How Preventable is Dementia?

Did you know that about 90% of what we know about dementia has been discovered in just the last 20 years or less? Another sobering fact is that neurodegenerative diseases begin an estimated 20 years, possibly more, before the first symptoms become apparent, meaning that, sadly, a lot of damage has already been done to the brain by the time people realise that something is wrong. Therefore our best line of defense against this disease seems to be raising awareness and prevention.

The good news is that researchers have discovered tests which can detect changes in the brain linked to Alzheimer's years, possibly even decades before the first symptoms present. Whether these tests will become widely available remains to be seen. Even the current scans available to properly diagnose dementia once cognitive decline has begun aren't always covered as part of medical treatments.

^{Image courtesy of @ervin-lemark}

Risk genes and lifestyle risks

Could other potential preventative measures be testing for genes and gene mutations which could indicate that you are more predisposed to developing Alzheimer's? This can be costly, so is probably used more for research purposes than clinical purposes. There are thought to be genetic mutations in three genes that are almost guaranteed to trigger Alzheimer's if you have one; APP, presenilin 1 and presenilin 2. These are seen in familial Alzheimer's when generations of a family end up with the disease. They are actually not discussed very often, perhaps because only 1% of Alzheimer's cases have one of the mutations, although that increases to 5% in early onset cases. A more commonly discussed gene is APOE 4 which is seen in nearer to 50% of Alzheimer's cases. One copy of this gene slightly increases your risk of developing Alzheimer's, while two copies increases it fairly significantly. Yet it's also concluded that having this gene doesn't mean you will necessarily get the disease. In fact in some cultures where it is a fairly common variant of the APOE genes they don't even get Alzheimer's at all. I came across a mention where having the APOE4 gene seems to have good outcomes for those living in impoverished and dirty conditions. Could this mean that our comfortable lifestyles are a factor here? When I think about what's being uncovered in other research this could actually make a lot of sense.

Researcher and medical doctor Dale Bredesen specialises in neurology, in particular Alzheimer's. He's done extensive research into the potential causes of the disease finding the commonalities and differences between patients. His conclusion is that for the majority of people the factors causing their neurodegenerative diseases are completely preventable and even reversible to some extent. Because for most people it's not genetics that are causing it but metabolic/mitochondrial disfunction. In simple terms, this means that the cells aren't functioning properly due to damage and this damage comes from lifestyle factors. While genetic factors aren't within our control, most lifestyle factors are.

What particularly stands out for me in Dr Bredesen's treatment approaches with dementia patients is that he tailors them to the individual because there is such a large spectrum of causes for the disease and often more than one cause in most people. So a single approach might remove the root cause of one of the pathways leading to dementia, but not address another pathway which will continue to impact the patient. He runs an array of tests on his patients in order to find out which pathways are causing their decline.

While diet seems to be the most common factor of cognitive decline, stress, environmental toxins and pathogens often play a role as a trigger as well. Dr Bredesen mentioned that those patients who could relocate away from environments containing a triggering toxin, for example a mouldy room or house, showed improvement while those who couldn't continued to decline. It reminded me of two of my clients with Alzheimer's, one who declined very rapidly was in a house with automatic pesticide sprays (pesticides are a known trigger for neurodegenerative disease) continually adding this toxins to the home; while the other, who has had a much slower decline, seems to have a more toxin free home and windows in the house are nearly always open giving good air circulation. Both clients presented with Alzheimer's symptoms at a similar age, but the first one, who is 5 years younger, is now in a nursing home and can no longer even walk, while the older one retains much more of his faculties and until recently even still helped his wife around the house.

Hope or false hope?

When I was looking for more information on Dr Bredesen I came across an article from the Canadian Alzheimer Society saying that his protocol offers false hope for curing Alzheimer's. Always eager to learn other points of view or evidence I read what they had to say. Sadly it wasn't very enlightening because their arguments mostly touched on what Dr Bredesen has already mentioned which is that more larger studies need to be done for better scientific evidence. This is something his team is working on, but the larger the study the bigger the expense and seeing as most medical research is funded by pharmaceutical companies and there is no profit for them without a potential drug outcome it's hard to get enough funding to complete these studies. In fact pharmaceutical giant Pfizer pulled out of doing any further research on neurological diseases because they couldn't foresee any profit in it, so counted it as a wasted investment.

The other main argument against his protocol was that the tests weren't covered by health care or insurances, so it could get expensive. Again, this isn't really much of an argument and there seems to be no accusation that he doing it just to try and make money, either, so it's merely a statement that few tests are actually covered by health insurance providers and healthcare systems.

It's ironic because by their own admission there are no effective drugs to treat dementia, yet people still come forward to participate in research trials and why would they if not for that little bit of hope? That also seems like false hope to me no matter how much they might explain the risks and the slim chances of the drug working. Yet what are the risks or downsides of eating a healthier diet or finding out if you are coming into contact with toxins? On balance I would personally rather take the risk of a lifestyle change over a drugs trial, especially given the track record that most of the trials concluded that their drugs actually sped up decline in their test subjects.

Everything is connected

The more I learn the more I realise how interconnected everything is. It's often cited that obesity causes higher risk for diabetes, cancer, heart failure etc. Obesity and diabetes are indicated as high risk factors for dementia too. Yet the reality is that all of these conditions connect back to the same root causes, which is mitochondrial/metabolic disfunction. Therefore the triggers for them are the same. So we're cycling back to lifestyle factors: diet, sleep, stress, activity levels and toxins.

Dr Casey Means explained how the cause of all chronic diseases is cell energy disfunction, but because we have over 200 different cell types in our bodies then different diseases will manifest depending which cells are being affected the most. So neurodegenerative diseases will develop when the mitochondria in brain cells become dysfunctional and it depends which ones are affected as to which neurological disease manifests. Often more than one will manifest. For example around 75-80% of people with Parkinson's disease will also develop dementia.

This doesn't just happen with similar cell types. People often have more than one chronic health issue. I work with clients with disabilities and when I get to know them they'll often tell me about their health problems. One has macular degeneration caused by type 2 diabetes. Another has tremours and hearing loss due to neurodegeneration and, you guessed it, type 2 diabetes. Insulin resistance is the biggest symptom telling us that something is going wrong in our cells. Once it has manifested as type 2 diabetes we should have alarm bells ringing, but because the clinical world compartmentalises conditions they aren't making these connections and are instead just trying to treat symptoms as they arise.

Further resources

If you're interested in learning more about dementia then here are a couple people you might be interested in looking into. There are some enlightening interviews with them on YouTube:

Dr David Perlmutter is a neurologist who has written books on how foods can affect our brains.

Professor Stephen Cunnane is a researcher who has spent years studying the links between nutrition and the brain.