Alzheimer's, Dementia & Mental Health
No Way Found to Prevent or Delay Alzheimer’s
Disease: Worst Fear of Most Senior Citizens
New York Times explores the NIH report and the
dilemma as part of its Vanishing Mind series
Aug.
30, 2010 – We are failing in the massive attempt to stop the disease
most senior citizens fear most – Alzheimer’s disease. The New York
Times, as a part of its Vanishing Mind series, published an article by
Gina Kolata on Sunday that takes a close look at this crisis. The
article was spurred by the report of a National Institutes of Health
panel that concluded nothing has been found to prevent or delay AD.
The Vanishing Mind series of articles about
Alzheimer’s has been building for several years at the NYT. This report,
“Years Later, No Magic Bullet Against Alzheimer’s Disease,” is certainly
one of the most jarring.
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Alzheimer's, Dementia & Mental Health |
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The NIH appointed a jury of 15 medical scientists
with no vested interests in Alzheimer’s research to consider the
evidence and reach a judgment on what the data showed about the medical
communities ability to prevent or delay AD.
“It is an issue that has taken on intense
importance because scientists recently reported compelling evidence that
two types of tests, PET scans of Alzheimer’s plaque in the brain and
tests of spinal fluid, can find signs of the disease years before people
have symptoms,” wrote Kolata.
“That gives rise to the question: What, if
anything, can people do to prevent it?”
She says, “But
the jury’s verdict was depressing and distressing. So far, nothing
has been found to prevent or delay this devastating disease, which
ceaselessly kills brain cells, eventually leaving people mute,
incontinent, unable to feed themselves, unaware of who they are or who
their family and friends are.”
The panel issued their report in late April of this
year.
Independent Panels Report Finds Insufficient Evidence to Support
Preventive Measures for Alzheimer's Disease
On April 28, 2010,
the National Institutes of Health issued a news release saying, “Many
preventive measures for cognitive decline and for preventing Alzheimer's
disease—mental stimulation, exercise, and a variety of dietary
supplements—have been studied over the years. However, an independent
panel convened this week by the National Institutes of Health determined
that the value of these strategies for delaying the onset and/or
reducing the severity of decline or disease hasn't been demonstrated in
rigorous studies.”
"Alzheimer's disease
is a feared and heart-breaking disease," said Dr. Martha L. Daviglus,
conference panel chair and professor of preventive medicine and medicine
at Northwestern University, Chicago. "We wish we could tell people that
taking a pill or doing a puzzle every day would prevent this terrible
disease, but current evidence doesn't support this."
The panel's
assessment of the available evidence revealed that progress to
understand how the onset of these conditions might be delayed or
prevented is limited by inconsistent definitions of what constitutes
Alzheimer's disease and cognitive decline. Other factors include
incomplete understanding of the natural history of the disease and
limited understanding of the aging process in general. The panel
recommended that the research community and clinicians collaborate to
develop, test, and uniformly adopt objective measures of baseline
cognitive function and changes over time.
Although many
non-modifiable risk factors have been examined, age is the strongest
known risk factor for Alzheimer's disease. Additionally, a genetic
variant of a cholesterol-ferrying protein (apolipoprotein E), has strong
evidence of association with the risk for developing Alzheimer's
disease. Although it is hoped that improved understanding of genetic
risk factors may ultimately lead to effective therapies, currently these
associations are primarily useful in the clinical research setting.
The panel determined
that there is currently no evidence of even moderate scientific quality
supporting the association of any modifiable factor—dietary supplement
intake, use of prescription or non-prescription drugs, diet, exercise,
and social engagement—with reduced risk of Alzheimer's disease. The
evidence surrounding risk reduction for cognitive decline is similarly
limited. Low-grade evidence shows weak associations between many
lifestyle choices and reduced risk of Alzheimer's disease and cognitive
decline.
Although there is
little evidence that these interventions lessen cognitive decline, some
are not necessarily harmful and may confer other benefits. However, the
panel also emphasized the need for enhanced public understanding that
these proposed prevention strategies are currently, at best, only
loosely associated with improved outcomes. This means that
carefully-designed randomized studies may reveal that these modifiable
factors enhance, detract, or have no effect on preventing Alzheimer's
disease and cognitive decline.
"These associations
are examples of the classic chicken or the egg quandary. Are people able
to stay mentally sharp over time because they are physically active and
socially engaged or are they simply more likely to stay physically
active and socially engaged because they are mentally sharp?" added Dr.
Daviglus. "An association only tells us that these things are related,
not that one causes the other."
The panel found that
certain chronic diseases, such as diabetes and depression, and risk
factors such as smoking are associated with increased risk of both
Alzheimer's disease and cognitive decline. However, studies have not yet
demonstrated that these medical or lifestyle factors actually cause or
prevent Alzheimer's disease or cognitive decline, only that they are
related.
There is
insufficient evidence to support the use of pharmaceuticals or dietary
supplements to prevent Alzheimer's disease or cognitive decline. Ongoing
studies exploring factors including but not limited to physical
activity, omega-3 fatty acids (typically found in fish),
antihypertensive medications, and cognitive engagement may provide new
insight into Alzheimer's disease and cognitive decline prevention.
The panel made a
variety of recommendations to shape the future research agenda and fill
identified gaps, while acknowledging that advancing our understanding of
these complex conditions in order to develop conclusive, evidence-based
prevention recommendations will require considerable time and resources.
For example, the panel advocated launching long-term, longitudinal
studies to better characterize the natural history and progression of
these diseases in the community. They also recommended the establishment
of registries for Alzheimer's disease and cognitive decline, modeled on
existing registries for cancer.
Extensive research
over the past 20 years has provided important insights on the nature of
Alzheimer's disease and cognitive decline and the magnitude of the
problem. Nevertheless, there remain important and formidable challenges
in conducting research on these diseases, particularly in the area of
prevention. There are numerous ongoing or planned investigations which
may offer promising new insights regarding the causes and prevention of
these diseases.
An updated version
of the panel's draft consensus statement, which incorporates comments
received during this morning's public session, will be posted later
today at
http://consensus.nih.gov.
The panel will hold
a press telebriefing to discuss their findings today at 2:00 p.m. EDT.
To participate, call 1-888-428-7458 (US) or 201-604-1577 (International)
and reference the NIH Alzheimer's conference. Audio playback will be
available shortly after conclusion of the telebriefing, by calling
1-888-632-8973 (U.S.) or 201-499-0429 (International) and entering
replay code 35986458.
The conference was
sponsored by the NIH Office of Medical Applications of Research and the
National Institute on Aging, along with other NIH and Department of
Health and Human Services components. This conference was conducted
under the NIH Consensus Development Program, which convenes conferences
to assess the available scientific evidence and develop objective
statements on controversial medical issues.
The 15-member panel
included experts in the fields of preventive medicine, geriatrics,
internal medicine, neurology, neurological surgery, psychiatry, mental
health, human nutrition, pharmacology, genetic medicine, nursing, health
economics, health services research, and family caregiving. A complete
listing of the panel members and their institutional affiliations is
included in the draft conference statement. Additional materials,
including panel bios, photos, and other related resources, are available
at
http://consensus.nih.gov/2010/alzmedia.htm. Interviews with panel
members can be arranged by contacting Lisa Ahramjian at 301-496-4999 or
AhramjianL@od.nih.gov.
The conference was
webcast live and will be archived shortly. Links to the archived webcast
will be available at
http://consensus.nih.gov/2010/alz.htm.
Individuals
interested in obtaining resources for patients and families affected by
Alzheimer's disease may wish to contact the National Institute on
Aging's Alzheimer's Disease Education and Referral Center at
1-800-438-4380 or
http://www.nia.nih.gov/alzheimers.
In addition to the
material presented at the conference by speakers and the comments of
conference participants presented during discussion periods, the panel
considered pertinent research from the published literature and the
results of a systematic review of the literature. The systematic review
was prepared through the Agency for Healthcare Research and Quality
Evidence-based Practice Centers (EPC) program, by the Duke University
Evidence-based Practice Center. The EPCs develop evidence reports and
technology assessments based on rigorous, comprehensive syntheses and
analyses of the scientific literature, emphasizing explicit and detailed
documentation of methods, rationale, and assumptions. The evidence
report on preventing Alzheimer's disease and cognitive decline is
available at
http://www.ahrq.gov/clinic/tp/alzcogtp.htm.
The panel's
statement is an independent report and is not a policy statement of the
NIH or the federal government. The NIH Consensus Development Program was
established in 1977 as a mechanism to judge controversial topics in
medicine and public health in an unbiased, impartial manner. NIH has
conducted 122 consensus development conferences, and 34
state-of-the-science (formerly "technology assessment") conferences,
addressing a wide range of issues. A backgrounder on the NIH Consensus
Development Program process is available at
http://consensus.nih.gov/backgrounder.htm.
The Office of the
Director, the central office at NIH, is responsible for setting policy
for NIH, which includes 27 Institutes and Centers. This involves
planning, managing, and coordinating the programs and activities of all
NIH components. The Office of the Director also includes program offices
which are responsible for stimulating specific areas of research
throughout NIH. Additional information is available at
http://www.nih.gov/icd/od.
The National
Institutes of Health (NIH) — The
Nation's Medical Research Agency — includes 27 Institutes
and Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting and
supporting basic, clinical and translational medical research, and it
investigates the causes, treatments, and cures for both common and rare
diseases. For more information about NIH and its programs, visit
www.nih.gov.
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More about the
panel and this report.
