“Pain is inevitable. Suffering is optional.”
I always liked that saying, and, as somebody who has personally witnessed the parallel degeneration of humanness and brain atrophy – in people I have loved and those I’ve cared with and for – I feel the above statement is way too applicable, and – perhaps – shouldn’t be.
There is now no doubt that the increasing prevalence of Alzheimer’s disease and other forms of dementia is one of society’s greatest problems. According to the World Health Organization (WHO), dementia meets the criteria for an international pandemic-level health problem.
Yes, dementia is a pandemic.
As the baby boomer generation enters into the range of early stage dementia, the number of people with dementia will triple, causing further major personal and financial distress. This is sometimes referred to as the “Silver Tsunami” (https://rxfilm.org/problems/silver-tsunami-united-states-healthcare-thomas-gill-yale-center-on-aging-interview/).
As the esteemed Scientific American editor Jeremy Abbate accurately points out, we have been having the same dead-end conversation about Alzheimer’s and other forms of dementia for a while now. As multiple drugs have failed (including two recently promising compounds; Lyon, 2017) it appears there is no hope. By all accounts, we’re set to crash into the most dangerous and debilitating disease burden in history: a 2.5 million person asteroid crashing into the heart of our planet, carving out a (at least) 40-year wake.
Lots of pain; for sure. Suffering, yes.
But that might be optional.
As we mobilize to meet the other major societal issues of our day (e.g., climate change) we must not sleep on this reality. We need to wake up.
To really tackle dementia in a helpful way we must come to terms with two apparent and hard truths: 1) there is unlikely to be a cure soon and 2) there may never be. Only by facing these destitute realities and the inevitable pain that comes can we proceed to take the most appropriate and vital next step: action. Action that will have a tremendous effect on our personal and collective suffering secondary to this disease. Simple, yet effective, daily behaviors designed to mitigate and perhaps – for a time – suspend this tragedy.
More on that in a bit, but first, the question is, “when?” The answer: Now. Or, really, yesterday. That goes for you as a reader and a member of the human race, but also for science.
Technically, we must get people before they get dementia. The prodromal phase of the disorder is called Mild Cognitive Impairment (MCI). It’s what you get before you get dementia. Like pre-hypertension before hypertension. Unlike pre-hypertension, there is no accurate form of detection for MCI.
As such, everybody must act. Or, at least, anybody over 55. And, yes, not just those with dementia.
People who have MCI are often at a more increased risk to develop dementia. Mild cognitive impairment is not a form of dementia, but can be considered a pre-dementia condition that causes systems to worsen over time.
Most people see a gradual decline in cognitive functions as they age, but people with MCI suffer from a greater decline in their mental abilities, but again, not severe enough to be considered dementia.
I have spoken to thousands of people in my talks and in my practice. In this relatively short endeavor (so far!) I have surmised a few truths: 1) dementia is the most stigmatized and scary illness, 2) this fear causes both paralysis and prejudice among people, and (but) 3) the overwhelming majority of elders and their children, even if they express initial reluctance to address the problem of dementia, want to do something about it. They don’t want to go gentle into that good night. They want to fight. Even if it does only a little. And – like most humans – they will almost immediately take action if it’s simple, accessible, effective, and transparent.
Which mental exercise is. At least the right type of exercise. You see, most people do it wrong. If they are doing any mental exercise at all, they usually do things they already know how to do, or like doing (which are typically one and the same). The more advanced among them try to play “brain games” in an effort to help “prevent” dementia. Unfortunately, this doesn’t work (see Lumosity’s $50 million lawsuit 2 years ago: https://www.ftc.gov/news-events/press-releases/2016/01/lumosity-pay-2-million-settle-ftc-deceptive-advertising-charges).
Along with doing the wrong exercise, they also do it alone. A variety of research has found that social support and community involvement has a beneficial effect in reducing dementia and stroke (Kuehn, 2015, 2017).
Lumosity had the right idea, but the execution was wrong. The brain tolerates novelty rather quickly: neurons (the microscopic building blocks of the brain) stop releasing the glutamate cascade after 7-9 days of repetitive learning. We must be learning something NEW, with the emphasis on NEW.
Like what? ANYTHING, with an emphasis on… (sorry, getting repetitive).
Just as dementia is ubiquitous, so are there a plethora of choices for dementia mitigation: learning a foreign language, a new subject, a novel game, a musical instrument. Really, the most important thing is cultivating a spirit of new learning. Then, keep changing it. And keep changing it. And keep changing it…
All of the above are – maybe obviously – are in addition to good heart health and an emphasis on regular aerobic exercise. Most people – whether they maintain good physical habits or not – know this. Very few know and follow the right kind of mental habits. If even half of the baby boomers would practice new and novel mental exercise, our impending disease burden may be cut by almost a third (!).
By delaying the inevitable cognitive and functional decline associated with dementia we do not just prolong life’s final act; we give meaning to the struggle. We find ourselves within this – our most individual yet community – challenge.
And as the clock runs out, we play a game with reckless abandon, spitting in the face of defeat, of an invisible opponent that does not play fair.
Through engaging in community action against Alzheimer’s and other forms of dementia – at the level of MCI – we know at once our highest self and our supreme collective potential and, with our last breath, in all the muddled confusion and despair, we realize us and ourselves.
We feel pain.
And we are free.
By: Dr. John DenBoer, Founder, Chief Medical Officer, SMART Brain Aging, Inc.
Abbate, Jeremy (8/27/2017). With Every Alzheimer’s Diagnosis, The Same Bleak Conversation. The Wall Street Journal.
Kuehn, B.M. (12/15/2015). The Brain Fights Back: New Approaches to Mitigating Cognitive Decline. Journal of the American Medical Association.
Lyon, J. (3/7/2017). Alzheimer’s Outlook Far From Bleak. Journal of the American Medical Association.
About the Author
Dr. John DenBoer is a Clinical Neuropsychologist specializing in the assessment and detection of early-stage dementia. He received his internship training at VA Boston Healthcare System (Boston University School of Medicine/Harvard University) and received his postdoctoral training at Barrow Neurological Institute. He has published extensively in the area of Clinical Neuropsychology and has been an expert speaker at many local, national, and international conferences.
By reading this blog, I acknowledge that I am not creating or entering a clinical or medical relationship with Dr. DenBoer and SMART Brain Aging. I understand that all materiel included in this blog is strictly for informational purposes only. The content is to provide me with information and knowledge and I will not substitute it for diagnosis, treatment or medical advice. I am aware the author does not hold a medical degree or license and is simply providing me additional information on a variety of health topics.