Saturday, February 1, 2003 The Globe and Mail
By ANDRÉ PICARD
When Norma Selbie starts rhyming off the list of people in her family who were stricken with Alzheimer's disease, it is dizzyingly long, and she knows, with virtual certainty, that her name will be added some day.
"It's going to be my turn up at the plate soon," she says. Despite the frightening prospect of dementia, the words are spoken with an air of realism, not resignation.
With genetics and a diagnosis of early-stage Alzheimer's, Ms. Selbie, 63, already has two strikes against her. But she is not giving up. Far from it.
Rather, the resident of Kelowna, B.C., has adopted a vigorous program of "brain gymnastics" to stave off the disease. It is an approach that, while unproved, is gaining legions of followers among baby boomers desperate to avoid the horrors of dementia.
Ms. Selbie devours Word Finds. She does puzzles on-line and plays three rounds of cribbage daily. Then there is weekly choir practice, and a regular "girls night out" that she hosts. She facilitates a support group for sufferers of early-onset Alzheimer's, along with other volunteer activities in the community.
Ms. Selbie keeps a journal, and participates every day in a Web-based international chat group devoted to dementia. She also has written a play, a comedy about Alzheimer's that is aimed at the sandwich generation and entitled Mom on Rye -- Hold the Mayo.
In addition to the brain exercises, there is a physical-fitness regimen that includes long walks and tai chi. As well she takes Aricept, a drug designed to delay symptoms in people in the early stages of Alzheimer's.
"I know I can't beat this disease forever, but I think this approach helps me have a better quality of life," Ms. Selbie says. "I think it helps. I hope it helps. The one thing I know for sure doesn't work is feeling sorry for yourself."
Angela Troyer, a psychologist at the Baycrest Centre for Geriatric Care in Toronto, says there is no doubt that keeping the mind active reduces the risk of developing Alzheimer's and related dementias.
The great unknowns, however, are what kind of activities work best, and how often and how long you need to engage in stimulating activities. "Personally, I don't think the activity matters," Dr. Troyer says. "What is important is that activities are intellectually stimulating."
While there is a booming market for "Brain Gyms" and specialized programs to combat Alzheimer's, she says these expensive products are no better than cheaper, more accessible alternatives such as puzzles, crosswords and card games.
Dr. Troyer also stresses the importance of social interaction for keeping the brain sharp, saying isolation is a real danger. "The important thing is you find something you like. If you do brain exercises the way you take medicine, it's not going to help, because you're not going to enjoy it," she says.
One of the most intriguing studies published to date on the topic was a look at a group of nuns around the United States. Researchers who have been following the group for a number of years were able to draw a direct link between mentally stimulating activities and the onset of Alzheimer's.
Scientists looked at seven activities that involve information processing: watching television; listening to the radio; reading newspapers or magazines; reading books; playing games such as cards, checkers; doing crosswords or other puzzles and visiting museums.
The frequency of participation was rated on a five-point scale, with the highest score assigned to participating in at least one of the activities daily and the lowest score to engaging in the activities once a year or less.
During the five years of the study, those who scored highest were 47 per cent less likely to develop Alzheimer's, a dramatic difference.
Gordon Winocur, scientific director of the Alzheimer Society of Canada, says this kind of research "gives credence to the time-worn adage 'Use it or lose it.' "
But he cautions that the brain is complex, and it is unclear why stimulating activities would actually lower the risk of dementia.
In animal research, it has been shown that activity, both mental and physical, actually alters brain cells, making the connections stronger. This may, in turn, reduce the risk of plaque buildup that is the root of Alzheimer's disease.
"Are people actually exercising the brain like a muscle and that makes it stronger? It could be," Dr. Winocur says. "But maybe people who are stimulated just feel better, and we know how much attitude contributes to good health."
It is also possible that people who engage in intellectual activities late in life are more likely to have come from wealthier socio-economic backgrounds, and are less likely to have been exposed to environmental hazards that can trigger Alzheimer's.
"People hate to hear this, but we really do need a lot more research to know why the changes occur," Dr. Winocur says.
An estimated 364,000 Canadians suffer from Alzheimer's disease and related dementias, and that number is expected to more than double by 2031, because of the aging population. (One in 13 people over the age of 65 and one in four people over 85 suffer from Alzheimer's.)
That makes the search for preventive treatments all the more urgent, Dr. Winocur says. "We would really like to learn how much and what kind of exercise is needed to help people delay the onset of symptoms," he says.
Ms. Selbie says she will leave those questions to the scientists and, in the meantime, she will do as much as her health allows. "I know I'm slipping a bit, but I'm not into sitting back and saying: 'Let's just take it.' I'm fighting back against Alzheimer."
She also remains remarkably down to earth and philosophical about her fate. "I can't change yesterday, and I can't change tomorrow. But I can have quite a good time today."
André Picard is The Globe and Mail's Public Health Reporter.
Alzheimer's disease is the leading cause of dementia -- a set of symptoms that includes loss of memory, judgment and reasoning, and changes in mood and behaviour. To help you know what warning signs to look for, the Alzheimer Society has developed a checklist of 10 common symptoms:
Source: Alzheimer Society of Canada