Back in the 1960s, a successful Minneapolis businessman was hit on the head with a golf ball while playing golf at his country club. Not long afterward, he started deteriorating mentally and eventually had to stop working. His family suspected that the golf ball injury was the cause of his dementia.

Now, 35 years later, his family’s suspicions have been largely vindicated. Head injury indeed appears to be a risk factor for Alzheimer’s disease, various studies suggest. And some of the latest, most intriguing evidence for such a link was reported at the World Alzheimer Congress 2000, held in Washington, D.C., in July.

Steven DeKosky, M.D., of the University of Pittsburgh School of Medicine and his team looked at samples of cerebral cortex from persons who had experienced traumatic brain injury. The researchers then compared these samples to cerebral cortex taken from persons who had died from other causes. Analysis revealed more beta-amyloid deposits in the injured cortex than in the control cortex, and the deposits appeared to be the amyloid plaques that characterize Alzheimer’s.

Thus ducking golf balls, as well as avoiding other forms of head injury, appears to be one ploy that people might use to avoid getting Alzheimer’s. But some other strategies might help as well, other research findings presented or highlighted at the Alzheimer congress imply.

For instance, Kenneth Rockwood, M.D., of Dalhousie University in Halifax, Nova Scotia, is excited about a study headed up by Francoise Forette, M.D., of the University of Paris and reported in the October 24, 1998, issue of The Lancet. Forette, along with her European, Russian, and Israeli colleagues, found a 50 percent reduction in the incidence of dementia among 1,238 persons who had been treated for systolic hypertension, compared with 1,180 who had not, and this included not just vascular dementia, but Alzheimer’s. Protection against the former was expected, the researchers admitted, but not against the latter.

They suspect that the drug used, the calcium channel blocker nimodipine, may have protected against Alzheimer’s less by lowering blood pressure per se than by exerting some yet-to-be-identified action on the brain. In any event, keeping blood pressure in check might help keep Alzheimer’s at bay, Rockwood believes.

And keeping blood cholesterol levels under control might help too, a Finnish study reported at the congress suggested. Miia Kivipelto of the University of Kuopio and colleagues had measured the blood pressure and blood cholesterol levels of a large population during the 1970s and 1980s. Then, in 1998, they followed up 2,000 of these individuals, who were now between the ages of 65 and 79, to determine which of them had developed dementia. Fifty-seven, it turned out, had, of whom 48 had probable or possible Alzheimer’s.

The researchers then compared the midlife blood pressure and blood cholesterol levels of subjects who had developed dementia with those who had not to see whether there were any links between midlife levels of blood pressure and cholesterol and later susceptibility to dementia. Indeed, there seemed to be, they found.

Subjects who had had high or even borderline systolic blood pressure at midlife appeared to be at a significantly higher risk for dementia a few years later. Persons who had had, at midlife, elevated cholesterol levels also seemed to be at added risk for dementia some years afterward. And most interestingly, a combination of borderline or high systolic blood pressure plus high cholesterol levels appeared to up the risk for dementia more than either risk factor alone did.

But while keeping those cholesterol levels down might be a good idea, keeping those vitamin E levels up might also pack some wallop. In 1993, Martha Morris, Ph.D., of Rush-Presbyterian-St. Luke’s Medical Center in Chicago and her coworkers gave cognitive tests to some 3,000 persons between the ages of 65 and 102. The researchers also had the subjects fill out food questionnaires so that they could determine the subjects’ intake of various nutrients. The investigators then attempted to learn whether any changes in subjects’ cognitive function over the subsequent three years might be related to how much vitamin E and vitamin C they had consumed earlier.

Persons who had consumed larger amounts of vitamin E appeared to be more protected against subsequent cognitive decline than those who had consumed little. For instance, the average annual decline in cognitive score for a 75-year-old who had ingested 299 I.U. of vitamin E daily was 34 percent less than that of a 75-year-old who had ingested only 6.7 I.U. daily. In contrast, there was little evidence of a link between vitamin C intake and cognitive changes.

Nonetheless, two other vitamins besides E might also be able to ward off Alzheimer’s—vitamin B12 and folate. Actually these two have long been suspected of being involved in Alzheimer’s, since a deficiency in them is known to trigger confusion and memory loss. So Oke Wahlin and colleagues at the Karolinska Institute in Stockholm assessed the nutritional intake of 370 persons aged 75 years or older, followed them up for three years to see who developed Alzheimer’s, and then determined whether getting Alzheimer’s might be related to previous intake of vitamin B12 and folate.

The answer was yes. Subjects who had ingested low levels of at least one of the two vitamins had a 2.2 times higher risk of Alzheimer’s, and this risk was seven times higher in persons who had started off the study with good cognition, but with a paucity of vitamin B12 and folate in their diets.

And besides taking vitamin E, vitamin B12 and folate, one might want to imbibe a glass or two of wine daily as well, not just for the pleasure but for the protection it might afford against Alzheimer’s.

Annemieke Ruitenberg of the Erasmus Medical Center in Rotterdam and colleagues examined the relationship between alcohol consumption and the risk of dementia in a prospective study of some 5,000 subjects 55 years of age or over. The study population consisted of persons who had been nondemented at the start of the study (1990 to 1993) and about whom the researchers had gathered alcohol intake information. Between 1993 and 1999, the scientists monitored this population to see who came down with dementia. A total of 199 subjects did, 149 of whom developed Alzheimer’s. But could contracting Alzheimer’s be linked with previous alcohol consumption? It could be, they found. Mild-to-moderate drinking (one to four drinks a day) was associated with a lower risk of dementia. The risk reduction was largest for vascular dementia, but also present for Alzheimer’s.

Tippling isn’t the only Alzheimer’s weapon to be suggested by Dutch studies, though. Mental gymnastics during midlife may very well pack a punch as well. Hans Bosma of Maastrict University of his colleagues inquired about the mental work demands that some 700 middle-aged or older persons were experiencing in their current job or had experienced in their last job before retiring. The researchers then followed these subjects for three years. Persons who had, or had had, mentally demanding jobs showed less cognitive decline than did those who had, or had had, less mentally demanding positions. Similar results were also reported recently by Cleveland, Ohio researchers.

In fact, even giving that brain a workout early in life may well prepare it for a later standoff against Alzheimer’s. Gary Small, M.D., of the University of California at Los Angeles mentioned something intriguing at the Alzheimer congress: One of this colleagues has found that persons in their 50s with a college degree show more activity in the posterior cingulate brain area than do similarly aged persons without one. The posterior cingulate, which is located behind the hippocampus, is involved in the modulation of memory performance and appears to be one of the first brain areas to succumb to Alzheimer’s, Small said.

Yet perhaps the best tips for warding off Alzheimer’s come from the 101-year-old grandmother of Small’s wife, who "still has all her marbles," he proudly announced at the Alzheimer congress. For instance, she has to climb two flights of stairs to reach her apartment, so maybe physical exercise has helped keep her brain ship-shape, Small speculated in an interview. Also, she has never smoked, so perhaps never lighting up is another weapon against Alzheimer’s. And "as far as I know," Small said, "she has never had a serious injury to her head!"

In other words: Duck those golf balls!