BANGKOK, Thailand -- Alzheimer's and dementia can be triggered by
small silent strokes caused by high blood pressure, but "birthdays are
dangerous" and can be fatal for elderly people, warned a World
Federation of Neurology former president.
   "We can begin preventing some dementia by preventing strokes.
That's the big news," said Dr. Vladimir Hachinski, a clinical
neurological sciences professor at Canada's Western University.
   "The cutting edge, the big thing about Alzheimer’s disease, is that
with Alzheimer’s disease, pathology is very common -- a lot of people
have [Alzheimer’s] pathology -- but you need a trigger. And the
trigger is stroke," Dr. Hachinski said in an interview.
   "It doesn't necessary have to be clinical stroke.  There are little
silent strokes.
   "So the big news is that you can prevent the Alzheimer’s pathology
from becoming dementia by treating the risk factors and preventing
stroke."
   Dr. Hachinski specializes in stroke, vascular dementia and
Alzheimer's, and helped establish Canada's first acute stroke unit.
   He also authored a book titled, "Brain Attack" and introduced the
Hachinski Ischemic Scale as a tool to determine specific forms of
dementia, Alzheimer's and senility.
   "There is some good news here. It turns out that in the elderly,
the genetics don't matter that much," he said, referring to people who
have an inherited risk of developing Alzheimer's because their
ancestors suffered from the disease.
   "APO-E4 is the most powerful gene that may increase the risk of
inheriting Alzheimer’s disease. So if you are unfortunate enough to
have APO-E4 and then have the high blood pressure, the risk goes way
up.
   "The good news is that if you control the risk factor, the risk
goes way down. So the people who have high risk, have the greater
benefit from controlling their blood pressure, exercising and having a
healthy diet.
   "One percent of Alzheimer’s disease is inherited dominantly, and
there the genes are very important.
But in the elderly, the genes are relatively unimportant compared to
environment and what you can do for yourself," Dr. Hachinski said.
   Preventing strokes if the first step.
   "Blood pressure. This is the most powerful risk factor for both
stroke and dementia."
   Other symptoms also need examining.
   "If you have a transient loss of speech, or a transient loss of
feeling on one side, or [loss of] moving one side, and it goes away,
you may not go to an emergency [hospital]. Even though the symptoms go
away, the risk doesn't. These warnings are emergencies."
   Everyone can try to protect themselves against stroke, dementia and
Alzheimer's.
   "The strongest evidence shows that physical activity is an
all-round good thing to do, to a much greater degree than we thought.
And it has all sorts of benefits, not only physically, but this is one
of those things that actually improves mental capacity.
   "Diet also. The Mediterranean diet. That's good for overall health,
but its also good for brain health.
   "High blood pressure is very bad for the brain. There are some new
studies that show that the targets for high blood pressure shouldn't
be 140 systolic. It may be closer to 120."
   During the interview when asked how old he was, the elderly Dr.
Hachinski refused to reveal his age.
   "First of all, on the question of age, a colleague of mine studied
whether there was any time, any one day of the year, when you were
more likely to have a heart attack or a stroke.
   "And they showed that the one day in the year -- no, it's not New
Year's, it's not Christmas, it's not Thanksgiving -- it's your
birthday.
   "We published this. This is serious science. And it's because
birthdays are dangerous.  I stopped having them. So you cannot ask my
age.
   "We think that stress is, you know, it’s only when something bad
happens to you. But if you are very happy, you have the same reaction.
Your blood pressure goes up. The heart pounds. You begin sweating.
   "I have two quotes. One is from Lucretius who was a [1st century
BC] Roman writer, and he was describing terror. The sweat and all the
rest of it.
   "And then I have a poem by Sappho, the [600 BC] Greek poetess, and
she describes how she trembles, and her agitation.
  "That's the same description. So, being fearful and being in love,
physiologically, is the same...there's stress. Old people don't like
surprises, because they get stressed."
   Dr. Hachinski was visiting Bangkok to receive Thailand's $100,000
Prince Mahidol Award which is given annually to two individuals or
institutions for their "outstanding and exemplary contributions to the
advancement of medical and public health services for humanity
throughout the world," according to the award's foundation.
   He was president of the World Federation of Neurology from 2010-2013.
   This year's other award winner was Sir Gregory Paul Winter from
England's Cambridge University, for his work developing humanized
therapeutic antibody technology, which allows antibodies to be used as
medicine.