Donna Kaye Hill realized that her 80-year-old mother was cognitively impaired when her phone suddenly stopped working. When Ms. Hill called the phone company, "they told me that she had not paid her bill for three months".
Finding other alarming evidence of gaps in memory, she took her mother, Katie, to a memory clinic. A geriatrician diagnosed dementia and recommended two prescription medications and a dietary supplement, a form of vitamin E.
Katie Hill conscientiously took vitamin E capsules, as well as many other medications, until her death four years later. As she refused, her daughter did not think that the vitamin, or both prescription drugs, made a big difference.
"But if it does not hurt, if there is a chance it helps, even a little bit, why not?" She says to herself. Hill, 62, a retired civil servant in Danville, Va., Herself taking fish oil capsules daily, hoping they will help fight the disease that killed her mother .
The eldest, Mrs. Hill, was unusual only by the fact that a doctor had recommended the supplement; most older Americans take them without medical advice. The Food and Drug Administration estimates that 80% of older people rely on dietary supplements, many of which claim to prevent or treat Alzheimer's disease and other forms of dementia.
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Last month, the F.D.A. cracked down on this burgeoning market, sending warning letters or notices to 17 companies selling about 60 supplements bearing names such as Cogni-Flex and Mind Ignite.
The warnings pointed out that companies had touted these products as functioning as drugs for Alzheimer's disease, "but naturally and without side effects". Or as "clinically proven to help brain diseases, such as Alzheimer's disease." said to treat other diseases, too, from a stroke to erectile dysfunction.
To say that these products were intended to "cure, mitigate, treat or prevent disease" meant that they were drugs, according to the agency's letter.
And since they were drugs, the F.D.A. have never reviewed or approved their safety and effectiveness, companies must now submit applications for approval or stop making such claims. In the past five years, the agency has taken action against 40 other products that are the subject of Alzheimer claims.
The appeal of the supplements is understandable. An increasingly older, longer-lived population means more people with dementia fell in this country and other Western countries.
More and more of us have seen the devastation closely and would do almost anything to avoid it. But until now, news about drugs and supplements have been discouraging.
While scientists have learned a lot more about dementia, the scientific literature and major pharmaceutical trials have served to inform Americans concerned about the many substances that do not seem to be able to prevent, treat or slow dementia.
Vitamins, various antioxidants, concoctions of animals and plants – "We see a lot of ads on TV, but we have no evidence that this is preventative," said Dr. Steven DeKosky, Neurologist and Deputy Director of McKnight Brain. Institute of the University of Florida.
For example, Dr. DeKosky led a study on the federally-funded Ginkgo biloba extract, which was followed in more than 3,000 people for seven years to determine if it helped reduce dementia. This is not the case.
"No effect," he says. "But look on the shelves. Many companies still sell ginkgo – if there really are, because the supplements do not always have the content they say they have. "
In addition, "some of these supplements are biologically active and may cause toxicity when you take other drugs," said Dr. DeKosky. Supplements can also be expensive.
But there are other ways that people can reduce their risk of dementia. Two prestigious panels, examining numerous prevention studies, have recently made several recommendations.
"Genetics has a role to play. Bad luck has a role to play.
Dr. Kristine Yaffe
University of California at San Francisco
The most conservative report of the National Academies of Science, Engineering and Medicine in 2017, was based mainly on large randomized clinical trials.
Since there are not many of them, the panel approved only three interventions "supported by encouraging but inconclusive evidence" to prevent, delay or slow down cognitive decline.
L & # 39; shaft:
Increase in physical activity;
Management of blood pressure in people with hypertension, especially in their forties;
And cognitive training.
The latter recommendation does not necessarily refer to commercial online brain games, said Dr. Kristine Yaffe, a neuropsychiatrist and epidemiologist at the University of California at San Francisco, who was part of the panel.
"It's really the concept of mental activity," she said. "Find something you love where you are learning something new, stimulating and stimulating your brain."
Although the evidence to date does not establish which mental training has the greatest impact or how often people should engage in it, "they are not expensive and they do not cause side effects," he said. Dr. Yaffe.
The recommendation regarding blood pressure was strengthened in January by the latest findings of the Sprint trial. A multisite study was discontinued in early 2015 when intensive treatment of hypertension (a goal of systolic blood pressure lower than 120, compared to standard 140) reduced cardiovascular events and deaths.
The investigators, however, continued the trial with 9,361 hypertensive participants (mean age: 68 years) and completed their cognitive follow-up assessments.
Their results, published in JAMA, showed that the intensive treatment group was less likely to develop dementia than the standard treatment. but not by a statistically significant margin. Intensive treatment, however, significantly reduced the risk of mild cognitive impairment, often a precursor to dementia, in participants.
"For me, this has been one of the most exciting discoveries in recent years," said Dr. Yaffe, who noted in an accompanying editorial that it was about first large-scale trial to demonstrate an effective strategy for the prevention of age-related cognitive impairment.
"The same things we recommend for heart health turn out to be important for cognition," she said. "It's a field in bloom."
The Lancet Commission on Prevention, Intervention and Dementia Care has also recommended hypertension treatment for middle-aged people, as well as exercise, l-39. social engagement and quitting, as well as the management of obesity, diabetes, hearing loss and depression. Such measures could prevent or delay a third of cases of dementia, the commission said.
When Dr. Yaffe gives lectures on the prevention of dementia, she also mentions good sleep hygiene and urges listeners to protect themselves against brain damage.
This is an important tip, but sadly dramatic. Where is the magic bullet? Do not we already know how to stay active physically and mentally, maintain normal weight, treat high blood pressure, etc.?
In addition, "it's not foolproof," acknowledged Dr. Yaffe. In the lottery of dementia, "there is a role for genetics. Bad luck has a role to play. "
She added: "The concept is important. You can do something about it. You can reduce your risk. "
That's why the most useful approach Donna Kaye Hill uses to protect herself from dementia probably does not take fish oil.
This includes the use of medications to control his blood pressure. And read biographies and mysteries and join a reading group with friends. And walk four or five thousand five days a week with Annie, a yellow Labrador.