Prof. Dr. Liana Apostolova: Vegetables and legumes protect the brain from being dumbed down

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Prof. Dr. Liana Apostolova: Vegetables and legumes protect the brain from being dumbed down
Prof. Dr. Liana Apostolova: Vegetables and legumes protect the brain from being dumbed down
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Liana Apostolova is a professor of neurology, radiology and genetics at the Indiana University School of Medicine in Indianapolis, USA.

Her research focuses on early-onset dementia patients. Prof. Apostolova answered the questions of Bulgarian patients and their relatives in a webinar organized by the Citizen Association "Alzheimer Bulgaria" on October 18, 2021

We are publishing part of the webinar. The top specialist shares how to take care of the brain to avoid dementia.

Prof. Apostolova, can dementia occur after recovering from COVID-19?

- SARS-CoV-2 is a very dangerous virus. We are seeing that COVID-19 can cause cognitive impairment that is of varying duration in individuals. Whether it causes dementia, however, we can only say after we have followed the patients for at least a decade or two. Regarding the COVID-19 vaccines, all my dementia patients are vaccinated, even with the third dose. The vaccine does not affect dementia - it neither increases nor decreases it.

Is it possible to prevent dementia through lifestyle changes?

- Many scientific studies prove the positive effect of proper nutrition on cognitive functions. Eating well means eating lots of vegetables, fruits, nuts, legumes and less red meat. Chicken and more fish are recommended instead of red meats. Olive oil should be used instead of sunflower oil. People with this diet do not accumulate amyloid in the brain even in middle age. However, I emphasize that prevention is done in middle age - from 30 to 55 years, and not when dementia has already occurred. Then the effect of he althy eating is minimal.

Other preventive measures in middle age are controlling blood pressure, cholesterol, blood sugar, managing all chronic diseases in general and maintaining an optimal weight. Daily sports activities are also needed.

At the same time, it should not be burdensome and intense. One does not have to climb mountains and run marathons. It is enough to walk more and do cardio training only a few times a week. Cardio is beneficial because it stimulates the brain-probably through increased blood flow, which improves connections between neurons. All of these lifestyle factors have been shown to help prevent dementia.

Is it possible to delay the progression of Alzheimer's disease with early detection?

- Monoclonal antibody therapy can be referred to existing secondary prevention. Monoclonal antibodies are currently being tested in he althy people whose head scans already show amyloid buildup in the brain.

Amyloid begins to accumulate 20 years before dementia actually occurs. So we have a period of 20 years in which we can do interventions to stop and delay the disease. If monoclonal antibodies can remove amyloid from the brain at this stage of undetected Alzheimer's disease, its progression could probably be stopped. But the first results of this study will come out in 2022

What investigations should be done at the first symptoms of dementia - for example, forgetting activities that need to be done?

- This is more of a distraction than a forgetfulness. If a person forgets to do something at the moment and a few hours later remembers, he does not have Alzheimer's. If you walk into a room in your home and wonder why you went there, it's not Alzheimer's.

If you forget a person's name, it's not Alzheimer's If you forget your shopping list when you go shopping and can remember 7 out of 10 things on that list, you don't have Alzheimer's.

There is Alzheimer's disease when a person begins to forget in a malignant way, when he cannot recover forgotten information at all, when he completely forgets what happened yesterday, what he ate, who he met, etc.., when he repeats many times questions like "when are we going to meet someone?", "where are we going", he is answered, but after 10 minutes he asks the same question again. These are the symptoms that would worry me. It is good to ask your relatives and friends if they are worried about you. In the case of a malignant change in memory, relatives and friends are the first to notice it.

If there are people with a family history of Alzheimer's in the family, it is not a bad idea to get tested. They should go to a dementologist and a psychologist.

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Prof. Apostolova with her patient in the USA

What is the relationship between severe stress and the onset of dementia?

- The relationship is more with chronic stress rather than one time severe stress. There is evidence that chronic stress causes dementia in middle-aged people. This is related to hormonal changes that affect the brain. Chronic stress affects sleep badly, and poor sleep increases the risk of Alzheimer's. I advise people with sleep apnea to get treatment too.

And those who are stressed and depressed and can't sleep at night, find ways to relax, to deal with stress. You should know that amyloid in the brain is cleared during sleep. If you don't sleep well, you have more amyloid deposits. As we age, any increased production of this protein and lack of sleep lead to dementia.

Which factors influence the dynamics of dementia diseases, their progression or delay?

- The earlier Alzheimer's disease is diagnosed, the greater the chances of slowing its progression. A person with early Alzheimer's or mild cognitive impairment can become aware of what is happening to them and start living a he althier life. In this regard, sleep is very important. And in the Alzheimer's stage it is of great importance.

At an early diagnosis, therapy can be started to slow the progression of the disease. The drugs are donepazil and memantine, which are sold in Bulgaria under other trade names.

Vasodilating and neuroprotective medications are not prescribed because they have been proven not to help with Alzheimer's disease. There is a new drug - the monoclonal antibody Aducanumab. It was expected that by then it would be prescribed to half a million patients in the US. However, only 200 patients have undergone this therapy so far. It's just that the drug is incredibly expensive. It is assumed that its price will come down over time and we will be able to prescribe it more widely.

Education and continuing education play a huge role in delaying dementia. The more intellectually stimulating your job is, the more it requires you to constantly educate yourself and learn new things, the more it develops your brain.

Regardless of age, learning stimulates the brain and develops it. My great grandmother died at almost 100 without any brain disorders. But she spoke seven languages and in the last years of her life was learning an eighth language. This greatly helps preserve intelligence, but also slows the progression of dementia because it creates strong connections between brain cells.

How do relationships and communication with the patient's close and wider environment affect the disease?

- I participate in several studies on the impact of the patient's social connections on his illness. When included in a wider and more diverse social network, the study participants had no memory impairments or signs of the disease.

As the cerebral cortex thins-that objective marker of brain changes that begin before a person has symptoms of Alzheimer's disease-the patient's social network begins to impoverish. It is not clear whether the lack of social connections or their sharp narrowing leads to the thinning of the cerebral cortex, or whether the thinning of the cerebral cortex causes the social contacts to decrease.

The question is analogous to that which is primary - the chicken or the egg? Social isolation is certainly not good for the brain. And the pandemic has done exactly that to many of us – it has narrowed our social network to the point of social isolation. For the prevention of dementia, I recommend extensive social contacts.

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