Healthy Brain Aging—Part 1

Hating Dementia

For those of us mere mortals who missed it, Glenn Smith, Ph.D. from the University of Florida, wrote the lead article in May-June 2016 issue of American Psychologist. His provocative and hopeful article is entitled, Healthy Cognitive Aging and Dementia Prevention. I would like to share some of his findings with you. Why?

Primarily, because nearly 5 million Americans have Alzheimer’s disease (AD). Because an estimated 17% of women and 9% of men living to age 65 will receive a diagnosis of AD before they die. Granted it may be our preference to avoid all talk of such things, but how did that work out for the millions of smokers in the 1950’s and 1960’s who thought smoking was what made men strong and women sexy? Those smokers by in large didn’t like the bad news from the Surgeon General, and of course the tobacco industry continued to kick and scream for many years, after the “truth” came out. But in the end, we all were better off for moving beyond our safe little corner of “avoidance”.

It is estimated that by 2050 the number of Americans with AD will triple to over 13 million. Economically the cost of AD to the Medicare budget is already disastrous. Estimates are that $150 billion come from Medicare and Medicaid. The value of unpaid family caregiving is estimated at $220 billion (Alzheimer’s Association, 2014).

BUT there is good news. There is evidence of a decline in rates of dementia, emerging from first world countries. Prevention is the key theme of the National Alzheimer’s Plan.

Diagnoses

A generally accepted diagnostic continuum is:

1. Aging with Normal Cognitive Changes > Pre-Clinical States > Mild Cognitive Impairment (MCI) > Dementia (Glenn Smith, Ph.D.)
2. Aging with Normal Cognitive Changes: is the subtle loss of cognitive and functional performance in normal aging, even when known brain diseases are absent
3. Pre-clinical States: this involves biomarker measurements of brain changes in people with neurodegenerative disease years before they show measurable behavioral manifestations of disease. The brain changes may account for a significant component of the supposed normal cognitive declines associated with aging.
4. Mild Cognitive Impairment (MCI): this is a syndrome in which cognitive impairments are measurable even though functional impairments are subtle.
5. Dementia: is a syndrome of clear cognitive and functional decline caused by a range of diseases including Alzheimer’s Dementia (AD), Parkinson’s disease, Vascular Dementia (stroke), etc.

So with this continuum we can see that the ever-feared “dementia” is not just a black/white issue. Like most things in life, there are degrees. I personally believe it does us well to know where we stand on that continuum. It is then that we are able to take seriously the issue of prevention. Be clear, prevention doesn’t just happen on its own because we take an early look at the process.

In Part 2 of this topic we will look at the so-called “Primary Prevention” and some interventions which will move us closer towards preventing the decline.

Tim Berry, Ph.D.