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If you're a man, your chances of developing Alzheimer's disease at some point in your life are one in ten. If you're a woman, the statistics are even grimmer: one in five.

While most people would find these numbers hard to accept, they are a fact of life for Dr. Sudha Seshadri, a neurologist and associate professor at the Alzheimer's Disease Center at Boston University School of Medicine.

In fact, Dr. Seshadri helped compute those lifetime risk predictions. Late last month, the research that she conducted with another neurologist, Dr. Philip Wolf, was used in a report for the Alzheimer's Association called Alzheimer's Disease: Facts and Figures.

To Seshadri, 46, the findings are more than numbers. She has an intimate knowledge of neurological disorders. Her mother was diagnosed with a disease similar to Multiple Sclerosis when Seshadri was just 4 years old.

"She had it fairly severely," she recalled. "It affected her thinking and behavior. So I was a little more sensitive, perhaps, than the average medical student to the problems that cognitive issues can bring up."

When Seshadri was 18, the disease took her mother's life. At the time, there were few treatments available for the illness.

"You gave steroids and those had horrible side effects," she said. "When my mother became ill, there were no CAT scans. You had to do a very primitive test where you had to inject air into the space around the brain and basically look at the shadow around the brain to see if there were any tumors."

She now feels that her family experience with the nervous system disorder was a reason she decided to pursue neurology, long before she enrolled in Madras Medical College in the mid-1980s.

After completing her residency at the All-India Institute of Medical Sciences, she moved to the United States in 1992 with her husband, Dr. Vasan Ramachandra, a cardiologist, for a neurology fellowship at the University of Massachusetts Memorial Medical Center.

"It was apparent that she was very talented, extremely industrious and hardworking," said Dr. Wolf, who first met Seshadri in the early 1990s.

When she began her education in neurology, Seshadri said, she perceived there was a general attitude among doctors and medical students that the specialty could do little for patients.

"If you were a neurologist, you spent a lot of time making wonderful diagnoses, but you didn't have a lot of treatment options to offer," she said.

This view began to change by the early 1990s with advances in medications for diseases such as Parkinson's and other neurological disorders, and the discovery of genes that are suspected to help predict the likelihood of getting Alzheimer's.

And with her recent research with Dr. Wolf, the ability to assess the risk of Alzheimer's for populations is also advancing.

Their study - which calculates lifetime risk of stroke and dementia, including Alzheimer's - looks at subjects of the Framingham Heart Study, a 50-year study of 2,794 residents of Framingham, Mass.

Among their findings is that the lifetime risk for stroke for middle-aged men is one in six; for women it's one in five. The risk of dementia is the same.

Seshadri and Wolf, a principal investigator in the Framingham Heart Study, also looked into individual risk factors, like high blood pressure, and how they contribute to the risk of dementia or stroke.

Still, neurology has its limitations. And diseases of the brain and nervous system can be emotionally upsetting for patients and their families, especially since several conditions still have few known medical treatments.

This is one of neurology's many challenges, she said, but it doesn't outweigh the rewards of the specialty.

"To me, [being a neurologist] is very satisfying, because you don't just deal with an organ, for instance. You deal with the entire person; you deal with the entire family."

Diversity and Alzheimer's

One of the Framingham Heart Study's drawbacks, said Seshadri, is that it was not very ethnically diverse. But, she said, the 50-year study is still thought to be fairly representative of the population.

"They picked Framingham in part because people said ‘This is a really diverse representative sample.' But the definition of diverse at the time was that they were Irish and Italian and that sort of thing," she said.

She did note, however, that studies of Alzheimer's in other countries, such as India, show few differences from studies of mostly Caucasian Americans.

"I wouldn't say that we have found something that is very different about Alzheimer's in India as compared to Alzheimer's anywhere else," she said.

Predicting Alzheimer's

Unfortunately, according to Seshadri, the "top predictors are not ones you can do a lot about."

These are age - the longer one lives the greater the risk - and a gene called Apolipoprotein E, or the E-gene.

Presence of a certain type of E-gene, called E-4, appears to bring with it increased risk of having Alzheimer's.

"Most people have E-3 and that seems to be okay. If you have E-4 from both your mother and your father... that is going to increase your risk a whole lot," Seshadri said.

Another predictor of Alzheimer's is plasma homocysteine. Homocysteine is a type of sulfur-containing amino acid that is released in the blood, she said. It is somewhat controllable

Eating a lot of fruits and vegetables and consuming a diet rich in vitamin B-12, folate, and B-6, can lower levels of homocysteine, Seshadri said.

But smoking, drinking a lot of coffee and having low levels of B-vitamins can increase homocystein levels. High levels can also be caused by kidney disease or genetics.

The list of controllable predictors includes exercising, both the body and the brain, obesity, high blood pressure and diabetes - "basically, all the things that affect blood flow to the brain," she said.

She said that controlling these factors in midlife will have more of an effect than later on. "This is an important message to get out there," she said. "I'm not the sort of person who advocates we spend our life worrying about what might happen, but it's one more reason to have a healthy lifestyle."

Source: INDIAnewEngland.com [2]

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