He is also in the early stages of developing related online services. His experiments with community-based efforts for dementia prevention may help answer broader questions about the future of healthcare.
recent failure of several Alzheimer’s drugs in clinical trials, and the growing controversy about what causes Alzheimer’s, it’s unlikely that some sort of cure will be available in the near future. In the U.S. and elsewhere, it will be difficult to care for the predicted “tsunami” of elders with memory loss.
Some hope lies in preventing or delaying memory loss. Researchers at Johns Hopkins calculate that small delays in the average age of onset of Alzheimer’s (and/or slowing the rate of cognitive decline) would significantly reduce the number of people with the disease.
That sounds good, but a recent panel of experts convened by the U.S. National Institutes of Health concluded there is not enough evidence to make any recommendations about Alzheimer’s prevention or slowing cognitive decline.
Ken Kosik, a physician and neuroscientist at the University of California, Santa Barbara, disagrees with that conclusion. While he believes research will provide a long term solution, he thinks we should pay more attention to preventing or delaying memory loss while we wait for answers from science. On a recent Alzheimer Research Forum Live Discussion, he argued that the evidence that lifestyle changes and controlling chronic disease can reduce the risk of developing dementia is good enough.
“The NIH consensus panel found the glass half empty,” he said. “My own view is that this was a setback for our field. It’s one thing to be sure that your data is absolutely airtight when you are telling your patient that he should start on a drug…. But here, we’re talking about [lifestyle] interventions that do not do any harm and can help people in overall wellness, even if the data for Alzheimer’s remains somewhat questionable.”
Many of us, especially those with a family history of dementia, are worried about memory loss and would try to follow any recommendations for prevention. But people often need information, advice and encouragement to make and maintain lifestyle changes. Today’s medical system, with its clinical setting, rushed appointments and emphasis on drugs and surgery, is not well-suited for this task, says Dr. Kosik.
The Neighborhood Cognitive Shop Idea
“Alzheimer’s disease has been wedged into a medical system that has no place for it,” he writes in his new book, The Alzheimer's Solution: How Today's Care Is Failing Millions - and How We Can Do Better (written with Ellen Clegg). He thinks the needs of people concerned about memory loss would best be met in a less clinical community-based environment. Much as eye centers provide glasses, sunglasses and contact lenses along with optometry and ophthalmology services, “neighborhood cognitive shops” could provide information and assistance, social networks and classes along with medical services, all in a pleasant setting.
To see how this concept might work, he opened the first such center, Cognitive Fitness and Innovative Therapies (CFIT), in Santa Barbara last year. The center’s mission is to “help people maintain a healthy brain for life.” Services available at CFIT include:
- Medical and neuropsychological evaluation
- Genetic testing and counseling
- Risk reduction and lifestyle counseling
- Cognitive and physical fitness classes
- Driving education
- Assistance with Internet searches, technology and gadgets
- Advice on creating a healing garden
- Spiritual counseling
- Referral to local resources.
For Dr. Kosik and his colleagues, the purpose of CFIT is not to test whether specific measures will reduce the risk of memory loss or progression. Instead, they are testing whether the center’s services can help people make and stick with lifestyle changes that may reduce their risk. At this point, it’s too soon to say whether they’ll be successful.
Even so, he is already thinking about how to expand these efforts, and is in discussions about opening centers in other locations. The CFIT model is expensive, however (approximately $4000 per client per year), and most people can’t afford this level of service. Because of this, he’s developing an online version of CFIT that could be made available to a much larger set of clients at a much lower cost.
The Challenges of Preventive Care
There are other challenges besides cost, Dr. Kosik says. Especially in disadvantaged communities, it is often difficult to make risk-reducing lifestyle changes. Healthy food may not be available, and there may not be a safe and convenient place to exercise. There may be limited access to the medical care needed to manage chronic diseases, and dismal economic conditions can cause high stress levels.
The implications of his work go beyond brain health, of course. The medical evaluation, genetic testing and preventive care available at CFIT are at the heart of the much-discussed personalized medicine concept. But personalized medicine won’t lead to better health if it can’t change people’s behavior. There are already some reports that baby boomers are less physically active, under more stress and have more chronic diseases than previous generations. If neither the current medical system nor individuals can provide enough motivation for lifestyle changes, who will?
“I believe the push for healthy behaviors must come from grassroots movements and communities,” says Dr. Kosik. His experiments with community-based efforts for dementia prevention may help answer broader questions about the future of healthcare.