Alzheimer’s Disease Prevention or Cognitive Enhancement?
An independent expert panel organized by the NIH released yesterday a thoughtful report on the state of the science for prevention of Alzheimer’s Disease and cognitive decline. The report, available here, summarizes the panel’s review by saying:
- “Firm conclusions cannot be drawn about the association of modifiable risk factors with cognitive decline or Alzheimer’s disease.”
- “There is insufficient evidence to support the use of pharmaceutical agents or dietary supplements to prevent cognitive decline or Alzheimer’s disease. However, ongoing additional studies including (but not limited to) anti-hypertensive medications, omega‑3 fatty acid, physical activity, and cognitive engagement may provide new insight into the prevention or delay of cognitive decline or Alzheimer’s disease.”
To put findings in perspective, let me suggest our article Brain maintenance: it’s about cognitive enhancement first, Alzheimer’s delay second. Before people get scared away by the sentence “there is nothing we know of that can prevent Alzheimer’s Disease”, everyone should understand that this is true but different from saying “there is nothing we can do to reduce the probability from developing AD symptoms” or “there is nothing we can do today to enhance our cognitive functions today and tomorrow” (both areas with solid research and useful guidelines and tools). I gave a talk yesterday during the San Francisco Mini Medical School organized by California Pacific Medical Center/ Sutter Health, and making this distinction clear was in fact my main point.
The report provides great reading and several excellent recommendations for future research, including several areas we identified during the January SharpBrains Summit as areas where database-driven automated cognitive assessments are likely to add much value both to research and to clinical practice in years to come:
- “An objective and consensus-based definition of mild cognitive impairment needs to be developed, including identification of the cognitive areas of impairment, the recommended cognitive measures for assessment, and the degree of deviation from normal to meet diagnostic criteria. This consistency in definition and measurement is important to generate studies that can be pooled or compared to better assess risk factors and preventive strategies for cognitive decline and Alzheimer’s disease.”
- “A standardized, well-validated, and culturally sensitive battery of outcome measures needs to be developed and used across research studies to assess relevant domains of cognitive functioning in a manner that is appropriate for the functional level of the population sample being studied (e.g., cognitively normal, mild cognitive impairment); and age-gender specific norms need to be established for comparison and objective assessment of disease severity. We recommend a comprehensive approach to outcomes assessment that accounts for the impact of cognitive decline on other multiple domains of function and quality of life that may be affected by deficits in cognition (for example, emotional and physical functioning) of both the affected person and his or her primary caregiver.”
- “A simple, inexpensive, quantitative instrument to assess mild cognitive impairment, which can be administered in a repeated manner by trained (non-expert) staff in both the primary care office and the research/specialty clinic, needs to be established. This instrument should be sensitive to changes over time across a wide range of cognitive abilities and social, cultural, and linguistic backgrounds. The development and widespread implementation of this instrument is essential to enable better research.”
To read report: click Here