NIH State-of-the-Science Conference - Press Release and Briefing

On a conference call this afternoon, reporters were given a chance to ask questions about the draft report and press release (available from http://consensus.nih.gov/2010/alzmedia.htm) from the NIH’s State-of-the-Science Conference on Prevention of Alzheimer’s Disease and Cognitive Decline.

The main finding announced in the press release is:

“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.”

Prevention research is limited by lack of agreement on how to define both Alzheimer’s disease and cognitive decline, the release said.

Reporters on the call asked the panel what they expected doctors and the public to do with such negative findings.   “I think that physicians can actually benefit from the information contained in this report,” replied Dr. Evelyn Granieri , a panel member from Columbia University. “It provides them with factual information to provide to patients and caregivers. This is informational, and the public should have the information we have… the state-of-the-science is that we don’t know how to prevent Alzheimer’s or cognitive decline.”   

“…we’re not trying to take anyone’s hope away, not trying to make people feel helpless,” added Dr. Carl Bell from the University of Illinois at Chicago.  “We have to go with the hard science, but we’re not trying to take away from people’s personal choices.”  At 63, he says he’s “scared to death” of cognitive decline himself.

The panel did recommend further research into measures that have shown some promise, including some dietary measures, “cognitive engagement” (mostly brain training) and tightly controlling blood pressure. 

This telebriefing turned out to have more discussion of healthcare economics than the actual conference did.  “We hope this will dissuade folks from spending extraordinary amounts of money on stuff that doesn’t work,” said Dr. Bell.  We found no evidence, and people should know that so they can make informed choices about how they spend their money,” said Dr. Dinesh Patel from George Washington University. 

The idea of assessing how effective various treatments are and advising the public and physicians is not new – the Agency for Healthcare Research and Quality has conducted many similar reviews, including one prepared for this conference.   Given current efforts to reduce the cost of healthcare, I’m sure we’ll see many more such reviews.

But new research might cost more than consumers save.  Dr.  Martha Daviglus of Northwestern University, Chair of the panel, acknowledged that the recommended research, where people will be monitored for 60, 70 or even 80 years, would cost “millions and millions” of dollars.

Comments

[Michael C. Patterson]

I attended the NIH conference and find the panel conclusions somewhat baffling and disturbing. There were numerous presentations from such respected researchers as Art Kramer, Carl Cotman, Yaakov Stern, Laura Fratiglioni, Martha Morris and Jennifer Manly, that discussed interventions that have proven effective in reducing the risks of cognitive decline and even AD. Granted, the research message is mixed and confusing. Most pharmacological approaches have failed. Many promising interventions have failed to be verified through randomized control trials. True. But, as reported at the conference, there is also a substantial body of evidence that many lifestyle and behavioral interventions are effective, particularly when done in a "combinatorial" manner. Dr. Bell says he doesn't want to take away people's hope, but I fear that is just what will happen as the "nothing works" headlines get spread by the media. I heartily agree with Dr. Patel that people have to be warned not to spend money on useless interventions. But they also need to be encouraged to get more physical exercise, to avoid isolation, to treat depression, to continue to stimulate their brains, and to eat healthy meals. These are relatively inexpensive, safe interventions that have been show to affect the progress of cognitive decline and the onset of dementia. I suspect the panel, like the rest of us, was disappointed that there is no magic pill. But we can make behavioral changes that will reduce our risk of cognitive decline and dementia and the sooner we start doing them, the better.

[Gail Rae Hudson]

Mona, Hi!
I read the review of the NIH draft report on Medscape this morning. That article was specific about the daunting problem of adequate research involving long term studies and the cost of doing it, just as your report states. I have to admit, though, I also had a similar reaction to Michael C. Patterson's. My experience tells me that quality of life, even in the face of cognitive decline, is easily enhanced by the "relatively inexpensive, safe interventions" about which Mr. Patterson writes. When quality of life is enhanced, I think, cognitive operation is enhanced, no matter what one's state of cognition. Such simple matters as dehydration and undiagnosed pneumonia can also severely affect one's cognitive operation; both of these can reach epidemic levels in certain cognitively challenged populations without adequate oversight.
I'm so glad you wrote about this. The article I read this morning is specifically why I dropped by this evening...to see if you'd written anything on it. I'm not surprised that you have and, frankly, you've written much more completely about it than Medscape did. As always, thank you, Mona!

[Richard Taylor]

Hello

Yet another "yes, but" or looked at another way "no, but" conclusion from a group of folks we expect to be telling us a flat out yes or no. Is it us who are expect too much or them to expect too much of themselves?

People living with dementia are now faced with the task of having to decide for themselves is there is "light at the end of the tunnel" that they will see and feel before they die, or is there no light, or is there no tunnel, or are there lots of dimly let tunnels all of which at the current time lead to a rocky conclusion?

In th eend we are left with ourselves and by ourselvs to make the most of a difficult set of symptoms that get worse no matter what we do, but may get worse slower than they might have had we not done this or that. Sometimes I wonder to myself "is it worth fighting, resisting, plotting against a condition that I don't understand, have not idea how it is suppost to impact me, at what rate, at what severity - and thus I have no standard to measure against my on going efforts to stay ahead/slow the progress/etc. the symptoms.

There is no consesus about anything. There are a number of growing/resisting consesusesus about most everything.

And people say I'm confused - what about them?

Richard