Expert Gives Advice on Alzheimer's Prevention
Dr. Gary Small, a New York Times best-selling author and director of the UCLA Center on Aging, spoke at Baylor College of Medicine last week about his new book, The Alzheimer's Prevention Program (Workman Publishing). He talked to Chronicle reporter Todd Ackerman about the expected explosion of the brain-robbing disease, the steps people can take to reduce their risks and the effect of the Internet.
QUESTION: So have you forgotten more about Alzheimer's than most people will ever know?
ANSWER: You have no idea the pressure I'm under to have a good memory.
Q: There was a report last week about the need for more effective Alzheimer's treatment by 2025. How realistic is that?
A: Not terribly. The field was optimistic that the latest generation of a particular class of drugs would have a big impact, but it's disappointed. Clearly, the U.S. needs to invest more in research. We spend about $500 million a year on Alzheimer's, compared to $6 billion on cancer. Obviously, cancer is important, but we have 80 million baby boomers who this year started turning 65 — and age is the disease's greatest risk factor.
Q: What's the second greatest Alzheimer's risk factor — genetics?
A: Hmm. I'm not sure — people don't often list what's No. 2. Genetics are important. About 20 percent of the population has a known genetic risk, ApoE4, that's neither necessary nor sufficient to get Alzheimer's. Non-genetic factors are more important for the average person than genetics.
Q: How prepared are we for the Alzheimer's avalanche?
A: We're not prepared at all. We have 5 million people today with the disease, and the projection is that number will grow to 16 million by 2050. It could cost us a trillion dollars a year. That's a huge burden.
Q: What kind of scientific evidence is there about preventing Alzheimer's?
A: There has been some pushback recently. A National Institutes of Health panel concluded we don't have enough evidence to prove you can take steps to prevent it. I would agree — we don't have proof from a 10- or 20-year study — but there are lifestyle strategies that improve brain health and that we think can delay the onset of symptoms. Certainly, it is easier to protect a healthy brain than to repair a damaged one.
Q: What does your book's program consist of? What are things people can do to stave off the disease?
A: Studies show genetics accounts for a third of what determines how well we age, that two-thirds isn't genetic. Most of that has to do with lifestyle. We recommend 30 minutes of daily aerobic exercise, a diet with lots of antioxidants — fruits, vegetables, fish, walnuts — stress reduction techniques such as yoga and meditation, and activities that encourage brain activity.
Q: Talk about those activities.
A: Computer programs that exercise the brain are a burgeoning area. There's no great vetting process — some work, some don't — so you have to be an informed consumer. Also, talking to people is important — one study found that having a conversation on an interesting topic is better for brain health than watching a Seinfeld rerun, likely because it involves more mental work. Studies with mice found that those raised in cages with toys or mazes have more neuron activity and perform better in tests.
Q: What kind of effect does technology have on brain health? I've seen articles suggesting the Internet makes us stupid, and others suggesting that it makes us smart.
A: My group did the study of your brain on Google. We looked at older people who were Internet-naive and older people who were Internet-savvy. In the first group, we found that reading a book and searching online didn't activate the brain that much; in the second, book-reading didn't do that much for their brain but searching online did. Our thinking is, if you know how to search online, it stimulates your neurocircuitry.
Q: So I don't need to feel guilty that I'm spending too much time online and not enough time reading books?
A: Actually, you maybe should. In our prevention program, we talk about finding the sweet spot that exercises the brain but doesn't overtrain it. If something becomes routine and you overdo it, you develop cognitive efficiency and you don't have much activity in the brain.
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