One Doctor's Efforts to Prevent Alzheimer's

Summary:  In the absence of a near-term cure for Alzheimer’s, Dr. Ken Kosik believes we should focus on lifestyle changes and managing chronic disease to try to prevent or slow cognitive decline.  He thinks “neighborhood cognitive shops” can provide one-stop shopping for the medical and non-medical services people need to support these healthy behaviors.  His center for Cognitive Fitness and Innovative Therapies (CFIT) in California is the first such shop.

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.

  Kenneth Kosik, MD

When it comes to Alzheimer’s, the big picture is alarming.  The risk of memory loss increases with age, and the oldest of the 80 million or so baby boomers in the U.S. are now in their mid 60s.  Given the 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. 

About half his clients are cognitively normal, he says, and half have been diagnosed with Mild Cognitive Impairment.  With its prevention mission, CFIT is not set up to care for people with more advanced dementia.

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.

Comments

[Mary Ann]

This is great news. The medical model as it is today doesn't serve my Mom well with the dementia she has. This new way of thinking sounds promising.

[Mhdonohue]

This article speaks loudly for a need not being met. The need? The plight of those of us with Alzheimer's Disease (AD)particularly those of us in the Early Stage whose quality of life could be enhanced which would in turn produce a huge savings for the community.

So much is concentrated on raising money for the cure so little for treating those already with that which is sought to be cured.

This article speaks of one of far too few who would redirect the effort in the field of AD and address a real problem lost in the dust by the "Race for the Cure"

Nice reporting Tangled Neuron, nice work Ken Kosik. You are on the money!

[Oran]

What a wonderful article! Thanks.

We would all be so much healthier if more of the research money in many fields went to prevention and not just cure.

Lifestyle changes can help prevent memory loss as well as many diseases. I hope Dr. Kosik can spread his idea of prevention to other memory and aging centers.

[Jay Smith]

It's gratifying to learn of Dr. Kosik's new cognitive shop. I echo my fellow traveler Mike Donohue's comments of two weeks ago. Like Mike, I've been living and preaching the value of lifestyle approaches to dealing with AD since my diagnosis five years ago. It was truly a shameful disservice that the recent report of that NIH panel of "experts" did to the cause in the name of "hard science." I think the NIH should mount a major effort to undo the damage done by their report, and correct to record based on the huge evidence supporting the value of exercise, healthy nutrition, stress reduction, social interaction, and mental exercise. And there is so much more that needs to be done in the area of support for people living with MCI and early Alzheimer's through support groups and other community services. Dr. Kosik's shop is truly a breakthrough - the tip of the iceberg, and the wave of the future - for dealing with Alzheimer's. There's so much we can do to prevent this disease through healthy lifestyle choices. And there are a lot of lifestyle changes that people like me and Mike can adopt, when we find we have Alzheimer's disease, that allow us to continue living our lives with joy and fulfillment for many years after diagnosis. Kudos to Dr. Kosik for his pioneering work.