What You Might Do to Possibly Fend Off Alzheimer's Disease:
I. Over-the-Counter, Do-It-Yourself Measures:
    (1) Eat foods rich in folates, such as spinach, peas, and grains. Multi-grain bread and rolls might be a tasty way to acquire folates.
    (2) Eat fish rich in the omega-3 fatty acids three or four times a week. This includes mackeral, salmon, tuna, whitefish, and sardines. This fish is beneficial not only as a source of omega-3 oils, but also as a carrier of vitamin B12 (cyanocobalamine). You might want to be moderate in your intake of vitamin B12supplements, since it can feed cancers. (The latest word on eating fish is that it protects against prostate cancer, reducing the incidence of prostate cancer by two-thirds!)
    (3) Get some aerobic exercise (if possible), as well as mental exercise. There's strong evidence that suggests that AD is at leat partially a disease founded upon poor circulation.
    (4) Although antioxidants such as vitamin E, selenium, and vitmin C haven't been shown to correlate with Alzheimer's Disease (AD), they are important, nonetheless, and probably ought to be included in some degree in one's diet.
    (5) Stay tuned for dietary strategies that can raise the level of neprilysin promoters or can lower the level of neprilysin inhibitors.
    (6) Soy products, or the isoflavones they contain may afford protection against AD. Tommie has some soy protein concentrate that is beneficial for cardiovascular disease, and may also protect against AD
    (7) Fruits, wines, soy, coconut oil, and green tea might beneficially boost Apolipoprotein A-1.
    (7) There is some indication that gingko biloba helps prevent AD, perhaps by improving cerebrovascular circulation.
    (8) One possibility is the arthritis drug, Aleve (sodium naproxen), taken once or twice a day. Its principal side effect is stomach distress.
    (9) Huperzine-A does not alter the course of the disease, and can only afford temporary relief of symptoms. The same thing is true of the prescription medicines, Tacrine and Donepazil, and will probably be true of galantamine when it becomes available.
  (10) For women, hormone replacement therapy reduces the incidence of AD in postmenopausal women  to 1/3rd what it is without hormone augmentation.
  (11) No one plans on a head injury, but it's interesting that boxers and people with head injuries develop the same kinds of plaques and fibrillary tangles as Alzheimer's patients. As neurobiologist Steven Rose says (in Possible New Memory Pill for Alzheimer's),

    "Further downstream there's the question of why do people get Alzheimer's Disease in the first place? Is there something we can do by way of neuro protection? Is there something you can take like you take Vitamin E or half an aspirin, something like that which will build up some protection? Interestingly, the best evidence for neuro-protection comes not out of the lab but out of epidemiology. It turns out that post-menopausal women who are on HRT are much less likely to get Alzheimer's Disease than if they're not on HRT, and that has to do with estrogen, although it's probably not estrogen itself in the brain.
    "What happens is that the sex hormones, the steroids, are converted in the brain into things called neuro-steroids, brain steroids. My guess is that if we're going towards neuro-protection there will be an interaction between these peptides I'm looking at, the neuro-steroids, and some other growth factors in the brain. So it will be possible to get a cocktail of processes which will be able to provide neuro protection in this sort of way. That will be the long-term aim.
    "There are a lot of risk factors for Alzheimer's Disease. Some of them are genetic, or in other cases there are genes you've got that are risk factors, and they will interact with things in the environment. The proteins that we're looking at are the risk factors for Alzheimer's Disease.
      "Somehow there's an interaction between whether you have some problems -- for example if you've had concussion as a kid, you've been involved in a football game and banged your head or had a car accident, or you've had general anaesthesia, you are more likely to get Alzheimer's when you're old than if you've had none of those things. So there's a whole lot of environmental risk factors. How they play together no-one knows."
    Dr. Rose on memory-enhancing drugs -
    "People are unclear about what we mean by a memory-enhancing drug. What they do is they help in the transition from short- to long-term memory."

    For anyone planning such a program, it would probably be highly advisable to discuss one's plans and protocols with one's physician. She or he can monitor serum levels of various enzymes to make sure that discernible damage to various organs isn't occurring, as well as watching out for overall health. The interrelationships among various supplements and pharmaceuticals is so complex that, in most cases, no one may really understand their interactions (witness the statins), and a high degree of caution is advised. "First, do no harm." For example, a healthy liver is important in warding off trouble, and as we grw older, we become more vulnerable to miscalculations.

II. Physician-Selected Prescription Medications
    Statins sound to me from what I've read to be the most promising existing Rx for Alzheimer's Disease. Because statins appear to be safe, and because the American Heart Association's recent guidelines call for tripling the number of U. S. citizens taking statins to 36,000,000, it might, perhaps, to be relatively easy to get a statin prescription as a prophylactic for cardiovascular disease.
    Clinical trials are currently underway using an old drug called "cloquinol". Cloquinol is a chelating agent (?) that removes from the brain the zinc and copper that 'decorate' plaques. It was taken off the market when it was found to drain vitamin B12 from the body. However, knowing about this side effect should make it possible to compensate for this problem. Since it's a well-known drug, it might, perhaps, be cleared for therapy before other drugs.
    Beyond the administration of statins, nothing else that could affect the course of AD rather than merely temporarily easing the symptoms seems to me to be beyond the "early human trials" stage. To say it another way, to my knowledge, "There are no proven treatments." This may change in the not-too-distant future as human trials progress.
    The best guess is that there will be "an armamentarium of drugs in the 5 years--10 years maximum--some or many of which will be effective". In the meantime, it might be woth noting that drug companies may have little incentive in promoting existing drugs like the statins whose patents aren't owned by them. Dietary modifications will presumably be of no interest to drug companies.
    Four prescription drugs have received FDA approval for the treatment of Alzheimer's disease:
1. Cognex (Tacrine, 1993)
2. Aricept (Donepazil, 1996)
3. Exelon (Rivastigmine, 2000)
4. Reminyl (Galantamine, 2001)
    Tacrine is now rarely prescribed because of its potential for possible liver damage.
    In addition to being an acetylcholinesterase inhibitor, galantamine also acts upon neurons' nicotinic acid receptors, improving their ability to receive messages..
    All four of these drugs are cholinesterase inhibitors that tend to block the effects of acetylcholinesterase, which breaks down the neurotransmitter, acetylcholine, in the brain. Acetylcholine levels are lowered in the brains of Alzheimer's patients, and blocking the effects of acetylcholinesterase tends to raise them.  Galantamine has just been approved, and not as much is known about it as is the case with the other three.
    The Alzheimer's Association says,
    "It should be stressed that the degree of improvement was modest, and more than half of the patients showed no improvement at all."

III. Promising Research Targets
(1) The Alzheimer's Vaccine
    This vaccine began Phase I trials in the summer of 2000 utilizing 100 volunteers in the US and the UK. Phase I trials are concerned with safety rather than efficacy. It will be the summer of 2002 before it will be known whether this vaccine is effective.
    For some reason, a similar vaccine developed subsequently at the University of Toronto is being hailed as a breakthrough..