Overview of This Week’s Report: “Preventing Memory Loss”

When I was getting ready to go to the basketball game this afternoon, I was brushing my teeth with my battery-operated toothbrush,” and “I couldn’t remember how to turn the toothbrush off,” wrote 50-year-old Kris Bakowski of Athens, Ga., in a Feb. 24 entry in her “Dealing with Alzheimer’s” blog.

“I decided that I would just put it in the sink and . . . the batteries would . . . wear out . . . my husband would come home and shut it off, or . . . I would remember before I went to the game what I was supposed to do. . . . What fun I have sometimes!” wrote Bakowski, a former journalist and marketer who was diagnosed with Alzheimer’s disease (AD) at age 46. She is among the estimated 5 to 10 percent of America’s 5.2 million Alzheimer’s sufferers diagnosed with the memory-destroying disease before age 65.

Bakowski’s story, chronicled with remarkable humor and acceptance, makes painfully clear the crucial – often unrecognized – role memory plays in our lives. “On my ‘foggy days’ nothing seems to really be in focus,” she wrote. “I don’t think clearly . . . not enough to really throw me off, but enough to know that I am not myself.”
Memory is “without doubt our most important possession, our most critical capacity,” said James L. McGaugh, a professor of neurobiology and behavior at the University of California, Irvine. “Memory is the ‘glue’ of our personal existence.” The experiences of each immediately past moment are memories that, “like individual frames of films that create moving pictures, merge with current momentary experiences to create the impression of . . . continuity in our lives,” he said.

But memory declines – gradually but surely – as we age. Worldwide, 84 million people are expected to have age-related memory loss by 2040.

Today’s multitasking, sleep-deprived and stressed-out culture, built around our ever-present cell phones, actually “contributes to long-term memory loss,” says Gary W. Small, a professor of psychiatry and biobehavioral sciences at the University of California, Los Angeles (UCLA).

The multiple distractions of electronically based lives are handled by the front parts of the brain – the mind’s “executive controller” – and studies have found that multitasking contributes to brain inefficiency and also “likely puts our bodies and brains into a stress response, cranking out the hormones that can damage the hippocampus memory centers,” the seat of memory encoding and consolidation, Small wrote.

Ultimately, about one-in-eight baby boomers – around 10 million Americans – will develop AD or another memory-destroying neurodegenerative disease. The cost of their care will be staggering.

Total annual care for a Medicare enrollee with Alzheimer’s or other dementia averages $13,207, compared to $4,454 for an enrollee without AD today, says Stephen McConnell, senior vice president for advocacy and public policy at the Alzheimer’s Association.

The high cost reflects the compromised care for other conditions a patient may have, McConnell explains. For example, if a doctor diagnoses diabetes and prescribes diet changes and exercise, the AD sufferer won’t remember or understand how to follow instructions, he says.

It’s no surprise, then, that the National Institute on Aging (NIA) has heavily promoted brain research as part of its elder-health agenda over the past decade and a half. NIA’s effort to bring researchers into the aging field is “a wonderful success story for the government,” says Valerie F. Reyna, a professor of human development and psychology at Cornell University. “They encouraged people to come over from other areas and effectively created a whole field.”

A freeze on health-research funding that began in 2004 may compromise that progress, many advocates argue.

Federal dollars spent on AD research fell by over $10 million annually between 2003 and 2007. That “pales in comparison” to the estimated $100 billion in federal funds spent to care for AD patients, according to a 2007 report by the Booz Allen Hamilton consulting firm for the Center for Health Transformation, a think tank headed by former House Speaker Newt Gingrich, R-Ga. Thus “for every dollar spent on care, less than one cent (0.65 cents) goes toward treatment and prevention,” the report added.

Nonetheless, a flood of research over the past decade has shed important new light on memory and dementia.

“We believe there are dozens and dozens of promising treatments that may enter clinical trials in the next few years,” says Eric Reiman, a professor of psychiatry and director of Alzheimer’s research at the University of Arizona.

Basic federally funded research is turning up potential AD treatments to the point where “every pharmaceutical company worth its salt is in on this now,” says Guy McKhann, a professor of neurology and neuroscience at Johns Hopkins University. Potential approaches include a vaccine or antibody to soak up the toxic products of metabolism that turn into plaques and tangles that choke the brains of AD sufferers, he says. Another possibility is “a drug to change the metabolism” of proteins so that they don’t become deadly in the first place, McKhann says.

“Earlier [AD] treatments have been targeted at the brain’s neurotransmitters” – chemicals that carry signals between neurons – beefing up those transmissions even in brain cells dying of disease, to prolong the neurons’ ability to function a bit longer, says Murray Grossman, an associate professor of neurology at the University of Pennsylvania.

Now, understanding of Alzheimer’s has advanced to include the abnormal proteins involved in the actual deterioration of brain cells, Grossman says. “But there are multiple proteins involved,” so there’s unlikely to be “one, single magic bullet,” he says.

Nevertheless, if scientists have turned up the right protein during the past decade-and-a-half of intense research, a “risk-reducing therapy” for AD could be available in as little as 12 years, Reiman says.

Understanding of memory itself – and the role of aging in its slow decline – has progressed as well, but here the complications may be even greater.

“We refer glibly to memory as if it might be one thing, but . . . it’s much more complicated than that,” said Harvard University Professor of Psychology Daniel L. Schacter. Support has grown over the past 20 years or so for “the idea that there are fundamentally different memory systems operating within the brain,” he said. For example, the “working memory,” which holds a few facts in mind for a brief period – such as when someone looks up a phone number – may be a fundamentally different and separate process from long-term memory.

With some 75 million aging baby boomers worried about losing their memories, a thriving business in “brain fitness” products – from nutritional supplements like the herb ginkgo biloba to “brain coaches” to motivate us to mental exercise – is springing up on the Internet. But research has produced little concrete information about how to preserve memory in old age.

“We do know there are specific nutrients that affect the brain,” says McKhann. “But do we know a specific diet that we can all follow? No.”

Nevertheless, small research studies and abundant anecdotal evidence back the effectiveness of some measures, says Small. For example, a two-week UCLA program that trains people on brain exercises and counsels more physical exercise and a light, heart-healthy diet has been shown to improve participants’ brain functioning, including on memory tasks, mainly by increasing “brain efficiency,” says Small. Brain scans showed that participants following the program, including its 15 minutes of daily brain exercises, developed more efficient activity in a front portion of the brain heavily involved with “working memory,” Small says.

Meanwhile, scientists say that pharmaceutical research may turn up memory-enhancing drugs that would work in the general population.

Making such drugs available to everyone could create a new branch of medicine – “cosmetic neurology” – according to Anjan Chatterjee, an associate professor in the Center for Cognitive Neuroscience at the University of Pennsylvania. But the wide use of central-nervous-system drugs would raise both safety and ethics issues, he said.

Memory-enhancing drugs raise the specter of “another economic divide” in an education system that already favors the haves over the have-nots, said McGaugh. “The rich kids get the pill in the lunch box, and the poor kids don’t.”

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