Don’t just sit or wait on Big Pharma. Modify your risks against dementia.

agingwell-150x150Although Americans dread the possibility of experiencing dementia and other debilitating cognitive decline as they age, they can do more than let fear rule their lives — or twiddle their thumbs waiting for Big Pharma to drop billions of dollars more to develop magical and, so far, unworkable pills.

Instead, doctors, epidemiologists, and public health officials argue that non-pharmaceutical approaches can be beneficial to patients’ overall health and play a significant role in decreasing the likelihood of individuals suffering severe memory loss and more crucially dementia, notably in its most common condition Alzheimer’s, the New York Times reported.

Dr. Gill Livingston, a psychiatrist at University College London and chair of the Lancet Commission on Dementia Prevention, Intervention and Care, told New York Times columnist Paula Span this:

 “It would be great if we had drugs that worked. But they’re not the only way forward.”

Instead, he and others are researching workable alternatives, reported Span, who covers aging for the newspaper:

“Emphasizing modifiable risks — things we know how to change — represents ‘a drastic change in concept,’ said Dr. Julio Rojas, a neurologist at the University of California, San Francisco. By focusing on behaviors and interventions that are already widely available and for which there is strong evidence, ‘we are changing how we understand the way dementia develops,’ he said.”

Experts, for example, have long established a significant  link between dementia and hearing loss. But Span also reported:

“The latest modifiable risk factor was identified in a study of vision impairment in the United States that was published recently in JAMA Neurology. Using data from the Health and Retirement Study, the researchers estimated that about 62% of current dementia cases could have been prevented across risk factors and that 1.8% — about 100,000 cases — could have been prevented through healthy vision. Though that’s a fairly small percentage, it represents a comparatively easy fix, said Dr. Joshua Ehrlich, an ophthalmologist and population health researcher at the University of Michigan and the study’s lead author. That’s because eye exams, eyeglass prescriptions and cataract surgery are relatively inexpensive and accessible interventions. ‘Globally, 80% to 90% of vision impairment and blindness is avoidable through early detection and treatment, or has yet to be addressed,’ Dr. Ehrlich said.”

Span reported that experts have built, bit by bit, various approaches to better deal with and avert cognitive disabilities associated with age:

“The influential Lancet Commission began leading the modifiable risk factor movement in 2017. A panel of doctors, epidemiologists and public health experts reviewed and analyzed hundreds of high-quality studies to identify nine risk factors accounting for much of the world’s dementia: high blood pressure, lower education levels, impaired hearing, smoking, obesity, depression, physical inactivity, diabetes, and low levels of social contact. In 2020, the commission added three more: excessive alcohol consumption, traumatic brain injuries and air pollution. The commission calculated that 40% of dementia cases worldwide could theoretically be prevented or delayed if those factors were eliminated.”

The experts underscore that caring for those with cognitive decline can be costly and burdensome on society but especially loved ones who act as caregivers — many of them wives and daughters. Reducing dementia even incrementally but in many different ways can add up.

Some of the evidence-based strategies, though, are not easy to pursue. It is tough, for example, to increase a society’s overall education levels, which have proven to be key to lessening dementia incidence. It is not easy to reduce obesity. But the positive outcomes with patients improved cognitive health are showing up in countries with advanced economies, the experts say.

As Span reported, the effort to deal with modifiable risks also runs up against real and difficult inherent challenges:

“Some important risks for dementia lie beyond our control — genetics and family history and advancing age itself. Modifiable factors, however, are things we can act on. ‘People have such fears of developing dementia, losing your memory, your personality, your independence,’ Dr. Livingston said. ‘The idea that you can do a lot about it is powerful.’ Even delaying its onset can have a great effect. ‘If, instead of getting it at 80, you get it at 90, that’s a huge thing,’ she said.”

So, what kinds of concrete, commonsense steps can individuals take to reduce the risk of cognitive debilitation? Span’s column contains ideas. Readers also can find suggestions in a separate New York Times report on memory and how to safeguard this invaluable brain capacity, based on the work of Dr. Richard Restak, a neurologist and clinical professor at George Washington University School of Medicine and Health. As this news article says of his latest of 20 books, “The Complete Guide to Memory: The Science of Strengthening Your Mind”:

“Memory decline is not inevitable with aging, Dr. Restak argues in the book. Instead, he points to 10 ‘sins,’ or ‘stumbling blocks that can lead to lost or distorted memories.’ Seven were first described by the psychologist and memory specialist Daniel Lawrence Schacter — ‘sins of omission,’ such as absent-mindedness, and ‘sins of commission,’ such as distorted memories. To those Dr. Restak added three of his own: technological distortion, technological distraction, and depression. Ultimately, ‘we are what we can remember,’ he said.”

Span’s list of modifiable, common-sense responses includes experts urging people to:

  • Get vision and hearing examined regularly
  • Exercise
  • Control weight
  • Don’t start or stop smoking
  • Take those blood pressure medications, if needed
  • And follow the steps for diabetes care, if appropriate.

Restak, the New York Times reported, advises this:

  • Be more attentive. When learning new information, like a name, visualize the word. Having a picture associated with the word, Restak said, can improve recall.
  • Regularly challenge your memory as part of everyday activities. Sure, write down that grocery list. But try to recall it while shopping, too. Or try getting to a destination without using smartphone maps or car navigation systems.
  • Play games, especially simple and easy ones like 20 questions. Or listing the presidents or states.
  • Read not only nonfiction but novels. Fiction forces its readers to remember characters and their actions in ways that nonfiction may not.
  • Reconsider your technology use. It can become an issue if individuals rely on devices to store and recall important information, rather than using their brains to recall and process it. People also can be distracted by their technology, multi-tasking and failing to focus, concentrate, and process the world as they must.

Good ideas. In my practice, I not only see the harms that patients suffer while seeking medical services, but also the clear benefits they may enjoy by staying healthy and far away from the U.S. health care system. It is fraught with medical errorpreventable hospital acquired illnesses and deaths, and misdiagnoses. Patients also suffer far too many harms due to bankrupting and dangerous drugs.

Prevention matters. It can be far cheaper, often easier, and a much better alternative than spending time waiting for even the most optimal medical services. If you need medical care, you should not hesitate to seek it. And health care in the wealthiest nation in the world should be a right not a privilege. But we have much work to do to take good care of ourselves, steering clear of Big Pharma’s profiteering and the risks inherent in all medical interventions. Who doesn’t want to live long, well, and to prosper with friends and loved ones at home?

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