Does Alzheimer's Prevention Research Deserve More Funding?

Three separate items caught my eye recently related to the demographic challenge of aging and clinical neuroscience disorders of old age--primarily Alzheimer's disease and Parkinson's disease.

The first was the TED Talk of Gregory Petsko on the coming neurological epidemic. Here are my notes on the presentation--it is only about 4 minutes in lengh.

• Next 40 years epidemic of neurological illness on global scale
• Map of countries with >20% over 65 expanding
• Lifespan doubled since 1940
• Risk of Alzheimers increases exponentially after age 65
• Alzheimers and Parkinsons Disease key disorders
• Misfolding protein key to the development of Alzheimers
• His research tries to develop drugs to inhibit this folding of tangling of brain proteins
• Alzheimers disease linked to lower cancer risk
• Current research funding by private entities
• Government has dropped the ball
• Caffeine protects against Parkinsons
• Brain injury (concussion) is significant dementia risk factor
• Chronic hypertension also raises risk
• The clock is ticking for all of us

The second item was an editorial in October 27,2010 New York Times by Sandra Day O'Connor, Stanley Prusiner and Ken Dychtwald entitled "The Age of Alzheimer's". Key points in this editorial:

• For every penny spent on research on Alzheimer's the U.S. spends $3.50 on treatment.
• Yearly costs for the treatment of Alzheimer's estimated to increase from current $172 billion per year to $2 trillion in 2020 and $20 trillion in 2050.
• When U.S. research efforts target key illness with sufficient funding results emerge.
• A 10-year commitment to fight AIDS found effective treatments and added $1.4 trillion to U.S. economy. NIH spends about $3 billion per year on AIDS--there are five times as many
• Alzheimer's disease patients and this disease only receives about $469 million per year in NIH research funds.

Congress has a bill to raise annual federal investment to $2 billion per year. The authors endorse pushing this investment through during the lame-duck session of Congress following next week's mid-term election.

The third item is the a scientific research summary manuscript entitled: Promising Strategies for the Prevention of Dementia. Middleton and Yaffe recently summarized the best research evidence for the most promising strategies for prevention of dementia. Although there is no universally endorsed prevention approaches in Alzheimer's disease, the authors note promise in the following areas:

Vascular Risk Factor Reduction:

• Treat hypertension
• Reduce high cholesterol
• Identify and treat diabetes
• Encourage reduction in smoking
• Identify and treat metabolic syndrome (abdominal obesity, hypertriglyceridemia, low HDL cholesterol, hypertension and/or hyperglycemia) 

Cognitive Ability

• Encourage people to get a college degree (or pursue highest level of education possible
• Stay mentally active throughout adulthood 

Physical Activity

• Reduces several vascular risk factors
• Increase  brain neurotrophic factors 

Social Engagement

• Develop and strong social network
• Stay connected with friends and family members
• Watch for the onset of social disengagement as it may be an early sign of dementia

Diet

• No generally endorsed diet
• Mediterranean diet (high in fruits, vegetables, fish, olive oil) may reduce dementia risk through reducing cardiovascular risk factors

Depression

• Depression may be a early symptom or prodrome of dementia
• Depression treatment (and seeking care) in elderly may lead to diagnosis of depression
• Cognitive deficits may induce depressive symptoms

One promising prevention for dementia interfaces with prevention of brain trauma.  Funding brain trauma prevention is likely to also aid in reducing the risk of dementia in later life.

So the clock is ticking and like the national debt, the numbers are scary and growing daily. Promising prevention and treatment approaches are available. What will the research funding response be?

Middleton LE, & Yaffe K (2009). Promising strategies for the prevention of dementia. Archives of neurology, 66 (10), 1210-5 PMID: 19822776