Am I losing my mind?

Early signs of Alzheimer's can now be detected in middle age. Jane Feinmann took the tests - and the results were less than perfect. So what can she do now?
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Indy Lifestyle Online

It was the Argentinian tango that got me worried about my brain. Far from merely sloping around the dance floor looking foxy, my newish hobby turned out to require persistent attention to posture and balance as well as to the nuances of the steps into which I was being led. I was distracted sufficiently often for one partner to regularly bark at me: "Focus, can't you?" - which eventually stopped being irritating and started to worry me.

It was the Argentinian tango that got me worried about my brain. Far from merely sloping around the dance floor looking foxy, my newish hobby turned out to require persistent attention to posture and balance as well as to the nuances of the steps into which I was being led. I was distracted sufficiently often for one partner to regularly bark at me: "Focus, can't you?" - which eventually stopped being irritating and started to worry me.

Worry, it seems, was the right response. Earlier this year, psychiatrist Professor Tonmoy Sharma, a leading researcher into age-related mental decline, called for a national screening programme for the over-55s to check for early signs of Alzheimer's disease, a problem currently affecting 750,000 people in the UK. His demand was founded on several growing certainties within medicine: that a condition known as Early Cognitive Impairment (ECI) predates the diagnosis of the first symptoms of Alzheimer's by about 20 years; that screening can pick up people with ECI; and that, once identified, ECI will soon be treatable with drugs currently in clinical trials.

A month before becoming an over-55, I set out to sample the tests available and discovered a substantial screening industry aimed at enabling people to optimise their mental health in later life. I began at Cognitive Drug Research (CDR), an award-winning, Berkshire-based company which has been providing the pharmaceutical and herbal supplement industries with sensitive, computerised cognitive-function tests since the mid-Eighties. Now the company is investigating ways of offering the tests to the public to provide what the chief executive, Professor Keith Wesnes, describes as "a vital baseline" against which future cognitive deterioration can be measured. "People worried about their memory are unlikely to be referred to a memory clinic by their GP because hardly any exist. Yet knowing cognitive status in middle age will prove useful later on."

I'm convinced, and for half an hour I sit in front of a computer taking a series of tests to assess the state of different aspects of my ageing brain. A test of concentration has a single number to the right of the screen while a series of different numbers flashes on the left, at the rate of 150 a minute. I have to press "yes" whenever the two numbers on the screen are the same. A second test does the same using words. Both are a piece of cake.

Next, my working memory comes under scrutiny. I get a glimpse of a house with nine windows, four of which are briefly lit up - and I have to pick which of 36 lit windows, flashed consecutively on to the screen, fit these four. Five numbers gallop across the screen and I have to pick out, from 30 subsequent numbers, those that belong to the original series. It's very simple. But the final test is more difficult: I'd been told to memorise 20 pictures of objects flashed on the screen. Later, they're shown again but this time in a random order, interspersed with 20 "distractor" pictures. When I'm asked to list all 20 objects, my memory cells disperse in panic and I can only write down four.

My next port of call is the Radcliffe Infirmary's Oxford Project to Investigate Memory and Ageing (Optima). Here, hundreds of healthy and impaired volunteers have had their cognitive function intensively studied since the late Eighties - with the results monitored against regular brain scans and eventually, in some cases, by post-mortem examination. The key test, highly accurate at identifying ECI, involves six boxes appearing in a diamond formation on the screen, each containing a different, complicated shape. The shapes disappear and are then flashed up one by one on the screen - and I have to put each shape in the right box. Embarrassingly, it takes me several attempts. A second test involves circling as many petrol-station signs as possible on a map dense with other information within one minute, testing my ability to focus on a single task without being distracted by other data. Scores of 75 plus out of a possible 80 petrol stations are not uncommon. I manage to circle 60.

So, if I improve my memory, do I reduce my risk of Alzheimer's? It's all about retaining as much as possible of your hippocampus, the part of the limbic brain that controls memory, according to Professor David Smith, director of Optima. "While normal ageing shrinks the hippocampus by 1 per cent a year from the forties onwards, that loss becomes as much as 15 per cent for Alzheimer's sufferers."

But there's a significant difference. Normal ageing involves a steady loss of brain cells and a gradual slowing down of the ability to send messages from one bit of the brain to another. Alzheimer's is a distinct disease where massive cell damage occurs, disrupting verbal and visual memory, as well as the brain's ability to concentrate and communicate with itself.

Research in the US in the 1990s has shown that a good education and an active brain provide some protection against Alzheimer's by creating a "cognitive reserve", explains neuro-psychologist Dr Celeste de Jager. There's also evidence that a healthy lifestyle, avoiding both smoking and overdoing alcohol, can help, as can a sunny disposition - stress, depression and anxiety are all considered risk factors. The right genes can also help. And it's wise to avoid bangs on the head, high cholesterol and high blood pressure. But just as the healthiest people get cancer, so anyone can develop Alzheimer's, says Dr de Jager.

But some of the factors thought to trigger Alzheimer's may be reversible. Homocysteine is a naturally occurring enzyme that becomes toxic at high levels, normally as a result of a deficiency of folic acid and vitamin B12. It has been shown to be an independent risk factor for cardiovascular disease - and is suspected of being a cause of Alzheimer's. Researchers at Optima are about to embark on a major study to measure homocysteine levels of people with ECI and to find out whether B vitamins reverse the impairment.

My homocysteine levels (tested at Quest Diagnostics in London, where you need a doctor's referral) are slightly high, but my B vitamin levels are perfectly respectable. "I would say you are in average poor health," explains nutritionist Patrick Holford. "While high homocysteine levels normally only occur in people with low B vitamin levels, that's not always the case. We now know that one in 10 people inherits a gene (MTHFR) that reduces the body's ability to process homocysteine whatever the level of B vitamins." Though I have close relatives suffering both Alzheimer's and heart disease, I decide against being tested for the gene - though I do put myself on a high dose (50 mcg compared to the 2 mcg RDA) B-vitamin supplement that Holford says will bring down levels of homocysteine and also sharpen my mind.

With the jury still out over whether female sex hormones in HRT protect women against Alzheimer's, some evidence suggests that low testosterone levels in both sexes are associated with the disease - though it's not clear which comes first. Another recent study shows significant protection against Alzheimer's is from eating oily fish.

Finally, I find an unexpected snippet of research. Scientists in York have specifically identified tango dancing as reducing the risk of developing Alzheimer's disease by an astonishing 75 per cent - the same being true of playing chess or the piano. These activities, it seems, demand an unusual combination of multi-tasking, mixing mental and physical activities, thereby helping to maintain a robust hippocampus.

My results, back from CDR, show a graph roughly equally above and below the average for my age - "quite good considering you were tested for the first time," reassures Professor Wesnes. "In any case, the tests are a baseline: it's what happens in future that counts." So who knows what can be achieved? Watch this space in 20 years' time.

A free online one-off cognitive evaluation is available from CDR - log on to before the end of this month to take part

A longer version of this article appears in the November issue of 'Saga magazine', on sale now. To subscribe, ring 0800 056 1057