Alzheimer’s Op-Ed: Give up on Brain Health?

An important op-ed piece appeared in yesterday’s New York Times authored by Sandra Day O’Connor (former Justice of the US Supreme Court), Nobel prize winner Robert Pruisner, and Ken Dychtwald, a well-known gerontologist.

They argue that prevention of Alzheimer’s disease hasn’t worked because, as they point out, Ronald Regan got Alzheimer’s even though he was both mentally and physically active. They also argue what we really need is a massive increase in research funding to find drug treatments for Alzheimer’s disease. Click here to see the opinion piece.

Is it possible to agree with someone’s conclusion but think that their reasoning is wrong? I think the answer for me has to be yes.

Their argument reflects a basic misconception about prevention. It’s as though we were saying because Jim Fixx (a famous runner) died of a heart attack we should give up on exercise and only focus on drug and surgical treatments for heart disease. It as thought we are saying, Let’s give up being healthy, because even people who exercise and eat right still get heart disease.

O’Connor and her colleagues argue that a major increase in funding for Alzheimer disease drug development might lead more rapidly to effective treatments, and cite the effort made in the 1980s to develop treatment for HIV infection. A similar effort, they argue, would lead to similar progress in Alzheimer’s.

We don’t know that, but there’s only one way to find out. Even though there have been important advances in understanding the basic pathology of Alzheimer’s, it’s still not clear how well treatments based on those advances will work. Recent drug trials have not panned out. A major advance could happen tomorrow, or not for many years.

An alternative model for understanding potential advances in treating Alzheimer’s might be efforts to treat cancer. While major advances in treatment have occurred since the time of the Nixon administration, reductions in cancer rates for things such as lung cancer are also heavily influenced by public health efforts to reduce smoking.

Maybe what we really need is a targeted effort to evaluate both preventive as well as drug treatment strategies in Alzheimer’s. The op-ed piece neglects promising developments such as Carl Cotman’s work on reducing amyloid load in animals that I wrote about several weeks ago. He showed that diet and exercise actually reduced amyloid (a substance believed to be central in Alzheimer’s disease) in aging dogs. That work can lead to preventive efforts but may also lead to drug therapies for cognitive decline and perhaps Alzheimer’s. (See my earlier post here.)

So give up on brain health? I think that’s a really bad idea. We know that people who are healthy as well as physically, socially, and mentally active are less likely to have cognitive decline. Will brain health prevent all Alzheimer’s? Probably not. But should we give up and throw all of our efforts into drug development? Until we have better treatments for cognitive decline, a brain healthy lifestyle is probably the best strategy for staying mentally sharp.

5 Ways to Focus on Brain Fitness

For pretty much all of us, developing brain fitness means doing something different. Either we have to do something we don’t do now, such as exercise or eat antioxidant-rich foods, or we have to do less of something we already do, such as eating high fat foods or just eating too much.

As a neuropsychiatrist, I often work with people who want to change something about themselves or their lives. And wanting to change raises the paradox we all face at times: we want to change, but we don’t.

The psychoanalysts used to have complex theories about why people do things that appear self-defeating. I think there’s a better answer: lack of focus. This may seem too simple, but attention is a complicated ability that is affected by things inside and outside of us.

When cognitive psychologists says that attention is a limited resource, they mean that you can only focus on a limited number of things at one time. Research has shown that even people who believe they are good at doing more than one thing at a time actually aren’t.

What does that have to do with change? In order to change, you have to be able to pay attention to what you’re doing and remember that you want to do something different. If you’re watching TV, it’s easy to eat an entire bag of chips. If you really pay attention to what you’re doing and at the same time remember that you want to lose 10 pounds, the chances are you will eat less. But when your attention is spent on the TV, your behavior becomes almost automatic (and probably outside of your awareness).

What can you do? Here are 5 ways to develop focus on what you want to change:

• Start every day with 10 minutes of focused thinking or meditation. Break up the morning rush for just a few minutes so that you’ll have the change to reflect on your goals for the day.
• Help yourself remember to pay attention. Recognize that you will forget or become distracted from your goals, and do something about it. In Aldous Huxley’s novel Island, birds were trained to help people to remember this point by repeatedly saying “Attention!” You may not have a mynah bird, but you can put a note on the bathroom mirror or a picture on the refrigerator to help you remember your goals.
• Schedule a reminder in your phone or computer. Set it to pop up at a particular time or interval to remind you to stop for a few moments and review your goals, to meditate, or to relax.
• Schedule time once a week for a more complete review of your goals at a time when you won’t feel rushed. Take some time to think about how well you’ve done during the preceding week, and focus on your goals for the coming week.
• Try writing down personal brain fitness goals and keep the list somewhere that you will see without making a specific effort, such a door you walk through every day.

If you want to achieve something – whether it’s weight loss, increased exercise, or consistent brain training – you have to deploy some of your limited resource, attention. Finding ways to keep your goals in mind, every day, is a key.