Q & A With the Neuropsych

Q & A With the Neuropsych

 

 

 

What is the difference between Alzheimer’s disease and dementia?

Dementia is actually an umbrella term to describe a progressive condition of the brain affecting thinking skills (among others) over time. There are a several different causes of dementia, with varying symptoms and disease course.

Alzheimer’s disease is the most common cause of dementia, with vascular dementia coming in as a close second. Vascular dementia is caused by several conditions, many of which are at least controllable, including history of stroke, obesity, high blood pressure, high cholesterol, heart conditions, lung conditions (such as emphysema), type II diabetes, and obstructive sleep apnea. However, we are also now beginning to realize that many of these conditions also increase risk for Alzheimer’s disease. Other causes of dementia include dementia with Lewy bodies, Parkinson’s disease (occurring in approximately 50% of people with Parkinson’s disease), normal pressure hydrocephalus, and alcohol-induced dementia, among others.

I have a family history of Alzheimer’s disease (or another dementia). What, if anything, can I do to decrease my risk?

There is substantial genetic risk with Alzheimer’s disease, especially early-onset Alzheimer’s disease (symptoms appearing before the age of 65). However, not everyone with a family history will ultimately develop the condition. Many conditions develop as a complex interplay of genetic and environmental risk (depression, for example), as does Alzheimer’s disease. However, it should be noted that some causes of dementia have much higher genetic association, including Huntington’s disease and some rare frontotemporal dementias, and there is little that can be done to lessen that risk.

As mentioned previously, we now understand that several preventable or at least manageable conditions are also associated with risk for Alzheimer’s disease and other dementias. Type II diabetes, in particular, is an increasingly recognized risk factor for Alzheimer’s disease. Even high normal glucose levels have been associated with cognitive decline in recent studies. Untreated obstructive sleep apnea- aka “snoring”- is also associated with increased risk for dementia, likely due to chronic oxygen and sleep deprivation. Importantly, it is also a substantial risk factor for stroke and heart attack- both of which are in and of themselves risk factors for dementia. A good rule of thumb is to remember that anything that restricts the flow of blood or oxygen is bad for your brain. Adequate control of such conditions is critical in decreasing your dementia risk. Chronic stress (and co-occurring sleep deprivation) is also being investigated as a possible contributor.

How do exercise and diet fit in with dementia prevention and/or treatment?

As far as possible side effects, medication interactions, and cost, diet and exercise are a win-win! Of course we know that diet and exercise are helpful in prevention so many of the previously mentioned risk factors for dementia. They are also helpful for a host of other physical and psychiatric conditions (i.e., chronic pain, fibromyalgia, depression). We all know that we really should be exercising and consuming a healthy diet, anyway. For some time now, however, studies have not been able to clearly document the benefits of diet or exercise for the prevention or treatment of dementia. Fortunately, recent high quality studies have begun to fill the gaps left by previous studies, often quite strikingly.

Perhaps the most remarkable study I’ve seen is one involving individuals with Alzheimer’s disease. After 1 year of regular physical exercise, these individuals showed improved cognitive function on objective cognitive tests! This is especially remarkable since current pharmaceutical options only stabilize cognition- actual improvement in a known progressive condition is essentially unheard of. Other studies on the effects of exercise have found improved function and increased volume in the structure of the brain first affected by Alzheimer’s disease. The importance of these findings really can’t be over-emphasized.

Research on diet has been difficult historically, due to methodological issues inherent in studying dietary habits. However, recent studies provide an overall take-home message that does appear to support not only adherence to the “Mediterranean diet” but– on the flip side- avoidance of the “Southern diet”. Both findings appear largely due to control of vascular risk factors which, again, we now know to be associated with risk for both vascular dementia and Alzheimer’s disease. Importantly, Arkansas is one of 10 states with the greatest adherence to the Southern diet.

The Mediterranean diet is high in consumption of vegetables, fruit, nuts, fish, legumes, and extra virgin olive oil. By contrast, the Southern diet is rich in salty, high-fat fried foods and sugary drinks. Briefly, recent findings have found: (a) increased stroke risk with the Southern diet; (b) decreased stroke risk with adherence to a plant-based diet; (c)decreased likelihood of cognitive impairment with the Mediterranean diet; and (d) benefit of the Mediterranean diet over a low fat diet in prevention of cerebrovascular disease. Also of note, there is little difference in actual calorie consumption between the Southern diet versus others, suggesting involvement of factors beyond caloric intake.

 

 

Dr. Addison-Brown is a clinical neuropsychologist. She opened her own private practice, NEA Neuropsychology, in June 2014, located at 304 Southwest Square. She can be reached at 870-203-6085 or neaneuropsychology@att.net. As a neuropsychologist, she performs evaluations for diagnosis and recommendations for various neurological and psychiatric conditions, including attention-deficit disorders, learning disorders, dementia, stroke, traumatic brain injury, and depression/anxiety, among others. She also conducts pre-surgical evaluations for bariatric and other surgeries and return-to-work and employment screening evaluations.