June 4, 2018
Anne Artley, Long Beach Business Journal Staff Writer
Dr. Susan Sklar, the founder and medical director of the Long Beach-based Sklar Center for Restorative Medicine, attributed the frequency of Alzheimer’s in part to toxins in the environment, poor diet, lack of exercise, loss of social structure and less sleep. “People are getting way less sleep than [they did] 30 or 40 years ago,” she said. “They’re also eating more sugar, and there is more obesity and diabetes. These are all the risk factors for Alzheimer’s.”
Sklar is a practitioner of functional medicine, which approaches health care from a holistic standpoint rather than merely prescribing medication for symptoms.
Dr. Omid Omidvar, a neurologist at MemorialCare Long Beach Medical Center, checks the reflexes of volunteer Vivian Kapono. When a patient presents symptoms of Alzheimer’s, physicians attempt to rule out other pathologies first, Omidvar said. (Photograph by the Business Journal’s Anne Artley)
As part of its Alzheimer’s prevention program, the Sklar Center performs genetic tests on patients who have a family history of the disease. Sklar said a genetic predisposition doesn’t necessarily lead to development of the disease, just as those without one may acquire it through their habits. “There’s a saying that your genes are the gun, but your lifestyle pulls the trigger,” she said.
According to Sklar, other possible factors that lead to brain function decline include toxins in a patient’s environment, such as mold in the house, and pesticides. “People who live on golf courses get exposed to them, and they’re really not good for the brain,” she explained.
Dr. Omid Omidvar, a neurologist at MemorialCare Long Beach Medical Center, said early signs of Alzheimer’s include forgetfulness as well as getting lost and experiencing difficulty recalling recent encounters. He added that it is sometimes difficult to differentiate signs of dementia from the natural aging process.
According to the Alzheimer’s Association, dementia refers to a decline in mental agility severe enough to inhibit daily functions. There are different types of dementia, with Alzheimer’s accounting for 60% to 80% of cases. “There’s a condition called MCI: mild cognitive impairment,” he said. “That’s a transitional state. From there, people can devolve into real dementia. Some people stay within that phase, and we don’t know why, while others recover from that state.”
For a patient in the transitional phase, Omidvar would recommend natural remedies as well as lifestyle modifications. “Isolation is a toxin to the brain,” he said. “And watching TV is not healthy. Studies show our brain metabolism, if you sit quietly and do nothing, is higher than if you sit and watch TV.” Omidvar added that recent research includes examining the incidence of Alzheimer’s in other cultures, and the factors leading to the contraction of the disease.
“We’ve learned that a Mediterranean diet, which is high in vegetables and low in fat, red meat and fried food, seems to protect our brain,” he said. “Turmeric [a spice] may also help. This [information] is based on certain cultures where the incidence of Alzheimer’s is lower because they consume more turmeric. When it’s cooked and mixed with fat, the brain absorbs it more.” But Omidvar said these observations are not objective, but rather represent a “fluid science that may change tomorrow.”
Hae-Ryong Oh, a neurologist at HealthCare Partners, expressed agreement about the benefits of a Mediterranean diet. She also said people with higher education levels are less likely to contract the disease. “It’s [due to] an increase of cognitive reserve,” she said. “It’s like we have a bank in our brain. Through education and social activity, you’re storing up a bank.”
As for medications, Oh and Omidvar said cholinesterase inhibitors were commonly prescribed for milder forms of Alzheimer’s. This category of drugs blocks the destruction of neurotransmitters within the brain that contribute to memory formation. Another medication, memantine, regulates the activity of glutamate, a chemical that aids in information storage and processing.
“Unfortunately, we don’t have great treatments for someone who’s already diagnosed,” Dr. Carolyn Kaloostian, an assistant clinical professor of family medicine and geriatrics at the University of Southern California (USC) Keck School of Medicine, said. “Once Alzheimer’s starts, it’s like a cascade; so far it has been impossible to stop.” Kaloostian is also a lead physician educator for the Alzheimer’s Association.
Kaloostian mentioned that a drug called Aducanumab is currently undergoing a phase three clinical trial. The highest level of development, a phase three trial compares the test drug against the current standard treatment for safety and efficiency. According to Kaloostian, Aducanumab is a preventative treatment that clears the brain of amyloid clumps. Amyloids are proteins in the brain that block neurons from firing when they accumulate, leading to loss of memories.
“We recommend learning new things, languages and tasks, even if you’re cognitively normal,” Kaloostian advised. “It’s going to build more neurons and preserve more cognition. We want to make as many brain cells and keep them safe. That’s why we advise minimizing alcohol; we want to preserve them.”
According to Kaloostian, USC is performing a study on how to leverage technology to reduce the risk factors of Alzheimer’s. “We’re using virtual reality as well as memory tests for some of our patients who are cognitively normal, but they may have some other impairments, like they can’t go outside and run in the park,” she explained. “Instead, they sit on a stationary bike and navigate the park through virtual reality.” Kaloostian said the medical school plans to follow the subjects long-term to determine whether continued use of these methods prevents the onset of dementia.
As for other preventative measures, Sklar is holding monthly training sessions at the Sklar Center beginning this summer called “Supercharge Your Brain and Prevent Alzheimer’s.” Classes are planned for the fourth Wednesday of the month for six consecutive months. Topics range from stress prevention to the importance of sleep. The first session will take place June 27. Her offices are located at Kilroy Airport Center.
“In general, doctors have viewed [Alzheimer’s] as something you can’t stop, that it’s incurable and mysterious,” Sklar commented. “That’s why people end up with a late diagnosis: because they feel like nobody can do anything about it and they don’t want to face the fact that they may be developing it. That’s why I want to teach these classes.” Sklar is also teaching the same course through the City of Lakewood Recreation & Community Services Department in August. One of her future goals is to start a nonprofit organization dedicated to the disease.
All physicians interviewed by the Business Journal agree that, not only does preventative care help block the development of Alzheimer’s, it also decreases the likelihood of other health concerns such as cancer, heart disease and diabetes. “When you’re on a healthy lifestyle program, you lower your risk of all the chronic diseases that take people down,” Sklar remarked.