Event Date: Oct 23, 2014
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Dementia is a syndrome that can have many causes. Alzheimer's disease is the leading cause of dementia in older people, accounting for between 2/3 and 3/4 of all cases worldwide. There are more than 35 million people suffering with Alzheimer's dementia, and half a million or more in Canada alone. Today we have medicines that can improve symptoms for some people, but there are no true cures on the horizon. Instead, the most promising approach by far is prevention, called by some "the Ultimate Cure".
But how do we do that? After decades of intensive research, we still don't know the root causes of Alzheimer's disease. If we did, it might be possible to come up with cures that attack these causes directly.
As it is, however, we need to look for other ways around the problem. These fall into two broad categories. The first is to eat and act in ways that promote health in general, and heart health in particular. Solid evidence now suggests that "what's good for the heart is good for the brain", and changes in health habits over the past few decades seem finally to have brought some benefits with declining rates of onset for any given year of life, at least in some parts of the world. These benefits seem unlikely to reduce the global burden of disease for the simple reason that so many people are living so much longer now -- and age is still the most potent risk factor for Alzheimer's by far. Sadly, the numbers of new cases in the developing world are rising faster than ever. But at least the tide may have started to turn.
Are there more efficient ways to stem the tide? We don't know, but we now understand the disease much better than we once did. We know, for example, that Alzheimer's dementia is the "end stage" of a disease process that unfolds over thirty years or more. In recent years, we have found various ways to detect the brain changes that are part and parcel of the "pre-clinical" or "pre-symptomatic" phase of the illness. Now we are learning to measure these changes. By doing so we can actually "monitor" the progression of the disease without relying on symptoms -- the only way we could track the disease process in the past. If we can track the development of the brain disease, we should be able to "see" the effects of treatments that could slow it down. Slowing it down would mean delaying the onset of symptoms -- or even preventing them altogether. This is the approach my colleagues and I are pursuing in Montreal. In the past year or two, other groups have begun to pursue similar strategies, although they are testing new strategies in very restricted groups of people. It will probably take several more years before we can be certain whether these approaches work, but early results are at least encouraging.
Prevention as "the Ultimate Cure" is no longer an impossible dream, but there's much to be done to get there from here.
Questions? Contact: Karen Parrage
Dr. John Breitner is a geriatric psychiatrist and epidemiologist who has devoted his career to Alzheimer’s disease (AD), its risk factors and their implications for its prevention. He has worked extensively in diagnosis and treatment of patients with dementia but is better known as a researcher. Dr. Breitner founded the Cache County Study of Memory in Aging, a longitudinal investigation of genetic and environmental antecedents of AD, which has produced over 100 scientific papers. More recently he has been Chair of the Alzheimer’s Disease Anti-inflammatory Prevention Trial (ADAPT), and has recently joined the McGill faculty as Professor of Psychiatry as Director of a new Centre for Studies on Prevention of AD (StoP-AD) at the Douglas Hospital Research Centre