NIH Says "Alzheimer's not Preventable"

Contributed by: Dennis Fortier, President, Medical Care Corporation
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Based on current evidence, the recent conclusion reached by a National Institute of Health panel of experts, is pretty sound. They concluded that we do not yet have proof that the progression of Alzheimer's disease pathology can be slowed by actively reducing known risk factors and by adopting certain lifestyle changes such as smoking cessation, intellectual stimulation, and physical exercise.

Careful Interpretation Required
As we often write in this blog, scientists speak in a language of precision that serves them well amongst themselves but often leads to unintended conclusions in the public realm. This is a case where I think it is worthwhile to translate the panel's conclusion for public consumption.

Here is a quote from one of the panel experts; this was one of the direct comments that generated the hopeless headlines in countless news outlets over the past week:

"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) can prevent Alzheimer's or age-related cognitive decline."

Now let me state it in another way that would be equally acceptable to the independent and precision minded scientists on the panel:

"There is not a high level of evidence that any of these factors (supplements, mental exercise, medications) do not prevent Alzheimer's or age-related cognitive decline."

It is a simple switch in perspective but might have dramatically changed the message that most lay-readers take away.

I understand that many commercially driven entities are selling solutions with exaggerated claims about efficacy. We all appreciate the consumer advocacy the expert panel has provided in helping us understand how well certain supplements or brain games have been (or have not been) validated with solid science. However, it is important to stay balanced and to understand that certain approaches, although not proven, have growing evidence of benefits. When those approaches have no harmful side-effects and are supported by rock-solid common sense, it might be best to present them with some degree of optimism.

How to Read the News: Part 5 of 5

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The purpose of the Brain Today blog is to distill the daily news about brain health and help the public understand the essential meaning of each article. Through time however, I have found myself clarifying the same themes over and over again. Five of these themes are explored in this five-part series “How to Read the News About Alzheimer’s and Dementia”.

How to Read the News About Alzheimer’s and Dementia - Part 5 “No Cure” is not Nearly as Bad as it Sounds

For some reason, journalists feel compelled to point out the fact that Alzheimer’s has no cure. The mere mention of this basic truth tends to cast a pall over the topic and suggests a direness that is not necessary. Diabetes has no cure; hypertension has no cure; multiple sclerosis has no cure; yet all of those diseases are reported in the press with optimism about treatment that never seems to follow Alzheimer’s disease.

I concede that available treatment for Alzheimer’s disease generally yields only modest effects and sometimes none at all. However, some patients respond quite well to treatment and physicians have no way of distinguishing responders from non-responders ahead of time. For this reason, it makes sense to get all AD patients on treatment as early as possible to optimize treatment efficacy for all.

Also, the realm of treatment goes beyond the pharmaceutical arena. Solid research shows that physical activity, a good diet, social engagement, an educated caregiver, intellectual stimulation, and perhaps certain supplements are components of a robust treatment plan that can slow progression of symptoms in many patients. Reading that a single component of treatment, say a certain drug, has an unimpressive impact on disease progression is not enough to conclude that treatment is worthless.

Finally, a major barrier to effective treatment is that we generally fail to diagnose AD in a timely manner. Most patients are diagnosed after several years of symptoms when significant brain damage has already occurred and treatment is unlikely to help. Certainly we cannot cure the disease at that late stage but an earlier intervention might delay it long enough to prevent the patient from becoming demented. New drugs in the FDA approval pipeline might halt it all together.

The bottom line is that stating, “AD has no cure”, obscures the fact that it can be treated with some degree of success, for many people, especially when diagnosed in an early stage. Many diseases have no known cure but we manage them in the medical system with a sense of purpose and optimism. We need to approach AD in a similar manner.

Here are the links to each other part of this series:
Part 1 of 5: Be Aware of the Author's Definition of AD
Part 2 of 5: Don't be Mislead by Data on Treatment Efficacy
Part 3 of 5: Common Assertions about Diagnostic Accuracy Hide Truth
Part 4 of 5: The Term "Dementia" Cannot be Interpreted Loosely

More Perspective on Brain Exercises and Supplements

Contributed by: Dennis Fortier, President, Medical Care Corporation
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The Stanford Center on Longevity released a statement today describing their perspective on the utility of consumer products for brain health.

Given the proliferation of supplements and software for brain exercises, this center felt it appropriate to issue a cautionary message about the relatively modest evidence so far amassed about the benefits of these various approaches.

We are all hopeful that many approaches to brain health will prove viable but, in the meantime, it is best to be clear and objective while setting realistic expectations about the impact of these consumer products.