Optimism and positivity are associated with a reduced incidence of Dementia and reduced deposition of toxic deposits of amyloid and tau proteins in the brain. In contrast, negative thinking is linked to an increase in dementia.

Intervention: Be happy. Be upbeat. Use Mindful meditation, Cognitive Behavioral Therapy to get your dose of happiness. Spirituality has been shown to improve mood.

Elevated insulin levels were found in a series of 39% of Alzheimer’s patients. This is caused by insulin resistance found in individuals with metabolic syndrome, obesity and prediabetes.

A Ketogenic diet produces among other ketones, Beta Hydroxybutyrate. This ketone is associated with increased neural autophagy. This refers to elimination or repair of brain cells by specialized glial cells in the brain. Additionally, this ketone body stimulates production of a brain growth factor called Glial cell Derived Neurotrophic Growth Factor (GDNF or BDNF). Reduced amyloid and tau proteins has been found in brains of those with Ketogenic diets.

Intervention: A ketogenic diet, even just a few days weekly, reduces insulin levels and increase ketones. Create ketosis long term even if only a few days weekly.

Neutraceuticals are foodstuffs that provide medical or health benefits including the prevention and treatment of disease. Especially important for vascular and brain health are anti-inflammatory and anti-oxidant supplements. These supplements reduce the Empirical Dietary Inflammatory Pattern score (EDIP) and the incidence of dementia. Thiamine and vitamin B12 deficiency causes neurologic degeneration. Individuals with lower EDIP scores have a lower incidence of vascular disease and dementia.

Intervention: Supplements or foods containing strong antioxidants. These include foods with high flavonol content such as kale, arugula and dark chocolate. Foods with significant DHA and EPA, the Omega 3 fatty acids derived from fish are strong antioxidants that have been proven to aid vascular and brain health. Antioxidant supplements include CoQ10, fish oil capsules, and vitamin D. If your diet or a medical condition leads to a deficiency of thiamine or vitamin B12, supplements containing these neutraceuticals would be advised.

Certain unhealthy foods and noxious substances increase the incidence of Alzheimer’s Disease. Diets with a higher intake of saturated fats from egg yolks, dairy, and red meats produce a higher level of TMAO in the gut. TMAO, a metabolite of choline, is a direct pro-inflammatory substance that increases the incidence of vascular disease and dementia. Vegetable, chicken, and fish derived fats do not produce harmful levels of TMAO. Trace metals such as copper and mercury can be toxic to the brain. Excess alcohol intake can be toxic to the brain. Even particulate matter in air pollution has been associated with dementia.

Intervention: Avoid all unhealthy foods and noxious substances.

Distorted sleep with increased sleep latency and decreased deep sleep (REM) is associated with an increased incidence of Alzheimer’s and increased amyloid deposits in the brain. Poor sleep also inhibits loss of excessive fat.

Intervention: Distorted sleep can be reversed with Cognitive Behavioral Therapy (CBT) and Mindful Meditation. In those with snoring or unexplained excessive daytime sleepiness (EDS), evaluation and treatment of sleep apnea would be helpful.

Lack of frequent daily intellectual activity is associated with an increased incidence of Alzheimer’s Disease and brain atrophy.

Intervention: Intellectual pursuits stimulate the brain and prevent cognitive decline and promote brain growth. Reading, language courses and almost any courses in arts or sciences foster cognitive stimulation. Hobbies, puzzles, and games that require learning and thinking are effective and fun cognitive stimulants.

Age related memory loss is due to declining function of the hippocampal brain network. The hippocampus is the first part of the brain to reflect atrophy when viewed by advanced medical imaging techniques to find early Alzheimer’s. In addition to memory, there are other spheres or capacities of cognition. For optimal brain function, all of these spheres must be functioning at full potential and must be optimally synchronized. Including Memory which is the major cognitive sphere challenged by Dementia, the full list of cognitive spheres includes sustained attention, response inhibition, information processing, cognitive flexibility, multiple simultaneous attention, memory, category formation, and pattern recognition. Not all mild cognitive impairments are due to memory deficits.

Intervention: Noninvasive magnetic or electrical stimulation modalities improve memory. Transcranial magnetic stimulation (TMS) with high frequency magnetic waves can improve this functional impairment. Low intensity transcranial alternating current stimulation (tACS) can improve memory performance and synchronize brain rhythms.

Specific brain exercises can improve cognitive spheres other than memory that might be impaired in certain individuals. Testing and directing interventions to improve specific cognitive sphere impairment will result in greater cognitive improvement and functional capacity.

Lack of regular exercise increases the incidence of brain atrophy and leads to Alzheimer’s Disease.

Intervention: Exercise prevents cognitive decline and promotes brain growth. Additionally, exercise increases production of brain GDNF, a substance associated with removing “cobwebs” from the brain and promoting brain growth.

Social isolation is considered the major source of mental and psychological stress. Lonely persons have a higher incidence of Alzheimer’s.

Intervention: Social activity and social interaction prevents dementia and rescues Alzheimer patients’ memory by increased brain GDNF production. This removes more “cobwebs” and promotes more brain growth. Brain plasticity is increased with social interaction. Brain plasticity refers to the ability to alter structure and function according to experience. Experience is fostered by regular social interaction. Smiling and being friendly is neuroprotective!

This refers to taking ownership of the use and misuse of antibiotic therapy. Overuse of antibiotics can unfavorably alter intestinal bacteria (“flora”) to cause an increase of inflammatory substances and increase of TMAO. This substance is independently an inflammatory substance and also a marker for ingestion of deleterious saturated fats. There is evidence of infections being one of the multifactorial causes of Alzheimer’s. In particular, prior herpes infection is noted in the brains of Alzheimer patients.

Intervention: Only use antibiotics when absolutely indicated. It has been documented that more than half of all prescriptions for antibiotics should not have been given. Particularly subject to antibiotic stewardship misuse, is treating respiratory viral infections with antibiotics or treating fever without a known cause with antibiotics. Surprisingly, there is a marked decrease in the incidence of Alzheimer’s in persons who have been treated with antiviral agents active against herpes virus infections.

Although rare, there is an inherited dominant gene that causes Alzheimer’s disease twenty or more years earlier than the usual form of Alzheimer’s. There is no replacement gene therapy for this. There is an association of Alzheimer’s with a gene that causes expression of APOE (E4). In individuals who have two copies of this gene, the incidence of Alzheimer’s could be over 50%. There appears to be defect in the brain uptake or utilization of the omega 3 oils DHA and EPA in those with APOE (E4).

Intervention: As of 2020, there is no gene replacement therapy for those rare patients who have the dominant gene variant. Perhaps with evolution of CRISPR technology, such gene replacement may occur. There is targeted therapy for those who are APOE (E4) positive. High dose supplement of the essential omega 3 fatty acids decreases the expression of Alzheimer’s.

It would be no surprise to learn that many, if not all of the modifiable medical risk actors that cause vascular disease also cause Alzheimer’s Disease. These risk factors include Hypertension, Diabetes, Elevated lipid levels, blood levels of certain Inflammatory Markers, Tobacco use, and Obesity. Hearing loss or visual impairment have been associated with an over 30% increased incidence of Alzheimer’s Disease.

Intervention: Control of Hypertension, Diabetes and elevated Lipids by medical intervention will decrease the incidence of Alzheimer’s. Reduction of inflammatory markers such as C-Reactive Protein (CRP), and homocysteine by eradication of the underlying causal inflammation will modify risk of Alzheimer’s. Reducing or eliminating Tobacco use and Obesity further reduces the risk of Alzheimer’s. Many of the Lifestyle Modifications of this section, especially diet, sleep and exercise, will modify medical risk factors favorably also. Screen and treat hearing loss and visual impairment.