Do you have Pre-Alzheimer’s?

It being Presidential silly season, what better than to write a post about past presidents. So I read the latest magnum opus on said topic recently (The American President: From Teddy Roosevelt to Bill Clinton 1st Edition by William E. Leuchtenburg). Warning: it’s a bit of a slog, but it’s worth the trek.

The chapter that really caught my attention was the one about Ronald Reagan. It covered all the historical and biographical bases as it should. But the really interesting thing was how much the book panned him. It comments that he was probably the worst candidate ever to be chosen President from the standpoint of his ability to fill the job. It points out his numerous flubs, the legion of times he couldn’t answer questions, or couldn’t even remember topics from the same day’s newspaper and his frequent strange behavior. It’s not an edifying spectacle; to think that the President of the US could be so totally clueless.

We now know that Reagan had Alzheimer’s. Here’s a chronology. He was elected in 1980 at the age of 69. He served two terms and retired from office in 1989 when he was 77. In 1994 it was announced that he had Alzheimer’s. His age then was 83.

Research has now shown that Alzheimer’s starts at least 18 years before it is actually symptomatic (“Alzheimer’s May Begin 20 Years before Symptoms Appear” Neurology, June 24, 2015). So the neurological processes that precipitated Regan’s disease started at least in 1976, that is at least 4 years before he became President. At that stage his age was 65.

By the end of his first term, in 1985, Reagan’s disease would have been well advanced and partly visible. In fact, his terrible performance in the Presidential debates of 1985 against Vice-President Mondale led many observers to suspect the truth.

In fact, during his second term, Reagan would have been experiencing rapid declines in cognitive capacity. So the accounts of his performance in office are hardly surprising. It provides another perspective on the frequent judgment of him that he was intellectually shallow. Maybe, but clearly this serious mental disease might also have been the cause.

So here’s the $64 question. How many of us have undiscovered Alzheimer’s? Let’s call it pre-Alzheimer’s to follow the pre-diabetes example. How many people who might just be thought to have poor judgment or who are just “slowing down” actually have it rather than just simple ageing? And, worryingly, what proportion of people in high – or critical – places has it?

What proportion of CEOs, senior executives, politicians, airline pilots, and safety supervisors, power station operators, doctors, nurses, professors or military contractors actually have a mental disease that is increasingly seriously compromising their performance while they are still in an important, senior, or critical job or role?

This of course is not an idle question. From census data we know that currently around 20% of the population is 60 or older. That’s more than 60 million people in the US. And around 1 in 9 people above the age of 65 has Alzheimer’s. So that’s around 6 million people. But that’s only the people who have been diagnosed with Alzheimer’s, not the ones who are in the process of developing it, those with pre-Alzheimer’s.

If the statistics stay the same (actually they are getting worse) then there are at least an additional 6 million people who are developing Alzheimer’s who have no visible symptoms and who have not yet been diagnosed with the disease. The majority of these are in jobs and since many of them are in their 40s and 50s, most of them are in senior, responsible and sometimes critical jobs.

Yet the cognitive functioning and mental performance of these asymptomatic sufferers is already compromised, sometimes severely. If we couldn’t see that the leader of the most powerful nation on the planet had severely compromised judgment and mental performance how can we see it in anyone else?

It’s obviously a serious issue. And it’s not widely recognized. We tend to focus – understandably in view of Alzheimer’s impact on families and the healthcare system – on people whose disease is visible and diagnosed.  But at least we don’t have them flying planes or running the country. These people without visible symptoms are still flying planes, running the country, managing our nuclear deterrent as well as our largest corporations and government agencies. But we don’t know, just like we didn’t with Reagan.

There isn’t an easy answer since currently even methods to detect subclinical Alzheimer’s are poor to nonexistent although this is changing a little. None of the approved drugs has any significant impact on delaying the onset of the disease. The only thing we know is that exercise and a healthy diet might delay it a little if indeed you already have it but don’t know about it.

And getting an effective drug likely won’t happen soon, no matter the huge amount of research the pharmas are doing. I personally think much of this research is barking up the wrong tree (see my post “Is Alzheimer’s Contagious?”) but who am I to tell? All we know is that most of the drugs that have looked as if they could be a breakthrough have been bitterly disappointing in practice and the ones that have been approved are just a pinprick, at best. We might hit it lucky, here’s hoping, but we can’t just rely on that.

If you want to stand and fight, here’s the basic principle. If you have pre-Alzheimer’s you are losing neurons and brain mass fast. To address that you have to do things that increase the number of neurons you are creating at least as fast as you are losing them.

• Here’s the first thing to do. Whether you suspect you, a family member or a colleague have or are going to contract Alzheimer’s, start a program of vigorous daily exercise now yourself and inveigle the others to start it too. . That’s the only thing we know of right now that makes a difference. Vigorous exercise increases neurogenesis and the more exercise you do the more it creates and the more brain mass you get.

• BTW yoga doesn’t count; it must be vigorous like running, tennis or fast walking. And if you can get a group together so much the better since it will curtail dropouts.

• Here’s why this is so important. Research shows that regular exercise slows down the progression of the disease. If you or your family member is still in the subclinical stage you’ve maybe got 10 years before it goes clinical. Say you slow this down so now you’ve got 15 years before it goes clinical. Now you’ve got a good chance there will be an effective drug by then. So go for it! Exercise like crazy, but not so much you injure yourself.

• Here’s the second thing you can do, namely start intensive learning about something. But what you learn has got to be new, unfamiliar, intensive and difficult. If you like reading and read more, or restart reading, that won’t cut it.

• Learn Chinese if you’re not a linguist. Learn the piano. Go bird watching and learn about bird species. Learn how to distinguish between different bird songs. If you were never good at math, start learning it now. That will give birth to lots of new neurons and brain mass.

• But, to repeat, don’t do easy stuff. BTW work by the Feds seems to demonstrate pretty well that the brain exercise kits sold to people who want this sort of exercise don’t work. Maybe they haven’t tracked the outcome for long enough, but my advice is pick your own poison and stick to it. Every day too please, just like your v vigorous physical exercise.

No-one said this was going to be easy. You’ve got to be serious if you want to get ahead of the curve on pre-Alzheimer’s.

• Don’t retire unless things are getting difficult. Research shows conclusively that if you retire the rate of disease progression increases significantly. However make sure that you make it part of the work bargain that you get time to exercise every day. It will benefit both you are your employer.

• Here’s my general advice. If you see a family member or colleague whose behavior seems to be changing and who is getting noticeably less sharp or who starts to say apparently nonsensical things, or gets very forgetful about recent events, keep this post in mind. It might be asymptomatic Alzheimer’s. Be sympathetic and keep close, try to get them to a doctor. Get them to exercise and learn the piano. Even though there’s no cure at this stage they can be helped to get their affairs in order.

• There is just one further thing you can do; a tiny, tiny crumb of hope. It's a very recent development. Amazingly a commonly available, cheap drug has recently been shown to totally cure the mouse version of Alzheimer’s. The drug is a NSAID used to treat period pain. Its name is mefenamic acid and its brand name is Ponstel. It hasn’t been formally tested in humans for Alzheimer’s. Unfortunately the pharmas aren’t going to do it because it’s off-patent and there’s no money in selling it, even if it’s totally effective, which is probably unlikely in humans anyway.

• BTW this drug needs to be prescribed. So you have to sweet-talk a doctor. It’s used for period pain so if you are a pre-menopausal woman you’ve got it made. But if you’re obviously not, starting with being male, you’ll have to go another route.

• But here’s my irresponsible, totally unauthorized, maybe even dangerous stab at addressing the problem of undiagnosed Alzheimer’s. If you suspect you or a loved one might be getting it, get the drug and start taking it regularly. Maybe it will cause you stomach ulcers or even worse. But nothing is as bad as Alzheimer’s.

Even if it doesn’t work it’s not going to kill you. If it does work, God gave you a gift which is going to keep right on giving.