Memory Care Program and Dementia Protection Habits

THE TOP TEN RECOMMENDATIONS A DEVELOPING PLAN TO PREVENT DEMENTIA AND ALZHEIMER’S DISEASE J. Wesson Ashford, M.D., Ph.D. Stanford / VA Aging Clinical Research Center 2/23/08

1. Maximize and continue your education and mental exercise:
   • Learn about your brain and how to care for it.
   • Develop habits to maintain your brain.
   • Take classes in subjects that interest you; education is associated with decreased Alzheimer’s risk, learning a new language may be very good.
   • Do mentally stimulating activities, including puzzles (like crossword puzzles, sudoku, but also learn new things).

2. Maximize and continue your physical exercise:
   • Have a regular exercise program.
   • Physical exercise is best 10-30 minutes after each meal for 10-30 minutes, 3 times per day.
   • Do both aerobic and strengthening exercises.
   • Stretching improves flexibility.
3. Maximize your social network and spiritual interactions:
   • Stay active with your friends and in your community.
4. Continually monitor and improve your diet:
   • Take your vitamins daily.
   • Take at the morning meals: Vitamin E 200 iu; Vitamin C 250 mg; Multi-vitamin (with folate 400 mcg and no iron). For discussion, see: Willet WC, Stampfer MJ, “What vitamins should I be taking, Doctor?” New England Journal of Medicine, 345, 1819 (2001)
   • Check with your clinician yearly to be sure your homocysteine levels are not high and you have no signs of or risk factors for B12 deficiency.
   • Ask your doctor to make sure your B12 level is above 400. If diet doesn’t help, take oral supplement. If oral supplement doesn’t work, get monthly B12 shots additionally.
   • Maximize your vegetables.
   • Increase your dietary intake of omega-3-fatty acids.
   • OPTIMIZE Plant products and fish: Fruits – citrus, blue berries; Vegetables – green, leafy; Fish – deep sea, finned, oily, at least 3x/week; Nuts – especially almonds, and also dark chocolate
   • MINIMIZE other animal products: Red meat (no more than once per week); Dairy (limit to low-fat); Poultry (limit eggs to 7 or fewer per week)
5. Keep your Body Mass Index (BMI) in the optimal range (19-25):
   • To optimize your BMI, control your food intake and exercise.
6. Physically protect your brain:
   • Wear your car seat belt.
   • Wear a helmet when you are riding a bicycle or participating in any activity where you might hit your head.
   • Decrease your fall risk through physical exercise; improve your balance.
   • Make your environment safe.
7. Visit your clinician on a regular basis. Know your body and your health risks:
   • Decrease your risk of type II diabetes. Monitor your fasting blood sugar yearly. If you have diabetes, make sure that your blood sugar is optimally controlled.
   • Consult your clinician about your joint and muscle pains (treat arthritis with ibuprofen or indomethacin).
   • Keep your hormones stable. Check with your clinician about your thyroid hormone. Discuss sex-hormone replacement therapy with your clinician (such therapy is not currently recommended for Alzheimer prevention, but may help memory and mood).
8. Optimize your cardiovascular health:
   • Take your blood pressure regularly; be sure that the systolic pressure is always less than 130, diastolic blood pressure is less than 85.
   • Watch your cholesterol; if your cholesterol is elevated (above 200), talk to your clinician about appropriate treatment. Consider “statin” medications and be sure your cholesterol is fully controlled.
   • If approved by your clinician: 1 enteric coated baby aspirin each day.
9. Optimize your mental health:
   • If you have difficulty getting to sleep, consider trying 3 – 6 milligrams of melatonin at bedtime (consider different brands if not helpful at first).
   • If you snore, consult your clinician about sleep apnea.
   • Get treatment for depression if needed.
   • Keep your stress level under control. Severe stress is bad for health; some stress is needed to maintain motivation.
   • Avoid excess alcohol use.
10. Optimize your cognitive health:
    • Monitor your memory regularly.
    • Have your memory screened yearly after 60 year of age.
    • Be sure the people around you are not concerned about your memory.
    • If you think that you have significant difficulty with your memory, talk to your clinician about further evaluation and therapy.
    • Attend book clubs, local museums and/or art show