The Alzheimer’s Association recently reported the staggering estimate that Americans are paying $200 billion dollars a year for the care of 5 million Alzheimer’s victims, whose Medicare payments are almost three times those of older adults without dementia. One out of every seven Alzheimer’s patients, an estimated 800,000, lives alone—a frightening number considering they are unable to care for themselves and pose threats to themselves and others.
As age is the greatest risk factor for developing Alzheimer’s, these numbers are only going to get worse. Advances in medical technology have extended life expectancy, but what good are those added years when they only make us more likely to experience cognitive losses? Every 70 seconds, another American is diagnosed with Alzheimer’s. This illness robs people of their minds as tiny protein fibers—amyloid plaques and tau tangles—accumulate in brain areas controlling memory, language, judgment, thinking and behavior, and eventually leading to dementia.
President Obama has responded to this crisis by signing the National Alzheimer’s Project Act (NAPA) to accelerate research, education and caregiving efforts. A panel of experts will develop the first comprehensive plan by the Department of Health and Human Services that should help fight the disease more effectively, but pieces of this plan are missing—no one knows how we will pay for the initiative or where we will set priorities. Currently, only about $500 million goes to Alzheimer’s disease research, compared with the $6 billion the National Institutes of Health (NIH) spends on cancer and the $4 billion spent on heart disease each year.
Progress, but No Cure
Despite modest funding, scientists have made considerable progress. Doctors can now diagnose the disease earlier and differentiate it from other causes of mental impairment, such as drug toxicity, depression or medical illness, as well as common memory slips people begin experiencing as early as age 45. There are drugs that temporarily improve cognitive and behavioral symptoms of dementia, but no cure yet exists. Early detection methods allow for testing of novel treatments, even when symptoms are mild.
The goal of many studies, including my own, is to develop brain scans and other biomarkers that can detect the disease years before dementia develops, so people at risk could then be treated with preventive drugs or vaccines that would protect a healthy brain rather than attempt to repair damaged brain cells. The Food and Drug Administration (FDA) is considering a new brain positron emission tomography method for this purpose; but with recent disappointing drug development results, a biomarker without an effective treatment has limited applications.
Act Now to Prevent Alzheimer’s
Although the NAPA calls for research and education, it makes no mention of encouraging people at risk (that group includes everyone—if they live long enough) to adopt healthy lifestyle habits that might delay onset of Alzheimer’s symptoms. Many studies have demonstrated that exercise, mental stimulation, healthy diet and other lifestyle factors are associated with a lower risk for Alzheimer’s and a delay in symptom onset. Although the Agency for Healthcare Research and Quality commissioned a panel to review available evidence, this NIH panel found insufficient evidence to draw firm conclusions connecting such modifiable factors and risk for Alzheimer’s disease.
Definitively proving the effectiveness of Alzheimer’s prevention strategies would require years of double-blind studies. But evidence from current epidemiological studies and short-term clinical trials has already detailed what we can do now to delay the onset of symptoms. These studies suggest that people may be able to stave off cognitive decline that leads to Alzheimer’s dementia by as many as four years or more. For some individuals, that could mean preventing the disease entirely.
The medical community accepts physical exercise and healthy diet—two brain health strategies—as proven methods to prevent diabetes. A recent Japanese study showed that diabetes doubles the risk for Alzheimer’s disease. Thus, lifestyle strategies that prevent diabetes would also be expected to lower the probability of developing Alzheimer’s. University of California, San Francisco, scientists concluded that up to half of Alzheimer’s cases are potentially attributable to risk factors under our control.
Available evidence linking healthy lifestyle and reduced Alzheimer’s risk does not meet FDA standards for clearing a new drug, but these lifestyle behaviors pose no health risks and have shown short-term physical and mental health benefits. While doctors, scientists and policymakers work to detail the NAPA plan and Alzheimer’s prevention trials continue, there’s no reason to sit around and delay beginning a healthy lifestyle to protect our brains, improve our quality of life and reap immediate benefits in memory and health.
Gary Small, M.D., professor of psychiatry and aging at UCLA’s Semel Institute for Neuroscience & Human Behavior, is director of UCLA’s Longevity Center and co-author of The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life (Workman, 2011).
Editor’s Note: This article appears in the May/June, 2012, issue of Aging Today, ASA’s bi-monthly newspaper covering issues in aging research, practice and policy nationwide. ASA members receive Aging Today as a member benefit; non-members may purchase subscriptions at our online store.
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