Reimagining Dementia

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Physically fit women are 90% less likely to develop dementia.

Hörder, 2018

Over the past decade, at least 244 compounds have been tested in Alzheimer’s clinical trials, with only one being approved by Food and Drug Administration (FDA). This represents a 99.6 percent failure rate. The vast majority of these trials were for therapies targeting the protein beta-amyloid. Maybe we’re barking up the wrong tree?

To start things off, let's clarify a few things. Dementia is a general term for loss of memory and other mental abilities severe enough to interfere with daily life. Alzheimer's disease is the most common type of dementia; accounting for roughly 60 to 80 percent of cases.

Protective Plaques

We tend to demonize things that are linked to a problem or disorder. But science isn't black and white. Take stress. Everyone balks at the horrors stress causes. In truth, unregulated responses to stressors are linked to a variety of maladies, but at the end of the day it is our response to stress, not stress itself that can be damaging. Stress, even inflammation, are biologically protective mechanisms. Perhaps plaque formation in the brain is as well. In researching the effects of sleep deprivation on neurodegenerative diseases, I came across an array of new studies linking brain infection to amyloid plaque formation. These findings suggest that beta amyloid possesses antimicrobial and antiviral powers, enough to categorize it as part of our own immune system’s efforts in battling invaders. What’s more, researchers recently presented intriguing findings that some elderly brains, despite being riddled with plaques and tangles, showed normal cognitive and memory function. Future drugs targeting this important protein need not wipe it out from our brains, especially as we’re still uncovering its functions.

Lifestyle is Key

One of the ways in which our brain removes plaques and general waste is through sleep. During sleep, the glymphatic system - a system akin to dams and rivers - flushes out the extracellular junk and clears the path for a new day of thinking, moving, breathing and everything else that requires consciousness. A novel way to prevent or even reverse the damage that leads to dementia and Alzheimer’s is to boost waste clearance (beyond getting those 8hrs each night). Researchers recently noted that aquaporin-4, a key component of the glymphatic system, appears disorganized in Alzheimer’s brains, pointing to a possible new area for therapeutics. Similarly, other investigators are using flashing lights to mobilize the immune system to clear these plaques. Flashing light at specific frequency and duration can trigger gamma waves, which then recruit a class of janitorial cells called microglia that help with the clean-up process (in mice). These approaches enhance the brain’s own waste clearance systems, rather than introduce a pharmaceutical that targets specific end-products, providing a fresh - and hopefully more successful - approach to dealing with neurodegenerative diseases.

In addition to quality sleep, regular exercise can also ward off dementia. According to a study published this month in Neurology, women with high physical fitness at middle age were nearly 90 percent less likely to develop dementia decades later, compared to women who were moderately fit. 

Finding adequate therapies for dementia and neurodegenerative diseases is critical, as the aged population balloons worldwide. The global cost of dementia alone has been estimated to be $818 billion. As the number of people living with Alzheimer’s disease is expected to almost triple by 2050, the race is on to find a treatment that can prevent or slow the condition. The good news is, we may have the best weapon to prevent or reverse the damage in our own brain.

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