The New York Times (August 29, 2010) is running a series called “The Vanishing Mind” with the most recent installment titled “Years Latter; No Magic Bullet Against Alzheimer’s.”  The article is based on the conclusions reached by a “jury” of 15 medical scientists along with scientists at Duke University with no vested interests in Alzheimer’s research.  The National Institutes of Health convened this “court” to objectively evaluate the quality of research findings addressing the prevention of Alzheimer’s disease.  These studies covered all of the bases: exercise, mental stimulation, healthy diet, social engagement, nutritional supplements, anti-inflammatory drugs, drugs lowering cholesterol, amount of education, being married, and being a loner.  Last week’s article reviewed the conclusions of the panel and discussed the issue of standards of scientific proof. This article focuses on the meanings of prevention in medicine.

Consider the notion of prevention.  The dictionary definition of prevention is “to keep from happening” or “to hold back.”  The medical definition is not as precise.  There are several levels of prevention in the medical sense including health promotion, early detection, and reducing complications.  Prevention according to medical usage ranges from hand washing, immunizations, screening tests, hygiene, and pest control to  smoking cessation, reducing alcohol consumption, using seat belts, taking drugs to lower cholesterol, using condoms for sex.  We do not need cause and effect evidence (high or medium quality scientific evidence) to engage in many of these behaviors.  Correlational data are adequate to guide us in making many of choices we must to lead a better life.

What about the evidence that interventions may reduce the risk of Alzheimer’s disease.  We have more confidence in interventions that manage as compared to prevent Alzheimer’s.  But this is also true for such diseases as diabetes, cancer, and Parkinson’s.  Correlational studies have brought us a long ways toward better choices, earlier detection, better management, and possibly slowing the progression of these ailments.  I believe the same is true for managing Alzheimer’s disease.  The tone of the Times’ article continues to contribute to the attitude of many that early detection of risk for Alzheimer’s disease is a futile enterprise as “there is nothing that you can do.”  Despite lacking magic bullets against Alzheimer’s or definite scientific evidence, there is clearly so much you can do and there are many good studies providing converging evidence of effective interventions.

So what do we know about managing Alzheimer’s disease based on current evidence?  First, having the E4 variant of the ApoE gene or using combination hormones as hormone replacement therapy for women increases your risk for developing Alzheimer’s.  Second, that being depressed, never married, having little social support, having a head injury, or smoking may increase your risk of developing Alzheimer’s.  Third, there are positive and proactive interventions you can include in your life style.  Eat a diet rich in fruits, vegetables, fish and olive oil; become more educated if you have a choice; condition your body; and stay cognitively and socially engaged.  These choices may decrease your “risk of developing” Alzheimer’s.  This is good news.  Despite the fact that there are no guarantees, there are things you can do to help yourself or someone you love.  Furthermore, doing these things improves the quality of your life no matter whether you develop Alzheimer’s or not.