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Alzheimer's disease - Risk Factors

Description

An in-depth report on the causes, diagnosis, and treatment of Alzheimer's disease.

Alternative Names

Risk Factors:

Alzheimer's disease is the sixth leading cause of death in American adults. It affects more than 5 million Americans and 8 million more people worldwide. According to the U.S. Alzheimer� ' s Association, 1 in 8 people age 65 and older (and nearly 1 in 2 people over age 85) have Alzheimer� ' s disease.

Age

Age is the primary risk factor for Alzheimer's disease. The number of cases of Alzheimer's disease doubles every 5 years in people over 65. By age 85, almost half of all people are afflicted. People with the disease survive, on average, half as long as similarly aged adults without the disease.

Gender

More women than men develop Alzheimer� ' s disease but this is most likely because women tend to live longer than men.

Family History

People with a family history of Alzheimer's are at higher than average risk for the disease.

Heart and Vascular Diseases

Researchers are investigating whether diseases that affect the heart and vascular (blood vessel) system may increase the risk of Alzheimer� ' s disease. These conditions include high blood pressure, unhealthy cholesterol levels, and diabetes. There is some evidence that controlling these conditions may help prevent Alzheimer� ' s disease.

Blood pressure is the force applied against the walls of the arteries as the heart pumps blood through the body. The pressure is determined by the force and amount of blood pumped and the size and flexibility of the arteries.

Cholesterol producers
Click the icon to see an image of cholesterol.

Lifestyle Factors

Clinical trials have evaluated numerous substances for preventing Alzheimer� ' s disease but have not found them to be helpful. They included nonsteroidal anti-inflammatory drugs (NSAIDs), statin drugs, estrogen replacement therapy, and herbal remedies such as ginkgo biloba.

However, certain lifestyle changes may help in Alzheimer� ' s disease prevention:

Stay mentally active. Participating in intellectually engaging activity (such as doing crossword puzzles or learning a new language) may help reduce the risk of Alzheimer's disease.
Stay physically active. Exercise and regular physical activity of at least moderate intensity may help preserve cognitive function.
Stay socially active. Personal relations and connections may help protect against Alzheimer� ' s disease.
Eat a heart-healthy and brain-healthy diet. While no specific dietary factors have been found to prevent Alzheimer� ' s disease, a low-fat, low-cholesterol diet is healthy for the heart and the brain. Replace saturated fats and trans-fatty acids with unsaturated fats from plant and fish oils. Fish oil� ' s omega-3 fatty acids, which contain docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are an excellent source of unsaturated fat. Eat lots of darkly colored fruits and vegetables, which are the best source for antioxidant vitamins and other nutrients. (Although there has been much research on B vitamins and vitamin E, there is no evidence that vitamin supplements are protective.) The Mediterranean Diet is an example of an eating plan that includes many of these recommendations.
Maintain a healthy weight. Obesity leads to a more sedentary lifestyle and may increase the risk of Alzheimer� ' s disease.

[For more information, see In-Depth Report #43: Heart-healthy diet.]

Resources

www.nia.nih.gov/alzheimers -- Alzheimer's Disease Education and Referral Center (U.S. National Institute on Aging)
www.alz.org -- Alzheimer's Association
www.alzfdn.org -- Alzheimer's Foundation of America
www.alz.co.uk -- Alzheimer's Disease International
www.ninds.nih.gov -- National Institute of Neurological Disorders and Stroke
www.aan.com -- American Academy of Neurology
www.medicalert.org -- Medic Alert
www.clinicaltrials.gov -- Find clinical trials
www.medicare.gov/NHCompare/Home.asp -- Find a nursing home

References

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Aisen PS, Schneider LS, Sano M, Diaz-Arrastia R, van Dyck CH, et al. High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial. JAMA. 2008 Oct 15;300(15):1774-83.

Akomolafe A, Beiser A, Meigs JB, Au R, Green RC, Farrer LA, et al. Diabetes mellitus and risk of developing Alzheimer disease: results from the Framingham Study. Arch Neurol. 2006 Nov;63(11):1551-5.

Alzheimer's Association. 2009 Alzheimer's disease facts and figures. Alzheimers Dement. 2009 May;5(3):234-70.

Ayalon L, Gum AM, Feliciano L, Arean PA. Effectiveness of nonpharmacological interventions for the management of neuropsychiatric symptoms in patients with dementia: a systematic review. Arch Intern Med. 2006 Nov 13;166(20):2182-8.

Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD003120.

Burns A, Iliffe S. Alzheimer's disease. BMJ. 2009 Feb 5;338:b158. doi: 10.1136/bmj.b158.

Burns A, Bernabei R, Bullock R, Cruz Jentoft AJ, Frolich L, Hock C, et al. Safety and efficacy of galantamine (Reminyl) in severe Alzheimer's disease (the SERAD study): a randomised, placebo-controlled, double-blind trial. Lancet Neurol. 2009 Jan; 8(1): 39-47.

DeKosky ST, Williamson JD, Fitzpatrick AL, Kronmal RA, Ives DG, Saxton JA, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov 19;300(19):2253-62.

Durga J, van Boxtel MP, Schouten EG, Kok FJ, Jolles J, Katan MB, et al. Effect of 3-year folic acid supplementation on cognitive function in older adults in the FACIT trial: a randomised, double blind, controlled trial. Lancet. 2007 Jan 20;369(9557):208-16.

Farlow MR, Cummings JL. Effective pharmacologic management of Alzheimer's disease. Am J Med. 2007 May;120(5):388-97.

Fleisher AS, Sun S, Taylor C, Ward CP, Gamst AC, Petersen RC, et al. Volumetric MRI vs clinical predictors of Alzheimer disease in mild cognitive impairment. Neurology. 2008 Jan 15; 70(3):191-9.

Isaac MG, Quinn R, Tabet N. Vitamin E for Alzheimer's disease and mild cognitive impairment. Cochrane Database Syst Rev. 2008 Jul 16;(3):CD002854.

Knopfman DS. Alzheimer's disease and other dementias. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 425.

Lautenschlager NT, Cox KL, Flicker L, Foster JK, van Bockxmeer FM, Xiao J, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008 Sep 3;300(9):1027-37.

Mittelman MS, Haley WE, Clay OJ, Roth DL. Improving caregiver well-being delays nursing home placement of patients with Alzheimer disease. Neurology. 2006 Nov 14;67(9):1592-9.

Morris MC, Evans DA, Tangney CC, Bienias JL, Wilson RS. Associations of vegetable and fruit consumption with age-related cognitive change. Neurology. 2006 Oct 24;67(8):1370-6.

Regan C, Katona C, Walker Z, Hooper J, Donovan J, Livingston G. Relationship of vascular risk to the progression of Alzheimer disease. Neurology. 2006 Oct 24;67(8):1357-62.

Scarmeas N, Stern Y, Mayeux R, Luchsinger JA. Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol. 2006 Dec;63(12):1709-17. Epub 2006 Oct 9.

Small GW, Kepe V, Ercoli LM, Siddarth P, Bookheimer SY, Miller KJ, et al. PET of brain amyloid and tau in mild cognitive impairment. N Engl J Med. 2006 Dec 21;355(25):2652-63.

Sofi F, Cesari F, Abbate R, Gensini GF, Casini A. Adherence to Mediterranean diet and health status: meta-analysis. BMJ. 2008 Sep 11;337:a1344. doi: 10.1136/bmj.a1344.

Willis SL, Tennstedt SL, Marsiske M, Ball K, Elias J, Koepke KM, et al. Long-term effects of cognitive training on everyday functional outcomes in older adults. JAMA. 2006 Dec 20;296(23):2805-14.

Wilson RS, Krueger KR, Arnold SE, Schneider JA, Kelly JF, Barnes LL, et al. Loneliness and risk of Alzheimer disease. Arch Gen Psychiatry. 2007 Feb;64(2):234-40.

Reviewed last on: 6/24/2009
Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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