Posted on Aug 12, 2019, 7 p.m.
Researchers are optimistic about finding disease altering medicines to combat dementia, although that may not happen anytime soon, meaning the best medicine is still prevention via making healthy lifestyle choices.
The repeat failures at finding a cure for Alzheimer’s disease, and the massively expensive trials have forced researchers to recalibrate optimism regarding finding a cure, there is still hope for the future but that future seems even further away.
For several decades research was focussed on getting rid of beta amyloid build up in the brain which was thought would vanquish the brain wasting disease. When this theory failed, attempts moved to clearing the buildup at an earlier stage. However recent trials are proving that idea wrong as well, especially since the drugs are doing more harm than good which led to the announcement of the end of the latests anti-amyloid trials at the Alzheimer’s Association International Conference.
According to the Alzheimer’s Drug Discovery Foundation 102 drugs are currently being tested in patients, most in mid trial stages, perhaps one may turn out to make a difference, but few believe in the prospect of a magic bullet; most now believe that a combination of approaches are needed to prevent, treat, and cure the disease.
Although they may need to be used in combination, 2 approaches are holding the most promise in recent research. Addressing tau proteins which cause tangles of materials in the brain which compound the issues of beta amyloid is the first approach holding promise. Inflammation is this second factor which may play a large part as there is an indication of an immune reaction to a simple cold sore or gum disease which may be the spark that launched a series of events that ultimately lead to Alzheimer’s disease.
It is a great idea to treat patients before symptoms become disabling, but some are not convinced that it makes sense to treat 55 year olds who may or may not one day go on to develop the disease, as such some are starting to question if the brain must be treated before the brain has deteriorated.
Although a treatment is desperately needed the growing consensus is that people can take concrete steps to reduce their risk for developing dementia. “Prevention is the key element if we want to manage this epidemic,” says professor Miia Kivipelto of the Karolinska University Hospital in Stockholm.
According to Howard Fillit of the Alzheimer’s Drug Discovery Foundation and professor at the Icahn School of Medicine lifestyle modifications such as using statins and quitting smoking are reducing dementia rates. He suggests that the rates have been decreasing but the raw number of patients is growing as we live longer. According to the Alzheimer’s Association approximately 5.8 million Americans live with dementia.
A study published in JAMA investigated close to 200,000 people showed that an unhealthy lifestyle can increase the risk of developing dementia, and by contrast a healthy lifestyle can reduce the risk even among those with high genetic risk.
The Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability is a series of prevention trials that started in 3 countries and has now spread to 25 which is hoped to yield information on how lifestyle can impact the risk of Alzheimer’s disease.
According to Kivipelto there are 5 basic things that are clear people can do to lower their risk:
- Regular exercise has a significant amount of evidence showing it reduces the risk of dementia. It is not clear what precise amount or intensity provides the most benefit, but you don’t need to be an elite level athlete to reap benefits. 150 minutes a week of aerobic activity and muscle training is recommended.
- Following a healthy diet rich in fruits, vegetables, and healthy oils is also supported by a large body of scientific evidence to reduce risks.
- Keeping the brain active with activities such as reading, doing puzzles, crafting, playing games, and participating in social activities has been shown to lower the risk of mild cognitive impairment which precedes dementia.
- Keeping factors in check that lead to cardiovascular disease by addressing smoking, cholesterol, diabetes, and high blood pressure has been shown to lower risks; what is good for the heart is also good for the brain.
- Improving sleep quality and quantity has been shown to be important to Alzheimer’s disease, but it is not clear whether poor sleep with age is a cause or one of the earliest symptoms.
It is worth noting that none of the above lifestyle measures comes with a long list of side effects that accompany most drugs; simply living a healthy lifestyle can reduce the risk of chronic diseases by 60% and risk of hospitalizations by 20%.
“Your health-related quality of life is much better. You feel better,” says Kivipelto, who goes on to note it’s never too early to start practicing healthy behaviors, but it’s never too late either.
According to Kosik, “What’s resulted from these amyloid disasters is really 1,000 flowers blooming. I think people are exploring a lot of different areas. I think we’re in an interesting time right now.” Kosik supports a healthy lifestyle but feels we ultimately need drugs, “We obviously need both…. Lifestyle is no substitute for the drug research that has to be done.”
$400 million was provided for Alzheimer’s research in 2013, that number has increased to approximately $2 billion in 2018, adding fuel to the sense of optimism in the field. However, this federal increase ends next year, further funding is uncertain.
In the past activists have been very vocal and annoyed a great deal of people, but these actions were intentional and drew much scientific attention to the diseases, such as with HIV/AIDS, that rapidly led to the development of the cocktail which can now keep it under control. It would appear as if activists for Alzheimer’s are more polite and tame, most likely because they are too affected by the disease, or they are part of the generation trained to deferential.
“Older people think you’re supposed to be nice, and that doesn’t always work,” says Samuel Gandy, director of the Center for Cognitive Health at the Icahn School of Medicine at Mount Sinai. “We need some loud advocates … the squeaky wheel gets the grease.”
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