Alzheimer's disease: time to change the narrative ~ ~ ~ Dr. Domenico Pratico', MD, FCPP
The medical field has always struggled with inevitability because its primary mission is to prevent or delay death. This fact creates an internal tension and can impact and shape many aspects of medicine from diagnosis to therapeutic approaches. Historically, the struggle with inevitability found fertile ground within certain human diseases, some of which are now affecting an ever-growing number of individuals.
The first example that comes to my mind relates to cardiovascular diseases, in particular atherosclerotic vascular disease with heart attack as the most representative condition.
A few decades ago, this medical condition was seen as something that happened because an individual had high cholesterol or high blood pressure, just to mention 2 of the most frequent conditions.
Overall, a heart attack was considered some kind of fatal and inevitable outcome and not the result of a long often silent journey leading to the acute event.
Fast forward 30 years, and now we know that this is not the case. Thus, we have understood the importance of early screening for risk factors linked to cardiovascular diseases already in midlife. As result, today we treat high cholesterol and high blood pressure as early as possible, decades before a cardiac event would take place.
This knowledge shaped new thinking and new medical approaches based around the new idea that cardiovascular disease is not inevitable, that we can modify its trajectory and change the outcomes by acting on these factors as early as possible.
Today, the Alzheimer’s disease arena is somewhat at the same early point and transition state as the one I just described for cardiovascular diseases a few decades ago.
Originally, for most of its history, Alzheimer’s disease has been seen and accepted as something that happens to people who reach old age.
In other words, Alzheimer’s was considered an inevitable condition since was the fatal consequence of aging. The disease was considered some type of “destiny”, which was impossible to catch earlier and the only thing available was to try managing once it manifested clinically.
Bottom line, Alzheimer’s disease was never considered as the finish line of a trajectory, but simple as a fatal and inevitable condition.
I still remember when I was in medical school the attending physician who in front of an old person with clear clinical signs of “dementia’ would say to us “ It is ok, dementia is to be expected when you reach 80s, the patient is simply senile”! Paradoxically, no comments were made in front a subject of the same age and gender in the next room who was “sharp as a tack”!
Fortunately, today strong scientific evidence is gradually changing the view that the disease is not fate or an inevitable condition of old age.
This is a paradigm shift well accepted by the research and in good part by the clinical and health provider’s communities. Unfortunately, this is not yet the case for mainstream culture.
The Alzheimer’s disease field is at a crossroad since there are new key concepts about the disease that need to be disseminated, new knowledge that needs to be shared with lay people.
It is our responsibility as researchers, clinicians and health providers to disseminate new knowledge but most importantly to make it accessible to patients and families.
After all, knowledge is power. The more you know the more you can!
Here are a few examples of the knowledge that needs to be disseminated :
The condition is not simply a disease of old age.
The pathological changes in the brain begin in midlife.
Many of the factors that start and/or drive these changes are modifiable.
Early detection is possible.
While science is moving fast, it is obvious that there are many cases in which the culture is still lagging. To this end, it is still quite common that most of the patients and families keep assuming that cognitive decline and memory impairments are inevitable and easily describe memory changes as “just getting older.”
The time for a change in narrative is overdue.
We must tell a different story about what Alzheimer’s disease truly is by stressing on 2 major points.
Alzheimer’s disease is not an inevitable consequence of aging, but a long-developing biological process that starts decades before it clinically manifests.
Early diagnosis is not for giving in but for acting on since many of the changes and factors which are at the starting point of this process not only can be detected but, in most cases, modified.
We must share knowledge, because knowledge is power.
The more we know the more we can do.
If you are interested in reading more of my blogs:
Domenico Praticò, MD, holds the Scott Richards North Star Charitable Foundation Chair for Alzheimer’s Research and serves as a Professor at the Alzheimer’s Center at Temple, as well as a Professor of Neural Sciences at Lewis Katz School of Medicine at Temple University.
For more information on the research conducted by Dr. Domenico Pratico, please visit this link.
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Stay updated with the work happening at Dr. Domenico Pratico's lab by visiting the Pratico Lab website.
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