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By Eric Vidoni and Jill Morris

Eric Vidoni-finalJill Morris-finalAmericans now fear Alzheimer disease more than any other disease. Our dread of losing our memory is reflected in the click-bait in our Web browsers. Hardly a day goes by in which we don’t see an online ad or an article for the next miracle cure or prevention for dementia.

Unfortunately, we still aren’t certain what causes Alzheimer disease, let alone how to prevent it. Pharmaceutical approaches are currently targeting proteins called beta-amyloid and tau that begin to be destructive to brain cells as we age. Though the field continues to be hopeful, we are still years away from seeing these drugs in our clinics.

In the interim, we are left with approaches for overall health that we believe translate to the brain. Lifestyle modification approaches have a proven track record with regard to most chronic health conditions. People may be tired of hearing it, but the evidence strongly supports that regular physical activity, a heart-healthy diet, cognitive challenges, and strong social support are excellent preventive agents.

While we know that there is a strong genetic component to Alzheimer disease, mounting evidence suggests aerobic exercise, such as walking, sustains cognitive function and may delay dementia. We recently published an article suggesting a dose-response relationship of walking and benefits to some aspects of thinking; any physical activity was good, more was better. We have also shown that in the earliest stages of cognitive impairment, healthy blood sugar levels are associated with slower cognitive decline. However, lifestyle and metabolic factors likely enter into play much earlier than cognitive impairment begins. In cognitively-healthy middle aged individuals, insulin resistance (which precedes high blood sugar and development of type 2 diabetes) was associated with decreased brain volume and worse cognitive performance. On the flip side, a Mediterranean-style diet rich in fruits, vegetables, whole grains, and fish (of course served with a glass of red wine) have also been shown to reduce Alzheimer risk. This is especially true when dietary steps to lower blood pressure are taken, like adding low-fat dairy and reducing sodium.

While many people are excited about the potential to train the brain using games, there is limited direct evidence that investing in brain game apps like Lumosity will stave off Alzheimer disease. That being said, the brain does like a challenge, even as we age, and it is likely that an active mind will stay sharp. Traveling, joining a book club, taking gardening classes, learning a language, all of these things will challenge your brain and keep you socially engaged. Practice those things you want to be good at. If you want to be good at computer brain games or crosswords, great! Go for it. It can’t hurt. But don’t miss out on more enriching experiences than that Sudoku puzzle.

These four pillars of healthy aging (physical activity, healthy diet, cognitive challenges, strong social support) have strong epidemiological and clinical trial evidence to support them. Even when we finally develop that Alzheimer drug, we would all do well to make these “alternative” approaches a regular part of our prevention plans.

Eric Vidoni, P.T., Ph.D. is director of the Outreach, Recruitment, and Education Core for the University of Kansas Alzheimer Disease Center and a research assistant professor in the Department of Neurology at the University of Kansas Medical Center. His research focuses on the benefits of physical activity as we age.
Jill Morris, Ph.D., is a postdoctoral fellow at the University of Kansas Alzheimer Disease Center. She conducts research on the relationship between metabolic measures, such as insulin resistance and memory in the early stages of Alzheimer Disease.