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From Anti-Alzheimer’s “Magic Bullets” to True Brain Health

If you fol­lowed lat­est head­lines sur­round­ing the release of the National Alzheimer’s Plan, you’d prob­a­bly con­clude that the likely solu­tion to main­tain life­long brain health is sim­ple: sim­ply wait until 2025 for a “magic bul­let” to be dis­cov­ered, to cure (or end or pre­vent) Alzheimer’s dis­ease and aging asso­ci­ated cog­ni­tive decline. These kinds of beliefs, often rein­forced by doc­tors and adver­tis­ing, may explain the bil­lions spent today by pharma com­pa­nies on dis­cov­er­ing new com­pounds, and by con­sumers on sup­ple­ments like ginkgo biloba. But the fail­ures to pro­duce bet­ter drugs and con­flicts of inter­est are mak­ing many peo­ple ask what is wrong with this picture.

We need a new cul­ture of life­long brain health to empower that 80% of the 38,000 adults over 50 sur­veyed in the 2010 AARP Mem­ber Opin­ion Sur­vey who indi­cated “Stay­ing Men­tally Sharp” as their top ranked inter­est and con­cern, not to men­tion youth, work­ers and elders fac­ing cog­ni­tive and emo­tional challenges.

The prob­lem? That the “magic bul­let” approach nei­ther does it reflect exist­ing clin­i­cal evi­dence or emerg­ing neu­ro­sci­en­tific think­ing, nor does it address the life­long needs and demands of our citizens.

That’s why we need to shake the Etch-A-Sketch and cre­ate a new image of the future.

Let’s first draw our true objec­tive: is it to pro­mote men­tal vital­ity and col­lec­tive wis­dom or to declare war on Alzheimer’s plaques and tan­gles? Those are two rad­i­cally dif­fer­ent objec­tives, lead­ing to very dif­fer­ent pri­or­i­ties. For exam­ple, let’s imag­ine the impli­ca­tions of being able to max­i­mize cog­ni­tive per­for­mance and to delay cog­ni­tive decline.

Sec­ond, let’s build on what we know today. We know that 30% or more of the pop­u­la­tion with plaques and tan­gles do not man­i­fest sig­nif­i­cant cog­ni­tive decline. This is a fact –often explained via the “Cog­ni­tive Reserve” the­ory. It is also a fact (ignored in the report’s pre­sen­ta­tion and related media cov­er­age) that the most exhaus­tive sys­tem­atic evi­dence review [1], per­formed in 2010 under the aus­pices of NIH, found that non­phar­ma­co­log­i­cal fac­tors (such as phys­i­cal exer­cise, cog­ni­tive engage­ment, cog­ni­tive train­ing, and Mediter­ranean diet) seemed to be pro­tec­tive against cog­ni­tive decline, whereas “magic pill” inter­ven­tions (drugs, sup­ple­ments such as vit­a­mins and gingko biloba) had no such effect.

Third, let’s select the right frame­work and toolkit. While bio­med­ical research is indeed part of the solu­tion, pub­lic health/ edu­ca­tion ini­tia­tives and tech­nol­ogy inno­va­tion are equally impor­tant. The 2011 Sharp­Brains Vir­tual Sum­mit, which brought together more than 260 research, tech­nol­ogy and indus­try inno­va­tors in 17 coun­tries, high­lighted the need to devote suf­fi­cient atten­tion and resources to pre­ven­tive brain health strate­gies across the whole lifes­pan, and the need to bring to mar­ket a new gen­er­a­tion of reli­able and inex­pen­sive assess­ment and mon­i­tor­ing strate­gies of cog­ni­tive and emo­tional health — in order to tar­get and deliver those pre­ven­tive strate­gies in effi­cient ways. Inno­v­a­tive pub­lic edu­ca­tion ini­tia­tives, such as Expe­ri­ence Corps and The Inter­gen­er­a­tional School, may lead to bet­ter cog­ni­tive and health out­comes over the long-haul.

It sim­ply makes no sense to put all our eggs in the bio­med­ical bas­ket. Each of this column’s co-authors is pro­duc­ing a dif­fer­ent con­fer­ence in June: Dr. White­house and col­leagues on “Healthy Envi­ron­ments Across Gen­er­a­tions [2]” (June 7–8, NYC) and Mr. Fer­nan­dez on “Opti­miz­ing Health via Neu­ro­plas­tic­ity, Inno­va­tion and Data [3]” (June 7-14th, fully online). There are a num­ber of excit­ing and com­ple­men­tary approaches to “Stay­ing Men­tally Sharp” such as phys­i­cal exer­cise, mind­ful­ness med­i­ta­tion, biofeed­back, cog­ni­tive ther­apy and train­ing, volunteering…How can con­sumers make informed and rel­e­vant deci­sions today? And how can they use these reen­er­gized healthy brains to solve chal­lenges like global cli­mate change and eco­nomic stagnation?

Sure, more research is bet­ter than less, and we hope that the new funded tri­als will result in use­ful drugs. But nei­ther policy-makers nor cit­i­zens should wait until then to fos­ter and make lifestyle deci­sions than can max­i­mize cog­ni­tive per­for­mance across the lifespan.

JFK chal­lenged us not only to go to the moon, but to take proac­tive care of our phys­i­cal fit­ness. Per­haps the time has come for a seri­ous open national con­ver­sa­tion on true brain health and how the newly announced Alzheimer’s strate­gic plan must include health­ier and brainer think­ing than a war on Alzheimer’s plaques and tan­gles.

Dr. Peter White­house is a Pro­fes­sor of Neu­rol­ogy at Case West­ern Reserve Uni­ver­sity and co-author of The Myth of Alzheimers: what you aren’t being told about today’s most dreaded diag­no­sis [4]. Alvaro Fer­nan­dez, recently named a Young Global Leader by the World Eco­nomic Forum, is the co-author of The Sharp­Brains Guide to Best Fit­ness: 18 Inter­views with Sci­en­tists, Prac­ti­cal Advice, and Prod­uct Reviews, to Keep Your Brain Sharp [5], an AARP Best Book, and pro­ducer of the 2012 Sharp­Brains Vir­tual Sum­mit: Opti­miz­ing Health through Neu­ro­plas­tic­ity, Inno­va­tion and Data [3] (June 7-14th, 2012).

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