Healing Center

Learn About Alzheimer's Disease

What is Alzheimer's Disease?
Key Symptoms
What Causes Alzheimer's Disease?
Conventional Treatments
Medications
Tests and Procedures
Treatment and Prevention
How Supplements Can Help
Self-Care Remedies
Alternative Therapies
When to Call a Doctor
References
Evidence Based Rating Scale

What is Alzheimer's Disease?

Named for the German physician who first described it over a century ago, Alzheimer's disease is a progressive, degenerative, and fatal brain disorder. It is the most common form of dementia, which is a general term for the loss of memory and other intellectual abilities that interferes with daily life. Alzheimer's affects 5.3 million Americans and is the sixth leading cause of death in this country according to a 2009 report from the Alzheimer's Association. (1) In time it severely impairs memory and mental functioning, with devastating consequences for both patients and caregivers. Patients are usually over age 65 (and more likely to be in their seventies or eighties), but younger-onset Alzheimer's can occur.

The symptoms of Alzheimer's appear very slowly at first, with patients experiencing what can be mistaken for the usual forgetfulness associated with old age. Difficulty making decisions is another early symptom. As the disease progresses, however, memory loss accelerates, and patients may forget how to perform very simple tasks such as dressing and bathing. Increasingly disoriented, they tend to get lost in familiar places and fail to recognize friends and family. People with Alzheimer's often undergo personality changes, becoming hostile, anxious or withdrawn, and may display inappropriate social behavior.

In its advanced stages, the disease produces severe language impairment, loss of bowel and bladder control, and mental deterioration so great that patients become completely dependent on caregivers 24 hours a day. Alzheimer's patients die, on average, within 4-6 years of diagnosis of the disease. (2)

It is estimated that Alzheimer's affects about 13% of people over age 65. Although more women than men have Alzheimer's (16% of women and 11% of men aged 71 and older), this is probably due to the fact that women outlive men on the average and is not a gender issue.(2) The disease is neither curable nor preventable, and there are no diagnostic tests that specifically identify it. The diagnosis is made on the basis of patient history and clinical examination. Brain scans and lab tests are done to help rule out other possible causes of memory loss and dementia.

The prescription drugs tacrine, galantamine, and rivastigmine, ease symptoms to a degree in some patients with mild to moderate Alzheimer's. The FDA has approved memantine for treatment of moderate to severe symptoms and donepezil for treatment in all stages of Alzheimer's. (1) Certain supplements, particularly huperzine A, may also help improve mental functioning in the early stages of the disease. (1)

Because Alzheimer's disease, especially in its later stages, takes such a heavy toll on caregivers, anyone responsible for the care of an Alzheimer's patient should seek ways to ease the inevitable burden. Counseling, support groups, day-care services, visiting nurses and nursing homes are among the available options. (1)

Key Symptoms

The Alzheimer's Association is the primary voluntary health organization for Alzheimer's research, support, and care. They define seven stages of the disease based on symptom progression.

Stage 1â€”No impairment (Normal function). Individuals do not experience any memory problems nor exhibit any problems

Stage 2â€”Very mild cognitive decline (May be normal age-related signs or very early Alzheimer's symptoms). Individuals may sometimes forget familiar words or locations of familiar objects but show no signs to family, friends, co-workers, or health professionals.

Stage 3â€”Mild cognitive decline (Early-stage Alzheimer's can be diagnosed in some but not all individuals). Those close to the patient begin to notice changes in memory and concentration, which may also be measured during clinical tests and a medical interview. Symptoms in this stage include:

Problems with name or word finding that are noticeable to family and close associates
Decreased ability to remember people's names when introduced
Difficulty with social and work performance which is noticeable to family and close associates
Difficulty planning or organizing
Inability to retain information once something has been read

Stage 4â€”Moderate cognitive decline (Mild or early-stage Alzheimer's). At this stage, an interview with a healthcare professional recognizes clear-cut deficiencies including:

Inability to recall recent events or occasions
Difficulty performing challenging mental arithmetic such as counting back from 75 by 7's
Decreased ability to perform complex tasks such as managing finances or planning dinner for guests
Appearing withdrawn in mentally or socially challenging situations
Decreasing memory of personal history

Stage 5â€”Moderately severe cognitive decline (Moderate or mid-stage Alzheimer's). Individuals begin to experience major gaps in memory and cognitive function and require assistance with some day-to-day functions. They may experience:

Inability to remember important details such as their phone number or address during a medical interview
Confusion about their location, the date, or season
Problems with easy arithmetic such as counting backwards from 20 in 2's
No loss of memory concerning their own name or the names of spouse and children
No need for assistance with eating or using the bathroom but may require help in choosing the proper clothing for the occasion or season

Stage 6â€”Severe cognitive decline (Moderately severe or mid-stage Alzheimer's). Individuals experience increased difficulty with memory and significant personality changes begin to occur. They need help with daily activities. Symptoms include:

Loss of awareness of surroundings and most recent events
Ability to remember their name but unable to perfectly remember personal history
Ability to distinguish familiar faces from unfamiliar but sometimes forget name of spouse or primary caregiver
Disruption of normal sleep/wake cycle
Changes in temperament, characterized by anxiety, agitation, hostility, withdrawal, indifference to others, depression or displays of inappropriate social behavior
Inability to perform such basic tasks as bathing, dressing, eating or using the bathroom without assistance.
Loss of bowel and bladder control
Delusions, paranoia and unfounded accusations
Tendency to wander and become lost

Stage 7â€”Very severe cognitive decline (Severe or late-stage Alzheimer's). Individuals are in the final stage of the disease. They lose the ability to speak recognizably and require eating and bathroom assistance. Eventually, they acquire abnormal reflexes, they are unable to respond to their environment or control their movements, and their swallowing ability is impaired. (1)

What Causes Alzheimer's Disease?

The cause of Alzheimer's remains unknown. What is known is that the brain of Alzheimer's patients suffers a severe loss of nerve cells It is widely believed that abnormal structures in the brain known as amyloid plaques and tangles play a role in damaging nerve cells. Amyloid plaques are insoluble protein deposits that develop in the areas of the brain that control memory and other cognitive functions. However, researchers are not sure if amyloid plaques actually cause Alzheimer's or if they are by-products of the disease. Tangles are abnormally twisted protein strands that disrupt communication between neurons. This disruption leads to neuron death, which is a defining feature of Alzheimer's. Other factors that may play a role in memory loss and possibly in the development of Alzheimer's include a deficiency in certain memory-enhancing brain chemicals, decreased blood flow in the brain, a series of small strokes, cardiovascular disease, serious head injury, and slow-acting viruses. A family history of Alzheimer's may increase an individual's risk of developing the disease.

Animal studies and autopsies of human brains are providing strong evidence for a theory that Alzheimer's is a form of diabetes mellitus that selectively affects the brain. The insulin impairment seen in animal studies supports references to Alzheimer's as "type 3 diabetes mellitus." (3) In one study, treatment of Alzheimer's-induced rats with anti-diabetic drugs restored brain insulin receptor-binding. (3) A clinical study in humans showed cognitive improvement in early-stage Alzheimer's when treated with intranasal insulin. (4) A 2009 animal study concluded environmental and food exposure to nitrosamines in conjunction with a high-fat diet may promote the onset of insulin-resistant Alzheimer's neurodegeneration. (5) Some foods that contain nitrosamines include: cured meats such as bacon and lunch meats, beer, some cheeses, some fish, and non-fat dry milk. Sodium nitrite used as a preservative on the package label is a good indication that nitrosamines are likely to be present. (34)

Conventional Treatments

Since there is no cure for Alzheimer's, the primary goal of treatment is to improve functioning, decrease symptoms, and delay the progression of the disease. Delaying the onset of Alzheimer's decreases the length of time individuals have reduced quality of life and reduces healthcare costs for the disease. If onset is delayed by just one year, in ten years there would be 210,000 fewer people with the disease amounting to savings in healthcare related costs of approximately $10 billion.

Conventional treatments for Alzheimer's are based on theories about the causes of cognitive impairments. Generally, healthcare professionals divide the symptoms of the disease into two categories: cognitive and behavioral/psychiatric.

Cognitive symptoms affect an individual's memory, judgment, language, organization, and other thought processes. These symptoms are treated with prescription drugs and supplements.

Behavioral and psychiatric symptoms affect the way an individual feels and acts. Common symptoms include delusions, hallucinations, physical and verbal outbursts, restlessness, and overall emotional upset. Behavioral and psychiatric symptoms are first treated using non-drug strategies to try to minimize symptoms. For Alzheimer's patients, behavioral outbursts are often a response to environmental changes. Life events such as moving to a new residence, changing caregivers, or being asked to bathe or change clothes may increase the individual's sense of fear and confusion and lead to an unfavorable response. These responses can be minimized by:

Creating a calm environment with minimal noise, glare, and distractions.
Monitoring personal comfort by checking for pain, hunger, thirst, illness, and fatigue and maintaining a comfortable room temperature.
Avoiding confrontation and arguments about facts; instead, responding to the feelings behind impossible desires or trying to redirect the patient's attention
Being flexible, patient, and supportive.
Providing a safe environment by using safety locks if needed. (1)

If consistent use of such approaches fails to minimize symptoms, medication may be appropriate for severe symptoms or to protect individuals from hurting themselves. A number of anxiolytic, antipsychotic, and antidepressant medications are commonly used to treat the behavioral and psychiatric symptoms of Alzheimer's. (1)

Medications

Four different types of conventional medicines are used to treat the cognitive symptoms of Alzheimer's: cholinergic agents, N-methyl-d-aspartate (NMDA) inhibitors, antioxidants, and anti-inflammatory agents.

Cholinergic agents. Typically, Alzheimer's patients have a significant deficiency of the enzyme necessary for synthesizing acetylcholine, a neurotransmitter that has been associated with the memory deficits seen in Alzheimer's. Cholinesterase inhibitors such as donepezil (Aricept), rivastigmine (Exelon), tacrine (Cognex), and galantamine (Razadyne) prevent the breakdown of acetylcholine and help to keep levels high. On average, these drugs delay progression of symptoms for 6-12 months in half of patients who take them. (6)

NMDA inhibitors. In normal cell communication, NMDA receptors are activated when they bind with the neurotransmitter glutamate. The NMDA channel opens and is receptive to receiving calcium, which is necessary for learning and memory. However, too much calcium causes excitotoxicity, which leads to the neuronal cell death seen in Alzheimer's patients. Memantine (Namenda) helps to regulate the activity of glutamate and, thus, the influx of calcium. It is the only NMDA inhibitor approved by the FDA for the treatment of Alzheimer's. Memantine delays symptoms temporarily in some patients similar to the cholinesterase inhibitors. (1, 7-8)

Antioxidants. Antioxidants protect the body against free radicals, which can damage cells. The antioxidant selegiline (Eldepryl) has been shown to improve mild cognitive impairment in Alzheimer's patients by protecting neurons. (9, 10)

Anti-inflammatory agents. The neurodegeneration of Alzheimer's is associated with the activation of microglia cells which drive inflammation and that is believed to be detrimental to neurons. Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin improve cognitive symptoms. (9, 11)

Tests and Procedures

With Alzheimer's, early diagnosis is key to having more treatment options and more time to make choices in order to maximize quality of life. If you have concerns about memory loss or other cognitive impairment for yourself or for someone close to you, the first step is to locate a doctor with whom you feel comfortable and who is well-informed about Alzheimer's. Since there is no single type of physician specializing in the diagnosis and treatment of Alzheimer's, your primary care physician may sometimes refer you to a psychiatrist, psychologist, or neurologist. (1)

There is no single test that confirms Alzheimer's. Home-screening tests for dementia should not be substituted for a thorough doctor's exam. Physicians can almost always diagnose dementia, but it may be harder to determine the exact cause. Patients should be prepared to report on:

What symptoms have been noticed?
When did the symptoms begin?
How often do the symptoms occur?
Are the symptoms worse now than when they were first noticed?
Diet and alcohol consumption
Use of all medications and supplements (bring a list)

The physician will also want to know about the patient's past medical history and about the medical history of family members (both living and deceased), especially those with Alzheimer's or other related disorders. (1)

In order to assess mental function, the most popular test used by physicians is the mini-mental state examination (MMSE). With this test, physicians ask a series of questions designed to test a range of everyday functions. Some of the questions include:

State the season, day, date, year
Given the name of three common objects, remember and repeat them in a few minutes
Count backwards from 100 in 7's or spell a word backwards
Give the address of this office
Name two familiar objects in this office when pointed out
When prompted, repeat a common phrase immediately after it was said

The maximum score on the MMSE is 30 points. A score of 20-24 indicates mild dementia, 13-20 indicates moderate dementia, and below 12 indicates severe dementia. The MMSE score in Alzheimer's patients declines about 2-4 points per year on average. (1)

Another test for mental function is the mini-cog test, which involves two steps:

Remembering and repeating the names of three common objects within a few minutes
Drawing a clock with all twelve numbers in the right place that represent a time specified by the examiner. (1)

During the physical exam, the physician will:

Check vital signs and listen to the heart and lungs
Perform a neurological exam that may include checking reflexes; coordination and balance; muscle tone and strength; eye movement; speech; and sensation (1)
Collect blood and urine samples.

In addition to the physical tests, diagnostic imaging tests are often performed. Structural imaging tests such as magnetic resonance imaging (MRI) and computed tomography (CT) give information about the shape, position, or volume of brain tissue. Functional imaging tests such as positron emission tomography (PET) and functional MRI (fMRI) show how well brain cells are working based on how actively the cells use sugar and oxygen. (1)

Treatment and Prevention

Although strides continue to be made in the treatment of Alzheimer's symptoms, the disease cannot be cured or prevented and, after a certain point, its symptoms are irreversible. However, in the early stages of the disease, nutritional supplements may help reverse some mental impairment and perhaps even postpone the development of more severe symptoms.

Start taking supplements, singly or in combination, as soon as Alzheimer's is even suspected. It's safe to take the recommended supplements with the prescription Alzheimer's drugs tacrine and donepezil, but consult your doctor before you do so. If you have a serious medical condition or are taking medication, it is always a good idea to check with your doctor before beginning a supplement program.

How Supplements Can Help

The herb Ginkgo biloba is a key supplement in the treatment of early Alzheimer's symptoms. By increasing the blood supply to the brain, Ginkgo biloba may help improve memory in some patients. The herb also seems to have antioxidant properties, which help keep nerve cells healthy. (9, 12, 13)

A compound derived from Chinese club moss, huperzine A, has been shown in clinical studies to improve memory deficits in patients with Alzheimer's without the toxicity of tacrine. (14). Huperzine A has properties similar to approved cholinesterase inhibitors. In fact, it has better penetration of the blood-brain barrier and longer cholinesterase inhibitory action than donepezil, tacrine, and rivastigmine. (1, 14) However, Huperzine A should not be used with prescription cholinesterase inhibitors. (15)

Vinpocetine, a substance derived from the periwinkle plant, has been shown in animal studies to reduce the number of neuron deaths. (16) There is some evidence from small, short-term studies that vinpocetine improves mental functioning and memory in Alzheimer's patients. (17, 18)

In animal studies, supplementation with vitamins C and E improved cognitive behavior. (19) Low levels of these vitamins and carotenoids have been seen in Alzheimer's patients, but evidence is lacking to demonstrate that supplementation in humans prevents Alzheimer's or significantly improves cognitive symptoms. However, antioxidants improve oxidative stress, which has been linked to Alzheimer's. (20-24) Animal studies also suggest that the antioxidant properties of coenzyme Q10 may slow the progression of Alzheimer's, but human studies have not been performed in Alzheimer's patients. (25, 26)

Also take a vitamin B complex. Although not the cause of Alzheimer's disease, low levels of B vitamins have occasionally been found in patients who have Alzheimer's. Vitamin B12 and folate lower blood levels of homocysteine, elevated levels of which have been noted in Alzheimer's patients. (27) A 2009 pilot study indicated vitamin B12 may benefit patients with mild to moderate Alzheimer's; large, long-term studies are needed. (28)

Animal studies indicate the antioxidant herb gotu kola may slow the neurodegenerative effects of Alzheimer's. (29, 30) In addition, gotu kola may reduce fatigue and depression, as well as stimulate the central nervous system. Siberian ginseng may help improve memory in patients with early Alzheimer's by fostering better transmission of nerve impulses. A recent small study found Siberian ginseng improved mental functioning in the elderly after only four weeks of supplementation. (31)

Animal studies show promise with other supplements. A 2009 study showed supplementation with l-carnitine improved spatial memory retention impairment in rats. (36) A study of mice supplemented with phosphatidylserine (PS) in combination with alpha-lipoic acid, l-carnitine, glycerophosphocholine, and docosahexaenoic acid (DHA) indicated decreased oxidative stress in 57% of the mice. (37) Animal studies using carnosine indicate the supplement may prevent cell damage. (44, 45) Fish oils may help slow the cognitive decline of Alzheimer's. In animal models, specifically the DHA found in fish oil may help to protect the brain from the accumulation of beta amyloid plaques that accompany mental decline in Alzheimer's (46). In human studies, including omega-3 fatty acids as a part of an integrative treatment program slowed cognitive decline for 24 months (47). See the WholeHealthMD entries on these substances for more information.

Zinc is involved in numerous enzymatic processes related to DNA function and cell replication as well as in helping to normalize immune defects. It is known to be poorly absorbed with aging and early work suggested that it might be helpful in Alzheimer's disease. However, studies with zinc indicate the metal may have a dual role: it may initiate the formation of amyloid plaques then become involved in the mechanism of reducing the oxidative stress cause by the plaques. More studies are needed to determine if zinc supplementation is beneficial or harmful to Alzheimer's. (48) Zinc and copper have to be in balance for optimal function, and they are often supplemented together. However, in recent studies with copper supplements, the metal had no effect on the progression of Alzheimer's disease. (49)

Self-Care Remedies

Exercise regularly, although supervision may be needed if the person becomes disoriented with the surroundings. Even if it's only taking a short daily walk, exercise helps improve both mental and physical functioning. Exercises that increase blood flow to the brain and require concentration and balance such as Yoga or Tai Chi, may be even more beneficial. A dance therapy study comparing five patients with moderate Alzheimer's with five patients suffering from depression found that the AD patients actually did better in learning new waltz steps (procedural learning) than did the depressed patients. (38) Movement learning apparently happens in areas of the brain less affected by AD.

Keep the mind stimulated by reading, doing memory exercises and playing games.

Try to stay as calm and relaxed as possible. This will help minimize the agitation that interferes with concentration and may even improve memory.

Seek outside help and advice. Alzheimer's disease support groups and the Alzheimer Disease Foundation are good sources for information about caring for a person with this ailment. (1)

Since some prescription drugs can cause mental confusion, especially in older people, speak with your doctor about this issue, and ask to have all medications periodically reviewed. Medications used to treat anxiety, depression, diabetes, ulcers or Parkinson's disease are common culprits.

Alternative Therapies

Metals such as copper, zinc, iron, and aluminum have been found in the brain tissue of Alzheimer's patients and are believed to induce free radical formation. Chelation therapy targets these metals for removal from the body and may be effective in treating the neurodegenerative effects of Alzheimer's. However, some chelators have adverse effects; studies are being done to find safe and effective chelators for Alzheimer's. (32, 33)

When to Call a Doctor

Consult a doctor if you or a family member shows signs of increasing memory loss, becomes disoriented in a familiar place, or exhibits unexplained behavioral changes. (1)

References

1. Alzheimer's Association website. Available at http://www.alz.org/index.asp. Accessed January 6, 2010.
2.2009 Alzheimer's Disease Fac

Supplement Recommendations for Alzheimer's Disease

From Joyce Frye, DO/MBA/MSCE at WholeHealthMD:

I know this list looks formidable. And it's a lot of pills to take every day, especially for someone with Alzheimer's. But we do have evidence in medical literature that certain nutritional supplements can slow the deterioration of the disease. Since Alzheimer's is incurable, they're certainly worth trying.

How to Take the Supplements

I suggest simply initiating as much of this supplement program as you can afford and staying on it indefinitely. Ask your physician to perform a mental-status evaluation periodically to determine if the deterioration is indeed slowing and the program is working.

Make sure you're taking a basic daily high-potency vitamin, and 1,000 mg of C and 400 IU of E. In addition, you'll need additional antioxidant protection from an antioxidant complex that provides not only more C and E, but 25,000 IU of vitamin A activity a day. These extra antioxidants, in combination the energy enhancer coenzyme Q10, block the degeneration caused by free radicals.

Extra vitamin B complex and essential fatty acids (found in such substances as evening primrose oil) help to maintain the health of the nervous system.

The herbs ginkgo biloba and huperzine A have both been shown to slow progression of Alzheimer's, especially when combined with the conventional drug Tacrine. Although less well studied in Alzheimer patients, the supplement vinpocetine, derived from the periwinkle plant, also has been shown to enhance mental function.

The amino acid-like nutrients phosphatidylserine and acetyl-L-carnitine are expensive, but both have been shown to enhance memory function in Alzheimer's patients and people who don't have Alzheimer's but demonstrate mild everyday forgetfulness.

Adding borage oil or evening primrose oil and the herbs gotu kola and Siberian ginseng may benefit Alzheimer's patients by improving the transmission of nerve impulses.

For special consideration:

The gentle natural tranquilizing herb kava may be able to relieve agitation in an Alzheimer's patient without having to resort to prescription tranquilizers, which may increase mental confusion. Kava is neither sedating nor habit forming and it's virtually free of side effects. However, don't use kava in combination with prescription tranquilizers and sedatives.

Multivitamins Alzheimer's Disease

The Right Multivitamin

Women, men, those over 50, those with chronic illness, and vegetarians have special needs to consider when choosing a multivitamin. Review your special needs below.

Why Everyone should be Taking a Multivitamin

There's nothing like a sound, low-fat diet full of fruits, vegetables, and whole grains to supply the vitamins and minerals we need to stay healthy. Unfortunately, we don't always eat well. Add to that the possible harmful effects of stress, aging, lack of exercise, pollution and illness, and supplements become even more important. That's why so many experts now recommend that everyone take a daily multivitamin.

The Right Choice: See Our Multivitamin Chart

This chart outlines the key vitamins and minerals your multivitamin should supply and the main benefits of each nutrient. It also gives what's called the daily value (DV) - a new government standard that generally corresponds to the RDA. The DV satisfies minimum daily requirements and helps prevent a deficiency disease, such as scurvy (lack of vitamin C). The higher levels of vitamins and minerals found in many multivitamins may actually help prevent disease, delay its onset or even lessen the severity of certain ailments.

Good Reason to Take an extra-strength Formula

If you eat an optimal diet of low-fat foods, at least five servings of fruits and vegetables daily, and chicken, lean meat, or fish several times a week, you can probably get away with a once-daily formula. But even those who consume a fairly well rounded diet and yield to junk-food lapses only occasionally can benefit from an extra-strength formula. If your idea of lunch is a slice of pizza and a diet soda, look for a multivitamin in the upper ranges of our chart.


		*•Read the label carefully* to see what you're getting. Many "high-potency" formulas provide only extra amounts of the less-expensive ingredients. •Don't pay more for "timed- released" or "related" products. They're not worth the extra cost. *• Check the serving size.* You may need to swallow up to six extra-strength pills a day to get the amounts listed on the label. *•Don't double up on one-a-days* You'll be getting too much of certain nutrients, and not enough of others. If you want an extra-strength formula, buy one. *• Avoid mega doses* that greatly exceed the upper doses listed in our chart, especially with fat-soluble vitamins A, D, E, and K; the minerals iron and selenium; or when taking any supplements long term. Be sure to account for any vitamins and minerals you may also be taking as individual supplements or as part of an herbal formula.

Finding the Right Multivitamin for You

Vitamins	Main Benefits	DV	One-A-Day	Extra-Strength
Vitamin A	Fights infections; maintains eye and skin health. May be supplied in part as beta-carotene, which may lower the risk of cancer and heart disease and boost immunity. Pregnant women should not take more than 5,000 IU of vitamin A daily, but higher doses of beta-carotene are safe.	5,000 IU	5,000 IU	5,000-10,000 IU (up to 25,000 IU as beta-carotene
Vitamin C	Fights colds; may help prevent cancer, heart disease, cataracts. If your formula doesn't supply at least 500 mg, consider taking an extra supplement.	60 mg	60-100 mg	100-1,000 mg (up to 25,000 IU as beta-carotene
Vitamin D	Promotes healthy bones and teeth; may protect against cancer.Adults may be deficient even with the usual doses of 400IU in multivitamins. Those over 50 should get at least 1000 IU and those over 70 may need at least 2000 IU of Vitamin D3. Avoid daily doses exceeding 10,000 IU, which may be toxic.	400 IU	200-400 IU	may need an additional 1000IU above what is in the multivitamin. Get a Vit D blood test to determine your needs.
Vitamin E	May help prevent cancer, heart disease, and cataracts. Everyone should get at least 200 IU daily. Avoid doses above 1,200 IU, which can cause headaches.	30 IU	30-100 IU	100-400 IU
Thiamin (B₁)	Aids energy production; promotes nerve and heart health.	1.5 mg	1.5-25 mg	25-100 mg
Riboflavin (B₂)	May prevent cataracts and migraines; helps heal rosacea.	1.7 mg	1.7-25 mg	25-100
Niacin (B₂)	Helps lower cholesterol and improve circulation; fosters healthy nerve cells.	20 mg	20-25 mg	25-100 mg
Vitamin (B₆)	May prevent heart disease and stroke; maintains nervous system health. Avoid taking more than 200 mg on a daily basis.	2 mg	2-25 mg	25-100 mg
Folic acid	Prevents birth defects, heart disease, possibly some cancers. Pregnant women and women planning to become pregnant should get at least 600 mcg daily.	400 mcg	400 mcg	400-800 mcg
Vitamin (B₁₂)	Promotes nerve health; prevents heart disease. People over 50 and vegetarians should look for formulas that supply at least 100 mcg.	400 mcg	400 mcg	50-400 mcg
Vitamin K	Promotes blood clotting; helps strengthen bones.	80 mcg	0-80 mcg	60-300 mcg
Biotin	Promotes healthy nails, hair, and nerves.	300 mcg	0-100 mcg	100-300 mcg
Pantothenic acid B(₅)	Strengthens nerves; promotes energy metabolism.	300 mcg	0-100 mcg	25-100 mcg
Minerals
Boron	Builds strong bones, teeth, and nails.	*	0-50 mcg	50 mcg-2 mg
Calcium	Prevents or slows osteoporosis. Women of all ages and men over 50 need at least 1,200 mg daily. A separate supplement is probably necessary. Avoid daily doses of 2,500 mg or higher.	1,000 mg	0-25 mg	25-400 mg
Chromium	Maintains healthy blood sugar levels;helps break down fats.	120 mcg	0-100 mcg	100-200 mcg
Copper	Prevents cardiovascular disease; maintains bones, tendons, and nerves.	2 mg	1-2 mg	1-2 mg
Iron	Prevents anemia in younger women. Men and postmenopausal women should opt for iron-free formulas. Vegetarians who avoid all animal products and women with heavy periods should get at least 18 mg a day. Don't exceed 65 mg daily.	18 mg	0-18 mg	0 -18 mg
Magnesium	Protects against heart disease; may ease asthma and diabetes.	400 mg	100-200 mg	200-400 mg
Manganes	Strengthens bones; may be good for the heart and prevent seizures.	2 mg	2-5 mg	5-10 mg
Molybdenum	Helps the body use iron and burn fats.	75 mcg	25-65 mcg	65-100 mcg
Potasssium	May help prevent high blood pressure, heart disease, and stroke.	3,500 mg	5-100 mg	5-100 mg
Selenium	Helps prevent cancer, heart disease, cataracts, and macular degeneration; fights cold sores and shingles. Get at least 100 mcg a day, but avoid daily doses above 900 mcg, which can be dangerous.	70 mcg	0-100 mcg	100-200 mcg
Vanadium	Builds bones; may aid people with diabetes.	*	0-25 mcg	25-50 mcg
Zinc	May cure colds, relieve prostrate complaints, and slow macular degeneration. Vegetarians who avoid all animal products, including dairy and eggs, should aim to get 30 mg. Don't exceed 60 mg daily, which can be harmful.	15 mg	15 mg	15-30 mg

Special Needs

Women

of all ages need at least 1,200 mg of calcium daily, through supplements or diet, to slow bone loss. Most multivitamins don't supply this much: A separate calcium supplement is probably your best bet. Younger women, especially those with heavy menstrual periods, need plenty of iron (18 mg a day ). Those considering pregnancy should get extra folic acid and avoid high-dose vitamin A. Special "women's formulas" may contain expensive herbs you may not need.

Men

should avoid multivitamins containing iron: Iron build-up has been linked to heart disease. Be wary of "men's formulas that tout ingredients like saw palmetto for prostate complaints. Many of these high-profile "extras" are present in such small amounts that they provide little or no therapeutic benefit.

Over 50,

opt for iron-free formulas: Too much of the mineral can cause heart problems. Look for vitamins B₆ and B₁₂ in the higher ranges, because as people age, they often have trouble absorbing these nutrients. Older women and men can benefit from the bone-strengthening effects of extra calcium (1,200 mg a day) and vitamin D (400 to 600 IU a day).

Chronic Illness

can lead to poor eating habits or deplete nutrient stores. Extra-strength formulas are especially important if you suffer from a long-term digestive ailment or have liver or gallbladder problems. Consult your doctor before taking supplements.

Vegetarians

who avoid all animal foods, including dairy and egg products, need at least 100 mcg daily of vitamin B₁₂. Zinc, iron and calcium are also very important minerals for strict vegetarians.

Doctor's Bio

Alzheimer's Disease

An Overview from Joyce Frye, DO/MBA/MSCE

The whole world awaits a cure for Alzheimer's disease. The irony is that the worse the condition gets, the easier it becomes emotionally for the pati...more

Supplements We Recommend

Learn about natural remedies for your Alzheimer's Disease
WholeHealthMD doctors recommend specific vitamins, herbs, and nutritional supplements --with dosages, how-to take instructions, and other tips.

Find the right multivitamin
Virtually everyone can benefit from a daily high-potency multivitamin. Let us help you choose the best formula.

News & Perspectives

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Our experts give you their take on the latest treatments, controversies, and developments for Alzheimer's Disease.

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