Skip to Content
In My View: William Vega

In My View: William Vega

We live in a period of human history when life expectancy is increasing at an unprecedented pace. It is estimated that one in three people born today in this nation will live to 100 years of age, or even more. Advances in science, medicine and public health are transforming the aging process. This transition in longevity will challenge societies and cultures in two fundamental ways. Rapid acceleration of longevity will require better lifespan health, personal functioning and life satisfaction. And societies will bear the cost and social burden of older-adult disease, disability and long-term care.

October 11, 2023 at 9:00am

— 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.

“With a bounty of seemingly important discoveries comes the problem of teasing out the truly important breakthroughs.”

Medical science thrives on the use of well-established canons of experimental biology, psychometrics, neurology including neuroimaging, pathophysiology, genetics and epigenetics, to discover, test hypotheses and develop explanatory models.

However, Alzheimer’s Disease is an example of a health disparity disproportionately impacting vulnerable populations. The field requires an integrative multidisciplinary approach, including public health, psychology, nursing and social work. The highest rates of dementia are found among African American, Latino and American Indian populations, and other low-income subgroups.

“The highest rates of dementia are found among African American, Latino and American Indian populations, and other low-income subgroups.”

These populations experience lower educational attainment, racism and discrimination, early developmental and behavioral disorders, and occupational risk factors, and singly and collectively are linked to metabolic dysregulation before the sixth decade of life. A recent Alzheimer’s Disease Commission Report concluded that about 40 percent of attributable risk for Alzheimer’s Disease was modifiable, and if mitigated could dramatically reduce the dementia burden in America. Presently, preventive interventions are being developed to improve cognitive performance and modify behavioral risk factors including; diet; exercise; and social integration, associated with lifestyles and health histories over the life span that could be anticipated and altered.

The best news is that there are now several promising drugs that have been developed in the United States and internationally that could delay Alzheimer’s Disease progression. Prevention and early-stage detection is essential for preserving the highest level of functioning and quality of life. Caution is necessary as are expectations about the timing. Clinical trials do not necessarily inform us if and when effective, acceptable, and affordable drugs will be available. Years of work are ahead. Moreover, we must create a medical care delivery system equipped to overcome the healthcare inequities of the past, and to outreach and care for the highest risk populations with histories of poor preventive care and late dementia diagnosis.

These are solvable problems but hardened barriers must be addressed and overcome. Readiness of our public health and medical care systems to meet the needs of a diverse American population requires overcoming major care gaps in financing, work force preparedness, and services coordination, as well as supporting home care assistance programs. Of course, no progress can occur soon enough for the 6.5 million current dementia victims in this nation.

It is anticipated that the payoff of the current research mobilization in neuroscience will change the landscape of brain knowledge with implications well beyond dementia. This massive scientific endeavor will improve life span health in more ways than we could have foreseen. Hopefully these neuroscience discoveries will better prepare our global population for extended longevity, productivity, and life satisfaction.