Path to Prevention
The insidious nature of Alzheimer’s disease — with onset starting many years before symptoms appear — has reinforced the sense that it strikes at random, without warning or recourse. However, hope exists, with a growing number of experts arguing that the course of the disease can be changed, provided it is diagnosed early enough.
1. Growing Crisis
Alzheimer’s is the nation’s sixth leading cause of death — and the only one in the top 10 that cannot yet be prevented, cured, or even slowed. More than 5 million Americans have Alzheimer’s today, with triple that number expected by 2050. Meanwhile, the number of people worldwide with dementia is expected to climb to 76 million by 2030.
U.S. deaths from Alzheimer’s disease rose by 71 percent between 2000 and 2013, while those attributed to heart disease, the No. 1 killer, dropped 14 percent.
Every 67 seconds, someone in the United States is diagnosed with Alzheimer’s. One in three seniors dies with Alzheimer’s or another form of dementia.
2. Higher Female Risk
Women account for almost two-thirds of Alzheimer’s patients in the U.S. A woman’s estimated lifetime risk of developing Alzheimer’s at age 65 is one in six, compared to only one in 11 for a man.
Of the 5.1 million people age 65 and older with Alzheimer’s in the United States, 3.2 million are women and 1.9 million are men.
Women in their 60s are twice as likely to develop Alzheimer’s during their lifetimes as they are to develop breast cancer.
3. Economic and Personal Toll
Alzheimer’s is the nation’s most expensive condition, with direct costs of $226 billion expected in 2015. Caregivers of Alzheimer’s patients provided 17.9 billion hours, or $218 billion, in unpaid care in 2014. According to the Alzheimer’s Association, those caring for patients with Alzheimer’s and other forms of dementia incurred their own related healthcare costs of $9.7 billion in 2014.
The cost of treating all Americans with Alzheimer’s is expected to skyrocket from $226 billion today to more than $1 trillion (in current dollars) by 2050.
4. Drug Failures
To date, nearly 250 different clinical trials have tested new treatments for Alzheimer’s — and all have failed. Even after showing promise in animal models, the approximately 50 drugs developed so far as potential cures have been unsuccessful in humans.
According to Keith L. Black, MD — chair and professor of the Department of Neurosurgery, director of the Maxine Dunitz Neurosurgical Institute, and the Ruth and Lawrence Harvey Chair in Neuroscience — many of these trials likely failed because they focused on patients who were already symptomatic, which meant the research was being conducted too late in the disease process. 250 clinical trials to halt or cure Alzheimer’s 0 successes
5. Treating Symptoms
Although there is no cure, the U.S. Food and Drug Administration (FDA) has approved five medications to treat Alzheimer’s symptoms. These drugs function either by impeding the disease’s breakdown of acetylcholine, a neurotransmitter associated with memory and thinking, or by regulating glutamate, another neurotransmitter crucial to cognition but that can kill brain cells if it builds up too much.
6. Early Detection
Identifying patients who are in the pre-disease state is critical.
Dr. Black and his team at Cedars-Sinai pioneered a novel, noninvasive, and relatively inexpensive, experimental imaging technology that scans the retina to detect the amyloid plaque that is associated with Alzheimer’s disease — even before the plaque builds in the brain. This method — now in clinical trials in the U.S. and Australia — can be employed on a much larger scale than PET scan and spinal tap screenings. It also appears to identify brain plaque buildup before patients become symptomatic. In addition, its high resolution can help reveal whether specific interventions are working.
If the device receives FDA approval, it could offer an easy, painless, widely available method for early-detection screening. This in turn could lead to intervention with lifestyle modifications and eventually medications to stop or slow the disease.
7. Comprehensive Care
Cedars-Sinai launched the Alzheimer’s Prevention Program, which focuses on screening and providing comprehensive care for patients in the pre-disease state. Directed by Dean Sherzai, MD, PhD, the program identifies at-risk patients and those in the disease’s early stages, when treatments can have the most impact. It then provides patients and families with personalized approaches, long-term care, education, and access to a network of community support. The program also serves as a hub for testing experimental Alzheimer’s drugs.
8. Innovative Investigations
Unique to the Alzheimer’s Prevention Program is the focus on a variety of disease pathways, including inflammation and metabolic processes, rather than just the amyloid pathway traditionally studied. Investigators at Cedars-Sinai are planning to test the application to Alzheimer’s of drugs already on the market for other conditions. One may reverse insulin resistance, thought to play a role in Alzheimer’s, and another is used in multiple sclerosis to modulate the immune system and may increase clearance of amyloid plaques associated with Alzheimer’s.
9. Proactive Precautions
Evidence shows that interventions during the pre-Alzheimer’s stage of mild cognitive impairment can significantly affect the disease’s process. Steps you can take to slow or prevent cognitive decline include:
- Manage your blood sugar. Most Alzheimer’s patients have higher-than-normal blood-sugar levels or full-blown diabetes. Emerging research shows that ingesting large amounts of sugar may trigger Alzheimer’s brain changes.
- Adopt a Mediterranean-style diet. Eat more vegetables and fatty fish such as salmon, herring, mackerel, or tuna (baked or broiled instead of fried), and drink more juices, such as pomegranate, blueberry, and grape.
- Get 30 minutes of safe, moderate-to-vigorous exercise on most days of the week as well as engage in activities that improve strength, flexibility, and balance.
- Give your brain regular workouts. Dr. Sherzai suggests listing 10 mental activities that you enjoy and then engaging in three or four every day. Hobbies requiring mind-hand coordination also engage memory, problem-solving, spatial visualization, and other skills. Don’t depend solely on crossword puzzles and Sudoku, which get easier with practice and only target certain parts of the brain.
- Schedule an appointment with a neurologist if you notice memory loss or other worrisome cognitive changes. We all lose our keys or forget a birthday occasionally, but life-affecting memory lapses should be investigated. Even if you are only in your 30s or 40s, consider seeing a neurologist if you have a family history of Alzheimer’s.