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The Future of Preventive Brain Medicine: Breaking Down the Cognition & Alzheimer’s Disease Alphabet Soup

[1]As the pres­i­dent and med­ical direc­tor of the Alzheimer’s Research and Pre­ven­tion Foun­da­tion (ARPF), it’s my job to stay on top of advances in the field of Alzheimer’s research. Recently, a num­ber of arti­cles in the med­ical lit­er­a­ture have caught my atten­tion. They are focused on a par­tic­u­lar ques­tion that con­cerns most Baby Boomers like me: “Is mem­ory loss just a nor­mal part of aging?”

Many of my patients in their fifties, six­ties, and older notice that they occa­sion­ally for­get things like a name, face, or where they put their keys. They won­der whether this behav­ior is nor­mal, or if it is a sign of Alzheimer’s dis­ease. It’s a rea­son­able worry: Alzheimer’s dis­ease is reach­ing epi­demic pro­por­tions and recent sur­veys by the Alzheimer’s Asso­ci­a­tion and oth­ers reveal that it is the Baby Boomers’ biggest health fear [2].

The answer to that ques­tion used to be, “Yes, we all expe­ri­ence some mem­ory loss as we age. Don’t worry—it’s not Alzheimer’s.” Indeed, it was once thought that a lit­tle mem­ory loss was an expected and accepted part of the nor­mal aging process. There was even a term for it: Age-Associated Mem­ory Impair­ment (AAMI). [3] It included a gen­eral slow­ing of men­tal func­tions such as pro­cess­ing, stor­ing, and recall­ing new infor­ma­tion. It also included a gen­eral decline in the abil­ity to per­form tasks related to cog­ni­tive func­tion such as mem­ory, con­cen­tra­tion, and focus.

But here’s the rub: AAMI was never a clin­i­cal diag­no­sis, even though many physi­cians, lay people—and, yes, even yours truly—thought oth­er­wise. Instead, AAMI is a tech­ni­cal diag­no­sis. It’s made by a psy­cho­me­t­ric test, not by actual clin­i­cal symptoms.

These days, we have a num­ber of other, more accu­rate acronyms to describe the vary­ing states of mem­ory loss—a whole bowl of Alzheimer’s-related alpha­bet soup, if you will. And, unlike AAMI, these labels are based on real clin­i­cal diag­noses. They include:

That’s a lot of letters—but these new labels aren’t what I want you to take away from this prover­bial soup bowl. The real issue here is not just a name change; it’s a shift in the way we think about mem­ory loss and aging. Indeed, these alpha­bet diag­noses are not sim­ply sta­tic states of mem­ory impair­ment. A grow­ing body of research sug­gests that they are instead points on a con­tin­uum of mem­ory loss that often ends with a diag­no­sis of the dreaded Alzheimer’s dis­ease. Unless prop­erly treated—in my view, with an inte­gra­tive med­ical program—memory loss tends to get worse over time. In my expe­ri­ence, with inte­gra­tive treat­ment, mem­ory loss can be improved and people’s func­tion­al­ity can be pre­served for a much longer time.

But is any mem­ory loss “nor­mal”? I recently asked that same ques­tion of Barry Reis­berg, M.D., Pro­fes­sor of Psy­chi­a­try and Direc­tor of The Aging and Research Cen­ter at New York Uni­ver­sity. Dr. Reis­berg is one of the world’s lead­ing experts on the sub­ject of mem­ory loss and has stud­ied it for decades. His answer: “Mem­ory loss may be nor­ma­tive (aver­age), but that doesn’t mean it’s nor­mal. The real ques­tion is what is pro­gres­sive over time.”

And that brings us back to our alpha­bet soup. In one land­mark study [6], Dr. Reis­berg and his col­leagues looked at 260 peo­ple, 60 of whom had NCI and 200 of whom had SCI. After 7 years, they dis­cov­ered that mem­ory declined in 7 peo­ple with NCI (15%) and 90 with SCI (54.2%). Of the peo­ple with NCI, 5 devel­oped MCI and 2 devel­oped prob­a­ble Alzheimer’s. On the other hand, of the 90 peo­ple with SCI who pro­gressed, 71 devel­oped MCI and 19 declined all the way to Alzheimer’s.

What this means is that SCI appears to progress to MCI and even to Alzheimer’s dis­ease. Sub­jec­tive or not, even minor mem­ory problems—the kind that many of us typ­i­cally attribute to just “get­ting older”—are not nor­mal and should be taken seri­ously. Con­sider these sta­tis­tics, also from Dr. Reisberg:

Num­bers like these not only drive home the seri­ous news that no mem­ory loss is a nor­mal part of aging, but they also make it clear that we’re on the cusp of what many experts believe will be an epi­demic of Alzheimer’s dis­ease as Baby Boomers con­tinue to age.

I’ve shared infor­ma­tion on ARPF’s web­site [7] about the inte­gra­tive med­ical approach to pre­vent and reverse mem­ory loss. But the fact is that pro­tect­ing against mem­ory loss isn’t just an individual’s respon­si­bil­ity.  They say it takes a vil­lage to raise a child. Well, it takes a vil­lage to sup­port the fight against Alzheimer’s disease—and the types of mem­ory loss that pre­cede it—too.

To that end, in late Novem­ber, U.S. Rep­re­sen­ta­tives Ed Markey and Chris Smith, co-chairs and co-founders of the Bipar­ti­san Con­gres­sional Task­force on Alzheimer’s Dis­ease, out­lined their rec­om­men­da­tions for the National Alzheimer’s Plan, a strat­egy pro­posed for Pres­i­dent Obama’s admin­is­tra­tion to tackle the dis­ease. I heartily agree with many of their sug­ges­tions [8], which include:

Mem­ory loss isn’t like gray hair or wrin­kles. Con­trary to what many of us used to believe, it is not a nor­mal sign of aging. In my opin­ion, that’s all the more rea­son to make Alzheimer’s disease—and the whole bowl of “alpha­bet soup”—a thing of the past by pri­or­i­tiz­ing pre­ven­tion treat­ment today. Beyond that, we clearly need to move past a “magic bul­let” drug approach mentality.

There is a lot we can do right now to live a brain healthy lifestyle and shar­ing that work with soci­ety is where I’d like to see our focus in the future.

– Dharma Singh Khalsa, M.D., is the Pres­i­dent of the Alzheimer’s Research and Pre­ven­tion Foun­da­tion [7] (ARPF), a 501©(3) non-profit orga­ni­za­tion spear­head­ing dynamic research on the use of med­i­ta­tion and mem­ory loss pre­ven­tion and rever­sal. He grad­u­ated from Creighton Uni­ver­sity School of Med­i­cine and received train­ing in Anes­the­si­ol­ogy at the Uni­ver­sity of California-San Fran­cisco where he was chief res­i­dent. Dr. Khalsa is the author of the inter­na­tional best-seller “Brain Longevity,” pre­sent­ing an inte­gra­tive approach to the pre­ven­tion and rever­sal of mem­ory loss.

(Word cloud pic source: Big­Stock­Photo [9].)

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