Dec 8, 2011

Lifestyle Changes and Music as Alzheimer's Therapy

Can exercise, or healthy diet, or mental activities, or socialization, or music be used as a therapy to treat people living with Alzheimer’s?

By Wantland J. Smith
Alzheimer's Reading Room

This Man Decided
to Fight Alzheimer's

-- Jay Smith
I think each of these “lifestyle” strategies should be adopted as an urgent priority as a matter of public health and national survival.

But, even if the potential benefits were to become widely accepted, I acknowledge that their effectiveness will ultimately depend upon the extent of people’s willingness to commit to doing the therapy persistently.

But wait a minute! No one is promoting using these lifestyle prevention strategies as a treatment regimen for Alzheimer's disease.

Nonetheless, I am beginning to use these prevention strategies for myself, after living with the symptoms of Alzheimer’s for a long time – six years since my diagnosis of “early Alzheimer’s disease,” and more than a dozen years since the first symptoms became worrisome enough that I sought a neurological workup to try to find out what was causing them.

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Many of our doctors say there’s nothing we can do, other than taking our medications, and preparing for the inevitable end that is in store for us. Making matters worse, we recently received the official word – issued by a panel of experts at NIH who looked at the history of clinical trials and other studies – that there is not sufficient evidence to support using any of the lifestyle strategies to prevent it.

I don’t agree with the experts, and draw different conclusions from my reading of the body of evidence contained in numerous longitudinal studies showing the benefits of many of these lifestyle prevention strategies. I know I don’t have the qualifications to argue with them and their conclusions. But I’m happy that there are well-credentialed experts who also don’t agree with their conclusions, and who have cited reports of studies finding evidence of Alzheimer’s risk reduction through modifying lifestyle.

(For a comprehensive summary of the scientific evidence of the risk reduction benefits of lifestyle changes, see the chapter on the subject Dr. Kenneth Kosik’s book, The Alzheimer's Solution: How Today's Care Is Failing Millions- and How We Can Do Better)

In his comments to a recent Alzheimer’s Research Forum article about the NIH position on AD prevention, Dr. Kosik asserts that the potential for risk reduction through lifestyle changes has attained a reasonable level of certainty that they should be recommended as a matter of public health and for use in public policy planning. For more information, see Dr. Kenneth Kosik’s comment to recent article: “Research Brief: Last Word from NIH on AD Prevention” dated May 16, 2011
on the web at the Alzheimer’s Research Forum website, or search the web using these key words: “AlzForum Last Word from NIH on AD Prevention.”

So what should anyone who is worried about Alzheimer’s do? I suggest they adopt the lifestyle risk-reduction strategies without delay. The aging worried well who are not impaired, the baby boomers, and the generation following them would be well-advised to do it. They should not to wait for more proof, but to go ahead and do it. The known side effects of the lifestyle risk-reduction strategies are reduced risk of heart disease, reduced obesity and diabetes, increased longevity. Most of us can tolerate those side effects.

But what about those of us who are already living with early Alzheimer’s? Might the Alzheimer’s prevention or risk-reduction strategies be useful as treatment strategies? I say, yes, why not? While there is no proof that they will affect the course of Alzheimer’s disease, I believe there is a growing body of scientific evidence that suggests they might.

If the early AD patient is physically and mentally capable of managing and sustaining the lifestyle regimens, then they should consider the potential benefits from the lifestyle strategies. For those of us in the earliest stages, i.e., with MCI and mild Alzheimer’s dementia, while we no longer have the mental capabilities to hold a job, many of us are still driving, balancing our checkbooks, and maintaining some form of social life, at least with support groups, family, and closest friends. With the right motivation and support, I believe we are capable of adopting a regimen that uses a combination of the potentially beneficial lifestyle approaches!

Is there any science that suggests such a treatment strategy might actually help us? After all, we’re already on the slippery slope of decline. Isn’t it too late for us? No, I don’t think so, because science actually does already support the health benefits of lifestyle changes. I know this is heresy, but please hear me out.

First, science has shown that exercise and healthy diet can give us a healthy heart and robust immune system. Moreover, science is telling us that what’s good for the heart is also good for the brain. And more doctors believe that maintaining vascular health is a effective treatment strategy for Alzheimer’s patients.

Equally important is the science of brain plasticity that has shown we can create new working brain mass by forging new neural pathways. The recent successes of traumatic brain injury (TBI) recoveries demonstrate that those patients are forging new neural pathways through intensive restorative therapy – and are learning all over again how to walk, to talk, to read. That experience shows the capacity of our brains to restore themselves, if we try hard enough. (In his book, “Spark,” Dr. John Ratey explains the process behind brain plasticity. Aerobic exercise generates nascent neural stem cells, and those cells float around waiting for a mission. If the brain they’re in is engaged in learning something new and challenging, then the stem cells respond to the challenge by creating new neural pathways.)

The science of brain plasticity is being exploited every day in the TBI therapy setting. It is the reason that physical and mental exercise and new learning are included as Alzheimer’s risk reduction strategies. So why not employ them as an Alzheimer’s treatment strategy? Why not have early AD patients employ intensive and persistent therapies designed to build new brain pathways as a specific treatment strategy to proactively overcome and offset the ongoing destruction wrought by the disease?

Finally, there is the known health benefit of stress reduction, or relaxation therapies, such as meditation and yoga. Stress creates cortisol that is destructive to our immune systems. Stress reduction (i.e., controlling hypertension) has been shown to be good for our health, and has produced many healing miracles.

That’s the essence of the science that underlies the benefits of lifestyle risk reduction (and treatment) strategies, in a nutshell. Check it out yourself. I think you’ll find it undeniable.

Where does music fit in?

“Learning a musical instrument” is sometimes listed among the recommended mental activities that can be adopted as lifestyle changes for Alzheimer’s prevention. It can serve as some of the requisite “new or challenging learning” to cause neural stem cells to organize into new neural pathways. And so does learning to sing a new song, or learing to play a new song on your instrument, or learning a new language, or learning a new dance step.

There is a growing scientific interest, evidenced by many recent books and newspaper articles, in the potential the value of music for brain health. It is a fertile untapped field of study that must be explored in the future. For now, we must go with our instincts, and what we know already about brain plasticity.

My musical activities are much more than “learning a new instrument,” and I’m convinced that music is helping me in several ways.

First of all, I find musical study and practice to be a wonderful, satisfying mental activity. It challenges my brain to learn new things and build new neural pathways to support my mental capacity to do the new things. Examples of new things are learning note reading, learning new tunes, new chords and scales, learning to use my voice, and performing.

Secondly, music is relaxing to me. Relaxation is known to be a risk reduction tool, as it keeps hypertension in check and minimizes the ravages of cortisol that is produced by stress. Picking up my mandolin to review an old fiddle tune, or to learn a new one, is the most relaxing thing I know how to do.

Next, music a wonderful source of socialization. My weekly folk singing class that I created two years ago and lead at my neighborhood adult community center is one of the highlights of my week. Another is my old time folk music group that meets each month, and provides a wonderful place for musical sharing that is satisfying beyond words. My weekly choral practice with my wife Marilyn at our community chorus for the past eight years also provides social interaction with an every changing group of adults of all ages.

Finally, music gives me a sense of accomplishment and personal worth that charges my life force or chi. It is also a great outlet for self-expression and source of pride. Being in my Family Band is especially gratifying, as it combines learning and performing with the joy of being with my family. Singing, harmonizing, and soloing with our weekly chorus also combines learning, socialization, relaxation and self-expression in a personally satisfying healthy combination. My weekly vocal lessons are another related activity that, with its performance workshops and showcases, adds to the challenge of learning and provides the reward of a sense of accomplishment and gratification.

Our monthly old time folk music hoot group of the last ten years, where I was prompted to take up the mandolin about eight years ago, provides constant, recurring satisfaction, as I contribute to the jams with improvised solos and spirited rhythmical backup, and receive wonderful acknowledgement. My attending mandolin and guitar camps and workshops during each of the past five years has also been a great source of joy as a result of the musical growth, with the added benefit of those newly acquired neural pathways.

In my approach to living with Alzheimer’s, I’m committed to my regimen of lifestyle risk-reduction strategies that offer the hope of potential health benefits. Music will continue to be the centerpiece of my approach, because it gives me so much pleasure and reason to live. I’m going to continue to go for it, and am willing to handle the side effects. I am also holding onto the possibility that the combination of the strategies will help to slow the progression of Alzheimer’s, giving me more time to enjoy being with my family and enjoying my music.

More Insight and Advice for Caregivers

Wantland J. (Jay) Smith was diagnosed with early Alzheimer’s disease in late 2005, based on neuropsychological tests and FDG/PET.

Since diagnosis, he became an early stage Alzheimer’s advocate, creating the first early stage memory loss forum of the California Southland Chapter of the Alzheimer’s Association in October 2007, and led their second early memory loss forum in March 2009.

He has participated in three early stage support groups, including the one he instigated and currently co-facilitates Leeza’s Place.

With the Alzheimer’s Association he has attended two Public Policy Forums in Washington DC, recently served as a member of the Association’s second Early Stage Advisory Group, and was appointed as the first person with AD to serve on the board of directors of the California Southland Chapter, completing his two-year term in the summer of 2010.

He frequently shares his story as a panelist and through press interviews.

Original content Wantland J. Smith, the Alzheimer's Reading Room