What Your Doctor May Not Tell You About Alzheimer's Disease
by Gayatri Devi, M.D., and Deborah Mitchell, 281 pages, Warner Books, $14.95

Are you exercising your brain? Brain workouts are just as important for keeping your brain healthy as physical workouts are for your body, according to neurologist, psychiatrist, and memory therapist Gayatri Devi, M.D. In her new book, What Your Doctor May Not Tell You About Alzheimer's Disease, the director of the New York Memory Services presents 28 mental fitness exercises, or "brain boosters," that may help maintain and improve language and memory in people with memory disorders, including (and especially) Alzheimer's disease. The exercises also help healthy people keep memory and brain function sharp as they age and may help prevent dementia-type diseases.

Dr. Devi identifies three types of brain exercises: language boosters, memory boosters, and visual/perceptual boosters. The language boosters may be the most important, she writes, because "the ability to communicate effectively is even more important...than maintaining strong memory skills for independent functioning."

Language boosters include such activities as listing in a notebook all the four- and five-syllable words you can think of in 15 minutes. Or writing down a polysyllabic word such as "paraphernalia' and then listing all the words you can make from the letters in that word.

Memory boosters are a bit more "invigorating" and "frustrating," according to Dr. Devi. Examples include memorizing poems or listening to a short speech and then writing down the main points of the speech afterward. Such activities are good because they give your brain neurons a workout, Devi says.

Visual/perceptual brain boosters require you to use your creativity. An example is drawing a floor plan of the place where you live and putting in all the rooms, furniture, and appliances. Others are working a jigsaw puzzle or doing origami.

Brain exercises are really like games, and should be approached as "leisure activity and not 'work,'" Dr. Devi writes. She prescribes spending 30 minutes per day, at least three times a week, doing the brain exercises to help prevent memory loss and keep brain activity shipshape. Alzheimer's patients should spend about 15 minutes three times a week and should concentrate on exercises aimed at improving specific deficits identified by their doctors.

Can such simple exercises really help Alzheimers patients? Dr. Devi, who has treated thousands of Alzheimer's cases, argues yes. She reports there is much that can be done to improve the lives of Alzheimer's patients and retard their loss of function, including brain exercises, drug therapy and supplements.

For example, one patient named Karl, a retired banker of 74, was diagnosed with Alzheimer's disease in 1995 and came to her in 1997, concerned because he could no longer pursue his lifelong pastimes of reading, tinkering, painting and carpentry. Following Dr. Devi's prescription for an intensive program of brain exercises, Karl slowly and steadily improved to the point where he returned to reading and writing and other interests, and six years later he continues to enjoy life.

"I find that most people who have Alzheimer's disease who consistently and conscientiously do brain boosters maintain a high level of functioning for many years and at the same time enjoy a better quality of life," Dr. Devi writes.

There is as yet no cure for Alzheimer's disease, but there are treatments, prescription drugs, complementary medicines, and hormonal treatments that can be used with positive results, according to Dr. Devi. The drugs include cholinesterase inhibitors such as Aricept, a drug derived from black pepper, and Reminyl, made from daffodil bulbs. These drugs raise brain levels of acetylchofine, a neurotransmitter that is deficient in Alzheimer's patients. Other drugs include memantine, the first drug approved for advanced as well as moderate Alzheimer's, with which Dr. Devi has seen some dramatic results. Memantine protects brain neurons against toxicity from high levels of glutamate, which is released by cells that have been damaged by Alzheimer's disease.

Another class of drug, the MAO-B inhibitor selegillne, inhibits the monoamine oxidase enzyme that destroys neurotransmitters in the brain. It is an antioxidant previously used for Parkinson's disease and now used in dementia as well. But unless an Alzheimer's patient has parkinsonian features, Dr. Devi prefers prescribing the antioxidant vitamin E instead. Other useful nonpharmaceutical treatments include estrogen, B vitamins, ginkgo biloba, and melatonin. Dr. Devi believes in aggressive use of more than one drug at a time in treating Alzheimer's patients. In the book, she gives interesting case examples of how she manipulates and changes drug and nondrug therapies as patients' symptoms develop.

Of more hands-on use to Alzheimer caregivers may be Dr. Devi's tips for dealing with the challenging behaviors posed by Alzheimer's patients, such as anger and aggression; wandering; apraxia (loss of ability to perform everyday tasks such as brushing teeth or combing one's hair); and hemineglect (the loss of ability to hear, see, understand or interact with the environment).

Dr. Devi notes that her suggestions may work with some patients but fail with others, or work on a patient one day, but fail the next day. Dr. Devi offers hope to many who may fear that their memory problems are the first symptoms of Alzheimer's. A number of conditions affecting memory that may mimic Alzheimer's actually are other pathologies, some of which can be treated and cured. The important thing she stresses is not to fear or delay being tested for Alzheimer's. Early detection and aggressive treatment can improve your life, should you have the disease. Furthermore, she believes that all of us can do much to avoid Alzheimer's by reducing lifestyle risk factors that mostly parallel those of heart disease.

"Some people say that because we can't cure Alzheimer's disease (yet), we don't know exactly what causes it (yet), and we don't have ironclad proven ways to prevent it (yet), there isn't anything we can do except hope we escape its clutches," Dr. Devi writes. "I couldn't disagree more."