Dementia is a progressive syndrome in which memory, behavior and the ability to perform daily activities declines over time. Dementia onset typically occurs in those 60 years of age and older when our health habits, or lack thereof, begin to catch up with us. These health habits, such as diet and exercise, greatly impact our cardiovascular health, which is linked to brain health. Alzheimer’s disease (AD) is the most common (but not the only) cause of dementia.
There are an estimated 50 million people with dementia world-wide, with cases expected to rise to 152 million by 2050 [1]. This rise in dementia is partially due to an increasing global elderly population, with persons over 80 years of age projected to triple from 143 million to 426 million by 2050 [2]. These numbers suggest that around 35% of the world’s population will suffer from dementia. Another 35% or more, then, will be caregivers of those with dementia who can no longer care for themselves. To make matters even worse, preclinical AD and dementia can exist 20-30 years prior to the first signs of symptoms [3].
The disease may very well be in line to be the worst killer of the 21st century [4]. If not before, now is the time to seek out options for prevention and treatment. So, have we started to develop potential treatment methods? Yes. Have they been successful? Not quite. Clinical trials thus far have focused on the diagnosis and treatment of symptomatic dementia, particularly with drugs and genotyping. Current pharmaceutical setbacks due to FDA regulation has put the development of drug-based treatment methods on hold [3].
In short, there are currently no successful treatment measures for dementia. Recently, the conversation on dementia has shifted from treatment options to preventative courses of action. There is less talk about FDA approvals and pharmaceutical regulations and more about how our lifestyles impact our dementia risk. As a matter of fact, one-third of current dementia cases are thought to be attributable to modifiable lifestyle factors [3,5].
The specific modifiable factors that have been linked to dementia and Alzheimer’s disease prevention include nutrition, physical activity, sleep, and stress [3,6]. Dr. Richard Isaacson applies these factors in clinical practice. His philosophy, termed clinical precision medicine, is to not turn directly to machine-based or drug-based forms of prevention in treatment but focus on human-based clinical methods to delay the onset of the diseases. Dr. Isaacson’s approach includes evidence-based and data-driven lifestyle coaching. Rather than focusing on pharmacologic approaches, such as medication and supplementation, it focuses on nonpharmacologic interventions, particularly anthropometrics, cognition, and blood biomarkers that are personalized to each individual and this risk of dementia or AD.
In practice, clinicians recommend managing cardiovascular risk, monitoring nutrition, engaging in regular physical activity, improving sleep habits, enhancing cognitive abilities, increasing social interaction, strengthening one’s sense of purpose, mitigating stress, and sustaining good oral hygiene, each to various degrees, depending on the specific risk pertaining to the individual. Biometrics or anthropometrics (body fat % and lean muscle mass), genetic tests, blood biomarker lab tests, cognitive assessments, behavioral assessments, and clinical history are all used to quantify these factors. Ongoing care allows for both patients and clinicians to track progression toward better brain health [3].
Further studies are necessary for truly determining which factors make a difference in the onset of Alzheimer’s. With a sufficient dataset, the transition to predictive analytics can be made, from which artificial and representative neural networks can be made, allowing for automated patient recommendations, extended access to care, and optimized clinician workflow [3]. Still, we are not left in the dark until we obtain adequate data. Once again, making these lifestyle changes not only shows to be promising for improving brain health, but doing so improves many other aspects of overall health.
It is important to emphasize that these modifiable factors are preventive measures, rather than a cure for dementia and Alzheimer’s disease. Unfortunately, not all of dementia’s contributing factors are modifiable, and these unmodifiable factors (such as genetics, poor education, and social isolation) still play notable roles in the workings of the disease [4]. Yet, with preclinical AD dementia existing 20-30 years prior to the first sign of symptoms, mid-life lifestyle intervention is key. The earlier the start, the better, too, as these factors become more challenging to modify at older ages [4]. You can still teach an old dog new tricks, but those tricks will not be beneficial if the disease is further along in its progression.
Clinical precision medicine is a proactive approach to AD and delaying the onset, if not preventing it, for as long as possible. Delaying dementia by 3-5 years may not seem significant to the middle-aged population, but for the oldest of the old populations, that could be the difference between remembering the last few years or not.
References
[1] World Health Organization. Dementia. (2019)
[2] United Nations. (n.d.). Ageing.
[3] Isaacson, R. S., et al. (2018). The clinical practice of risk reduction for Alzheimer’s disease: A precision medicine approach. Alzheimer’s & Dementia, 14(12), 1663–1673. doi: 10.1016/j.jalz.2018.08.004
[4] Davis, N. (2017, July 20). Lifestyle changes could prevent a third of dementia cases, report suggests.
[5] Mohney, G. (2017, July 27). One-Third of Cases of Dementia May Be Due to Lifestyle.
[6] Ashby-Mitchell, K., et al. Proportion of dementia in Australia explained by common modifiable risk factors. Alz Res Therapy 9, 11 (2017). https://doi.org/10.1186/s13195-017-0238-x