Alzheimer’s and Exercise

Carl and I have been dealing with a growing pattern of emotional stress.  Carl has more and more been having these times when he’s saying to me, “I have nothing” – “I have nobody” – and asking me, “Why are you doing this to me?” – “What did I do to deserve this?”  These questions are asked in a sort of alarmed, resigned, defeated tone.

These patterns are certainly distressing for Carl.

They upset me “off the chart.”  But there’s nothing I can do, except persist in trying to distract him.  So I just ride them through.  I don’t want to think about, much less try to figure out, what they’re doing to me beneath the surface.

Walking

For the past two weeks or so, we’ve been walking – nearly every day.  We live in a community with a 4-way stop in the center and three winding roads of townhouse groups ending in cul de sacs.  In this milder weather, we’ve been walking to each cul de sac in turn – it takes us about 20 minutes.

And the emotional scenes have almost disappeared.

Now I have to keep my guard up.  This Alzheimer’s process is an up and down, roller coaster ride, with all the surprise dips and twists.  What I’m pleased about could be just a normal, gentle, high point – with a distressing dip to follow.  The odds that this is a real and substantial positive change seem pretty remote.

It’s sort of like me dreaming that it actually is logically possible that I could win the lottery.  Then half my problems would disappear – or at least become a lot more manageable.

Winning the lottery is possible – however long the odds – however much it’s a waste of time to dream.  Really slowing Alzheimer’s disease with exercise – well, it seems that the odds can’t be as good as those for the lottery.

But let me share the story.

The Story

Since our Alzheimer’s disease diagnosis, less than a year ago, I’ve been working to learn about the disease.  My main learning threads are: 1) a general understanding of the disease, the process, the epidemiology; 2) preventing, delaying, and slowing dementia and/or Alzheimer’s; and 3) research (what’s working – what’s coming – what could change our situation).

Along the preventing-slowing thread, it seems that the recommendations are the same for preventing or delaying the onset of dementia or Alzheimer’s as they are for slowing the progress.

They are:

• Manage vascular risk factors,
• Prevent or stop smoking,
• Physical activity,
• Social engagement,
• Nutrition,
• Mental activity.

If you read the Alzheimer’s Association – CDC document, “The Healthy Brain Initiative“, you’ll find, in the “State of Knowledge”, “What do we know?” section, that “research suggests the following factors may be associated with the maintenance of cognitive health.”  They are: managing the vascular risk factors (blood pressure, cholesterol, diabetes, weight), preventing or stopping smoking (as one of the three primary recommendations for maintaining cognitive health, this is an additional, terrifyingly compelling reason why smoking is appallingly unhelpful and unwise), physical activity or exercise.

Further down in the report, in the “Actions by Cluster”, “Moving research into practice” section, you’ll find the first mention of three additional “proposed risk factors”: social engagement, nutrition, and mental activity.

These, generally, are the same recommendations you’ll find in the Alzheimer’s Association’s “Maintain Your Brain” brochure (linked to on the “Home > Alzheimer’s Disease > Publications > Alzheimer’s Association” page).

In pursuit of my “preventing-slowing” learning thread, I’m reading a book by Kelly Lambert titled Lifting Depression.

Ms. Lambert describes what she calls effort-driven rewards.  Her idea is that by doing physical activities that take some effort – activities to achieve planned rewards that you can see, feel, and touch – you can come to feel more control over your environment and more connected to your world.  You can develop the feeling that you CAN make a change to improve your situation.  This increases your resilience against depression.

The importance of the hand-brain relationship is clear in the neuroanatomy illustrated by the homunculus.  The sensory homunculus and the motor homunculus show the relative space each of our body parts occupy on the somatosensory cortex and on the motor cortex.  In the sensory homunculus, the hands are enormous – in the motor homunculus, they are twice that enormous size or larger.

Kelly Lambert presents a persuasive argument that effort-driven rewards, accomplished with the hands, far more effectively than those without the hands, serve as a stress inoculation, “promoting stress resilience in the primate brain.”  And the impact of two hands working in concert compounds the benefit.

She includes in effort-driven rewards activities things like: cooking (something a bit more involved than microwaving a frozen dinner), knitting, tending a garden, woodworking, sculpture, exercise (if you perceive it as meaningful).

If Kelly Lambert’s reasoning depends significantly on the effect of activating large areas of the brain – in particular, large cortical areas – then her reasoning should logically carry over from depression to cognitive disorders like dementia and Alzheimer’s.  If mental and physical and social brain activities help to prevent or delay or slow these disorders, doesn’t it make sense that effort-driven rewards accomplished with the hands – or both hands working together – would be helpful as well?

I’m also reading a book by John Medina titled Brain Rules.

Dr. Medina’s first rule is, “Rule #1: Exercise boosts brain power.”

In this chapter, he poses the question, “Can exercise treat brain disorders?”

On the “preventing or delaying” side, he writes that aerobic exercise can cut your lifetime risk for general dementia in half, and the risk for Alzheimer’s disease is reduced by more than 60 percent.  He explains that this requires aerobic exercise for 30 minutes, twice a week.

After reading the dismal epidemiological information about Alzheimer’s, this risk reduction from aerobic exercise message is compelling and a little encouraging.

When he covers the “intervention” side – at least roughly equivalent to my concern about “slowing” the progress of Alzheimer’s – he doesn’t mention dementia or Alzheimer’s.  He lists only depression and anxiety.  My interpretation of this distinction is that Dr. Medina feels that the support for exercise as an effective intervention for dementia and Alzheimer’s is not strong, and he’s taking pains to carefully phrase his message.

But it seems to me that every suggestion you hear or read or see, to improve your life and/or your health, includes exercise – or is entirely exercise.  This is true for Dr. Medina’s book.  And this is true for nearly all messages, all media, all times, all places.  Make it better – get it moving.

Given the broad benefits of exercise described for Brain Rule #1 – for neurochemistry and for neurogenesis – it feels counter intuitive, illogical, irrational to conclude that exercise won’t make things at least a little better.

What I’m Doing

I’m going to continue to get us to walk every day – or as often as possible.  I’m encouraged by what appear to be positive results so far.

If it’s too hot, or too cold, to walk the neighborhood, then we’ll walk on our treadmill down in the basement.  Instead of getting kitted up in shorts and walking shoes – which increases our time overhead, reduces the odds that we’ll actually do it, and makes the whole enterprise more difficult – we’ll just walk on the treadmill in our street clothes and shoes.

I will keep my eyes open for helpful things that Carl can do, in the kitchen and around the house.

Years ago, I did a little knitting – one winter at the beach.  I have a very nice scarf to show for that effort.  I’m now working to get back into knitting, but I’m finding it a little difficult – more difficult, I imagine, than it was back then.  But if I’m nothing else, I’m persistent.  I’ll continue to work on it, as much as I can find the time.

However, finding an effort-driven rewards activity that Carl could and would do is that proverbial “horse of a different color.”  But I can think about it.  And who knows, maybe I’ll come up with something.  Kelly Lambert mentioned “a therapeutic form of Montessori intervention for Alzheimer’s patients.”  I ought to look into that.

As I’ve said in an earlier article, I touch and hug, as much as I can, pursuant to the idea that stimulating nerves will do at least something to keep them active and alive.

And I’ve found that gentle persistence, teaching Carl how to do things, can actually work – especially when punctuated by excited applause when he succeeds.  A few months ago, he could not figure which key to use to open our mail box, or which mail box to open.  Now, he’s often successful at opening the correct box first try.

But I have to be prepared – as much as I can be prepared – for the fact that this exercise idea may not help much – or help for very long.

But my friend deserves the best I can do for him.

And there is so little that I can do.

I have to try.