Gerry Gajadharsingh writes:

“With the exception of the recent accelerated approval of aducanumab, in over 26 years of research and development (R&D) investment in Alzheimer’s disease (AD), only five novel drugs—all for symptomatic treatment only—have reached FDA approval in the USA. In the USA alone since 1995, $42 Billion has been spent on Alzheimer’s research., the UK government spends over £100M per annum.

According to the Alzheimer’s Society in the UK the total cost of dementia in the UK is £26.3 Billion of which the NHS pays £ 4.3 Billion of the costs and social care at £10.3 Billion.

Outside of the distress that the disease causes patients and their families, this disease is costing a shed load of money. Whilst medicine and pharmaceutical companies and many patients generally would prefer a magical pill, the article below suggests, in keeping with my thoughts, that there is a growing appreciation that there will not be a single silver bullet. It will take an integrated approach to actively manage our brain health with evidence-based interventions. And the faster we get there, the better.

 The article below from Medscape is from Michael Merzenich, PhD. He is professor emeritus at UCSF and a Kavli Laureate in Neuroscience, and he has been honoured by each of the US National Academies of Sciences, Engineering, and Medicine.   

 The most popular approaches aim to prevent this brain disease much as we now try to prevent heart disease — with a multimodal approach focused on modifiable behavioural risks. In the case of Alzheimer’s research, those interventions tend to include brain training, physical exercise, and nutrition.

 I started my literature review into Alzheimer’s/dementia research around 2014 and it has helped me develop a unique protocol for both Diagnostic and Therapy intervention for managing cognitive decline.

 It’s good to know that much of what I am suggesting is backed up by research.

 For further information, including links to some of the research papers, I have looked at please go to”.

https://www.thehealthequation.co.uk/managing-cognitive-decline/

Medscape

Michael Merzenich, PhD

This often-occurring, natural, programmed self-destruction of the brain that we call Alzheimer’s disease is a result of broadly deteriorating organic brain health, and that’s probably why drug development has been so hard. Treating just one piece of this multifaceted brain health deterioration is inadequate to arrest or reverse the decline.

The Role of Cognitive Reserve

But what about those people who have many biomarkers of brain health decline, yet don’t express the behavioural symptoms of Alzheimer’s? What’s their secret?

Pathologists have a term for this mysterious factor that forestalls the development of Alzheimer’s disease in some: They call it “cognitive reserve.” I call it “organic brain health.”

Growing your cognitive reserve and actively managing your organic brain health should be high on the list of Alzheimer’s prevention strategies. How can you do that?

The most popular approaches aim to prevent this brain disease much as we now try to prevent heart disease — with a multimodal approach focused on modifiable behavioural risks. In the case of Alzheimer’s research, those interventions tend to include brain training, physical exercise, and nutrition.

A Multimodal Approach

The FINGER study, from Finland, used a structured program of brain training, a brain-healthy diet, physical exercise, and vascular risk monitoring. The initial results were exciting. FINGER showed a 25% larger cognitive improvement in the treatment group compared with a control group receiving general health advice. A similar multimodal behavioural intervention study conducted in Australia found a clinically significant reduction on a well-validated dementia risk scale.

These studies enrolled people at risk for dementia, raising the possibility that clinically validated treatment protocols using only behavioural interventions may be the most promising for dementia prevention — and perhaps even treatment.

A next generation of FINGER-like studies are now underway all over the world, including the US PONITER Study.

Virtually all of these studies include brain training, which has been a primary focus of my own scientific work for the past 25 years.

Brain Training

Brain training directly improves the organic health of the brain. Stronger brain activation and improved functional connectivity across brain regions are seen on functional MRI studies after brain training, and EEG studies show improved information processing speed.

The ACTIVE study, which tracked more than 2800 older adults for 10 years, found that those in the brain training arm showed a 29% reduction in dementia risk compared with the control group. This was with a miniscule 10-18 hours of brain training in total over the decade, on a particularly important type of exercise (so-called “speed of processing” training). Those who trained more than others had still larger reductions in dementia incidence.

This explosion in research on modifiable risk factors for Alzheimer’s is a blessing. The lancet commission estimates that 40% of dementia cases could be prevented or delayed by addressing 12 known lifestyle risk factors. I believe that this greatly understates the potential benefits of more complete and controlled management of brain health in older adults.

Finally…

You may have detected my frustration over our long, expensive journey to halt Alzheimer’s with a myopic focus on finding a magic molecule to address plaques, tangles, or the laundry list of potential causes.

That frustration is not directed toward the well-intentioned researchers involved in those efforts. It is addressed to the devastating disease itself. Like most of you reading this column, I have lost loved ones to it, including my mother.

It’s an exciting time now in Alzheimer’s research. Finally, there is a growing appreciation that there will not be a single silver bullet. It will take an integrated approach to actively manage our brain health with evidence-based interventions. And the faster we get there, the better.

Michael Merzenich, PhD, is often credited with discovering lifelong plasticity, with being the first to harness plasticity for human benefit (in his co-invention of the cochlear implant), and for pioneering the field of plasticity-based computerized brain exercise. He is professor emeritus at UCSF and a Kavli Laureate in Neuroscience, and he has been honoured by each of the US National Academies of Sciences, Engineering, and Medicine. He may be most widely known for a series of specials on the brain on public television.