“Keep your brain healthy for the rest of your life,” reads the book jacket. If you’ve watched a family member or friend fade into dementia, this is one promise you wish with all your heart to believe even as doubt simmers on that back burner. Dr. Gary Small is on the book tour to promote The Alzheimer’s Prevention Program, and as accessible, positive, and reasonable as the program is, I still balk. Not that I think Dr. Small is selling snake oil or is otherwise untrustworthy. He’s a well-regarded neurologist who is recommending, based on evidence from research, a program of nothing more than regular exercise, good nutrition, stress management, and memory exercises to maintain brain health. Nothing harmful here, and nothing we haven’t heard before. And even if it doesn’t keep your brain sharp, his program might just help you avoid or delay heart disease or diabetes. So why not? And why don’t I feel a sense of unease when the talk is about preventing heart disease using similar methods?
Maybe my attitude is emblematic of the Baby Boomer zeitgeist–we’re living longer, we’re fighting aging, and we’re scared to death we’ll exit this vale by staring off into space uncomprehendingly or “wandering off,” as some of our parents have already. I saw my mother gradually lose her engagement with daily life, her capacity to speak, her ability to eat, and, finally, her self, as she slipped steadily away from us. It just might be her shade that pulls me up short when I’m about to fully believe in prevention. I’m sure she’d want me to believe, much as she wanted me to believe in the Holy Trinity or transubstantiation, but it’s just not in me yet. I’ll gladly eat my fruits and veg, exercise to the point of injury, and OM with the best of them to keep heart disease, cancer, or diabetes at bay, but dementia? It can’t be that easy to save a soul, can it?
Alzheimer’s disease, the bane of Margaret Thatcher and now Glenn Campbell, may be preventable, said Dr. Gary Small to a crowd of about 100 people at a church in Cambridge, MA, last night. Speaking about his new book, The Alzheimer’s Prevention Program, Small, director of the UCLA Longevity Center, challenged the notion that Alzheimer’s, the most common form of dementia, cannot be prevented. Small’s plan combines physical activity, nutrition, stress reduction and memory training to defend against Alzheimer’s.
Paying attention to these four factors, Small believes, will help you delay or prevent the brain changes that may lead to Alzheimer’s. The same problems that are believed to contribute to heart disease—chronic inflammation and oxidation—may lead to the buildup of the plaques and tangles seen in the brains of people with the disease.
Despite the promise implicit in his book’s title, Small said he agreed with the substance of the National Institutes of Health 2010 Consensus Statement that there is not now enough evidence to associate the modifiable risk factors of his program with delaying or preventing the disease. The NIH statement also said that there is reason to continue research to discover ways to delay the onset of Alzheimer’s, if not prevent it.
Small’s book is accessible and energetic, and the program’s components boil down to behavior changes that many people find extremely difficult to make—exercise more, eat better and reduce stress. The audience, most of whom appeared over age 50, was animated and involved in the topic. Asked for a show of hands to gauge the level of personal connection to Alzheimer’s, about 95% responded. During the question-and-answer period, about 15 audience members approached the microphone with thoughtful and well-informed questions.
For example, one query asked whether people may be more motivated to follow his program to prevent Alzheimer’s over a similar one to prevent heart disease. Small’s response was that there is a fear factor, especially if one has watched a family member descend into dementia. The second is age. “As we get older we notice changes in ourselves,” he said. “But there is something about Alzheimer’s that strikes at the core. Our identity—who we are, memories, cognition, define who we are.”
Small’s language in selling his program—“slam dunk” techniques to improve memory, for instance, and a bright, can-do style—could be interpreted as manipulative or overpromising. However, Small’s scientific credentials are solid, and he does cite evidence and acknowledges the limitations of his approach. Preventing or delaying onset of Alzheimer’s, or reducing the risk of contracting it, is a growing area of research, and is far from the fringe.
After Small’s remarks, the event moderator, Dr. Margaret O’Connor, director of Neuropsychology at Beth Israel Deaconess Medical Center, introduced the question-and-answer period with a question of her own. When should a person be worried about changes they notice in themselves? she asked. Small answered that people with mild cognitive impairment (MCI), a transitional stage from normal age-related changes to dementia, should get medical advice.
MCI is a stage of early dementia, when people are beginning to have some cognitive difficulties, but can still live independently. This is a stage where drug therapies may be most effective. However, once cognitive changes are observed, it is likely too late to do much to delay progression. For this reason, any attempts at prevention or delay should begin early—in one’s 30s or 40s.
So, can people with MCI manage a program such as Dr. Small’s? O’Connor, in a telephone conversation the next day, said that MCI and dementia are heterogeneous, meaning they affect people in different ways. Some are more affected in their multitasking skills, others in language. If an individual is not too memory-impaired, then he or she could probably manage such a program. Otherwise, O’Connor said, a caregiver would have to be very involved.
Gary Small, MD, spoke about his new book, The Alzheimer’s Prevention Program, as part of the “How We Live Today” series presented by the Cambridge Forum.For further information on Alzheimer’s disease, visit the Alzheimer’s Association.