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

Alzheimers DiseaseFeed­ing the Brain’s Curios­i­ty Helps Delay Alzheimer’s, Study Says (Bloomberg):

Peo­ple genet­i­cal­ly prone to Alzheimer’s who went to col­lege, worked in com­plex fields and stayed engaged intel­lec­tu­al­ly held off the dis­ease almost a decade longer than oth­ers, a study found.

Life­long intel­lec­tu­al activ­i­ties such as play­ing music or read­ing kept the mind fit as peo­ple aged and also delayed Alzheimer’s by years for those at risk of the dis­ease who weren’t col­lege edu­cat­ed or worked at chal­leng­ing jobs, the researchers said in the study pub­lished today in JAMA Neu­rol­o­gy.

Keep­ing your brain men­tal­ly stim­u­lat­ed is a life­long enter­prise,” David Knop­man, a study author and a pro­fes­sor of neu­rol­o­gy at the Mayo Clin­ic in Rochester, Min­neso­ta, said…

Cur­rent­ly there are no effec­tive treat­ments for Alzheimer’s. A report by the Alzheimer’s Asso­ci­a­tion pro­ject­ed that any treat­ment that could delay the onset of Alzheimer’s by five years would reduce the expect­ed num­ber of patients with the dis­ease in the U.S. by about 43 per­cent by 2050.”

Study: Asso­ci­a­tion of Life­time Intel­lec­tu­al Enrich­ment With Cog­ni­tive Decline in the Old­er Pop­u­la­tion (JAMA Neu­rol­o­gy). From the abstract:

  • Impor­tance: Intel­lec­tu­al lifestyle enrich­ment through­out life is increas­ing­ly viewed as a pro­tec­tive strat­e­gy against com­mon­ly observed cog­ni­tive decline in the old­er pop­u­la­tion.
  • Objec­tives: To inves­ti­gate the asso­ci­a­tion of life­time intel­lec­tu­al enrich­ment with base­line cog­ni­tive per­for­mance and rate of cog­ni­tive decline in an old­er pop­u­la­tion with­out demen­tia and to esti­mate the years of pro­tec­tion pro­vid­ed against cog­ni­tive impair­ment by these fac­tors.
  • Results:…For APOE4 car­ri­ers with high life­time intel­lec­tu­al enrich­ment (75th per­centile of education/occupation score and midlife to late-life cog­ni­tive activ­i­ty), the onset of cog­ni­tive impair­ment was approx­i­mate­ly 8.7 years lat­er com­pared with low life­time intel­lec­tu­al enrich­ment (25th per­centile of education/occupation score and mid/late-life cog­ni­tive activ­i­ty).
  • Con­clu­sions and Rel­e­vance: High­er education/occupation scores were asso­ci­at­ed with high­er lev­els of cog­ni­tion. High­er lev­els of mid/late-life cog­ni­tive activ­i­ty were also asso­ci­at­ed with high­er lev­els of cog­ni­tion, but the slope of this asso­ci­a­tion slight­ly increased over time. Life­time intel­lec­tu­al enrich­ment might delay the onset of cog­ni­tive impair­ment and be used as a suc­cess­ful pre­ven­tive inter­ven­tion to reduce the impend­ing demen­tia epi­dem­ic.

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  1. Steve Zanon says:

    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
    Proac­tive Age­ing

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