The Four Pillars of Prevention are:

• Diet and Vitamins: Your brain is flesh and blood, just like the rest of your body. It requires nutrition, blood flow, energy, and care like any other organ of the body needs.
• Stress Management:This often underutilized form of preventive medicine is important in reducing the risk of Alzheimer's.
• Exercise: Physical, mental and mind/body exercises are all essential for maintaining a healthy body and a healthy mind.
• Pharmaceuticals: Medications and hormones taken in partnership with your physician are a part of the overall program.

“Clinical Protocols to Prevent or Retard Alzheimer's Disease”

Progress continues to be made in both the early detection and prevention of Alzheimer's disease. One of the physicians in the forefront of this work, Dharma Singh Khalsa, M.D., president and medical director of the Alzheimer's Research & Prevention Foundation in Tucson, Arizona, contends, however, that recent research simply confirms the idea that prevention is the only practical way to deal with Alzheimer's disease; while you can slow the progression of the disease, it is crucial to recognize and reduce the factors that lead to its development in the first place. And he is convinced that an integrative approach is the only effective method for either preventing or slowing Alzheimer's.

Dr. Khalsa notes that Alzheimer's disease is a multi-factorial disease, with nutrition, chronic stress, and lifestyle choices being among the most important factors. Of the most probable causes known at present, he considers chronic, unrelenting stress and free radical damage and oxidative stress to be at the top of the list. The Alzheimer's Research & Prevention Foundation points out that the hormones cortisol and adrenaline are produced by the adrenal glands in response to a stressful situation; when the stress is over, both these hormones should return to normal levels. However, with chronic stress this does not happen and cortisol levels stay high, with disastrous consequences for the brain. Cortisol affects the hippocampus, the part of the brain that helps sort and store memories. It prevents it from taking up glucose; it also slows nerve impulse transmission, and eventually can lead to death of brain cells. The size of hippocampus in Alzheimer's patients is considerably reduced as the disease progresses. Cortisol also inhibits a process called “long-term potentiation” that is critical to laying down memories. All together, high levels of cortisol are lethal to brain neurons and seriously impair memory.

Considered by many to be the main cause of diseases of aging that include coronary artery disease, cancer, rheumatoid arthritis, bronchitis and periodontitis, free radicals are also thought to be an important cause of Alzheimer's disease by causing oxidation of brain neurons. According to Dr. Khalsa, several studies have shown a greater amount of oxidative stress in the brains of Alzheimer's sufferers. Other factors contributing may include inflammation, head trauma, heavy metals, viral infections, pesticides, electromagnetic fields, genetics, melatonin deficiency, acetylcholine deficiency, elevated homocysteine, high fat diet, depression, Vitamin B 12 deficiency, folic acid deficiency, hormone imbalances, lack of mental stimulation, and lack of physical exercise.

Recent research serves to confirm that MCI itself is not only a marker for Alzheimer's, but may actually be a form of the disease. As reported in the Chicago Tribune on March 8, 2005, researchers at Chicago's Rush University reported in the science journal Neurology that MCI, in which a person has increasing difficulty forming new memories, had been considered a normal part of aging but now appears to be an indicator of Alzheimer's disease. The study's lead author, Dr. David A. Bennett, director of the Alzheimer's Disease Center at Rush, emphasized that most people who worry about losing their memory as they age are not suffering from creeping Alzheimer's. However, the findings of this study (the largest ever conducted on people diagnosed with MCI, involving postmortem examinations of the brains of 180 Catholic nuns, priests and brothers) indicate that most of the 2.5 million to 10 million Americans with that condition may already have some degree of Alzheimer's disease. The disease currently affects one in 10 people over age 65 and nearly half of those over 85; these figures could increase substantially if the early stage is added to the calculations. In fact, "the number of people with Alzheimer's disease could double if you included all the people with mild cognitive impairment," said Dr. Ronald Petersen, director of Mayo Clinic's Alzheimer's Disease Research Center and spokesman for the Chicago-based Alzheimer's Association.

Bolstering Dr. Khalsa's position that prevention is the key, the studies have found that some people appear to be able to protect themselves against memory loss even though their brains show significant damage from Alzheimer's disease, possibly by being mentally engaged and physically active. In addition, many people live into their 80s and beyond with their memory intact, suggesting that Alzheimer's disease is not a normal part of aging. The finding supports the growing notion that people who remain mentally active may build more connections between brain cells, which may provide a reserve against the ravages of Alzheimer's, reported the Tribune. Scientists call it plasticity, a process by which the brain builds more synaptic connections between neurons in response to new learning. New synaptic formation is critical in the development of children's brains, and it is a process that continues throughout life. People who keep mentally active are believed to have a denser network of connections than those who do not. "It may be that there are more connections between nerve cells in the brain so that even though you have a loss, you can compensate for that," said Neil Buckholtz of the National Institute on Aging.

That physical activity can help prevent Alzheimer's disease, as Dr. Khalsa has long contended, is also supported by a recent Finnish study showing that middle-age people taking regular exercise at least twice a week could reduce their risk of developing Alzheimer's disease by 50 percent in old age. Reuters reported on March 3, 2005 that Dr. Miia Kivipelto, a neurologist and Alzheimer's disease specialist at Stockholm's Gerontology Research Center, told an Amsterdam conference on old age organized by Britain's Royal College of Psychiatrists, "An active lifestyle, both physical, mental and social, is preventive. It's never too early to start to prevent Alzheimer's disease." Regular exercise and a healthy diet could go a long way to reducing the risk of developing Alzheimer's disease, she said, adding that studies have shown that people with high blood pressure, high cholesterol and obesity could have a greater risk of Alzheimer's or other dementia than those with a more active, healthy lifestyle. People could reduce their risk by getting regular check-ups to monitor blood pressure, cholesterol and weight, she added.

Dr. Khalsa's own research has shown that an integrated complementary medical program can have a powerful impact on both age associated memory impairment (AAMI) and early Alzheimer's disease. The results of Dr. Khalsa's pilot study, “New Developments in the Prevention and Reversal of Memory Loss: A Complementary Therapeutic Alternative” show that a Four Pillar Program resulted in improvement, either self-reported or by family members, in cognitive ability and activities of daily living. Patients who followed the complete regimen of drug, dietary, and nontraditional therapies showed the greatest improvement. “Research from the University of Texas,” notes Dr. Khalsa, “finds that physical and mental exercise combined with Aricept works better than Aricept alone.”
Dr. Khalsa emphasizes that further study clearly needs to be undertaken in this area, and the Alzheimer's Research & Prevention Foundation is in the process of organizing research to test these methods in larger studies at the university level.