By Dr. Ardeshir Hashmi
Every 65 seconds, someone in our nation develops Alzheimer’s dementia. From the current six million, it is expected that the number of people with Alzheimer’s will increase to 16 million by 2050.
Alzheimer’s is just one type of dementia. Dementia is an umbrella term that describes any decline in memory significant enough to start impacting day-to-day functioning. In addition to Alzheimer’s, other types of dementia include vascular (related to stroke), Parkinson’s disease, Frontotemporal and Lewy body dementia.
Challenges, Hopes
No clinician likes to talk about the sad reality that we do not have a cure for dementia. There are five FDA-approved drugs for Alzheimer’s but these are designed to slow down the progression of the disease, not to reverse the decline.
Consider this: In the last 113 years, these five drugs are the only medications approved for dementia. There has been no new medication approved since 2003. Before any of us first notice significant changes in memory, internal dementia-related changes in the brain have already been occurring for the past 20 years. Contrast that somber reality check with this: How many times does your doctor ask you specifically about memory, much less do formal screening for it?
There is a silver lining and some hope if we look in the right places. As I say to my patients, medication is only 2% of the solution; 98% is the non-medication lifestyle changes that each of us can make today and every day to preserve and actually improve memory.
Here are simple things we can do to promote brain health:
- Aerobic exercise (regularity not intensity is most important)
- Mediterranean Diet (seafood, green leafy vegetables, olive oil)
- Social connectivity and sense of purpose
In addition, hobbies and special interests are excellent exercises for the mind. Examples include reading, doing crossword or jigsaw puzzles, Sudoku and learning a new language or a musical instrument. Scientific evidence from the world’s leading Scandinavian healthcare system has proven the value of these lifestyle changes.
Science also has shown that specific medical conditions external to the brain, classically not considered in dementia, have a significant impact on memory and brain health. These include underlying sleep disorders, depression, hearing loss and macular degeneration. Identifying and treating these conditions can potentially improve memory.
Medications that cause ‘brain fog’ have been well described in the media. Benzodiazepine anxiety medications, several over-the-counter sleep medications, and pharmacotherapy for urinary incontinence can lead to memory impairment and confusion. Medications then are often part of the problem, not the solution.
Another area of concern is the 40 million family caregivers who take care of loved ones with dementia. Caregiving can take a toll on the medical health of caregivers themselves. A good way to plan for what help may be needed is to map out the stages of dementia:
- The level of independence with activities of daily living (eating, bathing, dressing, toileting, transferring, continence)
- The level of independence with instrumental activities of daily living (managing medications, finances, driving, phone calls, grocery shopping, cooking, laundry and housekeeping)
Let’s move towards the future of dementia care which harnesses technology to combat the scourge of dementia:
- Visits which use artificial intelligence to assess memory, based on each unique individual’s upper limit of cognition and how that changes in time
- Technology tablets that help people self-assess hearing
- A team that actively “de-prescribes” harmful medications and focuses on caregiver needs
Out-of-the-box solutions are needed and may be available closer than you think.
Dr. Ardeshir Z. Hashmi is Endowed Chair, Geriatric Innovation and Director of the Cleveland Clinic Center for Geriatric Medicine.
