Alzheimer's May Not Be Exactly What We Thought...


Many of the early years of my career was spent conducting clinical trials on Alzheimer's disease therapies. The medications we were studying were thought to potentially slow the progression of the disease. I enrolled countless patients and caregivers into these trials with one common thread between all of them: hope that their participation would make a difference in the course of Alzheimer's research; if not for them, then for future generations. I'm thankful for the many clinical research participants and caregivers who have volunteered to participate in research for Alzheimer's because their participation has mattered greatly in the development of our knowledge about this devastating disease. We have learned so much about the disease in the last two decades, all of which is guiding our path forward on lessening the impact of Alzheimer's. The potential impact of the disease in the coming years is significant, but thankfully, our hope in lessening the burden of the disease is even greater. 

Alzheimer's disease currently impacts 5.2 million Americans, two-thirds of which are women. It is the sixth leading cause of death in the United States. We now know that 45 million Americans hold a gene called ApoE4, which can increase your risk of developing Alzheimer's disease anywhere between 30-90%. The disease is projected to affect between 13.8 to 16 million people in the U.S. by 2050. Pretty concerning. 

And sadly, even after decades of research on new therapies, we are no closer to either a cure or even an modestly, effective treatment. In fact, of the six medications that have been FDA-approved (one of which was discontinued for safety issues) for Alzheimer's disease, each of them only temporarily reduces the symptoms of the disease for a period of 6-12 months. A new Alzheimer's drug has not been approved since 2003. Alzheimer's is the ONLY one of the nation's 10 most common causes of death for which there is no effective treatment. Yes, there are many new drugs in the pipeline for Alzheimer's disease research as well, but interestingly, each only targets one specific mechanism in the body that we think contributes to Alzheimer's. 

Emerging research is demonstrating that cognitive decline (including Alzheimer's disease) may not actually be caused by one specific mechanism, as once thought. Rather, it seems that cognitive decline can develop based on any combination of 36 different mechanisms. So, while taking a drug that targets one or two of these mechanisms can make a difference, according to Dale Bredesen, MD, whose team has discovered and documented these mechanisms, "it's like trying to plug a roof with 36 different holes." Dr. Bredesen's work is focused on not only what drugs can make an impact on as many of these different mechanisms as possible, but also what lifestyle factors can make a difference in Alzheimer's disease as well. His work is exciting and more research is ongoing. You can learn more about Dr. Bredesen's work in his book entitled "The End of Alzheimer's." 

We know that in individuals with Alzheimer's disease, there is an accumulation of amyloid-beta in the brain. Amyloid-beta is a protein fragment that forms sticky plaques which build up in the spaces between nerve cells. The disease also features neurofibrillary tangles made from another protein called tau that builds up inside of cells. Additionally, neuroinflammation (inflammation in the brain) seems to be the key trigger that causes someone to exhibit symptoms of cognitive decline. In fact, brains of the elderly without cognitive decline were examined after their death and were found to also contain plaques and tangles, but without neuroinflammation, symptoms of cognitive decline were not displayed. 

According to Dr. Bredesen's research, they are finding that production of amyloid beta is actually a normal defense mechanism of the brain to injury, infection or some other type of assault. These assaults can be from inflammation, lack of nutrients or even toxic exposures. Also, the disease process starts decades before someone starts to show symptoms of cognitive decline. In fact, this process can start as early as age 40 in someone with high genetic susceptibility to the disease (those with the ApoE gene, for instance). So early intervention is key in reducing the likelihood of developing the disease. 

So what can we do about Alzheimer's disease? I'm glad you asked because the one thing we can do is focus on the things that we can control. We may not be able to control the time it takes to research new therapies. We also may not be able to control our genetic risk for the disease. But we can begin to impact our approach to Alzheimer's disease by changing our mindset and therefore our approach to risk. First, our genes don't have to necessarily be our destiny. We know that our genes are influenced greatly by our environment, so even if your mother had Alzheimer's disease, steps you take now could impact your ability to prevent the disease. Additionally, we have learned that our brains can change and grow throughout our lifetime, so new behaviors you take on can grow your brain and the networks within it. 

So what do experts recommend that we do to prevent Alzheimer's disease? Change your lifestyle through simple steps that can make a big difference. Ensure 8 hours of quality sleep each night with consistent sleep and wake times. Handle stress in your life- better yet, embrace any stress in your life because it's a reaction to something that you care about deeply. Be engaged with others in community- do all that you can to avoid feeling isolated. Move your body. Our bodies were designed to chase animals for food and walk miles and miles each day foraging. Continue learning new things- read books, learn a new language, hobby, etc. And finally, eat real food. The Mediterranean diet has shown great promise in reducing the risk of cognitive decline, and even improving memory in aging populations. Plus, it's a great way to eat with a focus on fresh, local food around family and friends and with a nice glass of red wine every now and then. 

Interested in leaning more about how you can reduce your risk of cognitive decline? Stepwise Health is offering a new program starting in Spring of 2018 that will guide you through each step of the risk reduction process. You will learn the latest science on how to prevent cognitive decline, learn how our brains are capable of changing and growing throughout our lives and build new habits that will contribute to optimal brain health, energy and longevity. For more information, please contact us directly. We are planning to offer individual and group programs in the local Winston-Salem community. If you live outside of Winston-Salem, we also have a Telehealth option so you can engage in the program from the comfort of home.