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Thursday, May 20, 2010 11:55 am

Preventing Alzheimer’s

SIU researchers say exercise is the best medicine

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Exercise may help delay the onset of Alzheimer's disease, says Dr. Ron Zec, an associate professor at Southern Illinois University. While there's no guarantee it will prevent the disease, activities like weight lifting have health benefits regardless, he

Brent Bohlen, a retired state worker and current exercise enthusiast, is an unlikely person to be speaking to doctors at a high-level conference on Alzheimer’s disease held this month at Southern Illinois University School of Medicine in Springfield. But several of those researchers say he may have discovered an effective form of prevention against the devastating illness.

Bohlen is leading the racewalking movement in Springfield, and has trained more than 100 people in the sport. Racewalking is an official Olympic sport which involves walking at a brisk pace without lifting both feet off the ground at the same time. Last summer, 40 residents formed an official racewalking club, with 15 participating in half-marathons this spring. Some club members were sedentary a year ago, he says.

Bohlen has been an athlete since he joined the junior high track team at the tender age of eight. So when bad knees forced him to give up basketball in his early 50s, Bohlen sought a new low-impact workout in form of racewalking.

“There’s no reason what’s happening in Springfield couldn’t happen anywhere,” he says. “We just need to get the word out.”

Bohlen became interested in racewalking after discovering it didn’t bother his knees, reading the book Younger Next Year and attending the Illinois Senior Olympics.

“The confluence of these events changed the way I look at exercise,” Bohlen explains. “Then they began to change my life, and now they’re changing the lives of others in Springfield and elsewhere.”

Bohlen authored the book Boomerwalk, published last March as a guide to racewalking for aging baby boomers. Like the authors of Younger Next Year, he wanted to assure his generation that physical fitness is still possible during aging.

“I used to think that once you hit about 50, you just hit a physical decline and there’s nothing you can do about,” he says. “But with the proper exercise, you can stay at a high physical level until your 80s and beyond.”

Bohlen told his story at Southern Illinois University School of Medicine’s third annual Alzheimer’s Disease Conference May 11. The conference, hosted by SIU’s Center for Alzheimer Disease and Related Disorders, stressed that healthy living is a key to preventing Alzheimer’s, dementia and other health problems.

Alzheimer’s disease is a progressive irreversible neurological condition. It is the most common type of dementia, a condition where increasing numbers of nerve cells (neurons) deteriorate and die. According to the Alzheimer’s Association, a healthy brain has about 100 neurons, with long branching extensions (synapses) connecting at 100 trillion points in the brain. Information flows through these connections in tiny chemical pulses. During the disease, information transfer begins to fail, and the number of synapses decline and cells eventually die. The affected brain shows dramatic shrinkage from cell loss.

Symptoms usually become visible between ages 60 and 80. Warning signs, according to the Alzheimer’s Association, include memory loss that disrupts daily life, challenges in planning or solving problems, difficulty completing familiar tasks, confusion with time or place, new problems with words in speaking or writing, misplacing things, decreased or poor judgment and withdrawal from work or social activities.

Alzheimer’s disease affects 5.3 million Americans, and 200,000 in Illinois alone.

There is no known cure.

Southern Illinois University School of Medicine has been studying the disease at its Center for Alzheimer’s and Related Disorders in Springfield for more than 20 years. The center, established by the legislature in 1987, serves 93 counties in the state (excluding Chicago and the collar counties) and works with 28 hospitals, clinics and mental health centers across the state. Scientists are currently working on a variety of research projects in an attempt to diagnose and treat the disease.

According to Dr. Jeffrey Burns of the University of Kansas Medical Center, only one third of older adults achieve the recommended amount of physical activity per week.

The conference brought together health care providers, Alzheimer’s caregivers and researchers to discuss the latest findings. Though most presentations focused on the more technical, scientific research, Dr. Ron Zec, an associate professor at SIU, chose to emphasize what he believes the public needs to know about Alzheimer’s — the importance of healthy living as a strategy for prevention.

The disease is a product of three things, he says: aging, genes and the environment. Since people can neither control aging nor genetics, they have to change the environment they live in, he says.

“I kind of view Alzheimer’s as a disease of aging,” he explains. “I have a sneaking suspicion that to cure Alzheimer’s, you’d have to cure aging.”

However, people can take actions that may reduce the effect of possible Alzheimer’s risk factors. Risk factors like diet, physical activity and heart health are lifestyle-related, and thus modifiable, Zec says.

According to Zec’s research, the prevalence of Alzheimer’s disease doubles every five years after age 65, so if seniors can delay the onset by five years, it could cut the number of people affected in half.

“That is dramatic and that is a realizable goal,” he says.

An increase in obesity and diabetes during the past 20 years have put more people at risk of developing Alzheimer’s, he says. Health problems like hypertension, high cholesterol and metabolic syndrome lead not only to heart disease and diabetes, but also better the odds of developing Alzheimer’s. Metabolic syndrome includes high blood pressure, insulin resistance and central obesity (weight gain around the waist). Other risk factors include a diet high in saturated fats, smoking and a sedentary lifestyle.

If aging adults want to make a change, their best bet is to strengthen both body and mind, Zec says. Several studies have indicated an association of exercise and physical activity with higher cognitive performance and lower risk of developing dementia.

What’s healthy for the heart is healthy for the brain, he says, and evidence suggests that the same heart-healthy lifestyle changes also decrease the risk of Alzheimer’s.

“Good health factors are a near-panacea for major health conditions associated with aging,” he says. “There is a great overlap between the risk and protective factors for major medical conditions like Alzheimer’s, other dementia, heart disease, stroke, diabetes, some forms of cancer and even depression.”

Currently, there are about five million individuals with Alzheimer’s in the United States, and that number is projected to grow to 7.7 million in 2025 and 16 million by 2050, Zec says. He predicts there will be “an epidemic of Alzheimer’s disease” when baby boomers enter their 70s, about a decade from now.

Intervention must begin in middle age, Zec says. By the time clinical symptoms like memory impairment appear, the disease has already been in the body for 10-20 years. Because there is currently no cure for the disease, once clinical symptoms begin, it is too late to effectively treat the disease by slowing or stopping the progression.

“If baby boomers are going to do anything to try to decrease the risk, they need to make those lifestyle changes right now,” Zec says.

Activities like biking with a group are beneficial because they provide a chance to exercise and socialize. Heart-healthy activities combined with a rich social life may reduce the risk of Alzheimer’s, SIU experts say.

Lifestyle changes that may reduce risk of Alzheimer’s include lowering high blood sugar, blood pressure and cholesterol levels, controlling or preventing diabetes, exercising regularly, maintaining a healthy weight and engaging in socially and mentally engaging activities.

Intellectual stimulation strengthens cognitive reserve, the brain’s network that is grown and exercised through activities like learning a new sport, language or hobby. Cognitive reserve acts as a kind of backup battery, as it’s built during the second and third decades of life, and spent as the brain ages.

According to Zec, if people build their cognitive reserve during middle age, it can decrease their chances of developing Alzheimer’s as they enter their 70s and 80s. If people have larger cognitive reserves, their brains will be less damaged even as they lose neurons and synapses.

“It may not be about how much you’ve lost, but how much you have left,” Zec explains. “Even if you get the disease, you can stay cognitively intact several years longer. You’ve increased your health and mental health span.”

Staying physically active is equally important, says Dr. Jeffrey Burns, an associate professor and director of the Alzheimer and Memory Program at the University of Kansas Medical Center in Kansas City. Burns presented his research on the impact of exercise and fitness on Alzheimer’s disease during SIU’s May 11 conference.

According to Burns, a majority of adults do not achieve recommended levels of physical activity, which includes two and a half hours per week of moderate aerobic activity (such as walking briskly, dancing and canoeing) per week along with strengthening activities (like push-ups, sit-ups and lifting weights) two times a week. Less than one-third of older adults achieve this goal, with one third reporting no physical activity at all, Burns says.

“Being sedentary is a significant risk factor for any health problem,” Burns says. “We need to understand the importance of exercise in promoting health and preventing disease.”

Exercise can act as medicine, he says, because it promotes healthy brain aging. The brain begins to shrink when people reach their late 30s and 40s, and an Alzheimer’s brain shrinks at twice the normal rate. Individuals with higher fitness levels have less brain shrinkage, Burns says.

The physical and mental health of the caregiver (the person who helps an Alzheimer’s patient with daily life) is just as important as the person with the disease, says Dr. Tom Ala, associate professor of neurology and interim director for SIU’s Center.

Ala is in the process of developing a study that would focus on Alzheimer’s caregivers, examining their stress level, physical fitness and psychological health. There are 386,207 caregivers in Illinois, and most have difficulty grappling with the mental and physical challenges of caring for an Alzheimer’s patient at home.

The study would be the first of its kind, Ala says, as clinical research has not focused on anyone besides the patient.

“So far, studies have been patient-driven, but we’re being proactive and looking at the caregiver from the start,” he says. “We’d like to assess and follow the health of both the patient and the caregiver, from the time they contact us until the patient enters a nursing home.”

Researcher Robert Struble, Ph.D., (left) and Molly Orr preform a blunt dissection of brain tissue for analysis in an SIU Alzheimer laboratory.

Keeping the patient in the family home is better than an assisted living facility or nursing home, Ala says. It saves money and improves the emotional health of the family. However, it’s difficult to do when no one is giving the caregiver assistance. Ala wants to find out what help caregivers need, and provide them with those services. With reduced stress, he says, caregivers could continue to keep Alzheimer’s patients in the home two to five years longer.

He has presented the study’s proposal to SIU’s review board, and hopes to start recruiting patient and caregiver pairs by the end of the year.

While there have been hundreds of pharmaceutical trials, none have yet to provide long-lasting or reliable relief from Alzhiemer’s. SIU is participating in several drug studies; the results of some may not be known for years, he says.

The problem with pharmaceutical treatment, Ala says, is it’s difficult to know who will have Alzheimer’s, so drug studies can only treat those already infected.

“There’s a difference between treating someone who has Alzheimer’s disease and trying to prevent Alzheimer’s,” he says. “By the time there’s symptoms, there’s already significant damage.”

Currently, funding for SIU’s Alzheimer’s research projects totals $3.5 million, from both public and private sources. The center is partially state-funded, and partners with Eastern Illinois University as well as SIU’s Carbondale campus.

Dr. Robert Struble, an associate professor and research director for the center, is studying the severity of Alzheimer’s in autopsied tissue. His research has found that Alzheimer’s patients who had visual impairments like cataracts may have a different pattern of lesions in the brain than those without visual impairment, meaning that brain activity can influence the pattern of Alzheimer’s disease lesions.

Struble is also using animal models to study Beta-amyloid, a protein considered a key player in the development and progression of Alzheimer’s. Struble observes mice with the amyloid protein in their system, to see if their behavior is different from those without the protein. His team tests the animal models for symptoms like forgetfulness, which is often the first sign of the disease.

Animal studies are very helpful, Struble says, because researchers can watch for early onset of the disease, something it’s nearly impossible to do with humans, because of the delay between the start of Alzheimer’s and the onset of symptoms.

“We can’t follow these developments in the human population,” he says. “But with animals, we have benchmarks we can follow. We know what the mice are supposed to be able to do by a certain age. We want to know if we can change the progression of the disease, if we can create an intervention.”

However, SIU will continue to study Alzheimer’s patients. Zec plas to develop research projects on the subject of behavioral change. His goal is to get people exercising more, participating in activities like racewalking. Even 30 minutes of physical activity three times per week offers some advance over being completely sedentary, he says.

“Getting people to exercise, lose weight, change dietary habit isn’t an easy thing,” Zec says. “It’s even difficult to get people to take their pills. We hope to talk about ways to develop new improved health habits and to extinguish bad habits.”

That’s why it’s so important to have a healthy lifestyle, Zec says. The sooner a person starts exercising and eating right, the better the odds. Though it can be challenging to make people understand the importance of forming healthy habits, the results are worthwhile, he says.

“The earlier in life you begin to modify these risk factors, the better your chances are that you can delay the disease,” he says. “It’s scary, but there’s hope.”

Contact Diane Ivey at divey@illinoistimes.com.

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