By Pat Mooney
For Coastal Senior

This is the second of three columns on Alzheimer's disease.

Alzheimer's - a very troubling and threatening word. Cancer carried this connotation in the past, and still does, but now we see that diagnostic pronouncement as a declaration of war for a battle that can be won against a chronic condition.

Alzheimer's doesn't carry a hopeful prognosis at this point in our lives. It is s fatal disease that threatens a slow (3-20 years), inexorable and tragic decline. We may slow its onslaught but we can't stop it or permanently reverse the damage that has been done. Can we even prevent it? Maybe not in all cases, but there are tantalizing hints that we have some influence on this insidious thief of our minds.

No one knows really why Alzheimer's disease develops in one person's brain and not another. True, there is a genetic predisposition but it's not really a cause per se, since you can have the gene and not develop the disease. Diet and exercise have an influence also. Keeping your brain juicy, through mental exercise, helps too. Most researchers agree that a complex interaction of a number of factors is the cause.

There are two types of Alzheimer's disease -early onset and late onset. Early onset shows first symptoms earlier than the mid-60's and may start in middle age. Late onset typically manifests itself after age 65. The early onset variety is associated with three separate genes and has strong heritability. The late onset type is associated with a single gene that raises the risk of developing Alzheimer's. The greatest risk factor is increasing age. As many as one out of every 10 people over 65 has Alzheimer's while half of those over 85 have the disease.

Our brains are wonderfully complex and fragile structures. Our skull, with its associated structures and a thing called the blood-brain barrier, serves to protect its billions of neurons and synapses.

In Alzheimer's disease we see some additional microscopic structures called neurofibrillary tangles and beta amyloid plaques. The tangles are clumps of altered proteins inside the cells and the plaques are clumps of protein fragments that accumulate outside the cells. We're not really sure exactly what role these play in the disease process or whether or not they're key factors, but they're there and could only be discovered, until very recently, through autopsy.

So what can you do, other than picking your parents wisely or departing this life at an early age, to increase the likelihood that a PET scan in your future will turn up negative for Alzheimer's?

For starters, there are numerous studies linking diet, cardiovascular disease and dementia or Alzheimer's with the implications that cardiovascular disease and Alzheimer's disease share risk factors. High levels of HDL (the good cholesterol) and low levels of LDL (the bad cholesterol) are associated with good cardiovascular health and lessened incidence of Alzheimer's. There may also be a linkage between use of the cholesterol lowering drugs known as statins and reduced risk of Alzheimer's. (There appears to be no link with other types of cholesterol lowering drugs.)

The folk wisdom that fish is brain food may be true according to a recent French study which showed that eating fish or seafood at least once a week is associated with a lowered risk of cognitive decline in the 1,600 elderly people studied. Antioxidants that come as part of the food we eat seem to offer some protection so it is prudent to eat foods that are high in vitamins C and E. But, these same vitamins and other antioxidants taken primarily in the form of supplements don't seem to do the trick.

The bottom line is that a diet full of fruits, vegetables, whole grains, some fish and a multivitamin may be what Alice in Wonderland's door mouse was talking about when he said, "Feed your head."

What about "alternative treatments" like ginkgo biloba?

There are problems with all of them. First, since the FDA has no authority over supplements, the makers do not have to provide evidence of safety or effectiveness and there is no regulation of production. A recent survey of a particular supplement showed wide variation in the amount of the actual supplement in the product with some products having literally none of the advertised ingredient in the bottle. Bad reactions are not monitored, though there are channels for reporting them, and they can have bad interactions with prescribed medications. Ginkgo biloba, huperzine A, phosphatidylserine are the most common recommended "alternative" therapies. Though some show promise, more research needs to be done and all have risks. For example, ginkgo biloba decreases the blood's clotting ability.

There are some drugs though which may actually slow and temporarily reverse symptoms of the disease. They help buy time, precious time, to allow for planning and enjoyment. Cholinesterase Inhibitors and Vitamin E are prescribed for this purpose. The cholinesterase inhibitors - Tacrine (Cognex), Donepezil (Aricept), Rivastigmine (Exelon) and Galantamine (Reminyl) - are FDA approved for treatment of Alzheimer's disease and are designed to prevent the breakdown of acetylcholine thus keeping the levels of this chemical messenger, associated with memory and thinking, in the brain high. About half of the people taking these exhibit a modest improvement in symptoms.

Vitamin E, the antioxidant noted earlier, seems to reduce oxidative stress caused by a type of oxygen molecule called a free radical, which is a natural byproduct of cell metabolism.

The risk of getting Alzheimer's may seem like a crapshoot, but in this game you can load the dice in your favor. A healthy body and an active mind can tip the natural odds your way. They're your aces in the hole when you bet on long life, good health and happiness.

Pat Mooney is a Licensed Clinical Social Worker in Savannah. You can e-mail him with suggestions for future columns at patmooneymssw@att.net