Can We Stop Dementia Before It Starts?

Few diseases invoke more fear in patients and families than dementia (e.g., Alzheimer’s Disease (AD), progressive multiple sclerosis, Pick’s Disease). Surveys have shown the fear of dementia—especially AD—far outweighs concerns of a diagnosis of cancer, stroke, or cardiovascular disease.

Perhaps this fear arises from two concerns: (1) dementia robs us of what makes us human—memory, reasoning, emotions, language—and (2) in most cases there are no effective treatments to cure or palliate the disease. While diagnostics for certain forms of dementia are progressing—allowing us to sort out the reversible causes of dementia, such as hydrocephalus, electrolyte or blood sugar imbalances, brain tumors, and brain injuries—once the diagnosis of AD or Pick’s disease is made, there is little we can do aside from manage the comfort and safety of the patient and family.

What if we could prevent or delay dementia?

In the mid-1960s, the incidence of heart attacks and stroke were increasing at an alarming rate. Great strides were made in treating existing cardiovascular disease, followed by programs at preventing the disease in the first place. These prevention methods included exercise, diet, and the tracking of key incidence indicators such as blood pressure, body mass index, and cholesterol levels to maintain a quantifiable physical health.

Could we use similar prevention methods for preventing or delaying dementia?

While there are many resources available online for mental exercises—such as mental challenges like crossword puzzles, introducing novelties in the environment, and adult education—how do we know if these mental exercises work? Discussing mental resilience is tantalizing, but how much mental capacity do we need . . . and how long will it last?

What do you think? What are some good measuring sticks to quantify our mental state? Are existing measures of language, memory, perception, emotions, and cognitive skills suitable to allow comparison of a control group with an experimental arm? Are these measures suitable for comparing across experiments? How precise do we need to be?

We certainly have measures for identifying and quantifying protocols to prevent cardiovascular disease. What about Alzheimer’s Disease?

This post first appeared at rwjf.org.

5 replies »

  1. The best preventions for dementia are the simplest- lots of physical and mental activity, sensible diet, and good management of accompanying medical problems like hypertension, heart disease, and diabetes. Unfortunately, It will be years before there is a battery of accurate laboratory tests to predict who will later become demented and it will probably be decades before there is any effective treatment. Don’t run out and have your brain scanned until tests have proven themselves and are approved. Even then it is probably not a great idea to be tested- why find out you may someday become demented if you can’t do anything about it.

  2. As someone with more than a novice’s understanding of Alzheimer’s, this is a profoundly banal and misleading blog. Two main points:

    1) Although not a perfect analogy, the health of brain is somewhat similar to the health of the cardiovascular system; that is, someone with cardiovascular problems is more likely to be at risk for a disease like Alzheimer’s. With the increasing prevalence of hypertension and diabetes, this would seem to be a problem, although incidence forecasts of Alzheimer’s may be too much by magnitudes if those on statins and other drugs actually help out like we thing.

    2) Brain puzzles? I thought we through out that research years ago. Exercise and diet have shown substantially more promise in helping to keep the brain healthy rather than training a particular mental skill as puzzles do.

    3) Finally, no mention of recent trials that have shown potential promise in staving off Alzheimer’s; that is, the bulk of Alzheimer’s research is turning to prevention rather than necessarily treating those who are already down the road.

    This article seems to be eons behind the latest developments.

  3. I’m going to answer your questions with a question of my own.

    Are we seeing diagnosis patterns with alzheimer’s and dementia comparable to what we’ve seen in other areas ?

    The recent raging epidemics of asthma, autism and other developmental conditions, hypertension, obesity (insert your disease here) that have broken out in this country have been driven, at least in part, by diagnosis patterns caused by generational shifts in mainstream thinking.

    Alzheimers and dementia are a little different.

    Nobody would deny that the US is undergoing a demographic transformation that will push us to the edge of another dangerous cliff, as the numbers of people reaching Medicare age spike.

    Does anybody have a sense of what is happening here?