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Alzheimer’s Disease Part I: Preventive Exercise & Diet

Most of us know by now that Alzheimer’s disease is an incurable condition that destroys brain cells. It is a form of degenerative brain disease resulting in progressive mental deterioration with disorientation, gradually causing memory disturbance and confusion and loss, leading to dementia with extreme changes in personality and behaviour. It may give rise ultimately to weakness and paralysis of the limbs, and other neurological signs and loss of function, and it is the most common form of dementia. Delusions and hallucinations are associated with worse outcomes of the disease, which may predict cognitive and functional decline, the presence of which is also associated with institutionalization and mortality.⁰

In the UK there is great consternation of late about front line disease drugs for Alzheimer’s treatment, such as ‘Aricept’, ‘Reminyl’ and ‘Exeton’, which are accused of being a Post-Code Lottery in their availability and distribution.¹ Now the three aforementioned drugs have been approved by the NHS in Scotland, but rejected for NHS use in England and Wales, which has been said is tantamount to a ‘medical apartheid’ in the British Isles.

The spearhead of such decisions, by and/or for the National Health Service, is costs, e.g. these pharmaceutical drugs cost £2.50 a day per capita, but that’s £9,125.00 per annum per individual.² The drugs are not a ‘cure’, but estimated to work for around half of patients, with effects lasting for one-to-two years.

It is pointless to take umbrage at the Scots over what is happening, because of the disparity in population numbers. Of the 60+ million, (possibly closer to 63 million) souls that form the British population, in 2005 it was estimated Scotland had a population of a little more than 5 million (5,094,800 million) ³ of that total. Wales, the 3^rd largest population in the UK, was estimated in 2005 to be under 3 million (2,958,600),⁴ whereas the English contingent of the overall population is conversely vast. However, when it comes to the health of the nation and decisions are based on costs, it is a hard pill to swallow.

Furthermore, deciding who gets what, and what the administration of ‘care’ costs entail has to be incredibly difficult. For example, in May this year it was reported that official figures show that heart disease is still the biggest killer (20.2% deaths in men 16% in women), and kills people in England and Wales more than any other condition - about one in six women in 2005 died of heart disease, including heart attacks.⁵ Of the ‘Top 10’ list of causes of death in England and Wales, cerebrovascular disease, mainly strokes, was the second most common killer of men and women.⁶ At that time, the official statistics for deaths in men from Alzheimer’s was 2.1%, and in women 5.2%.⁷ The disparity in figures between ‘causes of death’ speak for themselves. Also in terms of intensity of ‘care’ costs required by patients and costs of drugs to the NHS, even though most Alzheimer’s sufferers are cared for by their nearest and dearest in the home.

Dementia currently affects over 750,000 people in the UK, of which 18,000 people with dementia are aged under 65 years. It affects one person in 20 aged over 65 years and one in five over 80 years of age.⁸ The number of people with dementia in the UK has been estimated, using population figures for 2001, as England 652,600, Scotland 63,700, Northern Ireland 17,100 and Wales 41,800, totalling 775,200 cases overall.⁹ By 2010 it is expected there will be about 887,000 people with dementia in the UK.¹⁰

Although Alzheimer’s disease is the most prevalent form of dementia, i.e. it represents 55% of cases, it is not the only one.¹¹ Even though dementia mostly affects the elderly, one in a thousand between the ages of 40-65 are also affected.¹² Sadly, the writer has known of one young women to die aged 28 years old of the disease, which was known to be an inherent case.

The Alzheimer’s Association UK has stated that: “many people talk about the ‘demographic time bomb’ or ‘tidal wave’ of older people which the state cannot afford to cater for”, but they believe this view is misleading and a steady rather than a dramatic growth of the disease is expected over the next 25 years; they also believe the state can provide for peoples’ needs as they age.¹³ Nevertheless, the latest development regarding the availability of ‘quality of life’ enhancing drugs is of major concern. Prevention is of paramount importance always, but especially where there is no cure. So, how can we help ourselves?

The public can help themselves to avert dementia, or at least ward it off for as long as possible, by taking their ‘life-style’ into consideration; to improve and adapt it where possible. For example, physical exercise is imperative. US research January this year suggests that regular exercise reduces the risk of dementia and Alzheimer’s disease (AD) by up to 40%. What’s good for the heart is good for the head.¹⁴

A further American study in May 2006 concluded that lower levels of physical performance were associated with an increased risk of dementia and AD. It suggests that poor physical function may precede the onset of dementia and AD, and that higher levels of physical function may be associated with a delayed onset.¹⁵ 

How We Can Help Ourselves?

Preventive Physical Exercise& Alcohol Intake

Danish research last month acknowledged that factors during early life such as nutrition, education, and parental socio-economic status can influence the development of dementia later in life. From mid- to late-life, a physically, socially, and intellectually active lifestyle is also associated with reduced risk for dementia. Moreover, modification of cardiovascular risk factors, which include diet and exercise during this period, can also potentially reduce risk of the disease.¹⁶

In a French review of AD this September, researchers pointed out that there are several risk factors that are associated with AD, especially some cardiovascular risk factors, including hypertension,^17a diabetes,^17B diet, obesity, and elevated levels of homocysteine and lipids^17D in the blood; the strongest being with hypertension and diabetes.

Moderate alcohol consumption also appears to be associated with decreased risk. ¹⁷ Alcohol inflicts damage to the brain, so only ‘a little of what you fancy’, especially ‘red wine’, does you good.

The positive aspect of the news about the booze is that the liverish¹⁸ ageist attitude of some young people towards the elderly as being a burden is up the creek. They are in no position to point the finger at the aged. They need to stop and think, because the undignified youth trend for ‘binge drinking’ likely could render them helpless with the scourge of AD a lot sooner rather than later.

It has been reported that the proportion of English women who could be tagged as ‘binge drinkers’ is intolerably high.¹⁹ The largest ever study on worldwide drinking habits, which looked at the drinking habits of more than 17,000 men and women, spanning 21 countries has been carried out. The report revealed one in three 17-35 year olds are now classed as ‘heavy drinkers’, bingeing on four or more units in one session at least once a fortnight. Appallingly, it puts English women second in the league of the highest imbibers at 33%, only topped by Irish women at 57%. In contrast, Englishmen who binge drink came 5^th lowest at 26%, before Spain at 21% and at the bottom of the league German men at 2%.²⁰  

Ladies please, take a pull and not a pint! The ‘ladette’ culture is storing up trouble for the future and is of particular concern, not only because of violent or disreputable and often dangerous or shocking social behaviour, which may or mayn’t have been facilitated or exacerbated by the relaxed attitude to alcohol and recent changes to drinking times in British Law – other research has shown that more than half of all violence in the UK is fuelled by binge drinking.²¹ It is also of major concern because women are drinking so heavily that some are developing serious liver disease 20 years in advance of what medical experts would expect.²²  

In another multi-national study in 15 countries, men and women demonstrated similar patterns in inequalities with regard to current drinking status within a country. In Germany, the Netherlands, France Switzerland and Austria it was found that educated women were most likely to drink heavily, while among men the lower educated were more at risk in most countries.²³ For heavy episodic drinking, almost no significant differences were evident among women, but for men a social gradient was observable with lower educated being more at risk in several countries.²⁴ Amazingly, education doesn’t appear to count for much when it comes to binge drinking among women.

There is some stunning and sobering news. Although education triggers new nerve connections in the brain, the latest New York community-based multiethnic study on education and cognitive decline published in spring this year, involving 312 Alzheimer’s sufferers aged up to 65-year-old with incident AD, suggests the disease progresses more rapidly in highly educated people.^24A It is thought high levels of education may ward off AD by helping the brain better tolerate damaging changes, but once accumulated damage reaches a critical level decline is relatively swift.^24B

Despite the thoroughness of the study, this is not the last word on the subject. Further evidence is required, as results from prior studies have been mixed. In this particular study each patient received a neuropsychological assessment consisting of 12 individual tests, and was followed up from between 5.6 to 13.3 years. Overall mental agility declined every year among all the patients, but each additional year of education equated to an additional 0.3% deterioration per year. The level of this ‘drop-off’ was particularly evident in the speed of thought processes and memory. The results were independent of age, mental ability at diagnosis, or other factors likely to affect brain function, such as depression and vascular disease.

The researchers said one possible explanation is what has been dubbed the ‘cognitive reserve’ theory.^24C This holds that highly educated people either have a greater number of nerve connections in their brains, or the nerve connections they have are more efficient. Therefore, when the damaging changes associated with AD, such as the deposition of toxic protein clumps, starts to take place educated people are better placed to resist their effect at first. However, the subsequent impact is likely to be greater than it would be in less educated brains, because of the higher levels of accumulated damage. Plus, a key question remains whether the effects found in the study’s results are due to years of schooling or due to other factors related to education, such as wealth, occupation or life-style.^24D

Whatever is finally scientifically discovered and decided about this element of AD in the future, it is unwise to kill off healthy brain cells with excessive alcohol intake and, as more women than men are affected by AD in the UK, and women about double in the United States,²⁵ who came fifth in the league of women who binge drink, it stands to reason that health-wise such alcohol abuse will likely come to an unwelcome sticky end.

Unfortunately, it is also all too easily observable that children (those under sixteen years of age in the UK) are starting to drink and get drunk early in life, which highlights and includes the female of the sexes. Part of the problem is that younger brains are more likely to resist alcohol’s effects on social behaviour. But, according to researchers using animals as surrogates for teen drinkers for the past several years, this tolerance for booze can backfire. It means that teens can drink more and are more likely to engage in heavy drinking, and may suffer long-term consequences in still-developing regions of the brain. In this new study, the researchers’ major concern regarding their findings is: ‘The ability of adolescents to rapidly counteract some unpleasant alcohol effects by developing acute tolerance may allow them to have more drinks per occasion. This binge pattern of drinking, being unsafe in general, might be extremely dangerous for adolescents, given that their brain is especially vulnerable to alcohol-related damage.’²⁶

In short, translated into human behaviour, a teen seeking to relieve stress or lose social inhibitions will wind up drinking more to sustain that effect than will an adult. The trouble is that even though the teen brain has the capacity to adapt quickly to an alcohol challenge, this comes at a cost, with important brain resources redirected from brain development to the adaptation to alcohol.²⁷ Children are putting their brain development at risk with alcohol, in function and development, as well as storing up health problems for the future that could well end up in dementia.

Another concern for the young is embedded in the Computer Age life-style. Younger people have been sitting-around for far longer than their elderly counterparts did at their age, staring at various types of VDUs, (half a year is spent doing this – See ‘Herbsphere’ “The Obesity Epidemic”). Also a recent report found British children to be amongst the laziest in the world,²⁸ which is deplorable commentary on their lack of exercise, but anyone of any age cannot sit back on their exercise laurels.

Moderate alcohol intake and exercise is essential to the health of body and brain. With the spectre of obesity looming large, aided by parents and schools PE/PT curricula, the child and youth section of the population is going to have to learn to pull-up their physical-fitness-socks and fast, and to abandon bad drinking-habits early on, in an effort to lay ‘good health’ foundations to avert this terrible disease. Although AD may be particularly prevalent in the senior age group, it should be made clear to those younger, including children, that AD can and does hit anyone at any age. The view of “A short life and a merry one,”²⁹ might not turn out to be so merry.                                             

Preventive Physio-Mental Exercise

The brain has often been called the three-pound³⁰ universe, our seat of ‘self’. It’s our most powerful organ about which we know least. It’s the electro-magnetic body’s P.C. (Personal Computer). The billions of neurons^30A within it act via a fine-tuned messaging system, which is a combination of chemistry (chemicals) and physics (‘energy’/electricity). Physical exercise is not for the body alone, though it assists the blood circulatory system and lungs (oxygen) that are involved in the complex workings of the brain.

Scientists’ view of the brain’s potential is changing, and providing people take good care of their health (diet and exercise) along their lives: “Older people can continue to have extremely rich and healthy mental lives.”³¹

Activity seems to be a ‘key’ to successful ageing, and both mental and physical exercises are strongly connected to cerebral fitness. It’s a ‘Use it or lose it’ approach.

It is amazing, but true; exercise is a powerful tool to stimulate several brain processes.

Last year a research summary stated, it is becoming clear that therapeutic effects of exercise are not only good for cardiovascular and other diseases, but that exercise really is good for the brain.³³      

Recent research (April 2006) demonstrates that exercise has many functional effects on the brain.³³ In fact, physical exercise influences the central dopaminergic (dompamine^33A), noradrenergic (noradrenaline^33B) and serotonergic (serotonin^33C) systems. These systems affect control of emotions and sexual activity; transmission of information, attention and impulsivity; regulation of mood, sleep, sexuality and appetite. For example, low levels of serotonin in the brain have been associated with depression and anxiety.

In 2005, at the ‘British Association’s Festival of Science’ held in Dublin, Republic of Ireland, it was said that studies of the ageing brain have shown mental decline is not inevitable. There are plenty of activities people can do to keep it together “up top”.³⁴ They reiterated and emphasized the need for a healthy diet, and suggested aerobic^34A exercise and mental stimulation all helped to keep the mind young. In contrast, prolonged stress and social isolation act to age the brain.

How does this translate into things to do and not do?

On the preventive physical exercise front aerobics^35A is recommended³⁵ – why not join a group and get some physio-socio needs met in one dose. Aerobic exercise is a vital contributor to maintaining brain function as the body ages. There are several explanations for the link between fitness of body and mind, exercise increases production of key brain chemicals which encourage the growth of brain and nerve cells and the development of new neural connections.³⁶ It also promotes the growth of blood vessels, which nourish and sustain existing structures.³⁷ More oxygen in the lungs, means more oxygen in the brain.

In one study, in which over-60s who exercised over a three-year period, the participants exhibited none of the usual mental decline in that period.³⁸ In another study, test subjects obtained mental improvements after just four months of a moderate aerobic training programme.³⁹

If you are a water-babe, Aqua Aerobics⁴⁰ may appeal. Water provides support for the body, so the risk of muscle or joint injury is greatly reduced, if not completely eliminated. As it is usually performed in chest-deep water, both swimmers and non-swimmers can join in the fun.

Whilst on the subject of water, ⁴¹ it is well to remember that ‘water’ is necessary to the body within. Hydration is important to the brain, as well as the body. About 72% of the fat-free mass of the human body is made of water. To function properly, the body requires between 1-7 litres of water per day to avoid dehydration, but it is generally accepted that 2.5 litres daily are required; the precise amount depends on the level of activity, temperature, humidity, and other factors. Most of this is ingested through foods or beverages other than straight drinking water.

Lately, beverages such as tea and coffee are included in the RDA for water. However, there is nothing better than pure clean water for hydration purposes. Tea and coffee were previously thought to act as diuretics, encouraging the body to get rid of fluid; this has now been refuted. On the other hand, large amounts of caffeine can reduce the amount of calcium absorbable from food; also caffeine can make some people stressed, jittery, and cause wakefulness. The tannins in tea have a similarly negative effect on iron absorption. The Sweet-tooth’s among you may go for Smoothies, but they contain very little water and quite a lot of sugar, which is also unhelpful for weight-watchers. They are classed as a ‘food’, not a drink, and can be added to the ‘5-a-day’ if they contain fruit or vegetable extract or juice, but are best restricted to one glass a day. For those who do not suffer kidney problems, it is somewhat difficult to drink too much water (water intoxication⁴²), especially in warm humid weather or while exercising, but it is dangerous to drink too little.

Water is essential to life. Have you ever wondered why one of the first things done for people in the A&E of hospitals, after an accident, is to put in a line of saline solution into them to boost their electrolytes.⁴³ The balance of water and salt is critical to good health. Salt, and other electrolyte chemicals in water solution, is essential in many bodily functions including fluid balance, nerve conduction,⁴⁴ muscle contraction (including the heart), blood clotting and pH balance. Put simply, without water brain cells like any other body cells would die.

Taking the crucial importance of water on board, and back to the benefits of physical exercise for the brain, preventive aerobic and other exercise is not only for the fit, semi-fit or non-afflicted by dementia alone. In 2004, Italian researchers carried out a pilot exercise plan with frail, elderly, demented patients living in a nursing home. It produced inspiring results on patient behaviour, also drug uptake.⁴⁵ A moderate intensity exercise programme consisting of a combination of aerobic/endurance activities, strength training, balance, and flexibility training, showed statistically significant reduction in behavioural problems, such as wandering, physical and verbal abuse, and in sleep disorders.⁴⁶ As a consequence, a significant reduction in the use of antipsychotic and hypnotic medications was observed in patients in the treated group.⁴⁷ The research team concluded that their preliminary results suggest that engaging in regular physical activity, among other health benefits, may delay or prevent the onset of behavioural problems in demented frail elderly people living in that environment.⁴⁸

Scientists often speak of a study or experiment as being ‘elegant’. These Italian researchers deserve to be lauded and applauded for carrying out something so simple in approach, yet practical and useful, and very elegant indeed. It is to be hoped further investigation into the pleasing benefits of this study will follow, to enhance the lives of those afflicted - less drugs can mean less side-effects - as well as improving on patients behavioural ‘fall-out’ for their carers.

According to scientist, Prof. Ian Robertson, continued learning and mental stimulation (brain strengthening) are also ‘key’ to retaining mental ability, because such stimulation can ‘literally grow your brain’.⁴⁹ Studies in both humans and animals have shown that brains that are more active develop a richer and more densely connected network of brain cells. It may partially point to dementia to be less prevalent among people who have spent or do spend more time learning. Try to learn something new every day.

In an American study in 2002, a randomized, controlled, single-blind trail, involving 2,832 volunteers aged 65-94 years, recruited (March 1998 to October 1999, with a two-year follow-up through December 2001) from senior housing, community centres, and hospital/clinics in six metropolitan areas in the United States, the researchers found that those given 10 sessions in ‘memory training’, or ‘reasoning’, or ‘speed of processing’ i.e. memory training in problem solving and decision-making tasks over several weeks, showed marked and lasting increases in cognitive ability.⁵⁰ The ‘booster’ training sessions received later resulted in further improvements in mental function, which effects persisted for over a year. The gained mental ability was equivalent to that which is typically lost by older people over a 7-14 year period and, on average, took about a decade off the cognitive age of the volunteers.⁵¹ More of this type of research is going forward.

This month, October 2006, Canadian researchers carried out a study, involving 47 participants, for improvement of ‘episodic memory’⁵² in persons with Mild Cognitive Impairment (MCI) and healthy older adults with normal cognitive ageing.⁵³ The intervention participants received interventions ‘focused’ on teaching episodic memory strategies. Three tasks (‘list recall’, ‘face-name association’, and ‘text memory’) were used as primary outcome measures.⁵⁴ The researchers found that there was no improvement in the performance of groups of individuals with MCI and normal elderly persons who did not receive the intervention programme, but the researchers concluded that these results suggest that people with MCI can improve their performance on episodic memory when provided with cognitive training.⁵⁵

Things to do for Body & Brain

Just as running upstairs or taking them two-at-a time when fit and young contributes to better agility later in life; or a daily walk to collect the newspaper can help ensure a minimal amount of daily physical exercise, exercising physically for the brain throughout life is important.

A regular gentle work-out is enough to produce a positive effect, even for people aged over 65. Scientist, Dr Eric Larson has said that walking for 15 minutes three times a week was enough to cut the risk – “even if you’re 75 and have never exercised before, you can still benefit by starting to exercise now.”⁵⁶

Last April, from an American study reviewed from a previous cardiovascular health cognition study of 3,375 men and women over the age of 65 who were tracked 1992-2000, researchers who surveyed them on the kinds of activity they performed, found that those doing the widest variety of exercise were far less likely to develop dementia.⁵⁷ The lead researcher said that older people who stay active in a wide variety of ways seem to have a better chance of warding off dementia, and it’s the diversity, not intensity, of exercise that counts.⁵⁸

From the fifteen most common physical activities put in the picture in this study by the research subjects, it can be seen that the advent of the gadget era has taken away a lot of natural daily unremarked physical exercise useful to the body and the brain that many of us no longer do, or not in the same exerting manner, such as the ‘keep fit’ stretch and bend of household chores, mowing the lawn – i.e. walking behind a mower instead of sitting on a machine. The variety of activities described, including household chores and mowing, were gardening (and raking), walking, hiking, jogging, biking, exercise cycling, dancing, bowling, golfing, general exercise e.g. weights, swimming and aerobics⁵⁹; all good energetic things to do, some with social group involvement and interactions mixed into them.        

Ballroom dancing has had a renaissance in the UK and in the United States of late; it is hugely popular. Hey, you don’t have to be an expert in the ‘Salsa’ or be an athletic contortionist and do a ‘Be Bop ‘n’ Holla' to enjoy it, just get a wiggle on and get out there and strut your stuff. If you’ve got two left feet, join a beginners dancing class, or if you are an elderly dancer or a more sedate type of person there are plenty of Thé Dansents (Tea Dances) held in hotels and community halls you could join. Have fun!   

Research really does show that the old adage “use it or lose it” applies to the mental power of your brain as much as to the rest of your body.⁶⁰ Exercise your mind, do crossword puzzles, sudoku, and other mind games; be sociable, play cards, do scrabble or snakes and ladders or play dominos with the kids. A game of dominos is taken quite seriously by older men in countries like Spain.

Keep your mind agile and active by not just reading rubbishy books that leave no lasting impression or books that do not challenge the intelligence; read newspapers and keep up with current affairs, (not everything is on TV!), or join some educational classes – do something you can take pleasure in that taxes the ‘little grey cells’, but is not stressful, because exercising the mind is meant to be enjoyed and not to cause ‘disstress’.

‘Stress’, ⁶¹ meaning psychological ‘tension’ or created state of mental or emotional strain or suspense, is something that needs to be reduced to conserve the mental equilibrium. It is also a vasoconstrictor⁶² and you need to keep your blood pressure under control. High blood pressure is the strongest risk factor for multi-infarct dementia. Although it’s easy to say, ‘It’s not circumstances that drive us mad but the way we react to them’, which is true, excited emotions are very powerful and over-excitability can do harm.

For example, in June this year, UK researchers in a critical review studied the relation between psychological factors and DNA-damage.  They investigated between acute stressors and DNA-damage in animals and significant correlations between psychological factors (e.g. depression, coping) and DNA-damage in humans, to better  understand how psychological factors affect cause or may be the origin of and prognosis for relevant diseases, such as cancer and heart disease, at the fundamental level of mutated cells.⁶³ The brain is cellular too, and at the very least psychological and emotional stress can contribute to Oxidative Stress (OS), for when the body is under stress it produces certain hormones that generate ‘free radicals’ i.e. chemicals that are highly reactive and can oxidize other molecules.⁶⁴ Subsequently, the liver must eventually detoxify them, and that process also generates free radicals.⁶⁵

Free radicals are capable of causing damage in the brain as well as other tissue. Consequently, those of a liverish cranky disposition, usually referred to as cantankerous in older people, or those who are inclined to be hyper-emotional, are being self-injurious. Don’t get in an emotional tizzy over things that don’t really matter, even if being of that disposition they may appear significant to you. Such over-reactions may stem from a form of egocentricity (self-interest) rather than of consequence to anybody else, and as a result can alienate others. Don’t do it, it’s not worth it.

Personality seems to play an important role in protecting mental prowess.⁶⁶ Maintain a positive attitude. Studies show that a positive emotional state may help ward off cognitive decline.⁶⁷ Learn and practice ‘coping strategies’ for stress. Use relaxation techniques like meditation and yoga, Tai chi or some other relaxant method attractive to you for dealing with emotional over-excitability and/or negativity.

Social ties, (looking outward and acting outside of the ‘self’) are also important. Good friends and family, as well as involvement in community or perhaps church affairs appear to be protective.⁶⁸   

Humming is known to be good for the blood - even Pooh Bear used to have little ‘hums’. Humming or singing is good for you, it lifts the spirits, e.g. convicts on chain gangs sing, soldiers in the Army chant musically; people in groups in adverse circumstances, like getting stuck in a lift, often sing to raise their spirits &c.

Nineteen years ago, a study was carried out that showed humming can also help change the regional cerebral blood flow (rCBF) in the brain.⁶⁹ Cerebral regional analysis revealed multiple regions of significantly increased cerebral blood flow in the brain in both cerebral hemispheres during both speech and humming. What is of particular interest is that some of these regions coincided with known speech centres in the left hemisphere of the brain, which might be useful to promote speech retention in AD sufferers, and that vocal activation during both speech and humming requires a collaboration of the two brain hemispheres in various functional patterns. So, doing a ‘Pooh Bear’ bit of humming could be a very useful cerebral habit.⁷⁰

Listening to music can be stimulating or tranquilizing to the mind and body. However, singing is another activity that has currently been in the news as the latest method to stop snoring! More importantly for AD, ‘Singing for the Brain’, is a way to access words and promote speech.

The ‘Singing for the Brain’ programme was founded by Chreanne Montgomery-Smith for AD sufferers four years ago, many of whom withdraw into themselves.⁷¹ Chreanne started singing with groups when she was working in a residential home and was so amazed by the positive effect on people with dementia that she introduced this to the Alzheimer’s Society West Berkshire branch, England, when she moved to work there and now gives weekly sessions to AD groups. She said: “People who have constant memory problems are so undermined by this, but the memory for singing is preserved for ever in the brain and it gives people a lift when they can remember things. It would seem that music has the ability to access words. It is so powerful that people who have lost their ability to speak can access songs and words from the melody.”⁷²

The singing sessions appeared to have positive effects on participants’ cognitive powers, their physical ability and their emotions. The singing has an emotional resonance, and material is chosen that allows people to express their emotions, such as feeling cross or sad, as well as happy.⁷³ This is not OT (occupational therapy) without any particular focus, but is a potentially serious aid to recall and speech problems. Singing can aid people with dementia; it can also be socially engaging, which is helpful to those who are shy, or withdrawn due to their illness.⁷⁴

For example, Canadian researchers this year found ‘choral singing’ is more effective than choral speech, (at least in French), for aphasics, i.e. ‘stroke ‘ survivors who have difficult or inability to understand and use language because of lesion(s) in the brain.⁷⁵ Aphasics can sing words they cannot otherwise pronounce. It was discovered that when aphasic subjects were allowed to sing or speak along with an auditory model while learning novel songs, they repeated and recalled more words when singing than when speaking!⁷⁶ Researchers noted that reduced speed or shadowing cannot account for this advantage of singing along over speaking in unison. The results suggest that ‘choral singing’ or ‘group singing’ improves word intelligibility because singing may entrain more than one auditory-vocal interface; thus, it appears to be an effective means of speech therapy.⁷⁷

Things are looking up, and it’s as well the Celts love singing, for following on from American research in 2000, ⁷⁸ on the impact of music therapy on language functioning in dementia, Irish researchers this year have been investigating the enhancing effect of music on autobiographical memory^*53 in mild AD.⁷⁹ It was already known last year that music and musical activities engage diverse regions of the brain, ⁸⁰ together with observations that these regions are the last to atrophy in AD. Patients appear to remain responsive to autobiographically salient musical stimuli.⁸¹ In the American study for tracking music in the brain, the researchers concluded that very early evidence is emerging from the literature for the hypothesis that the ‘rostral medial prefrontal cortex’ is a node that is important for binding music with memories within a broader music-responsive network.⁸²

What is exciting is that considerable improvement was found for AD individuals’ recall on autobiographical memory in the music condition.⁸³ It was also found that there was a significant reduction in anxiety state, suggesting that anxiety reduction is a potential mechanism underlying the enhancing effect of music on autobiographical memory recall.⁸⁴       

Aha! You may think ‘Karaoke’, if you are well enough. Sans booze to release inhibitions, it may not be everyone’s bag; being usually held in public house venues could have its drawbacks - it isn’t exactly a choral society scene! But, one can see it has its merits. Angry, and getting down and dirty: ‘I Will Survive’ is quite a favourite song of ladies who are cross with their boyfriends, spouses or ex-spouses!

Nonetheless, taking a fresh look at this form of entertainment, doing Karaoke as a group is one way of letting off steam and expressing emotions without doing physical harm; plus a large enough group doesn’t have to go to a public house to get into it. A Christmas Karaoke player deal can cost £250 (Euro 372 or $474); it’s not a sum of money that pooling of group funds, or raising cash with a Bring-and-Buy or Christmas Bazaar or other kinds of fund-raising couldn’t accumulate with a bit of effort.

Painting is an appealing retiree leisure occupation for quite a few people. Art Therapy, which was the latest thing in the 1960s and practiced in just about every psychiatric hospital in the land, may not feature strongly as an activity to assist AD, although its ability to tap into and fire the imagination and aid concentration is useful.

An example of practical use is the ‘Memories in the Making’ programme which began in 1988 in Orange County, California, USA.⁸⁵ By August this year, there were dozens of chapters in 26 States and experts say the artwork has provided an extraordinary outlet for AD patients. One of the things that emerged was that even with loss of memory the capacity for imagination still has its place, because even as memory fades the imagination has the capacity to be robust.⁸⁶

In 2005, in a small study of 12 people, aged 65-85, research suggested that artwork helps Alzheimer’s patients.⁸⁷ It was found that weekly sessions helped them focus their attention for 30-45 minutes, and that completing artwork brought them ‘pleasure and satisfaction.’ The sense of well-being attained by AD patients with dementia, who mostly have difficulty with attention and concentration, and are unable to initiate, maintain or complete a task without assistance and cueing, is indeed a marvellous achievement. Earlier research in 2002 involving 41 participants in the art programme’s weekly sessions found that the ‘self-esteem’ measured was complimentary to AD patients and contributed to their all important state of well-being.⁸⁸

Art may not hold the same practical results or force, such as to assist speech as singing. Painting, unless it is performed in groups and supervised, can be a solitary pursuit, but is relaxing past-time or hobby for older people. Essentially, it is a mode for ‘self-expression’ that should not be overlooked for both those with and without AD.

Finally, the one greatest other thing you can do for yourself is ‘Feed your brain’, nourish it well – not only does it do unimaginable things that man-made computers cannot; it has to last you a life-time and deserves the best nutrition it can get.

Eat an antioxidant-rich diet and omega-3 fatty acids, e.g. walnuts, fish oil, flax seed oil, and omega-6, and much more for which the Mediterranean Diet is recommended. Omegas-3 and omega-6 work best ‘in balance’ i.e. in the ratio of x 2 to 4 times more Omega-6 GLA (Gamma Linolenic Acid), than Omega-3 fatty acids, although supplementary omega-3 fish oil alone may also be good for your brain and mood.

The most recent study by Swedish researchers, published October 2006, investigating supplements of omega-3 fatty acids, recruited 204 patients with varying degrees of AD. Of the 204 persons recruited, 174 patients completed the year-long study.⁸⁹ Although they suggest more research is required, their findings were that the administration of omega-3 fatty acid in patients with mild to moderate AD did not delay the rate of cognitive decline. However, positive effects were observed in a small group of patients with very mild AD; plus the treatment was declared ‘safe’, in addition to being well tolerated’, which is good news. ⁹⁰

Currently, there has been a lot of news coverage regarding omega-3 deficiency in children and adolescents, how fish-oil can help their brain-power, which is also linked to aggressive behaviour and depressive disorders that may be exacerbated by nutritional deficiencies in omega-3 fatty acids.

This spring American researchers investigated the matter i.e. that deficiencies in docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), two types of omega-3 fatty acids, may lower serotonin levels at critical periods of neuro-development and may result in a cascade of sub-optimal development of neurotransmitter systems limiting regulation of the limbic system (fright and flight or ‘fight or run away’) of the brain’s frontal cortex.⁹¹ In other words, such diet deficiencies can also affect mood.

The research states that residual developmental deficits may be manifest as dysregulation of sympathetic responses to stress, including decreased heart rate variability and hypertension, which in turn have been linked to behavioural dysregulation.⁹² If, as stipulated, ensuring optimal intakes of omega-3 fatty acids during early development and adulthood shows considerable promise in preventing aggression and hostility,⁹³ might this not also apply to aggressive and depressive moods generated by AD? The effects of omega-3 is a line of research that requires to be looked at more closely for what benefits it may yet be able to offer AD.    

Whatever else you do, treat your brain well, it’s the most important and complex organ of your body, for without it nothing works! You can do without an arm or a leg, or the spleen, or may end up getting replacement parts, but the brain is the most precious thing ever created with which the body is endowed. Love and respect your brain, nurture it like a divine gift, for we do not know where ‘consciousness’ and/or the ‘mind’ resides or exactly how our spirituality has developed, but if you look up any dictionary you will find that ‘psyche’ means a lot more than ‘brain’, it can mean spirit or soul, without which we would not be human.

Artificial intelligence⁹⁴ is precisely that, artificial! If scientists ever manage to get close to just how inconceivably wonderful the workings of the human brain is, we may all live to regret that day.

Preventive Diet & Food Medicine

Foods for the ‘Five–a-Day’ UK & ‘Food Guide Pyramid’ U.S.A.

www.ars.usda.gov - Photograph by Keith Weller

New revelations of Science are happening constantly with regard to diet, which is the cornerstone of our health. The importance of diet, our ‘body fuel’, and the Food Medicine within it exhibit useful and constructive preventive ‘tools’ against disease. Food Medicine plays an important and necessary part in our health status from birth, through childhood to adulthood.

Organic food⁹⁵ is not some new-fangled idea; it’s what we ate naturally before WWII. Our diet was altered via the food industry and farming methods. Before food production methods and processes altered the national palate to a preference to eat unhealthily, with predilections for too much harmful fat, sugar and salt, the amount of disease, conditions and ailments common today, such as allergies, were rare and practically unheard of. In the 1940s and 1950s one heard of few instances of senile dementia, perhaps in the order of one to a village’s population over time. Those concerned were usually very old indeed. Britain by and large had a healthy adult population, which sends a message which directly points to the greatest change in our ‘life-style’ - our ‘diet’. 

At long last ‘The penny has dropped’ in the western world that natural and ‘organic’ foodstuffs are the best choice. Nevertheless, organic farming needs far more support at governmental level to make more organic foods available at competitive prices to assist those of lower socio-economic status, because the demand is there. Diet, as well as having influence upon general health and a myriad of ills, clearly has impact on the development of dementia later in life.       

Although America has been stuck with genetically engineered (GM) foodstuffs for quite some time, which British consumers are still battling hard against to keep out of the UK, by report, the good news is that the United State’s appetite for organic food⁹⁶ is so strong; supply just can’t keep up with demand!

Organic products may as yet have only a tiny slice, about 2.5%, of the US nation’s food market, but the slice is increasing at a forceful pace. Growth in sales of organic food has been 15%-21% each year, compared with 2%-4% for total food sales. There are an estimated 10,000 organic farms in the States, and rising, but not fast enough.

Eyeing up the success of organic retailers, mainstream supermarkets have rushed to meet the demand. They are no longer ‘bucking’ the trend, they are chasing the bucks!

The scent of financial profits also means that here in the UK supermarkets are also looking to cash-in. There is such a ‘sea-change’ in consumer demand towards healthier and higher qualify food, (organic food), the voting ‘feet’ of consumers are leading the way.

Organic produce is without a doubt entering the mainstream. In 2005 (UK), organic food sales increased by 30%, nearly a third - a threefold rise on 2004. In fact, £1.6 billion worth of organic food was sold in Britain in 2005. Supermarkets took the lion’s share of organic produce profits, £1.2 billion of the total sales and are now sourcing two-thirds of unprocessed organic crops from Britain – a 13% increase last year. Plus sales through independent shops, farm shops, farmers’ markets and box schemes increased by 32%.

Why bother with these facts and figures? Well, with the proliferation of organic produce it means prices likely will no longer be only within reach of the trendy, ‘posh’ or wealthier consumer. According to a survey by the Soil Association, certifier and regulator of organically grown crops and foods, more than half of people in the most disadvantaged social groups are now buying organic food and drink. They are lying to rest the stereotype of ‘organic’ being only for the well-to-do.⁹⁷

The public have acknowledged for welfare reasons, going ‘back to the future’ makes sense, for the better we fuel our bodies the better chance we have of avoiding life-threatening diseases. Organic food providers’ profits or money being short in the NHS may be the incentive, but good health is the reward.

In February 2006, in the largest twin study to date involving 11,884 twin pairs, researchers confirmed that heritability for AD is high and that the same genetic factors are influential for both men and women.⁹⁸ A tendency for AD to have genetic influence may be high, but fundamentally whatever we can do to protect ourselves, body and mind, is vital. The researchers also concluded that non-genetic risk factors also play an important role and might be the focus for interventions to reduce AD risk or delay disease onset;⁹⁹ so it really is worthwhile doing the very best we can for ourselves.

The most basic ‘intervention’ we can effect for ourselves is to ensure we eat and drink the healthiest diet possible. The Mediterranean diet is still seen to be the best protection there is against most current life-threatening diseases, such as in the prevention of coronary artery disease and metabolic syndrome, and protection against some cancers, &c., barring the sudden onset of a pandemic¹⁰⁰ that are associated with the spread of viruses. Nevertheless, even those affected by a pandemic would have a better chance of survival if their immune systems have been built-up and fortified with a firm high-quality dietary foundation. This spring researchers confirmed the Mediterranean diet¹⁰¹ does reduce Alzheimer’s risk.

What is the Mediterranean Diet? ¹⁰²

Generally, it is a diet followed in the Mediterranean Basin countries, such as Greece, Crete, southern France and parts of Italy, which emphasizes fruits and vegetables, nuts, grains and olive oil versus butter, grilled or steamed chicken and seafood, as opposed to red meat. Plus meals washed down with a glass or two of red wine.

However, to be exact, there is not just one Mediterranean diet. What is consumed  varies from one Mediterranean country to another and within regions of a country. Whatever, the shared features of what is usually referred to as the Mediterranean-style diet includes: a high consumption of fruits, vegetables, (wholemeal brown) bread and other cereals, potatoes, beans, nuts and seeds; olive oil as the primary monounsaturated fat source; dairy products, fish and poultry in low to moderate amounts – little red meat is eaten. Eggs are eaten up to four times a week; and wine drunk in moderate-low amounts.

The consumption of fresh food is ‘key’, e.g. the French and many other Mediterranean people don’t just shop at supermarkets. If they do not have gardens in which to grow fruits and vegetables themselves, they routinely buy fresh ‘in season’ produce from their superb local and regional ‘open markets’, be it fruit and vegetables, or meat and fish.

Many similar outlets, such as ‘open food markets’, have disappeared over the years in the UK under the financial pressure of supermarkets. It is now up to us to encourage sales of this form of fresh seasonable food by supporting our farmers’ markets, thereby increasing the opportunities for more produce and a wider choice to be created – this applies to at least 11% of the country’s population who are urban dwellers and who may not have any form of garden in which to grow their own produce.

True, all those who have a garden mayn’t be able to grow all the wonderful fruits and vegetables common to the Mediterranean climate, but this is changing with Global Warming. Short of acute water shortage, and even then it is up to the gardener what he/she chooses to grow, e.g. figs, and many other edible fruiting plants are growing more successfully in British gardens. For example, this year there was a good crop of passion fruits (Passiflora incarnata), which is also a useful herb commonly used as a sedative, down and around East Devon and in the South-West of the country’s gardens.

It’s early days yet in terms of changing climatic conditions, and growing olive trees in our garden is likely to be for their effect rather than to extract your own olive oil, which requires pressing equipment &c. However, this year, Britain’s first olive grove has been planted in Devon and it is now considered possible to grow the iconic fruit of the Mediterranean countries commercially in southern England! ¹⁰³

This is not so surprising, because among other plants that this year’s weather has confused down here in Devon, Spring marigolds (Calendula officinalis) were still blooming in Exminster on 24^th October and late crop strawberries still fruiting; also growing outside and pictured on the same date were Caribbean plants, Banana palms flowering and fruiting at an hotel in Torquay, as well as Mediterranean orange bushes doing well. At Westcliff, beside the railway cuttings, a stray vine laden down with bunches of purple grapes is flourishing, possibly having grown from a pip thrown out of the window of a train, and has caused a great deal wayfarer interest.¹⁰⁴ Not to mention the odd avocado pear reaching maturity, and blackberries and holly seen growing together in East London, along with wild tomatoes taking up verge-side residence beside the A2 in South London.¹⁰⁵ The times they are a-changing, for all this has been happening only a week before the clocks go back to Winter-time!

If you have a suitable sunny sheltered spot in your garden, growing a nectarine tree (Prunus persica nucipersica), just about anywhere down south, could be a start to get a bit of fruit exotica going in your horticultural scene. The plant prefers acid, neutral and basic alkaline soils - light (sandy), medium (loamy) and heavy (clay) soils that are well-drained, it requires to be moist, but it cannot grow in the shade.

Another way to obtain fresh fruit and vegetables are the ‘Pick Your Own’ venues dotted around the countryside, where people can enjoy picking fresh fruits and vegetables ‘in season’ that they most like. The heartier, more industrious pickers are also inclined to freeze their ‘hand-picked’ products for out-of-season consumption. Arguably, modern workers don’t get time to do this, but it’s a ‘fun’ thing to do with the family for a weekend outing.

That the adoption of the Mediterranean diet for Alzheimer’s and other diseases can assist good health and is preventive. It is not some trendy chattering-classes ideal or figment of the imagination that it is the best diet. The study and use of it is well documented for a decade at least, and especially in the past two or three years.

In 2003, Italian researchers investigated diet in the role of cognitive decline, and cognitive impairment of both degenerative (AD) or disease of vascular origin.¹⁰⁶ They found that in particular, in an older population of Southern Italy with a typical Mediterranean diet, high monounsaturated fatty acids energy intake appeared to be associated with a high protection against cognitive decline.¹⁰⁷ They also reported that vitamin deficiencies, especially vitamins B₆, B₁₂ and folate, and antioxidant deficiencies (vitamins E and C) could also influence the memory capabilities and have an effect on cognitive decline.¹⁰⁸ They concluded that dietary antioxidants and supplements and specific macronutrients of the diet may act synergistically with other protective factors opening new possibilities of interventions.¹⁰⁹ Their follow-up research in 2004 amplified and confirmed their former findings.¹¹⁰

American research in June of this year also concluded that higher adherence to the Mediterranean diet is associated with a reduction in risk for AD.¹¹¹ And, this month in a multi-ethnic study, some of the same research team members confirmed once more that higher adherence to the Mediterranean diet is associated with a reduction in risk for AD and could cut that risk by a gigantic 68%.¹¹²

The findings of lead researcher Nikolaos Scarmeas and his colleagues are based on results from a study of 194 AD cases (average age 82) and 1,790 non-demented controls (average age 76). “The controls had almost equal representation of white, black and Hispanic subjects, while 59% of the AD cases were Hispanic, 31% black and 9% white. After adjusting the results for possible confounding factors, such as age, education, BMI, smoking status, and ethnicity, the researchers reported that people with the highest adherence to a model Mediterranean diet were associated with a 60% lower risk of AD, compared to people with the lowest adherence to the diet. When the researchers took into account a series of cardiovascular variables, such as history of stroke, hypertension, heart disease, diabetes, and plasma lipid levels, the associations for the high adherence group grew stronger, with an associated risk reduction of 68%.”¹¹³   

What more can be said? There are now over 700 research papers on, or associated with, the Mediterranean diet published by scientists, and it is frequently in the news. If the public choose to ignore the efforts of good scientists doing their best, and the same message being repeated ad nauseum, if they haven’t got the message now and persist in eating Junk Food and Fast Food there’s not a lot more can be done or said, except that in modern history the western world has never been so sick

On the lighter side of this state of affairs - Don’t forget that red wine is also part of the Mediterranean diet.

Red Wine and Thou!

A new study by the American Mount Sinai School of Medicine has found, in animals with amyloid plaques, that administering red wine (Californian Cabernet Sauvignon) slows their memory loss and brain cell death, which adds to a body of science linking compounds in the drink to slowing AD-related symptoms.¹¹⁴ Further research is required to see if the same will apply to humans.

So don’t raise your wine glass to celebrate yet! The research team recognize that alcohol has risks as well as benefits, and they are not recommending anyone to start drinking wine for AD prevention. The animals were free to drink as much as they wanted for seven months – none went on major benders. Is there a lesson to be learned here from animals?

Nevertheless, the red wine exerted a beneficial effect by promoting non-amyloidogenic processing of amyloid precursor protein, which ultimately prevents the generation of AD-type beta-amyloid neuropathology.¹¹⁵ It is envisaged that the results could have implications for formulations in the production of supplements for age-related conditions.¹¹⁶ In this latest study of red wine, the suggested amount for moderate consumption in humans is the equivalent of a five-ounce glass per day for women and two for men.

This is definitely not a carte blanche advocacy to drink alcohol; it is only indicating that a moderate red wine consumption can be part of an overall healthy life-style. The researchers caution that there is ‘no direct experimental evidence’ that red wine or antioxidants, polyphenols in wine, ‘beneficially influence’ AD, i.e. they are not making any Alzheimer’s prevention promises for people. Plus what ingredient in red wine might explain the study’s results is not clear.¹¹⁷

Still, we already know ‘resveratrol’, a salvesterol, (See ‘Herbsphere’ “Will Fruit and Vegetable Plant Salvesterols Save Us From Cancers?”), an antioxidant found in wine, has had other preceding research, but in this red wine study the resveratrol levels were 10 times lower than the minimum effective amount in past studies.¹¹⁸ The team are calling for more research to see if ‘red wine’ and its polyphenol extracts are beneficial against AD. Meanwhile, moderate consumption of red wine looks to be the best choice of alcoholic drink on the skyline.

Scientists are at pains not to recommend drinking anything alcoholic per se to avoid certain diseases because of the current trend of ‘binge drinking’ and addictive alcohol abuse. Medical practitioners also have understandable cause for concern in this area, as according to the National Centre for Health Statistics, in 2003 the number of alcohol-induced deaths, excluding accidents and homicides, was 20,687 and alcoholic liver disease resulted in another 12,360 deaths.¹¹⁹ Yet, moderate alcohol consumption as part of a healthy lifestyle can bring a great deal more than a modicum of protection against a bastion of killer diseases.

To quote one researcher, Dr Curtis Ellison, from Boston University School of Medicine, at the ‘Beer to Your Health!’, a one-day conference held there 10^th October 2006, which was convened for scientists and researchers in the field: “We are not telling people to drink more, but encouraging more people who do not have a contraindication to alcohol to drink small amounts on a regular basis.”¹²⁰ Because, according to many and various past studies, drinking alcohol can improve your health, but the ‘key’ is for moderate alcohol consumption to be part of an already established healthy life-style.

For example, in a large American study published this month correlating alcohol consumption with coronary heart disease in men with healthy life-styles, researchers assessed the connection between drinking alcohol and heart attacks, MI (myocardial infarction), in 8,867 healthy men between 1986 and 2002.¹²¹ The male participants included 51,529 dentists, pharmacists, veterinarians and other health-care professionals aged 40-75, all of whom had healthy life-styles. They did not smoke, had a body mass index (BMI) of less than 25, did at least 30 minutes exercise per day and ate a healthy diet that included large amounts of fruits, vegetables, fish and polyunsaturated fats, as well as low amounts of trans-fats (now being banished from many foodstuffs in the USA) and red meat. The study showed that men who drank 15grn-29grn of alcohol per day had the lowest risk for heart attacks and those who did not drink at all had the highest.¹²² Even in men already at low risk on the basis of body mass index, physical activity, smoking, and diet, moderate alcohol intake is associated with lower risk of MI.¹²³

A month earlier, September 2006, Australian researchers published a study on the association between older women’s use of alcohol and their health-related quality of life.¹²⁴ In this case the study was community-based and covered national surveys from 1996 to 2002. The participants, a national random sample of 12,432, were women aged 70-75 baseline. The researchers assessed the relationship between alcohol intake and mortality and explored the relationship between the women’s level of alcohol use and changes in physical and mental health-related quality of life.¹²⁵ Alcohol consumption was the factor of interest, and the main outcome measures were survival and health-related quality of life, with adjustment for potential confounders.¹²⁶

The results showed that women who did not consume alcohol or who drank rarely were more likely to die than women in the low-intake reference category, or if they survived, they had lower health-related quality of life scores on the general health and physical functioning of the medical outcomes, after adjustment for smoking, co-morbidity (i.e. the presence of more than one disease or health condition in an individual at a given time), education, body mass index (BMI), and area of residence.¹²⁷ It was concluded that being a non-drinker of alcohol was associated with greater risk of death and poorer health-related quality of life. It indicated that moderate alcohol intake may carry some health benefits for older women in terms of survival and quality of life.¹²⁸

To drink, or not to drink? It’s your choice, but make sure you always know if the door is a-jar, or like Eleanor Rigby, if you’re wearing the face kept in a jar by the door!¹²⁹

So where do we go from here?

Well, we could start looking for specific food medicines and herbs that may aid Alzheimer’s disease and help improve quality of life (See Part II).

Some special food medicines and herbs are more powerful than others. Helpful herbs in their natural form or their derivatives as supplements may not be the ‘answer’ to the overall problem, but at least it’s another avenue of approach of to ward off the blights of contemporary diseases such as AD. Drugs may prolong life or treat symptoms, but prevention is always going to be better than cure, especially where there is no cure, which is the status quo of most of our killer diseases including AD.

COMMENT: Organizations that provide AD support and information services:

The Alzheimer’s Disease Society

Website: www.alzheimers.org.uk/

The Alzheimer’s Research Trust

Website: www.alzheimers-research.co.ukk/

Age Concern

Website: www.ace.org.uk

Help the Aged

Website: www.helptheaged.org.uk/

Carers National Association

Website: www.londonhealth.co.uk/carersnationalassociaton.asp

References:

      0.             ‘Delusions and Hallucinations are associated with worse outcome in Alzheimer’s disease.’ Scrameas N, Brandt J, et al. Cognitive Neuroscience Div. of the Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, the Gertrude H. Sergievsky Centre, N.Y., USA. Arch Neurol. 2005 Oct; 62(10):1601-8. Comment in: Arch Neurol. 2006 Apr; 63(4): 627: author reply 627. 

1.                    ‘Medical Apartheid’ - Condemned to die early’ D. Mail 20^th October 2006.

2.                    Ibid.

3.                    Estimated population figures for Scotland 2005 - http://en.wikipedia.org/wiki/Scotland

4.                    Estimated population figure for Wales 2005 - http://en.wikipedia.org/wiki/Wales 

5.                    ‘Heart disease is biggest killer’  - BBC News Online 25^th May, 2006.

6.                    Ibid. ONS (Office of National Statistics)

7.                    Ibid. ONS (Office of National Statistics)

8.                    ‘Policy Positions’ Alzheimer’s Association - http://www.alzheimers.org.uk/News_and_campaigns/Policy_Watch/demography.htm

9.                    Ibid.

10.                 Ibid.

11.                 Ibid.

12.                 Ibid.

13.                 Ibid.

14.                 ‘Exercise ‘cuts Alzheimer’s risk’ BBC New Online 17^th January 2006 & ‘What’s Good for the Heart is Good for the Head!’ - Study finds exercise helps delay dementia by Patrick Walters, Associated Press Writer, and Philadelphia AP 16^th January, 2006.

‘Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older.’ Larson EB, Wang L, et al. Centre for Health Studies, Group Health Cooperative, Seattle, Washington, USA. Ann Intern Med. 2006 Jan 17; 133(2):73-81. Comment in: Ann Intern Med. 2006 Jan 17; 144(2):135-6. Summary for patients in: Ann Intern Med. 2006 Jan 17; 144(2):120.

15.                 ‘Performance-based physical function and future dementia in older people.’ Wang L, Larson EB, et al. Health Services Research and Development Centre of Excellence, VA Puget Sound Health Care System, Seattle, USA.

16.                 [Lifestyle-related risk factors for dementia] [Article in Danish] Phung TK, Andersen K, et al. H:S Righospitalet, Hukommelsesklinikken, Neruocentret, Nerugologisk Klinik. Ugeskr Laeger. 2006 Oct 2; 168(40):3401-5.

17.                 [Risk factors for Alzheimer: towards prevention?] [Article in French] Vogel T, Benetos A, et al. Pole de Geraitrie, Hopital de la Robertsau, Strasbourg. Presse Med. 2006 Sep; 35(9 Pt 2):1309-16.

        17A.        Hypertension: A common disorder in which blood pressure remains abnormally high (a reading of 140/90 mm Hg or greater) – High Blood Pressure (HBP)

        17B.        Diabetes: Any of several metabolic disorders marked by excessive urination and persistent thirst. It is characterized by persistent hyperglycaemia (high blood sugar levels), requires medical diagnosis, treatment and lifestyle changes. The World Health Organization recognizes three main forms of diabetes; Type 1, Type 2 and Type 3 (gestational diabetes occurring during pregnancy). These three ‘types’ of diabetes are more accurately considered patterns of pancreatic failure rather than single diseases. Type 1 is due to autoimmune destruction of the insulin producing cells, while Type 2 and gestational diabetes are due to insulin resistance by tissues.

17C.        Homocysteine: An amino acid used normally by the body in cellular metabolism and the manufacture of proteins. Elevated concentrations in the blood are thought to increase the risk for heart disease by damaging the lining of blood vessels and enhancing blood clotting.

        17D.        Lipid: An oily organic compound insoluble in water but soluble in organic solvents; essential structural component of living cells. Some lipids are used for energy storage, others serve as structural components of cellular membranes, and some are important hormones. Although the term lipid is often used as a synonym for ‘fat’, the latter is a subgroup of lipids called triglycerides.

18.                 Liverish: Peevish, glum.

19.                 ‘Only Irish women binge drink more than the English.’ By Fiona MacRae, Science Reporter, Daily Mail, 23^rd October 2006. http://www.dailymail.co.uk/pages/live/articles/health/womenfamily.html?in_article_id=412009&in_page_id=1799

Study: Professor  Andrew Steptoe, co-author, University College London, UK. International Binge Drinking League Tables: Percentage of women who ‘binge drink’ - Highest: Ireland 57%, England 33%, Iceland 30%, Slovakia 29%, USA 27%: Lowest: Greece 4%, Germany 3%, Italy 3%, South Africa 3%, Romania 1% - Percentage of men who ‘binge drink’ – Highest: Ireland 49%,  Belgium 48%, Poland 47%, Columbia 46%, Slovakia 44%: Lowest: England 26%, Spain 21%, Portugal 18%, Italy 6%, Greece 4% and Germany 2%.

20.                 Ibid.

21.                 Ibid.

22.                 Ibid.

23.                 ‘Social inequalities in alcohol consumption and alcohol-related problems in the study countries of the EU concerted action ‘gender, culture and alcohol problems: a multi-national study.’ Bloomfield K, Girttner U, et al. Alcohol Alcohol Suppl. 2006 Oct-Nov; 41(1):i26-i36. Research on 15 countries: Sweden, Norway, Finland, Germany, The Netherlands, Switzerland, Hungary, the Czech Republic, Israel, Brazil, and Mexico. Also: ‘Introduction to special issue ‘gender, culture and alcohol problems: a multi-national study’. Bloomfield K, Gmel G, et al. Unit of Health Promotion Research, Uv. of Southern Denmark, Niels Bohrs., Denmark. Alcohol Alcohol Suppl. 2006 Oct-Nov; 41(1): i3-i7. 

24.                 Ibid.

24A.        ‘Alzheimer’s ‘faster in educated’. BBC News Online 16^th February, 2006.

                ‘Education and rates of cognitive decline in incident Alzheimer’s disease.’ Scarmeas N, Albert SM, et al. Cognitive Neuroscience Div., Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, Columbia Uv. Medical Centre, NY, USA. J Neurol Neurosurg Psychiatry. 2006 Mar; 77(3):308-16.

24B.        Ibid.

24C.        Ibid.

24D.        Ibid.

25.                 ‘Women’s top health threats: A surprising list.’ Mayo Clinic.com http://www.mayoclinic.com/health/womens-health/WO00014

26.                 ‘The good news is bad news for teens who drink.’ By Lee Bowman, Scripps Howard News Service, 24^th October, 2006.

American Alcohol Study: Lead co-author Dr Marisa Maria Silveri, Asst. Prof. of Psychiatry at Harvard. Research carried out at Binghampton University, New York, and Harvard Medical School, funded by the National Institute on Alcohol Abuse and Alcoholism, to appear November 2006: J Alcoholism: Clinical and Experimental Research. 

27.                 Ibid.

28.                 ‘British children ‘among laziest.’ BBC News Online 5^th September 2006. Tesco Sport Report, commissioned by Tesco, 3,500 young people surveyed from 10 countries around the world, including Britain, the US, Australia and India. Britain ranked 7^th, plus the Health Survey for England also warned 19% of boys and 22% of girls aged 2-15 will be obese by 2010.

29.                 Quote: “A short life and a merry one.” Steve Hart, linked to Ned Kelly the Australian Outlaw once said it: “Steve’s part in the Kelly folklore revolves around a quote he was once heard to say while chopping wood at his father’s farm when Kelly’s asked him to join them in their fight against the police. ‘Here’s to a short life and a merry one!’ he exclaimed, throwing down his axe before riding off into the pages of Australian history.’

30.                 Brain size: the human brain is growing! In 1860 the average weight of a male brain was 3 lbs. Now a man’s brain weighs an average of 3 1/8 lbs. http://www.imcpl.org/kids/guides/health/nervoussystem.html

30A.        Neuron: Neurons (also known as neurones, nerve cells and nerve fibres) are a major class of cells in the nervous system whose main role is to process and transmit information. In vertebrate animals, neurons are found in the brain, the spinal cord and in the nerves and ganglia of the peripheral nervous system. They are typically composed of a cell body, a dendritic tree and an axon. The cell body and dendritic trees receive electrical signals from other neurons while the axon transmits electrical output signals. Neurons are able to generate and propagate electrical impulses because they have excitable membranes. Neurons make connections with other neurons and transmit information to them via synaptic transmission. http://en.wikipedia.org/wiki/Neuron

                Synapse: The human brain has a huge number of synapses. [The word “synapse” comes from ‘synaptein’ which Sir Charles Scott Sherrington and his colleagues coined from the Greek ‘syn-‘ meaning together and ‘haptein’ meaning to clasp. Chemical synapses are not the only the only type of biological synapse: electrical and immunological synapses exist too, but without a qualifier, ‘synapse’ by itself most commonly refers to a chemical synapse.] Each of 100 billion neurons has on average 7,000 synaptic connections to other neurons. Most authorities estimate that the brain of a 3-year-old child has about 1,000 trillion synapses. This number declines with age, stabilizing by adulthood. Estimates vary for an adult, ranging from 100-500 trillion synapses.

31.                 ‘Making our minds last a lifetime – anti-aging research – includes a related article on ‘smart’ drugs – Cover Story.’ By Katherine Greider, Jill Neimark. Psychology Today, Nov-Dec, 1996. Quote: Antonio Damasio, M.D., Ph.D., Head of Dept of Neurology at the Uv. of Iowa and author of Descartes’ Error. http://www.findarticles.com/p/articles/mi_ml175/is_n6+v29/ai_18836766

32.                 ‘Exercise and the brain: insight in new therapeutic modalities.’ Meusen R. Dept. Human Psychology & Sports Medicine, Vrije Universiteit, Brussel-Belgium. Ann Transplant. 2005; 10(4):49-51.

33.                  ‘Exercise and the brain: insight in new therapeutic modalities.’ Meusen R. Dept. Human Psychology & Sports Medicine, Vrije Universiteit, Brussel-Belgium. Ann Transplant. 2005; 10(4):49-51.

33A.        Dopamine: is a chemical naturally produced in the body. In the brain, dopamine functions as a neurotransmitter [chemicals that are used to relay, amplify and modulate electrical signals between a neuron and another cell], activating dopamine receptors.]Dopamine is also a neurohormone [any hormone produced by neurosecretory cells, usually in the brain] released by the hypothalamus. [the hypothalamus links the nervous system to the endocrine system via the pituitary gland, also known as the “master gland”, which is part of the Limbic system, which is primarily involved in the control of emotions and sexual activity. The hypothalamus also controls body temperature, hunger, thirst, and circadian cycles]. Its main function as a hormone is to inhibit the release of prolactin [a peptide hormone synthesized and secreted by lactotrope cells in the anterior pituitary gland] from the anterior lobe of the pituitary. Dopamine is essential for the normal functioning of the cerebral nervous system (CNS).  

33B.        Noradrenaline: is a neurotransmitter in the nervous system where it is released from noradrenergic neurons [also known as neurones, nerve cells and nerve fibres, are a major class of cells in the nervous system whose main role is to process and transmit information] during synaptic transmission [the process of propagating a signal from one cell to another via a synapse: a connection between excitable cells, by which an excitation is conveyed from one to the other]. As a stress hormone, it affects parts of the human brain where attention and impulsivity are controlled. Along with epinephrine, this compound affects the fight-or-flight response, activating the sympathetic nervous system to directly increase heart rate, release energy from fat, and increase muscle readiness. 

33C.        Seratonin: In the central nervous system, serotonin is believed to play an important role in the regulation of mood, sleep, emesis (vomiting), sexuality and appetite. Low levels of Serotonin have been associated with several disorders, notably depression, migraine, bipolar disorder and anxiety.

34.                  ‘Keeping ageing brains on top form.’ By Olivia Johnson, BBC News, Dublin, Republic of Ireland. 7^th September, 2005. British Association’s Festival of Science, conference, Dublin.

34A.        Aerobic: means ‘requiring air’, where air usually means ‘oxygen’.

35.                 ‘Keeping ageing brains on top form.’ By Olivia Johnson, BBC News, Dublin, Republic of Ireland. 7^th September, 2005. British Association’s Festival of Science, conference, Dublin. Quote: Prof. Ian Robertson, Dean of Research at the Trinity College Institute of Neuroscience.

35A.        Aerobics: is a particular form of aerobic exercise. Aerobics classes generally involve rapid stepping patterns, performed to music with cues provided by an instructor. Recently, Aqua Aerobics has gained in popularity. Group exercise aerobics can be divided into two major types: Freestyle Aerobics and Pre-choreographed Aerobics.

36.                 ‘Keeping ageing brains on top form.’ By Olivia Johnson, BBC News, Dublin, Republic of Ireland. 7^th September, 2005. British Association’s Festival of Science, conference, Dublin. Prof. Ian Robertson, Dean of Research at the Trinity College Institute of Neuroscience.

37.                 Ibid.

38.                 Ibid.

39.                 Ibid.

40.                 Aqua Aerobics: Exercising aerobics in the water has many benefits. Water-related exercise increases cardiovascular fitness, as well as improving overall strength. Also, as the water provides support for the body, the risk of muscle or joint injury in aquatic sports is greatly reduced, if not completely eliminated. A great advantage in aqua-aerobics is, as it is usually performed in chest-deep water, both swimmers and non-swimmers can participate. 

41.                 Water: is a tasteless, odourless substance that is essential to all known form of life and is known as the universal solvent.

41A.        Water RDA (Tea & Coffee): ‘Just how much water should you drink a day?’ by Jane Clarke, ‘Good Health’ D. Mail, 24^th October 2006

42.                 Water intoxication: (also known as hyperhydration or water poisoning) in medicine, is a potentially fatal disturbance in brain function that results when the normal balance of electrolytes in the body is pushed outside of safe limits by a very rapid intake of water.

43.                 Electrolytes: are minerals, including sodium, potassium, calcium, chloride, bicarbonate (carbon dioxide) and magnesium, that regulate bodily functions. These elements or chemicals enable the body and heart to work properly. If he levels are too high or too low in the blood, it may cause cardiac (heart) problems. 

44.                 Nerve conduction: the transmission of an impulse along a nerve fibre.

45.                 ‘Physical activity and behaviour in the elderly: a pilot study.’ Landi F, Russo A, Bernabei R. Dept. of Gerontology-Geriatrics and Physiarty, Catholic Uv. of Sacred Heart, Rome, Italy.  Arch Gerontol Geriatr Suppl. 2004; (9):235-41.

46.                 Ibid.

47.                 Ibid.

48.                 Ibid.

49.                 ‘Keeping ageing brains on top form.’ By Olivia Johnson, BBC News, Dublin, Republic of Ireland. 7^th September, 2005. British Association’s Festival of Science, conference, Dublin. Quote: Prof. Ian Robertson, Dean of Research at the Trinity College Institute of Neuroscience. Prof. Ian Robertson, Dean of Research at the Trinity College Institute of Neuroscience.

50.                 Ibid. ‘Effects of cognitive training interventions with older adults: a randomized controlled trial.’ Ball K, Berch DB, et al. Dept. of Psychology, Uv. of Alabama at Birmingham, USA. JAMA 2002 Nov 13; 288(18):2271-81. Comment in: Evid. Based Ment Health.  2003 May; 6(2):54.

51.                 Ibid.

52.                 ‘Improvement of Episodic Memory in Persons with Mild Cognitive Impairment and Healthy Older Adults: Evidence from a Cognitive Intervention Programme.’ Belleville S, Gilbert B, et al. Institut Universitaire de Geriatrie de Montreal, Montreal, Canada. Dement Geriatr Cogn Disord. 2006 Oct 16: 22(5-6):486-499 (Epub ahead of print]

53.                 Ibid. Episodic memory: (part of declarative memory) or autobiographical memory, is the explicit memory of events. It includes time, place, and associated emotions (which affect the quality of the memorization). It contrasts and interacts with semantic memory, the memory of facts and concepts, likened to written stories.

54.                 Ibid.

55.                 ‘Exercise ‘cuts Alzheimer’s risk’ BBC New Online 17^th January 2006 & ‘What’s Good for the Heart is Good for the Head!’ - Study finds exercise helps delay dementia by Patrick Walters, Associated Press Writer, Philadelphia AP 16^th January, 2006.

‘Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older.’ Larson EB, Wang L, et al. Centre for Health Studies, Group Health Cooperative, Seattle, Washington, USA. Ann Intern Med. 2006 Jan 17; 133(2):73-81. Comment in: Ann Intern Med. 2006 Jan 17; 144(2):135-6. Summary for patients in: Ann Intern Med. 2006 Jan 17; 144(2):120.

56.                 Ibid.

57.                 ‘Variety of exercise may ward off dementia.’ By Alex Dominguez, Associated Press Writer, 26^th April 2005.

‘Physical activity, APOE genotype, and dementia risk: findings form the Cardiovascular Health Cognition Study.’ Lyketos CG, Podewils LJ, et al. Dept. of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. Am J Epidemiol. 2005 Apr 1; 161(7):639-51.

58.                 Ibid.

59.                 Ibid.

60.                 ‘Recommended Lifestyle Changes.’ New View by Dr Andrew Weil.  It is well worth reading this reader-friendly work. http://www.nuvunow.ca/articles/lifestyle/mbf/weilaging.html#3

61.                 Stress:  is roughly the opposite to relaxation is a medical term for a wide range of strong external stimuli, both physiological and psychological, which can cause a physiological response call ed the general adaptation syndrome, first described in 1936 by Hans Selye in the Journal ‘Nature’

62.                 Vasoconstrictor: a chemical substance or an agent that causes constriction of blood vessels. This reduced local blood flow to an area, and temporarily raises blood pressure.

63.                 ‘The relation between psychological factors and DNA-damage: a critical review.’ Gidron Y, Russ K, et al. University of Southampton, UK. Biol Psychol. 2006 Jun; 72(3):291-304. Epub 2006 Jan 10.

64.                 ‘Staying on Top of Oxidative Stress (OS)’ by Stephen Byrnes ND, RNCP. http://www.westonaprice.org/moderndiseases/oxidativestress.html

65.                 Ibid.

66.                 ‘Recommended Lifestyle Changes.’ New View by Dr Andrew Weil.

67.                 ‘Making our Minds last a lifetime.’ http://www.findarticles.com/p/articles/mi_m1175/is_n6_v29/ai_18836766

68.                 ‘Recommended Lifestyle Changes.’ New View by Dr Andrew Weil.

69.                 ‘Changes of regional cerebral blood flow measured simultaneously in the right and left hemisphere during automatic speech and humming.’ Ryding E, Bradvik B, Ingvar DH. Dept.of Clinical Neurophysiology, Uv. Hospital, Lund, Sweden. Brain 1987 Oct; 110 (Pt 5):1345-58.

70.                 Ibid.

71.                 ‘How singing unlocks the brain.’ By Jane Elliott, BBC News Health Reporter, 20^th November, 2005.

72.                 Ibid,

73.                 Ibid.

74.                 Ibid. Clive Ballard, director of research at the Alzheimer's Society and Professor of Age Related Diseases at King's College, London.

75.                 ‘Making non-fluent aphasics speak: sing along!’ Racette A, Bard C, Peretz I. Dept. of Psychology, Uv. of Montreal, Montreal, Quebec, Canada. Brain. 2006 Oct; 129(Pt 10):2571-84. Epub 2006 Sep 7.

76.                 Ibid.

77.                 Ibid.

78.                 ‘The impact of music therapy on language functioning in dementia.’ Brotons M, Koger SM. Psychology Dept., Willamette Uv., Salem, OR, USA. J Music Ther. 2000 Fall; 37(3):183-95.

79.                 ‘Investigating the enhancing effect of music on autobiographical memory in mild Alzheimer’s disease.’ Irish M, Cunningham CJ, et al. Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland. Dement Geriatr Cogn Disord. 2006; 22(1): 108-20. Epub 2006 May 23.

80.                 ‘Brain networks that track musical structure.’ Janata P. Centre for Mind and Brain, Uv. of California, Davis, California, USA. Ann N Y Acad. Sci. 2005 Dec; 1060:111-24.

81.                 Ibid.

82.                 Ibid.

83.                 ‘Investigating the enhancing effect of music on autobiographical memory in mild Alzheimer’s disease.’ Irish M, Cunningham CJ, et al. Mercer’s Institute for Research on Ageing, St. James’s Hospital, Dublin, Ireland. Dement Geriatr Cogn Disord. 2006; 22(1): 108-20. Epub 2006 May 23.

84.                 Ibid.

85.                 ‘Art Boosts Alzheimer’s patients’ spirits.’ By Robert Weller, Associated Press Writer, 3^rd August 2006.

86.                 Ibid.  

87.                 ‘Observed well-being among individuals with dementia: Memories in the Making, an art programme, versus other structured activity.’ Kinney JM, Rentz CA. Dept. of Sociology and Gerontology, Scripps Gerontology Centre, Miami Uv. Oxford, Ohio, USA. Am J Alzheimers Dis Other Demen. 2005 Jul-Aug; 20(4):220-7.

88.                  ‘Memories in the making: outcome-based evaluation of an art programme for individuals with dementing illnesses.’ Rentz CA. Alzheimer’s Association, Greater Cincinnati Chapter, Ohio, USA.  Am J Alzhjeimers Dis Other Demen. 2002 May-Jun; 17(3):175-81.

89.                 ‘Omega-4 fatty acid treatment in 174 patients with mild to moderate Alzheimer disease: OmegaAD study: a randomized double-blind trial.’ Freund-Levi Y, Eriksdotter-Johagen M, et al. Dept. of Neurobiology, Caring Sciences and Society, Section of Clinical Geriatrics, Karolinska Uv. Hospital, Stockholm, Sweden. Arch Neurol. 2006 Oct; 63(10):1402-8

90.                 Ibid.

91.                 ‘Omega-3 fatty acid deficiencies in neurodevelopment, aggression and autonomic dysregulation: opportunities for intervention.’ Hibbln JR, Ferguson TA,Blasbalg TL. National Institute on Alcohol Abuse and Alcoholism, Bethesda, USA. Int Rev. Psychiatry. 2006 Apr; 18(2): 107-18.

92.                 Ibid.

93.                 Ibid.

94.                 Artificial Intelligence: A branch of computer science that studies how to endow computers with capabilities of human intelligence. E.g. speech recognition is a problem being worked on by AI scientists. It is the use of programs to enable machines to perform tasks which humans perform using their intelligence. Early AI avoided human psychological models, but this orientation has been altered by the development of connectionism, which is based on theories of how the brain works.

95.                 Organic Food: has both a popular meaning, and in some countries, a legal definition. In everyday conversation it usually refers to all ‘naturally produced’ foods, or the product of organic farming. As a legal term, it means ‘certified’ organic. The distinction is important, as the two definitions can represent quite different products.

Certified Organic Food:  is food from plants and animals that have been grown without the use of synthetic ‘artificial’ fertilizers, pesticides and herbicides, and without antibiotics, growth hormones, feed additives or biotechnology.

96.                 ‘Demand for Organic Food Outstrips Supply’ by Ubby Quaid, AP Food and Farm Writer, 6^th July 2006. http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/2006/07/06/financial/f121005D02.DTL

97.                 ‘Sales of organic food rise by 30% in a year in UK.’ By Martin Hickman, Consumer Affairs Correspondent, Independent, London, England, UK - Organic consumers Association, 7^th July 2006. http://www.organicconsumers.org/2006/article_1026.cfm & ‘Organic food sales rise after Jamie Oliver show.’ By Charles Clover, Environment Editor, The Telegraph, 7^th July 2006 http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/07/07//njamie07.xml&sSheet=/news/2006/07/07/ixuknews.html & ‘Sainsbury’s posts a healthy rise in sales.’ – Demand for better food fuels 6.6% improvement – Organic produce ‘clearly entering the mainstream’ by Julia Finch, City editor, The Guardian, 12^th October 2006. http://www.guardian.co.uk/supermarkets/story/0..1920206.00.html

98.                 ‘Alzheimer’s risk’ is 80% genetic’. BBC News Online, 12^th February, 2006.

‘Role of genes and environments for explaining Alzheimer’s disease.’ Gatz M, Reynolds Ca, et al. Dept. of Psychology, Uv. of Southern California, Los Angeles, USA. Arch Gen Psychiatry. 2006 Feb; 63(2):168-74.

99.                 Ibid.

100.              Pandemic: an epidemic occurring and attacking the population of an extensive region, crossing international boundaries, countries, continents, and usually affecting a large number of people. A global epidemic.

101.              Med diet ‘reduces dementia risk’. BBC News Online 17^th April, 2006.

‘International conference on the healthy effect of virgin olive oil.’ Perez-Jimenez. Lipid and Atherosclerosis Unit, Reina Sofia Uv. Hospital, Cordoba, Spain. Eur J Clin Invest. 2005 Jul; 35(7):421-4.

102.              Definition of Mediterranean diet – Medicine.Net.com  http://www.medterms.com/script/main/art.asp?articlekey=39284

103.              ‘Britain’s first olive grove is a sign of our hotter times.’ By Michael McCarthy, Environment Editor, The Independent, 26^th June, 2006.

104.              ‘The weather’s gone bananas’ – Never-ending summer confuses plants and brings a Caribbean crop to Devon.’ By Luke Salkeld and Liz Hull, D. Mail, 24^th October 2006.

105.              Ibid.

106.              ‘The role of diet in cognitive decline.’ Solfrizzi V, Panza F, Capurso A. Dept. of Geriatrics, Centre for Aging Brain, Memory Unit, Uv. of Bari, Bari, Italy. J Neural Tansm. 2003 Jan; 110(1):95-110.

107.              Ibid.

108.              Ibid.

109.              Ibid.

110.              ‘Mediterranean diet and cognitive decline.’ Panza F, Solfrizzi V, et al. Dept. of Geriatrics, Centre for Aging Brain, Memory Unit, Uv. of Bari, Bari, Italy. Public Health Nutr. 2004 Oct; 7(7):959-63.

111.              ‘Mediterranean diet and risk for Alzheimer’s disease.’ Scarmeas N, Stern Y, et al. Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, N.Y., USA. Ann Neurol. 2006 Jun; 59(6):912-21.  Comment  in: Ann Neurol. 2006 Jun; 59(6):877-9 

112.              ‘Antioxidant, polyphenol-rich Med diet could slash Alzheimer’s risk.’ By Stephen Daniells, Nutra Ingredients USA. 11^th October 2006.

‘Mediterranean Diet, Alzheimer Disease, and Vascular Mediation. Scarmeas N, Stern Y, et al. Author Affiliations: Taub Institute for Research on Alzheimer’s Disease and the Aging Brain, N.Y., USA. Arch Neurol 2006 Oct 9; [Epub ahead of print]  

113.              ‘Antioxidant, polyphenol-rich Med diet could slash Alzheimer’s risk.’ By Stephen Daniells, Nutra Ingredients USA. 11^th October 2006.

114.              ‘Red wine again linked to slowing Alzheimer’s ‘ , Nutra Ingredients USA Online: http://www.nutraingredients-usa.com/news/ng.asp?n=70901&m=2NIUO04&c=zvcdgfpbnucfltc

‘Red wine may slow the progress of Alzheimer’s disease.’ RSSL – http://www.rssl.com/OurServices/FoodENews/Newsletter.aspx?ENewsletterID=177

& CBS News –WebMD –  Sources: Wang, J. the FASEB Journal, November 2006. News release, Mount Sinai School of Medicine. By Miranda Hitti, Reviews by Louise Chang, MD. http://www.cbsnews.com/stories/2006/09/20/health/webmd/main2026049.shtml

Research:  Wang J, Pasinetti GM. Mount Sinai School of Medicine. Research to be published in November’s FASEBJ (Federation of American Societies for Experimental Biology Journal).

115.              Ibid.

116.              Ibid.

117.              Ibid.

118.              Ibid.

119.              Ibid.

120.              ‘Studies uphold health benefits of alcohol.’ By Clarissa Douaud. Nutra Ingredients USA, 25^th October 2006. - http://www.nutraingredients.com/news/ng.asp?n=71586&m=2NIEO27&c=zvcdgfpbnucfltc

121.               ‘Alcohol consumption and risk for coronary heart disease in men with healthy lifestyles.’ Mukarnal KJ, Chiuve SE, Rimm EB. Div. of General Medicine and Primary Care, Beth Israel Deaconess Medical Centre, Boston, USA. Arch Intern Med. 2006 Oct 23; 166(19):2145-50.

122.              Ibid.

123.              Ibid.

124.              ‘A drink to healthy aging: The association between older women’s use of alcohol and their health-related quality of life.’ Byles J, Young A, Furuva H, Parkinson L. Research Centre for Gender, Health and Ageing, University of Newcastle, Callaghan, Australia. J Am Geriatr Soc. 2006 Sep; 54(9):1341-7.

125.              Ibid.

126.              Ibid.

127.              Ibid. Confounders: This refers to a situation where two separate processes are going on that must be looked at individually. In our examples for bias, age would be a confounder, i.e. the investigators should have looked at the ages of the populations and separated them before drawing conclusions. An example could be the finding that people drinking coffee are more likely to have heart attacks.

128.              Ibid.

129.              ‘Eleanor Rigby’ song by Beatles John Lennon and Paul McCartney. “…Eleanor Rigby picks up the rice in the church where a wedding has been, Lives in a dream, Waits at the window, wearing the face that she keeps in a jar by the door, Who is it for? …”

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