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April 28, 2010

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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

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