In My View: William Vega

— By William Vega —

A premier issue already apparent in American society is the soaring numbers of dementia cases. Every family in America, including my own, has directly or indirectly experienced dementia. Dementia cases are increasing in lock step with an accelerating proportion of adults over 65 years of age. Alzheimer’s Disease is the most common type of dementia in part because people with other dementia types, such as Lewy Body, Vascular, Frontotemporal Lobe and Parkinson’s Disease, often progress into Alzheimer’s Disease. There are dramatic differences in cognitive performance between healthy older adults and older adults experiencing neurodegenerative diseases. American older adults are not well informed about these differences and are understandably concerned about their potential vulnerability.

Most older adults in American society, perhaps two-thirds, will experience minor to moderate declines in cognitive functioning such as problem solving and memory, usually commencing in the seventh decade of life. The majority will never experience neurodegeneration and extreme declines and functional limitations. In contrast, one in three older adults may be affected by destructive neurodegenerative disease between 75 and 80 years, albeit with considerable variation in onset age. Due to limitations in accessible and accurate testing procedures, it is difficult to identify with precision who is at risk for dementia in earlier adulthood, except in severe cases of preexisting brain damage or impairments. In this vacuum of evidence-based information, there is a rush of consumer products being marketed that are exploiting the information gap by offering products to conserve or boost cognitive performance, including memory and operational problem- solving abilities. The ultimate value of any of these products in reducing dementia risk remains untested and unknown.

Alzheimer’s Disease silently advances about 20 years before identifiable clinical signs are evident, and once diagnosed the remaining life expectancy is usually about 7 years, yet there are cases with longer survival. Affected individuals or their close relatives usually notice “signs” of changing cognitive performance. This stage may not be dementia per se but rather a warning sign requiring clinical evaluation. Often a difficult period may ensue, including anxiety, confusion, denial and a reluctance to seek medical assistance. Acceptance of an eventual dementia diagnosis can be a dramatic event given the consequences for the patient and their immediate support system. A difficult but necessary transition follows, and an even more difficult adjustment unfolds as the disease progresses. The impact on caregivers and families takes many forms but its stressful impact can’t be overstated.

Fortunately, help is on the way. There is urgency for our scientists to provide us with solid answers, and researchers and clinical experts worldwide have heard the call and have responded. An intensive search is underway for effective evidenced-based interventions, accurate biomarkers and accessible tests, and more effective medical services for timely evaluation over the life course that can reduce risk of disease or delay dementia progression.

Neurodegeneration is a process that involves synaptic damage and neuron elimination without adequate levels of cell replacement. A cure in the near term is unlikely because we lack a particular technology to replace neurons or repair damaged neuronal circuitry. However, scientific discoveries using sophisticated technical tools are advancing our knowledge of the brain at an unprecedented pace with great expectations for improving human health across the lifespan. With a bounty of seemingly important discoveries comes the problem of teasing out the truly important breakthroughs. While there are many interesting leads most afford only partial insights into time-ordered processes affecting neurodegeneration. This is inevitable because Alzheimer’s does not have a singular pathology. Late onset Alzheimer’s has multiple potential causes, including prenatal health of mother and fetus, diet, exercise, genetics, early cognitive development, cardiometabolic conditions such as vascular disease and diabetes, traumatic brain injuries, toxic exposures and other brain disorders that reduce robustness against neurodegeneration.