If you’ve been following this blog for a while, you’ll know that the starting point for my own Age-Well Project was my mother’s diagnosis with dementia 18 years ago. At that point, there was no effective medication or treatment, I simply had to watch her decline for the next 12 years, while trying to provide the best possible care I could. I know some of you reading this are in the same position, and it’s hard.
It seemed extraordinary to me, then, that there was no pill she could take to alleviate her symptoms. Now I know that Alzheimer’s and other dementias are the result of a cascade of symptoms, with multiple elements in play. Dr Dale Bredesen, author of The End of Alzheimer’s Programme, compares treating dementia to fixing a leaky roof, ‘if you’ve got 36 holes in your roof, you can’t patch just one and expect it to stop the rain from getting in’. No wonder the condition is hard to treat.
A DRUG FOR ALZHEIMER’S, AT LAST?
We have to live in hope, however. Since my mother’s diagnosis, many drugs trials around the world have tried, and failed, to find a way to alleviate the symptoms of Alzheimer’s. Then, last month, one was approved by the FDA (the American Food and Drug Administration). The drug aducanumab, known by the brand name, Aduhelm, is the first medication to be licenced for the treatment of Alzheimer’s for 18 years. It’s administered intravenously, and targets amyloid, a protein which causes plaques on the brain cells of people with Alzheimer’s disease, killing off those neurons, and causing memory loss, in the process. The hypothesis is that aducanumab binds to amyloid beta tangles and reduces them. It’s a controversial drug, however. Not only the cost – an eye watering $50,000+ a year – but also the limited amount of data to support its approval, reported side effects and the narrow time frame in which it can help those living with Alzheimer’s. There’s a well-balanced article in the New York Times here.
Will it become available in the UK? Regulators here are working on their own assessment of the data on aducanumab and are expected to announce their response in the autumn. If it gets through this stage, further assessment would be needed to see if it could be funded for use in the NHS. This decision wouldn’t be made until the middle of next year at the earliest. There’s a useful precis of the process on the Alzheimer’s Research UK website.
For those living with Alzheimer’s, and their families, the wait must be excruciating. The worst thing will be if this turns out to be a false hope. The drug’s approval by the FDA was accelerated on the condition that Biogen, the pharmaceutical company behind Aduhelm, conducts a further clinical trial. What happens if that trial fails?
PREVENTION vs CURE
Researchers continue to look for new areas to explore. Protein misfolding in the brain is getting a lot of attention at the moment. Every one of our cells contains thousands of protein molecules which perform a wide variety of functions within the cell. When they’re working well, they’re neatly folded so they can get on with the job. But stresses inside and outside the body cause them to unfold. Protein misfolding, as Annabel described in a post here is the process by which they fail to refold properly, causing damage, particularly in the brain. The misfolding of one protein in particular, tau, has been linked to dementia. Rather like amyloid, misfolded tau kills off brain cells by tangling around them and effectively strangling them. But, as Annabel detailed in her blog post, muscle-building exercise helps refold proteins across the body.
Other research we’re keeping an eye on is looking at how reduced blood flow to the brain is linked to the build-up of those amyloid and tau tangles, and memory decline. But until that research reveals a cure, we need to keep blood flowing to the brain with exercise and a good diet. See below for some recipe suggestions.
Annabel and I want to do all we can to reduce our risk of Alzheimer’s, with lifestyle interventions, rather than wait for the scientists to come up with a cure. Hence this blog, of course! So we’re always particularly interested in research which looks more broadly at functional medicine rather than a particular drug. Dale Bredesen has recently published pre-print data (ie it has not been peer-reviewed) from a proof of concept trial into his eponymous Programme. It appeared to show successful results in 21 of the 25 participants in the trial, all of whom had mild cognitive decline (pre-Alzheimer’s) or early-stage dementia. The overall health of each patient was assessed before they were treated with a personalized protocol, including diet, exercise and supplments, for nine months. The patients showed improved results in cognitive testing, and MRI scans showed that they didn’t suffer brain shrinkage during the trial.
WHAT YOU CAN DO NOW
BLOOD FLOW AND THE BRAIN: Eating nitrate-rich vegetables like kale, chard, beetroot and spinach has been shown to help maintain blood flow and lower blood pressure. It also resulted in a lower risk of heart disease of up to 26 per cent in one study. The participants ate either one cup of raw veg, or half a cup of cooked each day. Try these recipes:
THE BREDESEN PROTOCOL is individually targeted but many elements are universal. Dr Bredesen re-writes the traditional food pyramid, putting an overnight fast of at least 12 hours at the foundation of the pyramid (we’re written about that here ). Non-starchy vegetables and healthy fats come next, then a whole level devoted to gut health – prebiotics, probiotics and resistant starch from veg and ferments. Animal protein (especially oily fish) and fruit form the next level of the pyramid and, finally, ‘indulgences’ (red wine, dark chocolate) are at the very top. He also devotes sections to exercise, sleep, reducing stress, brain stimulation and – interestingly – there’s a whole chapter on oral health. He refers particularly to the oral microbiome which we’ve written about here and here
There are plenty of recipes on the blog which fit the Bredesen programme:
Baked mackerel with rhubarb relish
Roasted red onions with rosemary and Roquefort
Pea and watercress puree with smoked mackerel
Susan
Love the look of the recipes.
Thanks so much – there are some goodies here!
Dear Susan,
Thank you so much for this. Watching my mother-in-law decline to a non-functioning, unresponsive shell of her vibrant former self is so sad.
I love your newsletters and the links to research; so informative and helpful.
I especially love your recipes. I happened to have watercress in the fridge when you originally posted your sardine & watercress pâté … and thought it was both simple to prepare and amazingly tasty 🥰!!
Keep up the great work … loving that you refer to kale again (a hark back to early posts 😉) … but what a great title for your posts: we all want to AGE WELL and you’re helping us to achieve that. 👍🏼♥️
Hi Dawn, I’m so sorry to hear about your mother-in-law but thrilled you find the blogs and recipes helpful. And we’ll never stop loving kale! Susan x
Don’t want to be depressing but there is no real evidence that this Alzheimers drug works. Its approval has been criticised by experts in the field. It was more a political or commercial decision than a medical decision. There is an article about it in today’s New York Times.
Yes, it’s highly controversial, and has been heavily criticised. It will be interesting to see how Biogen’s forthcoming trials go, and whether it’s approved here in the UK. But for some people it’s approval gives a little hope. Alzheimer’s Research UK is remaining neutral on this for the time being. Meanwhile, it’s all about reducing risk through lifestyle for us!
Excellent – love the practical aspect of the blog. Thank you
Thanks so much – that’s really good to hear!
I saw beetroot powder for sale.
Would dried still have the benefits?
We always say ‘food before supplements’ but yes, beetroot powder does contain nitric oxide and is more concentrated than the actual vegetable!
that would be why I saw warnings about a daily ‘dose’
Have you read Dr Mosconi’s book – The XX Brain. She believes the menopause has a big effect on the female brain. I wonder what your thoughts are on that?
Hi Caroline
We’re big fans of Dr Mosconi and she’s been supportive of The Age-Well Project. Her point that oestrogen is a hormone of the brain, not just the ovaries is an extremely valid one, and something all women should bear in mind as we go through menopause and beyond. It makes so much sense and explains why menopause messes with our minds!
I do wonder how much of the menopause mania is media induced. We don’t all turn into werewolves with personality disorder. A lot of menopause discombobulating is probably due to life unhappiness; poor marriage, dying parents, difficult adult children, poor job prospects, lack of money. These life challenges often occur at the right time to be put down to menopause. But how many of the problems would disappear without the menopause in our lives? Perhaps not many.
Apparently gingivitis is often an early warning sign of dementia. My dental nurse said it was common knowledge amongst her workmates. Not so widely known in the community and another reason for good dental hygiene.
Indeed. Gingivitis is often found in the Alzheimer’s brain – a chicken and egg situation? Good dental hygiene is so important, as you say. Really important to keep the oral biome healthy too – good digestion starts in the mouth.
We all need to cut down on the sugar. We are killing ourselves and our brains with our appalling diet.
Pfizer have just announced that they are stopping trying to formulate an Alzheimer therapy drug. Presumably it is very difficult and complicated to get results. In fact none of our current medications is any use whatsoever and may even make symptoms worse. We must rid ourselves of the idea that it is our ‘right’ to live any way we chose and if we get ill someone will give us a pill.
Indeed our health is our responsibility in many ways. None of us can completely dodge the bullet if it’s got our name on it, but we can do a lot to reduce our risk of age-related disease and chronic conditions