by Dennis Fortier
More so than with any other major disease, our near-term progress in the battle against Alzheimer’s will be determined largely by our ability to improve awareness about several aspects of this encroaching threat.
Summarized here are five reasons why greater awareness about Alzheimer’s disease, and a deeper public understanding of risks and prevention strategies, will play a key role in the nation’s ability to triumph against the prospect of a devastating AD epidemic.
1. Low awareness drives higher medical costs
In this important but often overlooked regard, higher awareness and a better understanding of symptoms will benefit the vast majority of people who do not have Alzheimer’s disease (AD).
While AD is a worrisome topic, we have reached a point where the general level of education and awareness about the disease is high enough to induce worry, but not high enough to eliminate “unnecessary” worry. As a result, we are seeing a rise in expensive medical evaluations and increased costs of care driven by patients who are perfectly healthy.
In general, the public knows two things about AD. They know it is a debilitating disease with no cure, and they know that memory loss is a common symptom. That’s enough information to create a lot of angst in an aging population but a little more information would bring some needed relief.
For example, not every memory lapse is like every other, and many, if not most, are completely benign with no underlying medical cause. Furthermore, even those memory lapses that are related to a medical condition are often caused by some easily treatable problem.
Here are 3 things to know and to share.
1) Memory loss can be caused by many common and treatable ailments including, but not limited to:
- thyroid disorders
- vitamin deficiencies
- medications (both prescription and over the counter)
- poorly controlled diabetes
2) Every instance of forgetfulness is not akin to a diagnosis of AD and not all memory lapses are equal:
- Failing to store information for later recall when we are stressed or distracted is most likely a sign of overload than of a serious medical condition.
- Taking longer to recall names as we age is a natural part of slower information processing in an older brain.
- Forgetting where you parked at the mall is probably more like the rule than the exception.
3) On the other hand, repeating a question or a story within a short time and not remembering the first instance is the kind of memory loss that should prompt a discussion with your physician.
2. Awareness facilitates timely medical intervention
As discussed above, understanding the difference between worrisome signs and those that are less concerning can help the public make better decisions about if and when to speak with a physician. But there are other facets of increased awareness that will also facilitate earlier, proactive behavior that results in earlier medical intervention and better treatment results.
Specifically, knowing that treatment is more effective than is commonly reported in the press will drive more people to their physicians at early stage of symptoms before irreparable brain damage has occurred.
Many studies on drug efficacy have shown minimal treatment effect for the primary class of Alzheimer’s drugs (cholinesterase inhibitors) approved for sale in the USA. However, it should be understood that while the AVERAGE treatment effect is fairly moderate, some patients respond better than others. The average is comprised of a range of outcomes from better to worse and it is important to remember that no one knows in advance which patients will benefit more and which will benefit less.
More importantly, studies focused on isolating the effect of pharmaceutical therapy obscure the effect of a more robust treatment regimen that includes physical exercise, a healthy diet, proper control of hypertension and diabetes, avoidance of other medications that impair cognition and function, ongoing intellectual stimulation, and structured social engagement. Such a full regimen has demonstrated superior treatment effects than drug therapy alone in a meaningful number of patients. There is growing evidence that this is especially true when treatment begins early in the disease process.
While you should not be overly optimistic about currently approved treatments, you should not be overly discouraged by reports that drugs alone are not effective. In the real world, doctors prescribe drugs as one part of a more comprehensive treatment plan and, in some instances, AD progression can be meaningfully delayed.
3. Awareness erodes stigma and further enables timely medical intervention
Another major barrier to early intervention, aside from the nihilistic perceptions about treatment efficacy discussed above, is stigma. In fact, research shows that many people feel a sense of shame or embarrassment associated with a diagnosis of AD. This promotes denial and serves as an obstacle to early diagnosis and treatment.
However, research also shows that most stigmatizing topics can be brought into the open and can shed their embarrassing nature through education and discussion. Awareness campaigns generate discussion, which breeds familiarity and reduces stigma. In this regard, awareness is a direct path to openness, dialogue, information exchange, proactive management of symptoms, and professional medical intervention at the earliest possible stages.
Consider these facts and then be sure your mind and your heart are both open to the plight of those facing Alzheimer’s disease.
- More than 1 out of every 2 Americans now knows someone with Alzheimer’s disease.
- The risk of getting Alzheimer’s disease is low until about age 65 then doubles every five years.
- At age 85, the risk of AD is nearly 50%.
4. Awareness and management of risk factors can lower incidence of AD
While it is true that AD remains poorly understood and difficult to treat, an enormous amount of research and new learning has been achieved in the last decade. We now recognize several risk factors that increase the likelihood of getting the disease and a few others that reduce the risk. The best news is that many of the risk factors are completely within our control and lend themselves to active management.
Gaining a clear understanding of how to reduce risks for AD can sometimes require careful discernment between sound science and commercial hype. In this regard, awareness and education are critical components of an effective strategy for maintaining cognitive health through risk factor management.
Here is a brief summary of well-established risk factors that should be discussed with your physician to establish a risk management strategy:
1) Cardiovascular conditions increase the likelihood of Alzheimer’s disease and should be actively managed to mitigate the risk:
- High Cholesterol
- Hypertension (High-blood pressure)
2) Diabetes, especially when poorly controlled, increases the risk for Alzheimer’s disease. If you are diabetic, work with your physician to keep it under optimal control.
3) Substance abuse and heavy smoking are correlated with higher risk for Alzheimer’s disease providing one more important reason to seek any help you need in breaking a reliance on tobacco, drugs and alcohol.
4) There are also some manageable factors that reduce your risk for Alzheimer’s disease including proper diet, physical activity, and ongoing social and intellectual engagement. Gaining these benefits is as easy as being aware and making good life style decisions.
5. Awareness accelerates scientific progress
One of the challenges preventing faster progress in understanding Alzheimer’s disease is the availability of subjects who volunteer for research studies. In this highly active field, there are studies seeking healthy adults who do not have Alzheimer’s, others that seek adults with various levels of memory loss, and still other studies enrolling subjects who have been diagnosed with the disease.
Participating in a study is a commitment to pursue a regular regimen of therapy and a closely monitored protocol of care. However, it is also a commitment by the investigating physician to provide a defined level of care, which is in many cases, a higher level of care than you might get from your usual physician.
Often times, a study provides an opportunity to be treated with experimental drugs that are otherwise unavailable. Because drug development is a low-probability endeavor, early stage agents are more likely to be ineffective than they are to have a significant health benefit. However, depending on a person’s current prognosis, the opportunity to try an experimental treatment might be appealing.
In any event, each study contributes to our overall knowledge and moves us one step closer to the solution we all seek. Volunteers who participate in these studies keep the wheels of scientific progress moving.
Learn about ongoing trials and stay abreast of new studies as they are launched. After all, one out of every two of us knows someone who might be interested.
Resources for learning about FDA trials:
- Alzheimer’s Association
- NIH Alzheimer’s Education and Referral Center
It is easy to overlook “awareness” as an important part of the solution to the Alzheimer’s problem. This is especially true given the clear need for better treatment. However, a little reflection on the benefits of awareness, weighed against the relative ease with which we can spread information today, shows the massive benefits of greater awareness.
Dennis Fortier is President & CEO of Medical Care Corporation and blogs at Brain Today.
Submit a guest post and be heard.