Alzheimer’s Disease
Background
Alzheimer’s is a common form of dementia (senility) affecting almost 5 million Americans. As our population ages, this is an area that drug companies believe may be quite profitable, so there is heavy advertising being done for the medications Aricept and Namenda, which I believe offer very minimal benefits. Aricept has been shown to have no benefits for mild cognitive impairment.
The only definitive test for diagnosing Alzheimer’s is a brain biopsy, which appropriately is not done. Because of this, and because most doctors do not have time to do a proper 30-60 minute evaluation for underlying causes (Medicare pays poorly for visits over about 5 minutes), many elderly folks get a label of Alzheimer’s slapped on them and a prescription for Aricept at first sign of confusion, and perhaps a cursory look for other causes of confusion. It’s no surprise that an autopsy study showed that the majority of people diagnosed with Alzheimer’s didn’t actually have it — and often there are very treatable problems that are being missed!
With a thorough exam, we frequently find that the person doesn’t have Alzheimer’s, and that even if they do, even modest improvements in mental function can dramatically improve their ability to function. There is also a promising old "compounded" medication for Alzheimer’s that may stop it in its tracks .
Also, for those of you with day to day "brain fog" wondering if you may have Alzheimer’s, a simple rule of thumb:
Alzheimer’s is not when you keep forgetting where you left the keys. It’s when you forget how to USE the keys.
Treatments
Begin with a "brain tune up," which may make the dementia go away. A helpful mnemonic for the tune up is the word "DEMENTIA," which can stand for:
- Drugs: Get rid of the ones that are not essential. If you or I were on the 10-15 drugs many elderly are on, we’d be arrested for DWI!
- Emotional: Rule out depression and make sure the person gets adequate sleep.
- Metabolic: Hormonal deficiencies, especially thyroid and testosterone, dramatically increased risk of Alzheimer’s even with normal blood tests. These hormones need to be optimized — even if the tests are "normal."
- Ears and Eyes: Hearing and vision loss can mimic dementia. Get these checked.
- Nutrition: Give optimal nutritional support with a good multivitamin powder. Make sure vitamin B12 levels are over 540 and ferritin and iron levels (as measured through a "Ferritin" blood test) are over 60. Add herbal support with curcumin.
- Tumors and other brain lesions: An MRI or CT scan is appropriate if one is diagnosed with dementia.
- Infectionsn, Silent: Urine, Candida, and sinus infections can drag down mental function.
- Anemia and other overt medical problems.
A simplified meumonic (using the above info) is MIND. We currently have a study underway testing this protocol.
Recommended Supplements
Vitamin B12 injections
Check your vitamin B12 level. If it is under 540 (anything over 209 is "normal" but NOT necessarily acceptable), get a series of at least 15 B12 shots over several months (make sure the injections have 1,000-5,000 mcg of B12 per injection). If the B12 level is under 350, take the shots monthly forever.
Multivitamin supplement
Supply overall nutritional support with a good multivitamin powder (one that includes a strong B complex vitamin, which can take care of the low B12 if your doctor won’t give the injections).
Curcumin
This is the spice in Indian food that makes curry yellow, and high intake in India is associated with a 70% lower risk of Alzheimer’s. It is very promising, now that there is a new BCM 95 form that is highly absorbed. This means taking 1-2 caps a day instead of 15 of the next best form to get the same effect. For Alzheimer’s I recommend a mix of BCM95 curcumin plus herbs such as sage and rosemary that increase acetylcholine.
PEA
Research is mounting that for neurodegenerative diseases in general, especially in the presence of chronic pain, a supplement called PEA (Palmitoylethanolamide) 600 mg a day can be quite remarkable in both decreasing pain and regenerating nerve and brain cells. It takes three months to start seeing the effect however, so give it time.
Fish oil
Consume fish oil, either by eating 3-4+ servings of tuna, herring, or salmon each week, or by taking a tablespoon of fish oil 3-4 times a week. The brain is made of the oil found in fish oil (DHA). This can also help improve any hidden depression that may be present.
Other Therapies & Advice
Hormonal deficiencies
Treat hormonal deficiencies, even if your blood tests are normal.
Armour Thyroid
Prescription Armour Thyroid should be tried by those experiencing unexplained chronic confusion to see if it helps. A thyroid test even on the low side in the normal range in women was associated with more than a doubled risk of developing dementia!
Natural testosterone cream
Men with total testosterone under 400 should use natural testosterone cream to raise their total testosterone level to about 600-800. Testosterone topical gel used in the natural form and in safe dosages (25-50 mg a day) is associated with a lower risk of heart disease and diabetes risk and does NOT increase prostate cancer risk (in fact, low testosterone is associated with a higher risk of prostate cancer).
Aspirin
Consider a trial of 1 aspirin a day. Much of what is called Alzheimer’s is really the result of multiple small mini-strokes. This is especially likely if the progression of mind problems seemed to occur in discrete small steps (worsening with each small silent stroke). An aspirin a day (or, if aspirin bothers your stomach, willow bark — found in health food stores, 120 mg of salicin a day) can decrease the risk of further strokes and often will improve function. Use an enteric-coated or chewable aspirin.
Sleep
Get 8 hours of sleep a day. Begin with Melatonin 3-5 mg at bedtime (1/2 mg is normally recommended, but use the higher dose in this setting). If needed, add an herbal sleep aid at bedtime.
Depression
Make sure there is no depression (which can mimic Alzheimer’s). Curcumin has been shown to help improve mood as well.
Infections
Look for and eliminate any chronic infections (e.g., silent bladder infections seen on a urine culture; or bowel yeast overgrowth — which is suggested by increased gas or clearing one’s throat a lot).
Check your medications
Look for excess medications (or excess alcohol) that could contribute to confusion, and see if the doctor will work with you to leave each medication off for 2-3 days (if able) to see if the mind clears. It often will, as you eliminate many unnecessary medications that have simply accumulated over time and are no longer really needed.
More Information Online
Articles on Alzheimer’s by Dr. T
Alzheimer’s and Senility Are Reversible
Testosterone Associated with Lower Alzheimer’s Risk