The global Alzheimer's community met in Boston earlier this month for its annual confab, the AAIC. The conference can be baffling to the lay outsider, as it's dominated by researchers and scientists who dig into the deep, hard science of Alzheimer's. Nevertheless, from the dense talks of B-lymphocyte dependent delayed cognitive deficits and amyloid-beta experimental models, one fascinating insight emerges: we may learn to prevent Alzheimer's before we can cure it.
A few new studies begin to tell the story. One research project, undertaken in England and Wales, found that dementia rates among people 65 and over have fallen by 25% over the past twenty years. Other research in Denmark shows that mental ability in the over-90 cohort is now substantially higher than it was a decade ago. And a recent study from France finds that "professional activity may be an important determinant of intellectual stimulation and mental engagement, which are thought to be potentially protective against dementia."
What these studies suggest, and what other research at the AAIC has begun to confirm, is that healthier lifestyles and higher levels of education can increase mental acuity and decrease rates of Alzheimer's. Behavior, diet, and exercise habits, as well as the use of statins, can reduce incidences of diabetes and cardiovascular disease, thereby lowering risk of the correlated diseases of dementia.
This is no small hypothesis. With rates of Alzheimer's projected to reach 66 million by 2030, this ounce of prevention may be worth ten thousand pounds of cure. So why is the Alzheimer's Association not screaming this theory from Boston rooftops? Part of the reason, I suspect, is that the annual conference has not yet fully grasped that Alzheimer's needs to be analyzed not only through scientific and medical lenses, but also through those of policymaking and population studies. This has become standard practice with HIV/AIDS and oncology, and the AAIC would be wise to follow suit.
The role for breakthrough disease modifying medicines remains of the utmost importance -- and positive news emerged from the conference -- but it would be unwise to overlook the potential role and prospects of prevention.
Indeed, even if healthier aging processes have the potential to reduce global rates of dementia to levels below current projections, the Alzheimer's problem is still massive. In the next few years, the over-60 population will surpass one billion. By mid-century, it will double to two billion. And, globally, the fastest growing demographic segment is the over-80 crowd, otherwise (and poorly) known as the "oldest-old." And because Alzheimer's is precisely related to aging, it may prove to be the social, health, and financial nightmare of the coming century.
But perhaps the future of the aging planet is better illustrated through anecdote. Indeed, a recent set of stories from Japan -- the world's oldest country -- gives incredible life to the shocking consequence of population aging. In Japan, as is the case with most of the world, birth-rates are declining as life-spans are increasing. These twin-forces of population aging are producing a new demographic balance of young-to-old that the world has never before seen.
Case in point: by 2020, adult diapers will outsell baby diapers. The adult diaper market is growing 10% per year, and, barring a seismic change in fertility practices, Japan's fate is sealed to mid-century. And what this reveals, most essentially, is that last century's policies and habits cannot work for 21st century demographic realities. Older adults need to remain active and productive, both to maintain personal health and to contribute to national economic growth.
Japan's should serve as a wake-up call to the rest of us. Europe, China, the U.S. and others are just behind. The AAIC could play a leadership role by showing that Alzheimer's isn't only a medical issue.
If the AAIC can make this "political turn," it will have good company and willing partners. The OECD, Oxford University, and the Global Coalition on Aging recently held a workshop that recognized the fiscal implications of Alzheimer's and called for aging populations to become a driver of economic growth. The G8 has called for global leadership to rally around beating Alzheimer's, and British and American political leaders have equally pledged support.
The time is ripe, so to speak, for the Alzheimer's Association to broaden the scope of their conference and marry the esoteric scientific community with leaders from politics, economics, journalism, and more. If they wish to solve one of the 21st century's toughest problems, then they need to plan for a different kind of conference in 2014. As we learned from HIV/AIDS, the scientific and medical breakthroughs need political momentum to make a real difference.
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