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The Last Dance

Alzheimer's Association, cuts right to the chase in his opening remarks, saying, "We simply do not have the medical knowledge or technology to prevent Alzheimer's disease." Age is the number-one risk factor, he says. The incidence of Alzheimer's is 5% at age 65 and 50% at age 90. Given the country's aging population, Alzheimer's is on the rise. As Dr. Santulli reviews the other risk factors, my focus shifts from my mother to myself for the first time. In addition to age, gender is also a factor; more women than men have Alzheimer's, perhaps because women live longer. Genetics plays a role, too; the risk increases two to four times if a blood relative has had the disease.

The one glimmer of hope is that behavior modification may delay its onset. While describing the list of "behaviors that have been associated with Alzheimer's through scientific research," Dr. Santulli urges caution in jumping to conclusions "at this stage of medical knowledge."

Yet the research he cites is fascinating. Studies from France suggest that moderate use of red wine may decrease the risk, presumably due to its antioxidants. But everyone seems to agree that long term alcohol abuse significantly increases the risk. On the other hand, smoking may decrease the risk because, as Dr. Santulli notes with a wry smile, early death leaves less time for Alzheimer's to develop.

Education may lower the risk, either by creating a "cognitive reserve" of brain cells or by stimulating the synapses, the connectors that form neural pathways in the brain. One study shows that each year of higher education results in a 17% reduction in the risk of Alzheimer's. But, Dr. Santulli points out, the research may be flawed because people with more education often do better on cognitive tests, thereby masking the effects of the disease.

Numerous studies conclude that social isolation significantly increases the risk of cognitive decline, and research from Greece and France demonstrates that marriage reduces the risk. Other studies conclude that increasing the time devoted to intellectual activities or exercise decreases the incidence of Alzheimer's.

From the left: Dean "Pudge" Neidlinger at play, with his twin daughters. Ann Kuster looking over family photos with her mother. And with both of her parents.

Next Dr. Santulli lists possible medical interventions. The news of the week is a breakthrough study of ibuprofen in mice, resulting in an 80% reduction in plaque formation. Although the results are stunning, Dr. Santulli is cautious, noting the high dosage of ibuprofen used in the study. In addition to anti-inflammatory drugs like ibuprofen, scientists are probing the impact of antioxidants, such as vitamin E; folic acid; and an alternative remedy called ginkgo biloba that's been shown to have a small effect on retaining cognitive function. While acknowledging that medical science has yet to discover a definitive preventative, cure, or treatment for Alzheimer's, Dr. Santulli holds out hope with his faith in scientific research.

Dr. Julie Fago, an associate professor of medicine at Dartmouth (as well as a 1987 graduate of Dartmouth Medical School), focuses her remarks on women with Alzheimer's. She says the first patient ever diagnosed with the disease was a woman, in 1906, when a German physician named Dr. Alois Alzheimer noticed changes in the brain of a woman who had died of an unusual mental illness. Dr. Fago says studies have tried to determine why women are three times as likely as men to develop Alzheimer's. Research has shown that women treated with hormone replacement therapy, namely estrogen, exhibit higher cognitive function. Future discoveries may confirm a role for estrogen in delaying the onset of Alzheimer's.

Closing with a quote from George Eliot—"It's never too late to be who you

might have been"—Dr. Fago concurs with Dr. Santulli's advice to "use it or lose it." Physical and mental exercise, as well as a satisfying social life, still offers the best prevention for memory loss. Besides, she adds brightly, "it's a better way to live!"

Dr. David Knopman, a neurologist at the Mayo Clinic (and a 1973 graduate of Dartmouth Medical School), outlines recent advances in the scientific understanding of Alzheimer's. In closing, he mentions the cholinesterase inhibitors, Aricept and Exelon, which have proved to delay the onset of memory loss and Alzheimer's disease.

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