“Although people with Alzheimer’s may forget us, as a society we need to remember them.”
— Scott Kirschenbaum, filmmaker
Alzheimer’s disease is a debilitating neurological disorder that the German psychiatrist and neuropathologist Alois Alzheimer identified in 1906 when he analyzed the brain of the late Auguste Deter, a patient in an asylum in Frankfurt, Germany, who was showing signs of memory loss and problems with language and behavior. (Some critics later concluded that she may have been suffering from something else, including vascular dementia caused by problems with blood flow to the brain, as in mini-strokes, or metachromatic leukodystrophy, an enzyme deficiency.)
Dementia—the umbrella term for a group of disorders arising from disease, injury, and/or genetics and characterized by devastating cognitive impairment—is a leading cause of dependency, disability, and mortality. Current estimates assume that 44 million people are living with dementia worldwide. This figure is projected to more than triple by 2050 as the population ages, when the annual cost of dementia will exceed $600 billion in the United States alone. (The cost of caregivers, many of whom receive little financial or psychological support, is unpredictable.) Low- and middle-income populations appear to be at greatest risk for the largest increase, as they have higher rates of diabetes and cardiovascular disease Diseases such as high blood pressure that affect certain types of dementia.
Alzheimer’s disease, which can only be truly diagnosed by an autopsy, is now the most common type of dementia in the United States – accounting for 50% to 60% of all cases, again with a disproportionate impact on minorities. Alzheimer’s is characterized by certain changes in the brain, most notably amyloid plaque buildup and neurofibrillary tangles (NFT) of hyperphosphorylated tau.
Interestingly, Alzheimer’s starts deep in the brain, so these pathophysiological features can appear as early as 10 to 20 years before symptoms appear and then gradually spread to other parts of the brain. The main symptoms of Alzheimer’s and other forms of dementia include progressive memory loss, shortening of attention span, personality changes, discomfort in new situations, and difficulty organizing thoughts, learning new things, writing, reading, using numbers, and even speaking .
An estimated 5.4 million Americans have Alzheimer’s disease. Today, someone in the country is diagnosed with Alzheimer’s every 66 seconds. According to the Alzheimer’s Association, by 2050, one new case of Alzheimer’s is expected to develop in half that time, leading to nearly 1 million new cases per year, or 13.8 million, due in large part to the aging baby boom generation is due.
Unfortunately, there are no disease-modifying treatments yet. With this in mind, the best intervention strategies are those that detect dementia early. Epidemiological evidence suggests that education and physical activity may protect against certain types of dementia, while midlife hypertension and diabetes affect the risk of something like vascular dementia. Inexpensive lifestyle interventions that promote brain health, halt progressive degeneration, repair neuronal damage, and prevent cognitive disability are at the forefront of the dementia prevention discussion. Many intervention studies are shifting their focus to cognitively healthy individuals at risk of developing Alzheimer’s and other forms of dementia (before significant irreversible neural network disruption and loss associated with overt clinical symptoms has occurred) as the best strategy to reduce incidence the disease and frequency.
From a nutritional perspective, the Mediterranean and DASH (Dietary Approach to Systolic Hypertension) diets have been shown to slow cognitive decline. MIND (Mediterranean-DASH Diet Intervention for Neurodegenerative Delay) and DASH) are known to recommend high consumption of green leafy vegetables, nuts, berries, beans, seafood, and poultry, among others.
Something to think about
If our society really wants to confront this problem, we have to tackle it in the early stages and even well into the preliminary stages. Choosing a healthy lifestyle — eating nutritious foods and exercising more — at an early age is a start. What complicates things is that as people age, they may devote less effort to healthy behaviors like exercise because of pain, discomfort, or suboptimal beliefs.
But especially in our digital age of fear, it’s not just about good nutrition and exercise. Stress can play a role. (See page 68.) But the greatest challenge may lie in a technology that seems to do everything for us, distorting our brain patterns and attention spans in the process. According to a recent New York Times interview with Richard Restak, MD, a neurologist and clinical professor at the George Washington Hospital University School of Medicine and Health and author of “The Complete Guide to Memory: The Science of Strengthening Your Mind,” it’s missing of memory – the memory loss most commonly associated with dementia – is partly due to a lack of attention. And paying attention is hard for those who want it all at once in short internet bursts. (He also recommends doing something fewer people do more — reading books, especially novels, which force you to focus and remember schedules.)
The most efficient strategy we can use is to move from treatment to prevention. Even if the onset of dementia can only be delayed by a few years, this would have a major impact on our society and its health. It is more important than ever to study how lifestyle choices affect risk.