Jan 3, 2012
The Future of Preventive Brain Medicine: Breaking Down the Cognition & Alzheimer’s Disease Alphabet Soup
As the president and medical director of the Alzheimer’s Research and Prevention Foundation (ARPF), it’s my job to stay on top of advances in the field of Alzheimer’s research. Recently, a number of articles in the medical literature have caught my attention. They are focused on a particular question that concerns most Baby Boomers like me: “Is memory loss just a normal part of aging?”
Many of my patients in their fifties, sixties, and older notice that they occasionally forget things like a name, face, or where they put their keys. They wonder whether this behavior is normal, or if it is a sign of Alzheimer’s disease. It’s a reasonable worry: Alzheimer’s disease is reaching epidemic proportions and recent surveys by the Alzheimer’s Association and others reveal that it is the Baby Boomers’ biggest health fear.
The answer to that question used to be, “Yes, we all experience some memory loss as we age. Don’t worry—it’s not Alzheimer’s.” Indeed, it was once thought that a little memory loss was an expected and accepted part of the normal aging process. There was even a term for it: Age-Associated Memory Impairment (AAMI). It included a general slowing of mental functions such as processing, storing, and recalling new information. It also included a general decline in the ability to perform tasks related to cognitive function such as memory, concentration, and focus.
But here’s the rub: AAMI was never a clinical diagnosis, even though many physicians, lay people—and, yes, even yours truly—thought otherwise. Instead, AAMI is a technical diagnosis. It’s made by a psychometric test, not by actual clinical symptoms.
These days, we have a number of other, more accurate acronyms to describe the varying states of memory loss—a whole bowl of Alzheimer’s-related alphabet soup, if you will. And, unlike AAMI, these labels are based on real clinical diagnoses. They include:
- No Cognitive Impairment (NCI). This is just what it sounds like: You have no memory issues or complaints.
- Subjective Cognitive Impairment (SCI). This means that you feel your memory isn’t working as well as it used to or should—maybe you have trouble remembering names, numbers, or words, for example—and you complain about it to your doctor. Tests, however, show that your memory is normal.
- Mild Cognitive Impairment (MCI). You experience short-term memory loss that is greater than what people describe with SCI but still doesn’t interfere very much with your daily life. Tests may show some abnormalities. MCI is considered a serious progressive condition that many experts consider an early form of Alzheimer’s disease.
- Alzheimer’s Disease. This is a progressive neurodegenerative disorder that is incurable and fatal. It used to be that Alzheimer’s disease could only be diagnosed after death during an autopsy, but newer tests, some still investigational, can confirm an Alzheimer’s diagnosis much earlier.
That’s a lot of letters—but these new labels aren’t what I want you to take away from this proverbial soup bowl. The real issue here is not just a name change; it’s a shift in the way we think about memory loss and aging. Indeed, these alphabet diagnoses are not simply static states of memory impairment. A growing body of research suggests that they are instead points on a continuum of memory loss that often ends with a diagnosis of the dreaded Alzheimer’s disease. Unless properly treated—in my view, with an integrative medical program—memory loss tends to get worse over time. In my experience, with integrative treatment, memory loss can be improved and people’s functionality can be preserved for a much longer time.
But is any memory loss “normal”? I recently asked that same question of Barry Reisberg, M.D., Professor of Psychiatry and Director of The Aging and Research Center at New York University. Dr. Reisberg is one of the world’s leading experts on the subject of memory loss and has studied it for decades. His answer: “Memory loss may be normative (average), but that doesn’t mean it’s normal. The real question is what is progressive over time.”
And that brings us back to our alphabet soup. In one landmark study, Dr. Reisberg and his colleagues looked at 260 people, 60 of whom had NCI and 200 of whom had SCI. After 7 years, they discovered that memory declined in 7 people with NCI (15%) and 90 with SCI (54.2%). Of the people with NCI, 5 developed MCI and 2 developed probable Alzheimer’s. On the other hand, of the 90 people with SCI who progressed, 71 developed MCI and 19 declined all the way to Alzheimer’s.
What this means is that SCI appears to progress to MCI and even to Alzheimer’s disease. Subjective or not, even minor memory problems—the kind that many of us typically attribute to just “getting older”—are not normal and should be taken seriously. Consider these statistics, also from Dr. Reisberg:
- At age 65, 25% to 55% of people have SCI.
- After 15 years, up to 55% of people with SCI will have progressed to MCI. (Only 15% of people without SCI will develop MCI.)
- Even more sobering, according to the National Institutes of Health, about 40% of people over age 65 who have been diagnosed with MCI will develop dementia within 3 years
- By age 85, an estimated 55% of all people will have Alzheimer’s disease.
Numbers like these not only drive home the serious news that no memory loss is a normal part of aging, but they also make it clear that we’re on the cusp of what many experts believe will be an epidemic of Alzheimer’s disease as Baby Boomers continue to age.
I’ve shared information on ARPF’s website about the integrative medical approach to prevent and reverse memory loss. But the fact is that protecting against memory loss isn’t just an individual’s responsibility. They say it takes a village to raise a child. Well, it takes a village to support the fight against Alzheimer’s disease—and the types of memory loss that precede it—too.
To that end, in late November, U.S. Representatives Ed Markey and Chris Smith, co-chairs and co-founders of the Bipartisan Congressional Taskforce on Alzheimer’s Disease, outlined their recommendations for the National Alzheimer’s Plan, a strategy proposed for President Obama’s administration to tackle the disease. I heartily agree with many of their suggestions, which include:
- Increased funding for research. The federal government spends an astounding $130 billion in Medicare and Medicaid payments for the treatment of Alzheimer’s disease, and an estimated 15 million caregivers provide some 17 billion hours of unpaid care to loved ones with Alzheimer’s. Yet the National Institutes of Health gives Alzheimer’s disease just $429 million in annual research funding, compared to $6 billion and $3 billion for cancer and AIDS research, respectively. We need to start making Alzheimer’s disease a top research priority, as well as fund innovative screening, preventive, and treatment approaches.
- Increased resources. People with memory loss should receive the best care possible. Yet many Alzheimer’s patients and their loved ones do not get the resources they need. This is partly due to insurance limitations: Insurance companies typically cover some diagnostic tests for Alzheimer’s, but tend to curb the amount of time doctors can spend with patients. As a result, patients and their caregivers may not get the best information about the disease or get connected to resources to help them manage it properly. We need to continue to promote early diagnosis of memory loss and give patients and their families the support they need.
- Increased public awareness. If the “alphabet soup” lesson I’ve shared here comes as big surprise, you’re not alone. Many people are woefully misinformed about Alzheimer’s disease and about memory loss in general. While the ARPF and I do our part to try to educate the public about optimal brain health, we still have a long way to go in spreading the message about symptoms, diagnosis, clinical trials, treatment, and resources for patients and caregivers. We especially need to improve the dissemination about information on the current research proven methods of prevention.
Memory loss isn’t like gray hair or wrinkles. Contrary to what many of us used to believe, it is not a normal sign of aging. In my opinion, that’s all the more reason to make Alzheimer’s disease—and the whole bowl of “alphabet soup”—a thing of the past by prioritizing prevention treatment today. Beyond that, we clearly need to move past a “magic bullet” drug approach mentality.
There is a lot we can do right now to live a brain healthy lifestyle and sharing that work with society is where I’d like to see our focus in the future.
— Dharma Singh Khalsa, M.D., is the President of the Alzheimer’s Research and Prevention Foundation (ARPF), a 501(c)(3) non-profit organization spearheading dynamic research on the use of meditation and memory loss prevention and reversal. He graduated from Creighton University School of Medicine and received training in Anesthesiology at the University of California-San Francisco where he was chief resident. Dr. Khalsa is the author of the international best-seller “Brain Longevity,” presenting an integrative approach to the prevention and reversal of memory loss.
(Word cloud pic source: BigStockPhoto.)