Why is There a Developing Epidemic of Alzheimer’s or Dementia?

The dementia is a group of specific disorders where different parts of the brain degenerate causing symptoms such as memory loss, difficulty with aspects of functioning such as speech or behavior and eventually difficulty with all life functions.  Alzheimer’s is the most common form of dementia accounting for approximately 70% of this population.  While the ability to prevent and treat many other chronic diseases is improving, this has not been the case with Alzheimer’s and other dementias.  Some of the facts include:

·         Alzheimer’s is the only disease in the list of the 10 most common disease associated deaths that there is no available treatment that may prevent, cure or slow its progression. 

·         Approximately 200,000 adults in U.S. under the age of 65 years are already diagnosed with the disease.

·         Most will die from the disease within 4 to 8 years. 

·         It is perhaps the most costly disease involving greatest direct medical costs combined with great costs for long-term care. 

·         One in five (20%) individuals > 65 years have MCI (pre-Alzheimer’s) and many will convert to Alzheimer’s within 5 years.

·         Currently there are approximately 5 million adults with Alzheimer’s. 

·         This will double within 15 years and triple within 35 years resulting in a staggering $21 trillion in direct costs over that interval.

Given the inability of treatment to modify the disease once it is well established, the focus of favorably impacting the epidemic is shifting to prevention and aggressive early treatment.  Up to this point there had been little progress as treatment has been almost entirely focused on drug interventions.  To date there have been 244 drug trials for Alzheimer’s, and 243 produced no positive results in altering the course of the disease.  Only two classes of drugs have been approved for treatment, but they only “soften” symptoms in the short term and do not alter the progression of the disease.

The reasons for the disappointing treatment results are thought to relate to the fact that Alzheimer’s origins are multifactorial.  Dale Bredesen, MD, the Director of Neurodegenerative Disease Research, David Geffen School of Medicine at UCLA, describes the disease process as being like water leaking through a barn roof that has 36 holes.  Drug therapies have targeted one hole which does little to stop the roof from leaking during a heavy rain. 

The 36 factors that Dr. Bredesen discusses include genetic predispositions, environmental factors, metabolic factors and lifestyle driven factors.  While some are non-modifiable such as genetics and population aging, the majority are modifiable and therefore can be targeted with treatment.  The lifestyle/metabolic related factors are diverse such as vitamin B12 deficiency, low cell omega-3 levels, pre-diabetes, chronic high insulin levels, high inflammation and many more.

Dr. Bredesen has developed the first treatment approach that has actually demonstrated effectiveness in preventing the conversion of MCI into full Alzheimer’s as well as reversing mild Alzheimer’s itself.  The process involves measuring extensive numbers of variables and finding the collection that are imbalanced and contributing to the disease process in that given person.  Once the “triggers” are identified a diverse treatment program specific to each individual’s imbalances is designed and implemented.

One of the most interesting findings in the first group of patients treated with this process was that those who had genetic predispositions such as the apoE4 variant had equally good outcomes with intensive lifestyle management.  This is a very important finding as 75 million Americans have the abnormal apoE4 genetic predisposition and without changes to how things are currently being done, 30 million are destined to develop Alzheimer’s disease.  While individuals with the genetic risk have a greater tendency to develop the disease, they appear to respond well to tight metabolic regulation.  The genetic factors simply appear to make them more susceptible to errors in metabolic/lifestyle factors.

The population is aging, and age is a major risk factor for Alzheimer’s.  Approximately one in six individuals have genetic variations that increase their risk.  However, a rapidly changing factor that appears to be driving a significant portion of the increase in Alzheimer’s are the increases in metabolic/lifestyle factors.  Genetics and age are non-modifiable.  Fortunately, a major part of this puzzle is highly modifiable, and strong changes in this area have shown great promise in preventing and helping this disease.