How can I prevent Alzheimer’s disease? Are there any treatments for people who already have it?
“These are the two things people want to know,” said P. Murali Doraywami, director of the Program for Neurocognitive Disorders at Duke Medical School and co-author of the Alzheimer’s Action Plan.
Alzheimer’s, the most common form of dementia, affects 6.2 million Americans aged 65 and over. This is one of the most frightening diseases and one of the most elusive in terms of treatment and cure.
On Monday, the Food and Drug Administration approved Alzheimer’s first drug in nearly two decades, Biogen’s formidumab, to be marketed under the Aduhelm brand. The drug’s approval came after years of research and doubts about its effectiveness.
The approval is a “positive step in the right direction,”
Although progressive brain disease is difficult to combat, Dr. Doraywami is optimistic about progress in various areas. Blood tests are being developed to detect Alzheimer’s disease in a doctor’s office, and some home digital cognitive tools for follow-up and possible treatment have been cleared by the FDA. Researchers have found ways to use sophisticated brain scans to detect proteins associated with Alzheimer’s disease and have also found that a seemingly unrelated state of hearing loss is associated with a higher risk of Alzheimer’s disease.
“I think it’s time for hope,” says Dr. Doraywami.
In this edited interview, he discusses promising tools for detecting Alzheimer’s disease, steps you can take to reduce the risk, misconceptions about the disease, and the effects of Covid-19 on dementia.
How to understand the difference between memory problems in normal aging, as opposed to Alzheimer’s disease and other dementias?
If you can’t remember what you forgot, you have a problem. We all forget things, but they usually come back a few hours later or when we are not so stressed or trying. The second is that it gets worse over time. Normal age-related memory loss usually does not worsen significantly over time. Also, in Alzheimer’s disease, cues rarely help. If you signal to other people, they remember or give the correct answer.
And while we all have trouble learning new information and it takes time to understand smart TV, Alzheimer’s patients find it impossible to use a new microwave or remote.
What are the most promising developments in the detection of Alzheimer’s disease and the treatment of mild memory problems?
Simple blood tests that seem to have reasonable diagnostic and prognostic value. Instead of running a two-hour battery of tests or ordering complex brain scans that cost thousands of dollars, a simple blood test can be done in a primary care physician’s office. They are not approved by the FDA for routine clinical practice, but we are very close and expect to have several tests over the next two years that can do this.
There are also a number of digital cognitive tests. Some of them are free memory studies and self-tests that anyone can take at home, which provide an assessment of memory, but require some experience in interpretation. One, the Self-Managed Gerocognitive Exam, includes simple math problems, a questionnaire, and a drawing test. Some other digital cognitive tests that have been cleared by the FDA require a prescription and are used to assess memory. An FDA-cleared test includes a series of brain games to assess five cognitive areas, including attention, working, and episodic memory.
In the future, they can be combined with digital therapy. So, if you find that your memory, reaction time, or concentration is poor, you will play specific sets of computer cognitive games to enhance these skills. These digital therapies are approved for conditions such as ADHD and I see no reason why they may not be available next year or so to treat mild memory problems.
What are some of the advances in brain research?
One big development is something called “Alzheimer’s disease on a plate.” They were able to shape Alzheimer’s mini-brain with plaques and entanglements in a Petri dish using neurons from patients. This work was done at a Massachusetts hospital and is a very big step forward because you will be able to see if a drug works quickly. They can test hundreds or thousands of drugs in months, compared to a more expensive, time-consuming process using mice.
What are some preventative measures that people can take on their own?
Diet. People on a vegetarian or Mediterranean diet have a clearer brain in terms of Alzheimer’s pathology than those who eat a diet rich in saturated fat. The vegetarian diet is associated with reduced amyloid pathology in the brain. Reducing vascular risks, controlling blood pressure, cholesterol, diabetes, weight – they have all been shown to reduce the risk of developing dementia. Be mentally and socially active.
Hearing loss can be one of the biggest potentially reversible risk factors for Alzheimer’s. Studies show that if you have hearing loss for a long time, it leads to contraction of areas of the brain that are very close to the centers of memory. So hearing aids and regular hearing tests are very important.
How about sleep?
We know that sleep is when the brain boosts our immunity and archives our memories. We know that sleep is important for clearing toxic proteins from the brain. They are all crucial. So yes, it is important to get a good night’s rest for a healthy memory.
Much of the treatment and therapies seem to be targeted at those in the early stages. What about those in the middle or later stage?
We have drugs on the market that treat the symptoms of those in the middle stages, but we have not found anything to remove the damage to the brain after it has occurred. That is why there is so much urgency to develop prevention strategies.
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What impact has the pandemic had on Alzheimer’s patients?
This prevented Alzheimer’s patients from receiving adequate care for the last 12-15 months. More people with Alzheimer’s disease died during the pandemic than with any other disease. There are some studies that suggest an increased incidence of dementia among Covid survivors. We can end with a new term, Covid dementia.
Research on Covid vaccine technology has really given a boost to the field in terms of rapid resource mobilization and work with regulatory agencies. I hope that this will spread to other fields as well, ours.
What prevents people from being tested?
Fear. Alzheimer’s is the most feared disease, even more so than cancer. People are afraid of losing their independence, their identity and having to give up everything – from driving to managing their accounts. But many patients who are diagnosed and in the early stages can still drive and cope. This requires coordinated family planning around him to see what can and cannot be done.
Others think it’s not worth judging because nothing can be done about it. But if you don’t get a grade, you don’t know if it’s Alzheimer’s disease or something. I had a patient who thought he had Alzheimer’s, but it turned out to be a severe vitamin deficiency. We fixed him and his knowledge returned to normal.
It is also important for people to be tested so that they can make plans, including financial ones.
What do you do personally to keep your brain healthy?
I am an academic. It helps me to do challenging things every day from morning to night. I play tennis and train. I spend a lot of time communicating. I like chess and bridge. One random glass of wine 2-3 days a week. I’m a vegetarian, so I don’t have to worry about accumulating plaques associated with high saturated fat.
What do you expect to see in 10 years?
I think technology and brain science will be closely integrated. I think we will have amazing tools to map the brain and detect the early stages of the pathology of the disease with a drop of blood.
We will probably have many advanced sensors and wearable devices based on smartphones that can predict the onset of Alzheimer’s disease.
I hope we will have a vaccine to prevent Alzheimer’s in 10 years, but we have yet to find out.
Write to Claire Ansbury at firstname.lastname@example.org
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