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Confronting The Fear, The Facts, And A Future With Alzheimer’s And Other Dementias

The month of June packs many noteworthy events on the calendar. June is Pride Month and African American Music Month. There was still room in between for Flag Day, Father’s Day and the newest US public holiday – Juneteenth. Weather wise, it was time to herald in Summer, plan for hurricane season and attend weddings. With all those happy or somber observances, you may have missed another declaration important to everyone over the age of 50 and their families. In 1983 President Ronald Reagan declared the month of June as “Alzheimer’s and Brain Awareness Month” in response to a campaign by the then fledgling Alzheimer’s Association. Ten years after acknowledging that the Purple Campaign for Alzheimer’s awareness deserved a credible place in the national consciousness, President Reagan himself was diagnosed with Alzheimer’s in 1993 and eventually succumbed to its complications in 2004.


An Epidemic of Dementia In Many Countries Is Nearing Global Pandemic Level


There now exists national Alzheimer’s Associations all over the world. Reports from WHO Global Dementia Observatory tell us that there are currently 50million people afflicted with Alzheimer’s and other dementias making it the 5th leading cause of death. Early onset happens between age 50 and 65 representing 10% of diagnoses; those numbers are increasing. With 10million new cases every year, the number is projected to triple by 2050. Currently, one in 7 Americans over the age of 65 have been diagnosed as having Dementia ( https://www.alz.org/ ). More so than with any other chronic debilitating condition, Dementia – a syndrome of degenerative brain diseases which includes Alzheimer’s – exacts the deepest physical, economic, social and emotional toll on the lives and quality-of- life of patients, their family members and caregivers, with implications for health, social and economic systems of countries as a whole. If you haven’t yet taken notice, you should. It is what your nation’s Alzheimer’s Association appealed for you to do during the month of June. But awareness should be a constant in the minds of those not yet in the throes of Dementia, considering the torturous devastation that Dementia can wreak in your life. Prior to 2020, some global health experts were unofficially labeling Dementia a pandemic; but they were pre-empted by a faster-moving infectious-disease pandemic called Covid 19 that quickly commandeered total attention. Still, alongside that battle, many countries are admitting that they have an epidemic of Dementia on their hands, requiring just as much attention, and without a vaccine.


Alzheimer’ Is Only One Type Of Dementia


By virtue of name, Alzheimer’s Associations everywhere highlight the most commonly known type of Dementia. But beware the tendency to use the tag of Alzheimer’s as synonymous with Dementia. It is the type of error that infuriates grammarians, akin to the ‘genericization’ example of calling all tissues Kleenex. The incorrect use of the term Alzheimer’s interchangeably with Dementia may fall into the grammar pit of “metonyms’ which means using a word as a substitute for other things to which it is closely related. It's understandable when lay people switch up the two words. It's inexcusable when some medical professionals are lax about the terms. The error is much more than a pox on grammarians because misuse of medical terminology has complex consequences. The term Dementia existed first, not as a disease of itself, but as a syndrome with symptoms common to 9 or 10 recognized types of progressive brain diseases. Many of the dementias are named after a physician who isolated different groups of symptoms in order to target treatment. The list of dementias includes in part: Alzheimer’s Disease, Lewy Bodies Syndrome, and Creutzfeldt-Jakob Disease (named after German physicians); Parkinson’s Disease (British); and Huntington’s Disease (European-American). Also Vascular Dementia and Frontotemporal Dementia which are real diagnoses but are not yet claimed. Alzheimer’s is the most well-known perhaps through the chicken and egg principle – it is well-known because the term is used widely; and because the term is used widely, it is well-known.


Alzheimer’s was so named in 1910 by a colleague of German neurologist / psychiatrist Alois Alzheimer who observed a pattern of symptoms particularly in women, that departed from the other known dementias. He tracked progressive memory loss, disorientation, paranoia, personality changes and unpredictable behavior. Since then, through the years, men too have been diagnosed with similar progressive symptoms, but to this day, if diagnoses are accurate, two-thirds of Alzheimer’s patients are women, who are also affected more severely than men. It is paradoxical that clinical trials for new treatments recruit men more than women, which is a failing in nearly all pharmaceutical trials. Medical researchers were forced by Law to include women in clinical trials in 1993 (www.nih.gov). Medical scientists continue to parse observable patterns within the Dementia syndrome and such efforts to pin down specificities should improve the chances for finding useful treatment or a cure for each type.


Misdiagnoses And Mixed Pathologies Hamper Treatment


WHO estimates that Alzheimer’s may account for 60% to 80% of dementias. The margin of error is wide since some of the diagnoses may be another lesser-known dementia, or mixed pathologies – a concern raised in a March 2020 report by the Alzheimer’s Association (https://alzjournals.onlinelibrary.wiley.com/doi/10.1002/alz.12328). Even though a diagnosis may be given, there is a common scientific practice of confirming the presence of Alzheimer’s after the fact through autopsies. In one study of 477 autopsies, only 3% showed biomarkers in the brain specific to Alzheimer’s. It is known that some individuals have dementia-like symptoms that do not follow the pathways of Alzheimer’s. According to the same report, primary care physicians (PCP) as they are called in the US, and General Practitioners (GP) as they are called elsewhere, have the burden of dealing with the burgeoning problem of patients with dementia-like symptoms, but many are untrained and unprepared for making accurate diagnoses or treating such patients. At the same time, the specialists such as geriatric psychiatrists or neurologists are few and far between compared to the need. And expensive trial drugs are neither available nor accessible to all.


Genetics And Environment Trigger The Onset Of Dementia


There is optimism for the newest medications coming on the market in 2021 even amidst controversy about Aducanunab, marketed as Aduhelm, developed by Biogen and its Japanese partner Eisai approved by the FDA in June. China is testing a new drug and Western Europe is currently host to 43 studies. The mood among affected patients and families is that anything is better than nothing even though a cure is not promised. So far, medications can only temporarily delay the decline. And since there can be misdiagnoses as regards the type of Dementia, drugs specifically developed for Alzheimer’s symptoms will miss the mark for others or for those with mixed dementias.


Since a cure is not yet on the table, is there such a thing as prevention of Dementia? Research for cure and treatment is sexier than research into prevention studies. A cure brings a big bang for the buck with a lot of fanfare. A study published in May 2021 in the Journal of Circulation, gives a higher profile to the role of Prevention. Genetics play a part in many chronic conditions and Familial Dementia is a strong predictor and risk factor for you to get dementia. Heredity is not necessarily your destiny, although you can be thankful for good genes. When it comes down to ‘bad genes’ a UK Biobank 8-year longitudinal study of over 500,000 men and women between 50-73, explored whether those with familial dementia actually developed dementia. Lifestyle, diet and nutrition, physical activity and other habits were monitored. Results proved that there are opportunities for reducing your risk through non-genetic factors even if your family has high incidence of Dementia. You may hate the word Diet because it is one of those misused terms. Nevertheless, eating a healthy diet was a proven factor in reducing risk for dementia by at least 75% alongside other lifestyle changes like regular physical activity, sound sleep for 6-9 hours, no smoking, minimal alcohol consumption, managing your stress and recognizing depression and seeking treatment for it. Other studies over the years have also drawn a correlation for Dementia with environmental toxins in polluted air, and ingested toxins such as pesticides and aluminum. Are your problems caused by the soda in the can or by the can itself?


The MIND Diet Is Proven For Dementia Prevention


When it comes to a diet to prevent Dementia, it’s not as though any ‘healthy’ diet will do the job. The MIND diet – Mediterranean-DASH Intervention for Neurogenerative Delay (MIND) is a hybrid of two proven diet plans – the Mediterranean diet for optimum body function and health, and the DASH diet – Dietary Approaches to Stop Hypertension. It was developed by a group of medical scientists and nutritionists coordinated by the Chicago-based Rush-Copley University Medical Center, leaders in medical research. If you are over 50 and you accept that you may have a proclivity to get Dementia either through hereditary or environmental factors or both, and if you also believe that you can and should make non-genetic changes that can delay or stop onset of Dementia, then definitely pay attention to the results of the Biobank study as well as the dietary changes suggested by the MIND diet. If you have family members and friends already afflicted with Dementia, lifestyle and diet changes may help in the early stages, plus medical intervention of the right type, with the correct diagnosis. If your loved one is in late-stage Dementia, support groups exist. Dementia patients have a 2 to 12 years prognosis. There are real reasons for referring to Dementia as “The Long Goodbye.”

This year 2021 kicks off the UN Decade of Healthy Aging –2021-2030. You owe it to yourself to remain aware of prevention and treatment.


Here are some links for information on the MIND Diet.


https://www.pfizer.com/news/featured_stories/featured_stories_detail/the_mind_diet_a_guide_for_beginners

https://khn.org/wp-content/uploads/sites/2/2017/04/mind_ph_module-1_mind-diet_v2.pdf

https://health.clevelandclinic.org/should-you-try-the-mind-diet-to-preserve-your-brains-health-after-a-stroke/





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