Mental stimulation over genetics: How to hold off Alzheimer’s Disease 8+ Years (even APOE4 carriers)

1 Comments

1. Steve Zanon on June 26, 2014 at 8:50

   This study is great step in the right direc­tion. The real­i­ty of an Alzheimer’s Dis­ease drug or vac­cine is decades away at best and if one hap­pens to be found in the future it won’t be able to repair the dam­age already done. That will need to be part of an active reha­bil­i­ta­tion or relearn­ing process – rebuild­ing lost cog­ni­tive capac­i­ty. So how do we help or BETTER YET help pre­vent or slow down the next gen­er­a­tion (20+ years) of MCI and demen­tia suf­fers ? Part of the answer lies in stud­ies like this one. 

   Alzheimer’s dis­ease is a 30–40 year pro­gres­sive and chron­ic dis­ease – it doesn’t just hap­pen like a switch. The real ques­tion then is why pre­ven­tion activ­i­ties and cog­ni­tive reserve are stud­ied with less pri­or­i­ty than a poten­tial future phar­ma­ceu­ti­cal. We know that autop­sies have shown that the progress of the Alzheimer’s pathol­o­gy and the progress of demen­tia symp­toms are NOT always aligned. Refer “The Nun Study”, amongst oth­ers. Some of this par­tic­u­lar cohort had sig­nif­i­cant Alzheimer’s pathol­o­gy at autop­sy and NO demen­tia symp­toms. The gap between pathol­o­gy and symp­toms is referred to as Cog­ni­tive Reserve and we broad­ly know the lifestyle para­me­ters that build it up over time. 

   Giv­en that we know the lifestyle inter­ven­tions for demen­tia risk reduc­tion just like we do for car­dio­vas­cu­lar risk reduc­tion. Why are we not active­ly refin­ing these Cog­ni­tive Reserve para­me­ters with lon­gi­tu­di­nal stud­ies and get­ting some quick wins on the board mea­sured in years not decades ? Slow­ing dis­ease symp­toms for even a few years is a big achieve­ment in Qual­i­ty of Life and will save a mas­sive amount of health care costs. 

   This study refers to 8.7 years of poten­tial delay – that’s around 10–15% of the lifes­pan, depend­ing on the coun­try in which you live. At one Sharp­brains con­fer­ence sev­er­al years ago one sci­en­tist men­tioned that if we could delay the dis­ease by 10 years then demen­tia ceas­es to become one of our major health con­cerns. Why then is the bulk of the research effort and mon­ey going toward a phar­ma­ceu­ti­cal cure ahead of attempt­ing to incre­men­tal­ly get to 5–10 years of symp­tom delay ? 

   In 2010 The Boston Con­sult­ing Group report­ed on the mas­sive­ly decreas­ing pro­duc­tiv­i­ty of drug R&D, which has been in steady decline since the 1950’s. The cost of each New Mol­e­c­u­lar Enti­ty (NME) approved by the FDA has gone up well over 50 times over that peri­od and it con­tin­ues to rise. Giv­en what we already know about Cog­ni­tive Reserve it just doesn’t make eco­nom­ic sense to pri­ori­tise long term phar­ma­ceu­ti­cal clin­i­cal tri­als over lon­gi­tu­di­nal lifestyle research. 

   One con­ver­sa­tion we should be hav­ing is around the extend­ing retire­ment age and the Occu­pa­tion­al Health and Safe­ty issues of cog­ni­tive decline. This is an issue for TODAY not one for decades time. Insur­ance com­pa­nies are already look­ing into this and we real­ly need to get onto the front foot with well­ness pro­grams (pre­ven­tion activ­i­ties) deliv­ered in the work­place from mid life. 

   Our mus­cu­lar-skele­tal and car­dio­vas­cu­lar sys­tems decline with age – so too does our ner­vous sys­tem, which includes our brains. None of us are immune from this. We ignore the issue at our per­il. How­ev­er there is much we can active­ly do to delay the rate of that decline – exer­cise both phys­i­cal and men­tal helps build reserve capac­i­ty. There are no guar­an­tees in life, and that includes phar­ma­ceu­ti­cals, but we can all bet­ter man­age our health risks. I hope that our sci­en­tists can help us out a lit­tle more with that.

   The increas­ing preva­lence of demen­tia is hap­pen­ing right now and this study is great step in the right direc­tion. We need many more stud­ies that fur­ther refine these lifestyle para­me­ters and more impor­tant­ly pub­lic aware­ness cam­paigns that pro­mote the things we know so far. Let’s look more deeply into the incre­men­tal steps for­ward in pub­lic health outcomes. 

   Steve Zanon
   Director,
   Proac­tive Ageing