The good news about Alzheimer’s disease is that the rate of dementia in the United States appears to be declining. We hope this is a product of healthier lifestyles among baby boomers and portends a better future for many of us. The bad news is that another major experimental treatment for Alzheimer’s disease failed to show benefit — in line with 99 percent of all similar clinical trials in the past 15 years.
Stuck in between these news items is yet another “miracle brain tonic” being hawked on social media, with the “last three trucks leaving the warehouse” so better order it fast. Given all these stories, what is one to actually believe about the current status of this late-life scourge?
As a geriatric psychiatrist who runs a memory and research center in Miami and spends his days seeing every inch of Alzheimer’s, let me give you the bottom line: We now have a much clearer understanding of Alzheimer’s disease, with all roads leading to two toxic proteins in the brain called beta-amyloid and tau as being the central culprits. These proteins begin building up and doing their damage years if not decades before symptoms appear.
And therein lies the crux of the problem; once someone has symptoms, treatment may be too little, too late. It’s like trying to put out a forest fire with a garden hose. Even if our current approaches to rid the brain of these proteins work, we need to start years before symptoms emerge. There are several studies aimed at doing just this, assisted by newer types of brain scans that allow us to see the smoke long before the flames erupt. This is the potential promise of anti-amyloid immunotherapy and dozens of other experimental approaches being studied.
In the meantime, there are four medications approved by the Food and Drug Administration that may modestly improve symptoms, but we also know that exercise, music, art, caregiver support and other meaningful activities bring the best possible quality of life.
If you are worried about having problems with your memory or other cognitive skills, get an evaluation with a specialist such as a geriatric psychiatrist or a neurologist. Early diagnosis is key, and many times will reassure you that you don’t have Alzheimer’s disease. Sometimes the specialist will identify reversible factors, which is all the more reason to intervene at the earliest sign of problems.
A comprehensive evaluation should always include a thorough medical and psychiatric history, a review of medications, a neurological and psychiatric exam, blood tests, a brain scan, and some form of neuropsychological testing. Anything less risks missing the actual diagnosis and other contributing factors. Much of this work-up can be obtained for free as part of a clinical trial for Alzheimer’s disease.
It is important not to be taken in by fake or exaggerated claims about memory disorders.
There is no hidden cure, and it is certainly not in the last shipment leaving the warehouse. Think logically about the many outrageous claims that brain tonics make and ask yourself this: Despite hundreds of millions of dollars spent on scientific research that has yet to find an effective treatment, do you really believe that someone mixing a few herbs into a mysterious elixir has found something better? Such claims are more hype than hope, with next to no rigorous scientific evidence but significant injury to your wallet.
So what can make a difference? A brain healthy lifestyle may reduce the risk of Alzheimer’s, push off its onset, and improve the well-being of those already afflicted. It is available to all and relatively inexpensive, and includes moderate physical exercise (e.g., walking for 45 minutes three times a week), careful attention to vascular risk factors (e.g., high blood pressure, elevated glucose or cholesterol levels, and heart arrhythmias), regular mental and social stimulation (e.g., lifelong learning programs), and a Mediterranean diet full of fruits, vegetables, whole grains, olive oil. Even a glass of wine.
We have a long way to go, but none of us — clinicians, researchers, advocates, caregivers and those with Alzheimer’s disease — are standing still.
Marc E. Agronin, M.D. is a geriatric psychiatrist at Miami Jewish Health and the author of "The Dementia Caregiver: A Guide to Caring for Someone with Alzheimer’s Disease and Other Neurocognitive Disorders.”