Can you prevent or possibly reverse Alzheimer’s? This doctor says yes

Alzheimer’s disease is among the most feared diagnoses, with treatments that can slow early decline but do not stop the disease. But there is growing evidence that people can take steps to keep their brains healthy and reduce their risk of dementia.

D., assistant professor of neuroscience at Johns Hopkins and author of a new book on brain health. Majid Fotuhi, “Invincible BrainHe believes Alzheimer’s can be prevented and some cognitive degenerations can be reversed.

“I’ve been talking about preventing Alzheimer’s disease for over 20 years,” he told the Deseret News, noting that his first book was published in 2002. “I want people to know that they play an important role in whether their brains stay healthy or decay. And the other thing that’s very important to know is that just because you have members in your family with Alzheimer’s disease doesn’t mean you’re going to develop it.”

“This means you can use this as a call to action and be more proactive about taking care of your brain.”

Perhaps the people thought to be at highest risk of developing Alzheimer’s are those who have one or two copies of the apolipoprotein E4 allele, a known risk factor for Alzheimer’s that greatly increases the likelihood of developing the disease.

Even people with APOE4 who have an active lifestyle and exercise regularly have lower levels of Alzheimer’s amyloid protein in their brains, Fotuhi said. “In other words, exercise appears to counteract the effect of the APOE4 gene on the brain,” he said.

Creating your own difference

Fotuhi notes that there is no “one magic exercise” that is most effective, and experts debate whether aerobic exercise is better than weight training or vice versa.

“I generally recommend people do a combination, and that’s what I do,” he said. “I usually bike for 45 minutes to an hour and then do 30 to 40 minutes of weight training three times a week — and maybe the fourth day if I have the time.”

The key is to improve your fitness, measured by basic questions: Can you walk three miles easily? Can you climb 10 flights of stairs? He also notes that it’s not a matter of being in shape compared to peers of the same age, because the average person today is out of shape. He recommends being fit for someone 20 years younger than you.

It’s never too late, he adds, noting that he’s watched older patients become physically healthier and mentally sharper.

“I had many patients who got better in their 70s and even early 80s. And our brains don’t stop growing; they don’t stop changing just because we get older. There’s also a paper on this topic recently published in Nature. They found that individuals in their 70s and early 80s had neurogenesis in their hippocampus,” he said.

“Neurogenesis refers to the growth of new neurons, and the hippocampus is a thumb-sized brain structure that is critical for learning and memory. With aging, the hippocampus often shrinks, and when it gets too small, people develop symptoms of Alzheimer’s disease.”

According to the research paper cited by Fotuhi, neurogenesis does not stop as people age, but it occurs less in Alzheimer’s patients. He also noted that new cells do not mature normally in those with the disease. However, exercise increases brain-derived neurotrophic factor, which is necessary for cells to mature. He said boosting helps both produce new neurons and help them mature.

Brain ‘super old’

According to Fotuhi, brain “super-seniors” (those aged 80 and above whose brain functions are comparable to those of people 20 or 30 years younger) not only have more neurons but also their neurons are maturing.

“This study shows that whether you have Alzheimer’s disease depends on whether you are producing enough new neurons and whether those new neurons are maturing. If you don’t have enough new neurons and the neurons are immature, you get Alzheimer’s disease. If you have a lot of new neurons and they are too mature, you are ‘super old,’ and if you are in the middle, you are an average aging adult,” Fotuhi said.

He said it’s not just a matter of preventing damage, but it’s crucial. He is adamant that some of the damage can be reversed. There are stages to Alzheimer’s, and the first symptoms are usually mild cognitive impairment, and in some people the condition never progresses to true Alzheimer’s. Early brain changes can be reversed, he said.

“I’ve seen this firsthand in not dozens or hundreds, but thousands of patients over the past 20 years. You can reverse the effects of aging on the brain.”

Embracing the 5 pillars of brain health

It tells the story of a patient named Carol, whose sister brought her to a doctor’s appointment because of her forgetfulness. The sister said that Carol had been watching television all day, sitting dully in front of the screen; This was something he had been doing for over a year. Fotuhi said his sister wanted to be diagnosed with Alzheimer’s so she could get power of attorney, sell Carol’s house and use the money to pay for Carol’s long-term care.

He described Carol as well-dressed and quiet, but as someone who interacted very little, responding to questions with one or two words. Is there something bothering you? “NO.” Why are you here? “I don’t know.”

It turned out that Carol had medical conditions such as sleep apnea, diabetes, and depression. Some of his medications were sedatives. So he chose to address medical issues first, focusing on changes that could increase neurogenesis.

“He literally slowly woke up,” she said. “He started walking five minutes a day, and then 10 minutes a day. Six weeks into the program, he was walking almost normally, interacting with our brain coaches, and receiving brain training.”

He was studying what he called the five pillars of brain health:

• Stress reduction/meditation

These five things were the recipe he used to bring Carol back. “He was funny, had multiple hobbies, and actually started looking for a job.” He was also able to unravel the downward spiral: Pain medication sedated him, and so he sat all day, became depressed, stopped taking care of himself, and gradually refused.

Moreover, this was not just a theory. Fotuhi and colleagues published results MRIs were used to look at the size of the hippocampus before and after treatment targeting these five pillars for multiple patients, reports in the Journal of Alzheimer’s Disease Prevention.

As a normal part of aging, the size of the hippocampus begins to shrink slightly starting around age 50. But Fotuhi’s research found modest growth of the hippocampus in people who exercised, slept, ate well, reduced stress and exercised their brains.

“To be fair, Carol was our best patient,” he said, noting that while someone with severe cognitive decline and confusion may recover, it is unlikely they will ever return to full function. He said the sooner intervention is made, the better.

The results of the brain MRIs were so clear that the radiologist who read them said he sent his own mother to Fotuhi for the 12-week program.

brain-friendly habits

Fotuhi stated that the brain is large and different parts form networks. He recommends that people work on the parts of their brains they hope to improve. “Take classes in the subject you want to get better at,” he said.

“When you take classes and learn something new, you’re working on different networks in the cortex and hippocampus. In other words, there’s no single game that’s going to improve your brain function so you don’t get Alzheimer’s disease. You have to exercise your brain just as you can strengthen parts of your body. And just like you can say, ‘Okay, I’m just going to work on my biceps and triceps,’ or ‘I’m just going to work on my biceps and triceps. My quads’ or ‘I want to work on my core.’ You can do the same thing with your brain.

One of the keys is to choose things you enjoy because you’re more likely to stick with them, he said. Learning something new is great because you activate different parts of your brain. “Every time you learn something new, you activate your brain,” he said.

Over the years he learned different languages; Fotuhi is currently fine-tuning the French language because his book is being translated into French. His kids play speed card games when they come from college, and he feels proud when he manages to win because “these kids are so smart and so fast it’s hard to keep up with them.”

Variety is good. So is consistency. He wants people to incorporate brain boosting into their routines and make it as normal a habit as brushing their teeth. She keeps exercise, sleep, nutrition, stress reduction, and brain training in the back of her mind every day and helps these needs guide her decisions. This way, for example, when he chooses food, he doesn’t choose junk food.

He’s got a weird stress meter: “I guess this thing is worth destroying my hippocampus?”

Probably not, so it’s not too stressful. “I try to stay calm because I appreciate that everything is fixable, everything is manageable.” You can’t avoid all stress, he said, but he’s committed to keeping it low.

“I understand everything that is good for my brain and I do it out of habit,” he said. “My suggestion is for everyone to become aware of what the five pillars of brain health are and make them part of their daily routine so they don’t have to think about it.”

Looking forward

Fotuhi predicts that within 5 to 10 years, Alzheimer’s disease will be treated like diabetes. He said type 2 diabetes is a preventable condition in most cases. And those who begin to develop it can do things to help the disease return through medication and reducing risk factors, such as changing eating habits.

“The same goes for Alzheimer’s disease. You’ll have many opportunities to prevent Alzheimer’s disease. If you’re in what’s called mild cognitive impairment, you certainly have the opportunity to slow the rate of decline and reverse the cognitive decline and actually get one step sharper. And if you have the early stages of Alzheimer’s disease, you can still get one step better. The worse you get, the less likely you are to be the same as you were 30 years ago. As good as four years ago but not as good as 30 years ago.”

When the disease is severe, there is no stepping back. That’s why prevention is key, he said.