Dementia research conclusion: No evidence yet of behavior to prevent it



The release of a comprehensive report Thursday analyzing how people might stave off dementia could have spawned a public health campaign showing how to avoid one of any individual’s worst nightmares connected to aging.

That is not, however, what the National Academies of Sciences, Engineering and Medicine could deliver. Just as Alzheimer’s disease has proven elusive to any drug cure, it has defied researchers trying to identify a sure-fire lifestyle behavior or choice that will prevent cognitive decline.

A National Academies committee made up of experts in the Alzheimer’s field, who looked collectively at wide-ranging results of prior research, thus declined to offer any guarantees for avoiding the affliction of Alzheimer’s or the cognitive decline connected to it. There are too few rigorous studies with consistent, repeated positive findings to make that possible, especially considering the slow-developing nature of the disease over many years — even decades — where no symptoms are visible.

The report instead found evidence that, though “inconclusive,” was sufficiently encouraging, to suggest adults can assist the long-term health of their brains in the following ways: being physically active; engaging in mentally stimulating activities; and, in the case of people 35 to 65 years old with hypertension, managing their blood pressure. The report gave only general guidance to be physically and mentally active, and said further study would be needed of what specifically works best.

“These three areas are very encouraging to me, because they do no harm and they might do good,” said Alan I. Leshner, chairman of the committee producing the report. “We’re saying you can add these three things to the list. You can do these three things, or one or more, and you might — you wouldn’t want to say you will — but you might be able to delay cognitive decline.”

Those findings from the “Preventing Cognitive Decline and Dementia: A Way Forward” report weren’t earthshaking, but they were more than was provided in a similar analysis of research done seven years ago. The National Institute on Aging sought the new report to determine what progress has been made, and NIA director Richard Hodes said it’s helpful that the recommendations represent health behaviors or modifications already known for benefits.

“We can continue public health campaigns already in place, and add that there is a possibility these interventions could also have positive impact on cognitive function and dementia prevention,” Dr. Hodes said.

The Alzheimer’s Association, from its own analysis of prior research, already has a list of 10 lifestyle recommendations it deems potentially helpful, including the three aspects cited by the National Academies. Its list additionally recommends interventions such as avoiding obesity and smoking and adhering to a Mediterranean diet.

The National Academies committee determined there was insufficient proven research to make recommendations beyond its three. Keith Fargo, director of scientific programs and outreach for the national Alzheimer’s Association, did not dispute that assertion, but said there is also hope for the benefit of other behaviors that are still lacking equivalent evidence.

“There’s really no downside, frankly, to exercising more, and similarly, if you have high blood pressure to control that, and to keeping cognitively active as you age,” Mr. Fargo said. “We don’t want people to be hopeless about their cognition as they age. ... That’s the takeaway — there are things you can do now to protect your brain as you age.”

The report focused on what can be done by presently healthy adults rather than those who already have signs of memory loss, confusion or other cognitive decline at any stage. As there is no drug cure, researchers have increasingly focused on Alzheimer’s prevention, but the long-term nature of its progression makes that particularly challenging compared to other diseases.

“The big question is, can you do something during your life that can prevent something that will happen 20 or 30 years down the road, because there are no long-term studies that have collected that information,” said Dr. Oscar Lopez, a neurologist who is director of the University of Pittsburgh’s Alzheimer Disease Research Center.

He said the report’s findings nonetheless mesh with what he and many other health professionals were aware of in the three areas where recommendations were made.

“I would say it’s not optimistic, but at the same time it’s not depressing,” Dr. Lopez said of the report. “It’s somewhere in the middle.”

Gary Rotstein: grotstein@post-gazette.com or 412-263-1255.


First Published June 22, 2017 9:00 AM




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