Thwarting Alzheimer’s?

BOSTON
What we once called “forgetfulness” is being taken more seriously as family and friends struggle with the reality of their loved ones’ Alzheimer’s and other dementias. Leading physicians at July’s meeting at the Paris International Conference on Alzheimer’s Disease offered suggestions, but no definitive answers.
Despite discussion in Paris of such things as diet, exercise, socialization and stimulating activities, how many are ready to fully embrace these concepts? One woman, Berna Huebner, took a leap of creative faith when Alzheimer’s hit home. She directs the Center for the Study of International Communications, in Paris, and founded the Chicago-based Hilgos Foundation, which fosters artistic creativity for those with Alzheimer’s and other dementias.
When everyone at the nursing home was giving up on the worsening dementia of Huebner’s mother, painter Hilda Goldblatt Gorenstein, called “Hilgos,” she was given hope by her mother’s psychiatrist. “He suggested I contact her former art school, the Art Institute of Chicago. When I asked my mother if she would like to paint again, her eyes suddenly sparkled, and she answered, ‘Yes, I remember better when I paint.’ ”
Huebner hired trained art students, brought them into the nursing home, and later created a documentary, “I Remember Better When I Paint,” depicting the dramatic way her mother reclaimed some of her identity as an artist and as a person.
Is it possible to thwart Alzheimer’s disease? Christopher van Dyck, M.D., looks at memory decline from the vantage point of healthy cognitive aging. Noting the research at the Paris conference he’d attended, he said: “Despite the epidemiology evidence of lifestyle choices associated with reduced risk, we do not know causality. While there may be other health reasons to watch your diet and exercise, we do not know if doing so will help you to avoid Alzheimer’s disease.”
“Suggestions of doing crossword puzzles and eating fresh fruits, vegetables and fish may be beneficial, but none of them are proven as yet to be a preventive. Yet, these sorts of lifestyle choices are associated with a lower risk of Alzheimer’s, and if nothing else, they will likely reduce the risk for cancer and heart disease.”
Some lifestyle choices may also benefit normal cognitive aging. Dr. van Dyck says, “Normal age-related changes do involve decline in the executive functions of the frontal lobes — including working memory, blocking out irrelevant stimuli or interference, and mental flexibility — but you can try to improve upon that with challenging exercises. Additionally, there is some emerging science in favor of aerobic exercise and a low-fat diet as discussed at the Cognitive Aging Summit in Washington last fall.”
The Foundation for the National Institutes of Health sponsored the summit. Dr. van Dyck is a professor of psychiatry, neurology and neurobiology at Yale, whose Alzheimer’s research unit he directs.
Many wonder about the usefulness of recommendations once the disease is manifest: James M. Ellison, M.D., is clinical director of geriatric psychiatry at McLean Hospital, in Belmont, Mass., and an associate professor of psychiatry at Harvard Medical School. He told me: “The most authoritative evidence to date suggests that receiving training in cognitive skills such as processing speed, problem solving, and memory can produce persistent improvements in cognitively intact older adults.
“Even in the presence of mild cognitive impairment, training in reasoning and processing speed may have value,” he said.
J. Craig Nelson, M.D., a professor of geriatric psychiatry at the University of California at San Francisco, says: “Puzzles are fine. I’m not sure it’s clear how much they help once one has dementia versus staying sharp before. The other thing I would add is physical exercise. It may be more helpful and have more general cognitive effects than specific mental exercises.”
The Mayo Clinic’s Joseph I. Sirven, M.D., professor of neurology, seems to agree in regard to early dementia: “I always tell patients to exercise, keep active and to learn new things.”
Dr. Ellison added: “Keep in mind that the activities one chooses to boost memory should be enjoyable and pursed in moderation. Ultimately, I would put more faith in physical activity than cognitive stimulation. It seems to me that the evidence is stronger at this point for exercise and activity than for cognitive stimulation, but I believe both can help.”
When can those with dementia make their own choices? This must be balanced by “perceived” choice as well as “in the best interest of.” And often even the best of us need a little push.
When her mother became discouraged at first with painting and balked, Huebner said, “The art student-teacher persisted for three months. Finally, one day, my mother started up again and began creating hundreds of designs.”
Through Huebner’s devotion, and those of the student-teachers who sometimes had to pick up a brush and put it in the artist’s hand when she resisted — mother and daughter found ways to express love and art.
Rita Watson ( www.ritawatson.com), an associate fellow at
Yale’s Ezra Stiles College, is a regular contributor.