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Changing the paradigm around Alzheimer's disease

Prevention could begin with lifestyle in younger years, one researcher says during the American Public Health Association meeting.

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Philadelphia — In Peter Whitehouse's view, all people fall into one of two groups: those with Alzheimer’s disease and those who are afraid of getting it.

That fear is helping drive more and more dollars toward researching a treatment to "cure" the symptoms. But this spending comes at the expense of efforts that focus on improving the public’s understanding of Alzheimer’s and how it relates to normal aging, said Whitehouse, a neurologist at Case Western Reserve University in Cleveland, at the annual meeting of the American Public Health Association.

"There's this sense that if we invest enough money in research, fame and fortune will be ours if we find a biological fix, a magic bullet," he said during a packed session November 9. But Alzheimer’s disease is a moving, multifaceted target.

Several hundred genes play a role in the condition, which causes different symptoms in different patients. And while Alzheimer’s researchers often talk about the brain plaques and tangles that characterize the disease, the reality is that not all Alzheimer’s patients show these deposits and some patients with other forms of dementia do show them, said Whitehouse, who recently published The Myth of Alzheimer's: What You Aren't Being Told about Today’s Most Dreaded Diagnosis.

Whitehouse says that, instead of thinking of Alzheimer's as a strict dichotomy — you have it or you don't — he and a growing number of researchers are beginning to think of brain aging and dementia as more of a continuum. We’re all a little demented, the thinking goes. Some of us are just more demented than others.

This thinking implies different responsibilities for society, he said. First, it means greater acceptance for those who do have more advanced dementia, rather than stigmatizing or fearing those individuals. Second, it means recognizing that aging takes place throughout a person’s lifespan and that lifestyles during the younger years can affect people's health later in life. "We need to focus on the elders but not forget the young people," he said.

And the way many young people live today almost guarantees health disasters, including cognitive decline, later in life, argued Jill Stein, a physician and founder of the Massachusetts Coalition for Health Communities. Presenting just after Whitehouse, Stein laid out a simple — some might say overly simplistic — road map of pathways leading to neurodegenerative and other chronic diseases. Essentially, lifestyles today – which can include poor diet, lack of exercise and exposure to toxic substances in the environment — trigger inflammation within the body. This inflammation causes chemical stressors that interfere with critical systems, such insulin regulation. Chronic disease results.

So a major goal of treatment today should actually be to reduce these inflammation triggers in people’s environments, Stein said. "A ton of prevention is worth many, many more times than the ounce of cure that we can't afford anyway anymore."

Wait, does that mean cutting funding for treatments to help people who can no longer recognize their own families?

No, Stein said. But interventions that focus on lifestyle and environment are so powerful and accessible, "they deserve so much more attention than what they've been getting."

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