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.
Warning signs
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:
1. Memory loss that affects day-to-day function, particularly
short-term memory loss.
2. Difficulty performing familiar tasks. For example, being
unable to prepare part of a meal or forgetting you ate it.
3. Problems with language. Forgetting simple words or substituting
inappropriate ones.
4. Disorientation of time and place. For example, getting lost
on your own street.
5. Poor or decreased judgment. For example, dressing inappropriately,
wearing winter clothing on a hot summer day.
6. Problems with abstract thinking. For example, forgetting
what a birthday is.
7. Misplacing things. Not just misplacing the car keys, but
behaviour such as putting an iron in the fridge or watch in
the sugar bowl.
8. Changes in mood or behaviour. Rapid mood swings -- from calm
to tears to anger -- for no apparent reason.
9. Changes in personality. A person with Alzheimer's can change
dramatically, becoming extremely confused, suspicious or withdrawn.
10. Loss of initiative. A person with Alzheimer's may become
very passive, and require cues and prompting to become involved
even in very basic activities.
Source: Alzheimer Society of Canada
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