Alzheimer's Cure by 2025: An Unnecessary Goal?

Contributed by: Dennis Fortier, President, Medical Care Corporation

The National Alzheimer's Prevention Act, signed into law one year ago, calls for a national strategy for defeating this terrible disease. A late-stage draft of the strategy sets a goal to develop a cure by the year 2025.  While many have suggested a timeline with more urgency, say by 2020, others have suggested that this timeline is too ambitious.

On the one hand, given our still poor understanding of the disease, coupled with a dismal track record of success for pipeline drugs over the past decade, it seems unlikely that a cure could be developed prior to 2025.  In fact, against the backrop of recent evidence, it may well take longer than that.

On the other hand, we could stop short of a cure and still have great success.  For example, many chronic diseases like diabetes and hypertension have no cure, but we have effective treatments, and we manage those diseases with high efficacy.  It is likely that new drugs, developed well before 2025, will give us greater treatment benefits for patients with Alzheimer's.

Perhaps of greater importance is the fact that we already have approved therapies that can significantly slow Alzheimer's disease progression.  However, since we commonly detect the disease too late and intervene only after massive brain damage has occurred, the perception among physicians is that treatment is unhelpful.  This nihilistic perception actually perpetuates the cycle of late intervention because, believing that there is no treatment, many MDs don't look for early signs Alzheimer's.

In this regard, a key element to an effective national Alzheimer's strategy would be to update physicians about the benefits of early detection and equip them with the tools and training to proactively monitor the cognitive health of their patients.  When a cure is developed, that will be great.  But in the meantime, we can find the disease early and treat it as effectively as possible with robust therapy (drugs, diet, physical exercise, control of diabetes and hypertension, intellectual stimulation, social engagement, and caregiver education).  Such a comprehensive approach has been shown to significantly delay disease progression in a meaningful percentage of early-stage patients.

Best Foods for a Long Life

Contributed by: Dennis Fortier, President, Medical Care Corporation

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This summary of foods you should eat for a long life, was compiled by WebMD, and is well worth clicking through and reviewing.  It is not specifically about brain health, but the overlap between overall fitness and maintaining cognition is significant.

The 5 second version is fruits, vegetables, olive oil, berries, fish, beans, nuts and dairy.  But for a short blurb on why each of those foods helps which facet of your health, I highly recommend you review the WebMD slides.

Recent Press on Preventing Alzheimer's

 Contributed by: Dennis Fortier, President, Medical Care Corporation



There is no hope? 

Eating well, staying fit, and using your brain have no effect on your risk for Alzheimer's?  Many headlines have implied this dire message over the past 24 hours.

The source of these headlines is an article published in the Archives of Neurology, online edition.  The article reviewed the evidence that actively managing modifiable factors could reduce the risk of AD, and concluded that only a low level of evidence suggests a relationship between the risks and the disease.

Let's be sure not to misunderstand this.

What is a "Low Level" of Evidence?
The authors classified the level of evidence for each risk factor in accordance with accepted scientific standards.  These standards allow for three levels of evidence: low, medium, and high. 

Importantly, a "low" level of evidence means that real research, conducted with sound methods, that was published in peer-reviewed medical journals, showed an association between the risk factor being studied and the incidence of AD.  Perhaps the association was not overly strong, perhaps the sample size was small, perhaps similar studies have not been completed to verify the result, but even a "low" level of evidence is a pretty good start in finding a meaningful association.

The panel authoring this paper, on behalf of the National Institutes of Health, found a low level of evidence that diabetes, high cholesterol, and tobacco use all confer a higher risk of Alzheimer's disease.  Sure we want more evidence and a higher level of confidence, but all work so far suggests that these are real risks that need to be managed.

The panel also found a low level of evidence that a Mediterranean diet, folic acid intake, light alcohol consumption, cognitive activity, and physical activity all reduced risks of Alzheimer's.  That's more good news.

This review constitutes unbiased, expert confirmation that many modifiable risk factors should in fact be managed to reduce the risk of AD.  The evidence is not as strong as we would all like, but it has reached a minimum threshold of scientific scrutiny to establish a likely association.

The problem here is the massive and consistent misinterpretation of these findings by the press.  In every day jargon, a "low level of evidence" is a negative testimonial as to the likelihood of an association.  But in the scientific world, where facts are closely scrutinized before they qualify as "evidence", a low level of evidence connotes a pretty good start toward proving a point.  It is a shame that this is not understood by the major media outlets and is not more clearly represented in their publications.