Preventing Alzheimer’s disease and similar forms of dementia is a daunting challenge because destructive changes in the brain start happening many years before the first symptoms show up, and by then it’s too late to stop the degenerative process.

“There are medicines that can address the symptoms of the disease but not the underlying pathology,” says neurologist Dr. James Galvin, founding director of Florida Atlantic University’s Comprehensive Center for Brain Health. “Medications can stabilize symptoms so people decline at a slower rate, but the progression of the disease can’t be reversed.”

Galvin, who runs a research and clinical project called the Dementia Prevention Program on the school’s Boca Raton campus, adds that he doesn’t expect a cure for the mind-wasting conditions anytime soon. “By and large, doctors can’t cure diseases; we can only treat them,” he notes. “So it’s unrealistic to think that we’re suddenly going to find a cure for Alzheimer’s disease. But there are things we can do to prevent it, or at least delay its onset.”

Dementia is defined as cognitive impairment that is so severe it interferes with people’s ability to take care of themselves. Although there are more than 150 types of dementia, Alzheimer’s is the most common, making up more than half of the cases. About 5.7 million Americans suffer from Alzheimer’s, and that number is projected to soar to over 14 million by 2050. The next three most common dementias are vascular, Lewy body, and frontal-temporal degeneration. Other forms make up just 1% of cases combined.

“Researchers use Alzheimer’s as the model because it is the most common and we know the most about it,” says Galvin. “The pathology begins in the brain 10 to 20 years before symptoms, so by the time the person develops a recognizable symptom, there’s already a lot of damage done.”

That destructive pathology comes in the form of amyloid plaque and tau tangles, buildups of abnormal proteins that disrupt memory and cognition. But experimental medications used to reduce the clumpy proteins haven’t done anything to reverse impairment, and scientists are still debating whether they are actually a cause or an effect of Alzheimer’s.

“There was the assumption that if you got rid of the amyloid, you could get rid of the disease,” notes retired neurosurgeon and leading researcher Dr. Russell Blaylock. “So they found a bunch of ways to reduce amyloid, and none of it seem to work in reducing Alzheimer’s. Most of the recent research now points to a combination of chronic inflammation and excitotoxicity (overreactions to the neurotransmitter glutamate) in the brain that’s causing it.”

No matter what the cause turns out to be, waiting for symptoms to appear before trying to treat dementia is “like closing the barn door after the horses get out,” warns Galvin. So what can you do to prevent dementia? Galvin and his team focus on trying to reduce risk factors, which includes optimizing lifestyle and addressing other medical conditions that can contribute to dementia. Other experts point out that dementia is a disease of aging, and they recommend taking specific supplements that can slow the aging process in brain tissue on a cellular level. There are also hotly debated alternative treatments.

The First Step: Start your prevention process by getting screened. Just like having a mammogram or colonoscopy to check for cancer, you can get a brain health assessment that identifies risk factors for dementia. In Galvin’s Dementia Prevention Program, subjects undergo a comprehensive evaluation that includes brain scans, spinal fluid and blood tests, lifestyle questionnaires, and other tools to identify things associated with declining brain health.

“We might find elevated inflammatory markers, so we search for what may be causing them and formulate a plan to reduce them,” Galvin says. “Lipid profiles, vitamin D levels, and toxic byproducts of protein metabolism, such as homocysteine, are examples of things that can raise risk but be treated. You can’t do anything about the pathology, but you can do something about the risk factors.”

Even without all of those tests, your physician can determine some of your risk factors. It’s vital to identify and treat other medical problems that can promote the development of dementia. Conditions such as diabetes, obesity, high blood pressure, high cholesterol, and even inflammation-inducing gum disease all fall into this category and can have a profound effect.

“Diabetes doubles dementia risk; obesity quadruples risk,” says Dr. Gary Small, Director of the Longevity Center at UCLA. “Cardiovascular issues are also important. What’s bad for the heart is bad for the brain.”

So what’s the best way to reduce risk? “Tongue in cheek, the best way to prevent dementia is to pick your parents well,” says Galvin. “Even though many of these diseases aren’t genetic, your gene pool plays a role. You also learn a lot of your behaviors from your parents, so if they have unhealthy habits, you’re more likely to have them too.”

Whether or not you chose your parents well, it’s a good idea to be selective about what you choose to eat. Many experts recommend a Mediterranean-style diet that largely replaces processed foods and red meat with whole foods and fish or poultry.

Berries, dark leafy greens, vibrantly colored vegetables and green tea are especially high in antioxidants that help protect the brain against oxidative stress and inflammation. Rebecca Katz, author of The Healthy Mind Cookbook, counts some of her top brain foods to be fatty fish like salmon, walnuts, legumes, avocado, olive oil, beets, and the spice turmeric. Fiber and fermented foods are also vital because having a heathy mix of bacteria in the gut can help reduce inflammation in the brain.

A study published in the journal Alzheimer’s & Dementia suggests that a combination of the Mediterranean and DASH (Dietary Approach to Systolic Hypertension) diets “substantially slows cognitive decline with age.” Katz adds: “Nutrition is one of the keys to brain health that we hold in our hands.”

Exercise is another pillar of general health that also translates into brain health.”When you engage in physical exercise, it gets your heart to pump more oxygen and nutrients to your brain,” says Small, author of The Mind Health Report newsletter. “Your body produces brain-derived neurotropic factor (BDNF), which stimulates your neurons to sprout branches, so brain cells can communicate more effectively.”

According to a study published in the Journal of Applied Physiology, BDNF levels can be further boosted through high-intensity interval training (HIIT), in which short bursts of all-out effort are incorporated into a workout. But just about any form of exercise helps to some degree.

“Numerous studies show that people who exercise regularly, even just brisk walking, have larger memory centers in their brains,” Small says.

While diet and exercise are probably the two most impactful lifestyle factors related to dementia prevention, other elements come into play. Small notes that it’s also important to reduce stress through regular meditation or other means, get enough sleep (at least seven hours a day), stay socially connected, and stimulate yourself mentally by doing puzzles, learning new things, practicing memory techniques, and otherwise challenging your brain.

“It’s never too early to start protecting the brain,” Small concludes. “Modifiable risk factors for Alzheimer’s probably account for nearly half of the cases worldwide.”

There is scant scientific evidence that over-the-counter cognitive-enhancing supplements do anything to prevent or improve symptoms of dementia. But being deficient in some essential nutrients — such as vitamins D, K, B12, and B9 (folate) — can increase risk. However, some experts believe that there are specific substances that may help because they work on a cellular level to slow down the aging process, and aging is by far the greatest risk factor for dementia.

“You age on a cellular basis rather than a full body basis,” says Dr. Sandra Kaufmann, author of “The Kaufmann Protocol: Why We Age and How to Stop It.” “If your cells function the way they should, your body will function the way it should.

Still, Kaufmann points out that the brain has special needs. Because it uses more oxygen per unit of tissue and has higher energy requirements than any other organ, it is exposed to very high levels of oxidative stress, free radicals and destructive glucose residue called advanced glycation end products (AGEs).

All of these things can cause cellular dysfunction and with it increased risk of neurodegenerative diseases, including dementia. The brain also has a protective shield called the blood-brain barrier, which only lets through select molecules. But Kaufmann says there are some easily available “molecular agents” people can take to protect their brain cells from the onslaught, including:

• Curcumin: The compound in turmeric is a free radical fighter, antioxidant and anti-inflammatory. It supports the health of mitochondria, the organelles that power cells and whose dysfunction is a key marker of dementia. Curcumin also helps remove lipofuscin, a waste product which is especially troublesome in long-living cells, such as those in the brain.
• Alpha lipoic acid: Sometimes called the “universal antioxidant,” alpha lipoic acid (Alpha LA) is both water soluble and fat soluble. Lab studies have demonstrated that it has a “clear ability” to improve learning and short-term memory in aged rodents.
• Apigenin: This compound found in teas, especially chamomile, modulates neural inflammatory responses and also fights oxidative stress.
• Astaxanthin: This super-potent antioxidant found in red algae supports the hippocampus, the structure in the brain that basically files and retrieves information. In studies, astaxanthin helped cognition in both animal models and aging humans.
• Reservatrol: The skins of grapes are a rich source of this plant compound, which modulates brain function by improving glucose metabolism and blood flow. It has shown to be neuroprotective in both animal and human studies.
• Epigallocatechin gallate: Abundant in green tea, this polyphenol, also known as EGCG, is another free radical scavenger and anti-inflammatory that also has heavy metal chelating qualities to help detoxify cells. Epidemiological studies have shown a clear, inverse association between green tea consumption and the kind of cognitive dysfunction common in dementia.

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