1994
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