PUMPING IRONY: Is It Time for a New Take on Dementia?

The Great Aduhelm Saga that concluded unhappily for Biogen and millions of desperate Alzheimer’s patients in January is only the most colorful example of Big Pharma’s fruitless pursuit of a cure. For decades, drugmakers have been working overtime to develop a pill that would ease the suffering of an ever-expanding population of dementia sufferers. The results have not inspired confidence: About 99 percent of the trials have ended in failure.

Maybe it’s time to consider an alternative approach.

It’s been pretty well established in recent years that certain specific health conditions increase your chances of descending into dementia. The Lancet Commission on Dementia Prevention, Intervention, and Care in 2017 identified nine risk factors: hypertension, obesity, diabetes, hearing loss, depression, smoking, physical inactivity, social isolation, and lower levels of education. Three years later, the commission added these: exposure to unhealthy air quality, traumatic brain injuries, and immoderate alcohol consumption. More recently, a study in JAMA Neurology added impaired vision to the list.

There’s not a lot we can do about the air we’re breathing, educational attainment may be influenced by factors beyond our control, and a random tumble could unexpectedly rattle our fragile brains. But many of the other risk factors are modifiable — and probably more likely to mitigate our chances of developing Alzheimer’s than anything Big Pharma will offer in the future.

That’s not to say it’s easy to quit smoking or lose weight or tamp down your blood pressure, but we do have some control over these conditions, notes University of Michigan ophthalmologist Joshua Ehrlich, MD, MPH, lead author of the JAMA Neurology paper. Analyzing data from the Health and Retirement Study, he and his team determined that about six in 10 current dementia cases could have been prevented had those risk factors been eliminated. “We’re not talking about expensive interventions or fancy surgery or seeing specialists who are hours away,” he tells the New York Times. “These are things people can do in the communities where they live.”

The brain needs reliable stimulation from sensory organs like the ears in order to maintain its functionality. Without it, neurons die, and the brain system becomes rearranged.

My ears stopped functioning optimally several years ago, so I’m particularly intrigued by several recent studies showing the relationship between hearing loss and cognitive function. Researchers explain that the brain needs reliable stimulation from sensory organs like the ears in order to maintain its functionality. Without it, neurons die, and the brain system becomes rearranged. Hearing loss can also lead to social isolation and depression, two notable risk factors for dementia.

More than one in four U.S. seniors suffer from hearing loss, but only about 30 percent of those use hearing aids. I get that: They’re outrageously expensive — about $5,000 for a pair — and traditional Medicare doesn’t cover the cost. I recently managed to replace the one I lost nearly a year ago, courtesy of my Medicare Advantage plan ($699), but I realize even that kind of an outlay is a stretch for plenty of seniors.

Eyeglasses aren’t exactly cheap, either, but Ehrlich’s research suggests they’re well worth the expense, because poor vision can also affect cognitive performance as we age. The process is similar to that which occurs when your hearing goes: Your brain is starved for stimulation and gradually rearranges itself in a way that erodes its ability to smoothly function.

“An estimated 90 percent of vision impairment is preventable or has yet to be treated,” he writes. “Nevertheless, vision impairment has not been included in the dominant life-course models of dementia risk factors used to shape public health and research priorities.”

“Vision impairment has not been included in the dominant life-course models of dementia risk factors used to shape public health and research priorities.”

Ehrlich’s findings were echoed — and amplified — in a recent study from the University of Toronto that detailed the cognitive risks of both hearing and vision impairment. Reviewing 10 consecutive waves of the American Community Survey between 2008 and 2017, researchers determined that seniors grappling with impaired vision were more than three times as likely as a control group to develop dementia. And those navigating with vision and hearing loss were eight times more likely to display cognitive dysfunction. About half of the seniors dealing with both issues developed Alzheimer’s.

“Dual sensory impairment prevents an individual from compensating for the loss of one sense through the use of another,” explains study coauthor Aliya Nowczynski, MSW. “Our findings emphasize the need to reach out to older adults with dual sensory impairment, to assess whether there are opportunities for early intervention.”

Not long after I lost my hearing aid, I also began to realize that my glasses were no longer doing their job. Eight years had passed since I’d had my vision checked, which my optometrist assured me was much too long between visits. Not surprisingly, the checkup revealed some noteworthy changes in my ability to view the world. I really needed reading glasses, for one thing, and I’d become a bit more nearsighted than before. The upside? No cataracts yet.

So now I’m navigating with functional eyes and ears, which (theoretically, at least) should lower my risk of losing my marbles in the years ahead. I’m in reasonably decent shape for an old guy. I quit smoking a half-century ago, I stay pretty upbeat, and I do my best to maintain some social connections — all protective measures for an aging brain. But life is a crapshoot; nothing is assured from moment to moment. The other day while biking to the office, for instance, I nearly collided with a truck emerging from a blind alley. No harm done, but it did make me think I might want to consider wearing a helmet.