It is unfortunate that the National Institutes of Health/Aging and leading nonprofit Alzheimer's research organizations allocate the majority of their budgets to pharmacological "miracle cures" instead of the long-term solution...prevention. If you go to the Alzheimer's Association National Chapter website and click on Clinical Trials Index page, you will see a laundry list of medication trials underway. As of 9/23/2008, guess how many trials are listed under prevention? One.
In this piece, we try to lay out what we think is the most effective non-pharmacologic Alzheimer's policy based upon what the current research shows. Besides doing our own research, some of this information was presented by the Greater Illinois Chapter of the Alzheimer's Association. In our view, they are much more focused on prevention and non-pharmacological treatments than the National Chapter.
INCORPORATING A NON-PHARMACOLOGIC PARADIGM
While most of the experts lament the lack of pharmacological treatments to prevent mental slides or reverse "pre-dementia," there are non-pharmacological treatments that exist with research that can help. However, none of these are getting the funding or attention they deserve. While millions of dollars in grants are given to researchers studying pharmacological cures, a study such as one spearheaded by the University of Illinois to identify strong scientific evidence for the efficacy of non-pharmacological therapies for early stage dementia, received $3000. Preventive intervention will save a lot of money in the future and can produce tangible results immediately. Not to mention the current pharmacological treatments in use do little and produce debilitating side effects.
Let's make something crystal clear: most people are told when brain neurons die, they cannot regenerate. THIS IS WRONG! Data as early as the 1980's have shown that environment can have a detrimental as well as positive effect on neurons. The U of I researchers discovered that enriched environments can create neuronal regeneration.
Here are therapies with definitive research that embody Enriched Environment:
(starred items have the strongest evidence)
- Structured Exercise**
Exercise is cheap. Everybody can do it. Studies looking at exercise interventions showed overall improvements in numerous mental categories. Types of fitness included home-based aerobic/endurance activities, strength training, balance and flexibility training, Tai Chi, and Chi Gong. Researchers believe that they work so well because they cannot be done mindlessly and are great for balance. According to results presented at the 2008 Alzheimer's Association International Conference in Chicago, people in the early stages of Alzheimer's disease who are more physically fit had less shrinkage in areas of the brain that are important for memory.
In Alzheimer's, the hippocampus is one of the first regions of the brain to sustain damage. Researchers found that people who had early-stage Alzheimer's disease and were physically fit had more brain volume in areas that are important to memory that people with the disease who were less fit.
In a separate study, Australian researchers found people with dementia who took part in a 12-month home exercise program directed by their caregivers had fewer falls and better quality of life.
- Multiple Environmental Stimuli**
Examples such as music, cognitive tasks, and opportunity to explore environment. Studies looking at cognitive training and enhancement programs incorporating the above showed continued improvement of MMSE (Mini-Mental State Exam) scores for up to two years following the intervention.
- Social Interactions/Support groups**
Greater Illinois Chapter has myriad options to explore. Strength in numbers!
- Sleep Management**
CHAP (Chicago Health and Aging Project) finds 50% less risk of developing Alzheimer's with high vitamin E in diet. One weekly serving off fish showed a 60% reduction of developing Alzheimer's. Higher trans fat intake creates 2-3 times the risk of mental decline, whereas monounsaturated fats create a 70-80% reduction. High copper levels increase rate of decline, which is why detecting zinc deficiency (depleted by copper), is important. Antioxidants from fruits and vegetables are a given to reduce oxidative distress.
- Falls Prevention
Falls increase cognitive impairment so it is imperative to incorporate techniques to prevent them.
- Volunteer Programs
Volunteering for schools, nonprofits, etc. create an enriched lifestyle and are highly recommended.
- Driving Evaluations
At least every six months, driving evaluations, including an on-road test are suggested to track mental status.
- Education Programs**
This category can encompass two avenues to explore:
1) take college courses to broaden your education on myriad topics
2) participate in programs for individuals/families facing dementia and Alzheimer's
- Technology-Based Interventions
For example, learning email or computer programs. Technology-based programs also offered strong promise because they minimize the need for professional support services, may be utilized by caregivers, and may be widely disseminated.
NO DRUG CURE ON THE HORIZON
Drugs to reverse Alzheimer's disease have proven elusive. Recent clinical trials aimed at halting Alzheimer's have faltered and such treatment appears to be far off. As such, Alzheimer's disease research is at a crossroads, according to the Alzheimer’s Association 2008 International Conference. Though technology to detect the condition early is advancing rapidly, there is still no way to halt or reverse the devastating disease. The arrival of such a disease-modifying medication is now unlikely before 2010, perhaps later.
Five Alzheimer's disease medications are available. But all of these drugs treat the symptoms of the disease, such as memory problems and mental confusion. They do not cure, halt or even slow the disease process, and a review published earlier this year in the Annals of Internal Medicine concluded that the drugs produce few, if any, meaningful benefits.
WHAT THE FUTURE HOLDS
The Alzheimer's Breakthrough Act of 2007, which attempts to lay out an all-inclusive approach to treating Alzheimer's, is a step in the right direction. However, it is mired in the Congress' legislative morass and has not even reached a vote in the Senate, much less the House. Once the lobbyists get through with it, the focus will most likely be drug-heavy.
We need to coordinate a country-wide effort to create a database of non-pharmacological services and where they are available. It needs to be simple to access and easy to modify. Doctors, nurses, caregivers, family, friends, and patients need to all be on the same page. It would not be an expensive venture and could be done quickly. Let's allocate a small amount of the money going to drug research to accomplish it.
RELATED LINKS (within the last year)
High EPA concentration may decrease risk of dementia.
Vitamin E lengthens lives of Alzheimer's patients.
No good drugs for dementia.
Tips to prevent memory loss.
Researchers deem Alzheimer's Type 3 Diabetes.
Alzheimer's may be result of Western Diet.
Long term beta carotene may slow mental decline.
Driven people may avoid Alzheimer's.
Are statins a problem for the brain?
Obesity dramatically increases risk of Alzheimer's.
Common drugs hasten decline in elderly.
Antipsychotics no longer recommended for Alzheimer's patients.
Walking and exercise prevents dementia.