Is the Brain Today Blog Worth Reading?

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

As an avid reader of the press coverage of the Alzheimer's and dementia space, I am aghast at how inaccurately many stories are reported. This has been my motivation for editing this blog and for writing educational series like "How to Read the News". Some stories are so consistently mis-characterized in the press, even by respected sources, that it makes me question the quality of everything I read.

Last week, a completely unsurprising study was published in the journal Neurology. It showed evidence of a phenomenon that was already widely reported and well accepted, yet the coverage of the story has been twisted and sensationalized beyond recognition.

I am speaking of the study that showed how mental activity is most likely helpful in maintaining cognitive function. However, many notable media sources opted to frame the finding in a sensational light with headlines suggesting that mental activity is detrimental to cognitive health.

Here are a few examples:

NPR
Headline: Mental Stimulation Postpones, Then Speeds Dementia
Headline: Can Cognitive Exercise Speed Up Dementia?

Both of these would leave a headline scanner with the notion that using your brain may be, in some way, harmful to your cognitive health. In the second story, NPR was pretty clear about the finding but, given the overall poor quality of reporting on this study, I think the headline was reckless and lent itself to misinformation.

U.S. News and World Report
Headline: Mental Activity Linked to Alzheimer's Decline

Although this brief story was quite clear, the headline was entirely misleading.

LA Times
Headline: For the intellectually active, Alzheimer's diagnosis begins a steep slide

This headline shows a bit more editorial constraint, making a less clear connection between mental activity and poor cognitive health, but it suggests a pernicious relationship. I would expect more from the LA Times.

CNN
Headline: Brain exercises delay, speed up dementia?

Much like the NPR headline, this strongly suggests that exercising your brain may be bad for your cognitive health. It's unconscionable.

Fortunately, not every source leapt at the opportunity to use wild sensationalism as a hook to attract readership. Businessweek got it right twice with two honest headlines on their coverage and the Washington Post was accurate as well. Neither publication emphasized the optimistic finding that brain exercise might allow you to maintain sharp thinking skills, but at least they were honest. Here are their headlines:

Business Week
Headline: Mental 'Exercise' May Only Hide Signs of Alzheimer's
Headline: Brain Exercise Won’t Help Once Alzheimer’s in Place, Study Says

Washington Post
Headline: Does mental activity prevent dementia?

The point of the Brain Today blog is to read the news with a critical eye and to lend perspective to the news and to the way the news is reported. It is unfortunate, but you really need to read with a discerning focus to keep from being led astray by the popular press. This blog aims to help you with that effort.

--------------------------------------------------------------------------------
A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

Does Mental Activity Accelerate Cogntive Decline?

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

Does mental activity accelerate cognitive decline for people with Alzheimer's disease? Of course not. But to read the headlines over the past two days, one could be excused for wondering.

Contradictory Study?
A study published yesterday in Neurology noted that, among demented subjects with AD, those who had a history of high cognitive activity like reading, doing crosswords, and visiting museums, declined at an accelerated pace. On the surface, this seems contradictory to the notion that exercising your brain preserves mental function. A closer look, however, reveals an obvious and consistent conclusion.

This study demonstrates that, most probably, maintaining a high level of mental activity allows subjects with progressing Alzheimer's pathology, to continue functioning at a high cognitive level, even as the lesions accumulate in their brains. This means that those who remain mentally active may not manifest symptoms until they have very extensive damage in their brains. If so, symptoms will first appear in these subjects at a later, more pathologically severe stage. As such, there is little wonder that the decline seems more rapid for these subjects.

Delay and Compression of Symptoms
A good way to look at it is this: We don't see an acceleration of decline, but rather, a delay and compression of decline, into the final stages of the disease.

To illustrate this point, consider a typical course of decline between a mentally active person and a mentally inactive person. The inactive person may show subtle symptoms for 5 years, moderate symptoms for five years, and severe symptoms for five years, across a 15-year disease course. The mentally active person might show no symptoms for the first ten years of disease and then degrade quickly to severe symptoms during the final five years. Both had a 15 year disease course but the mentally active person showed no symptoms for the first ten. That person appeared to decline more rapidly, but actually declined much slower (perhaps not at all) during ten of the 15 years. In the broad context, the active person was certainly far better off across the full course of decline.

Many of the headlines on this study are sensationalistic and misleading. I thought this coverage from Bloomberg/Business Week was well done and represented the facts quite fairly.

--------------------------------------------------------------------------------
A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.

New Target For Alzheimer's Drug

Contributed by: Dennis Fortier, President, Medical Care Corporation
________________________________________________

This is an exciting story but needs to be embraced with proper expectations. The New York Times is reporting on research scheduled to publish tomorrow in Nature, that a promising new target has been identified for treating Alzheimer's disease.

The target is a protein that activates the role of gamma secretase in producing beta amyloid in the brain. Following the recent failure of Eli Lilly's phase III drug that inhibited gamma secretase, and the ensuing round of questions that the failure spawned about the validity of the amyloid hypothesis, this is fantastic news.

This finding points to a potential refinement of current thinking. It is clear that gamma secretase has multiple roles, some of which are neuro-protective and others which lead to overproduction of beta amyloid. As a treatment hypothesis, we are aiming to reduce the production of beta amyloid but inhibiting gamma secretase is apparently too crude of an approach. It seems as though the downside of inhibiting gamma secretase is greater than the upside, and two drugs based on that approach, have previously failed to show clinical benefits.

With the discovery of this new protein, it is suggested that we might be able to turn off the harmful activities of gamma secretase while allowing its beneficial activities to continue. This portends great hope.

One word of caution, to which I alluded in the opening. This science is a long way from being validated which is only the first step in a long FDA process to commercialization. If this discovery eventually turns out to be part of an effective treatment, that treatment is still many years from commercial availability.

--------------------------------------------------------------------------------
A better understanding and more awareness of Alzheimer's related issues can impact personal health decisions and generate significant impact across a population of aging individuals. Please use the share buttons below to spread this educational message as widely as possible.