Alzheimer’s disease is a top concern among aging adults and a growing societal problem in the United States, where 1 in 10 adults over the age of 45 report difficulties with memory or thinking. Currently, more than 6 million Americans are affected by Alzheimer’s disease and twice as many will be affected by 2050. Fear of dementia has increased public demand for better treatments and has spurred a much-needed increase in federal funding for Alzheimer’s research that will hopefully lead to a cure for this devastating disease.
Last year, the Food and Drug Administration approved Biogen’s controversial new Alzheimer’s medication, aducanumab — marketed as Aduhelm — despite a lack of clear evidence of its safety and benefits. Following much scrutiny and a decision by the Centers for Medicare & Medicaid to severely limit coverage of the treatment, the company declared that medication a commercial failure. Last week, Biogen announced promising results of a second drug, lecanemab, which appears marginally safer and more effective. Whether the FDA will approve lecanemab remains to be seen.
As the search for a blockbuster drug for Alzheimer’s disease continues, we should focus our attention on the solid evidence that relatively simple strategies for improving brain health are already known to lessen the risk of developing this feared condition. Lifestyle modifications such as quitting smoking, increasing physical activity and treating depression, hearing loss and high blood pressure are highly beneficial for preserving brain health and are very achievable with current treatment approaches. In 2020, an international panel of experts concluded that up to 40% of all dementia cases worldwide could be significantly delayed or even prevented by addressing such modifiable risk factors. Hearing loss, for example, is widespread among older adults and is one of the strongest risk factors for cognitive decline. It can also be easily addressed with hearing aids, which recently became available over the counter. More recently, psychosocial factors such as depression, social isolation and sedentary lifestyle, each more common during and since the COVID-19 pandemic, have been recognized as important risk factors for dementia. These can be treated with psychotherapy, medications, social interactions and physical activity.
Clinical trials of aerobic exercise, nutritional supplementation and cognitive rehabilitation are currently ongoing and may offer low risk, cost-effective strategies for lessening dementia risk in older adults. One positive aspect of this approach is that lifestyle interventions often address multiple risk factors, leading to extra benefits. For example, increasing physical activity through regular exercise not only lowers blood pressure but has been found to help relieve depression and anxiety and improve other risk factors for dementia like type 2 diabetes and obesity.
Research is showing us that many of the factors which increase our risk for Alzheimer’s disease can be treated with great benefit. While we continue to learn and discover new information on how to combat and cure this devastating disease, it is time for us all to increase our awareness of the lifestyle choices and changes we can adopt right away to decrease risk and lessen the number of individuals and families who will be impacted by this disease. Ask your health care providers to suggest which of these lifestyle changes will most greatly benefit you and your loved ones.
Christopher Martens, Ph.D, is an assistant professor of kinesiology and applied physiology at the University of Delaware and Director of theDelaware Center for Cognitive Aging Research, which is focused on conducting clinical trials aimed at addressing the modifiable risk factors of Alzheimer’s disease and related disorders. James Ellison, M.D., MPH, is the Swank Foundation Endowed Chair in Memory Care and Geriatrics at ChristianaCare in Wilmington Delaware and editor-in-chief of the Journal of Geriatric Psychiatry and Neurology.