Too soon for Alzheimer's Prevention?

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Julie G
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Too soon for Alzheimer's Prevention?

Postby Julie G » Thu Nov 29, 2018 10:33 am

Hi friends! I've had an idea bubbling in my mind for the past few weeks and I'd appreciate some input. Look at the strategies below and let me know if you think it's too soon to promote a public health campaign focused on Alzheimer's prevention through risk modification.

The ideas below come straight from a Centers for Disease Control (CDC) public health curriculum for Alzheimer's prevention yet the vast majority of physicians still maintain Alzheimer's can't be prevented. IMHO this information needs to get into the hands of these frontline providers and consistently delivered in an age appropriate manner to patients at every health screening. These general health recommendations aren't new, yet the connection to cognitive health isn't well known. Currently too many people people begin caring when symptoms begin to show and a significant amount of damage has already occurred. When I asked my neurologist for this information, I was told "Good luck with that." I know other members have been told to "Wait for it." Given the very long prodromal period (decades) doesn't it make sense to promote prevention?

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1.) Avoid head trauma. Moderate or severe traumatic brain injury leads to an increased risk that remains for years after original injury. Prevention efforts include:

-Seat belt use (through education and policy)

-Use of helmets when bicycling and participating in certain sports (through education and policy)

-Falls prevention: Putting safety measures in place at home (such as reducing tripping hazards, adding grab bars, and improving lighting)

-Exercise to improve balance and coordination

-Reviewing medicines and vision with health care provider

-Getting enough sleep

2.) Promote heart health. Growing evidence suggests a close link between the health of the heart and the health of the brain Several conditions known to increase the risk of
cardiovascular disease including high blood pressure, heart disease, stroke, and diabetes also appear to increase the risk of developing Alzheimer’s disease. Many cardiovascular disease risk factors are modifiable; that is, they can be changed to decrease the likelihood of developing cardiovascular disease. Many experts believe that controlling cardiovascular risk factors may be the most cost-effective and helpful approach to protecting brain health. Modify cardiovascular risk by:

-Quitting smoking

-Diet (DASH, Mediterranean)

-Physical activity

3.) Avoid/manage Alzheimer’s disease risk factors. Growing evidence suggests that the avoidance and management of diabetes, high blood pressure(hypertension), and midlife obesity may reduce risk for Alzheimer’s and other dementias. There is even stronger evidence that these factors may also help protect against cognitive decline in general. Preventing and managing these and other chronic diseases and conditions have been priorities of public health practice for many years. The increasing evidence base about the impact of these conditions on cognitive health must also be taken into account and incorporated into public health practice going forward. Prevent onset of or effectively manage conditions that can increase risk for Alzheimer’s:

-Diabetes

-High blood pressure (hypertension)

-Midlife obesity

4.) Maintain an active brain. In addition to the findings that years of formal education may be a preventative factor for Alzheimer’s disease, a number of studies indicate that keeping the brain active is
associated with lower risk for developing Alzheimer’s disease. Mentally stimulating activities may include:

-Learning new information and skills

-Volunteering

-Reading

-Playing challenging games (such as bridge, chess,
Sudoku, etc.)

-Other studies have also suggested a link between social connections and cognitive health. Keeping strong social connections may help reduce the risk of cognitive decline
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I can envision a public health campaign that piggybacks on Warren Buffets's metaphor below. If I knew the first car I got would have been my only car, I would have taken much better care if it. How about you?
When I was sixteen, I had just two things on my mind - girls and cars. I wasn't very good with girls. So I thought about cars. I thought about girls, too, but I had more luck with cars.

Let's say that when I turned sixteen, a genie had appeared to me. And that genie said, 'Warren, I'm going to give you the car of your choice. It'll be here tomorrow morning with a big bow tied on it. Brand-new. And it's all yours.'
Having heard all the genie stories, I would say, 'What's the catch?' And the genie would answer, 'There's only one catch. This is the last car you're ever going to ge tin your life. So it's got to last a lifetime.'

If that had happened, I would have picked out that car. But, can you imagine, knowing it had to last a lifetime, what I would do with it?
I would read the manual about five times. I would always keep it garaged. If there was the least little dent or scratch, I'd have it fixed right away because I wouldn't want it rusting. I would baby that car, because it would have to last a lifetime.

That's exactly the position you are in concerning your mind and body. You only get one mind and one body. And it's got to last a lifetime. Now, it's very easy to let them ride for many years. But if you don't take care of that mind and that body, they'll be a wreck forty years later, just life the car would be. It's what you do right now, today, that determines how your mind and body will operate ten, twenty, and thirty years from now.”


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Re: Too soon for Alzheimer's Prevention?

Postby Fiver » Thu Nov 29, 2018 12:37 pm

Julie. 100% agree! I just gave my talk....and this was the message I tried convey. Why on earth wait to do things that are already promoted to lower the risk of other major diseases?
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.

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Re: Too soon for Alzheimer's Prevention?

Postby Fiver » Thu Nov 29, 2018 1:28 pm

Delaying Alzheimer's by just 1 year with modifiable risk reduction strategies would prevent 10 million cases by 2050. It could be a "1 for 10 million" campaign, or something more clever. Who could possibly argue with the math? Wear a helmet, lower your risk. Breath clean air, lower your risk. Eat smart, lower your risk. Know your risk, lower your risk.
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.

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Re: Too soon for Alzheimer's Prevention?

Postby Jafa » Thu Nov 29, 2018 2:30 pm

Great idea Julie.. Because it is succinct and Mum hasn’t said it, I am sending the list to my three adult children. I see the glazed look appear whenever I broach the health topic. Also I think a printed list for patients to take away would be a good idea. Much information during a consult is forgotten.

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Re: Too soon for Alzheimer's Prevention?

Postby TheBrain » Fri Nov 30, 2018 6:20 am

Fantastic idea, Julie! I think the time is now, definitely not too soon.
ApoE 4/4 - When I was in 7th grade, my fellow students in history class called me "The Brain" because I had such a memory for detail. I excelled at memorization and aced tests. This childhood memory helps me cope!

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Re: Too soon for Alzheimer's Prevention?

Postby Fiver » Fri Nov 30, 2018 6:46 am

The popular press is already out promoting these delay/prevention approaches. It just seems that the large medical associations and most family physicians aren't getting the message to people early enough, or at all.

http://discovermagazine.com/2018/dec/al ... dsctwitter
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.

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SusanJ
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Re: Too soon for Alzheimer's Prevention?

Postby SusanJ » Fri Nov 30, 2018 7:42 am

The challenge, as it always is, will be for people to actually take the message to heart. We're a motivated bunch here, but so many others are not. It's a very frustrating aspect of my doctor's practice. She gives plenty of advice on healthy living, but patients aren't always very compliant.

For many of us, we were quite honestly scared into doing something either because of genetic testing, symptoms and/or close family members with Alzheimer's. How do you drive home the urgency not to wait?

It's a tough nut to crack is how to motivate people into healthy living before their symptoms occur, even if the doctors have the information to distribute.

Maybe look at the anti-smoking campaigns? Those made a difference in driving down the numbers of smokers (but there are still plenty of people who still smoke unfortunately).

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Re: Too soon for Alzheimer's Prevention?

Postby Fiver » Fri Nov 30, 2018 8:09 am

I completely agree. It must be frustrating for physicians to imagine getting their patients to make these lifestyle changes when many aren't very good about taking their medications consistently or doing the very basics.

Would need a campaign to get the information out there people were discussing it with friends and family members - to leverage the power of social influence. Usually, this starts with a few "influencers" with engaging stories and social capital (we certainly have those!). Would need to to identify and break down the barriers - short-term thinking, social stigma, fear, initial costs. I can think of lots of potential approaches! But it's hard work to turn that into an effective campaign.

For one thing, 'tis the season for gene testing kit advertising. Come January 1 there will be a lot people who have gotten genetic information that concerns them.
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.

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Julie G
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Re: Too soon for Alzheimer's Prevention?

Postby Julie G » Fri Nov 30, 2018 9:57 am

Lots of great insight! I agree that the idea is out there in the popular medical press but It's largely eschewed by the broader medical community leading patients to feel frustrated.

I think a public service campaign needs to be multi-pronged, starting with educating frontline practitioners- neurologists, physicians, physician assistants, nurse practitioners and genetic counselors. The current paradigm concludes that there's no point to learning APOE status because there's nothing that can be done. We don't have prevention strategies, treatment or a cure. Why upset patients? For me, learning that the CDC has a dusty, unused public health curriculum for Alzheimer's prevention feels like a turning point. We must get this information into the hands of those working directly with patients. I suspect that broadly promoting cognitive health from within the mainstream medicine system will naturally lead to people wanting to learn their APOE status.
Would need a campaign to get the information out there people were discussing it with friends and family members - to leverage the power of social influence. Usually, this starts with a few "influencers" with engaging stories and social capital (we certainly have those!). Would need to to identify and break down the barriers - short-term thinking, social stigma, fear, initial costs. I can think of lots of potential approaches! But it's hard work to turn that into an effective campaign.

Exactly! Part two should be a campaign directed at the general public using some of the ideas Fiver has suggested. I agree that we have a wealth of engaging stories that could be effectively used.

I plan to start by reaching out to the CDC and simply asking how we can get this Alzheimer's prevention public health initiative into the hands of mainstream practitioners. This is an educational process that must start by educating the educators...

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Re: Too soon for Alzheimer's Prevention?

Postby Fiver » Fri Nov 30, 2018 10:48 am

:) let us know if we can help.
Four relatives with AD. Concerned, but hopeful. Introverted, but will talk about science.


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