Thinking 'out-of-the-box' may build a better brain and prevent dementia

September 25, 2017
FAU Neuroscientist James Galvin, M.D., uses the functional range of motion board to test a patient's manual dexterity as part of the Dementia Prevention Initiative program he developed. Credit: Florida Atlantic University

More than 5 million Americans today are affected by Alzheimer's disease (AD). If nothing is done to stop this upward trajectory, there will be more than 16 million people with AD in the United States and more than 60 million people with AD worldwide by 2050. In the past 25 years, only five symptomatic medications for AD have met their primary clinical endpoints in Phase III clinical trials and successfully come to market; of these, four are still available.

There is increasing evidence that multiple medical conditions increase the risk of neurodegeneration and subsequent development of dementia. It also is becoming clear that a majority of those acts in amyloid- and tau-independent ways. Since 2003, every symptom- and disease-modifying agent has failed in Phase II or III trials because of challenges with safety or efficacy, including trials testing the amyloid hypothesis, anti-inflammatory agents, and early-phase anti-tau therapies.

With disease-modifying treatment trials unsuccessful at the present time and only medications to treat symptoms available, what now?

Thinking "out-of-the-box," a leading neuroscientist at Florida Atlantic University has developed an innovative program in the Comprehensive Center for Brain Health at FAU called the "Dementia Prevention Initiative" (DPI), which abandons generalized methods used to research and treat AD. His secret weapon: a novel "N-of-1 design" that individualizes medicine down to a single patient. Instead of conducting a conventional trial of 100 people all getting the same treatment, he has switched it around and is conducting 100 single trials personalized to the individual. His youngest patient is 61 and the oldest is 86.

"Because Alzheimer's disease is heterogeneous in terms of risk factors, age of onset, presentation, progression, and pathology burden, designing a study to treat individuals as a homogenous population requires thousands of patients who have to be followed for years and even decades. This approach is very costly and burdensome on clinicians and patients," said James E. Galvin, M.D., M.P.H., associate dean for clinical research in FAU's Charles E. Schmidt College of Medicine, a world-renowned neuroscientist, a leading international expert on AD and Lewy Body Dementia (LBD), and founder of the DPI.

The DPI is a two-year clinical trial and Galvin is developing a best-practice model of personalized care that looks at each individual as the sole unit of observation. The idea is to treat neurodegenerative diseases as a disorder that develops over a lifetime and individualize ways to build a better brain as we age. The ultimate goal is to prevent dementia from happening in the first place.

Galvin's approach follows a form of personalized treatment similarly used in cancer and delivers an individualized prevention plan, tailored to each patient's risk profile based on their genetic traits, biomarkers (blood, imaging, and electrophysiology), socio-demographics, lifestyle choices, and co-existent . This approach specifically targets the heterogeneity of AD by identifying person-specific risk factors and applying a customized intervention directed against this risk profile. Galvin anticipates that this method will provide more rapid information on whether personalized prevention plans can improve person-centered outcomes.

"While we know that a well-balanced, healthy lifestyle may be the cornerstone of disease prevention and brain health, each risk factor such as vascular, lifestyle choices, psychosocial behavior may both act independently and potentiate the effects of each other. Therefore, a prevention initiative needs to be multimodal and tailored to address individual risks," said Galvin.

Although the single greatest risk factor for AD is age, AD is not inevitable. It is estimated that at age 85 there is a 42 percent risk of developing AD, which means that 58 percent of older adults do not develop dementia, even if amyloid can be detected in the brain. The reasons are unknown, but may be explained in part by a host of modifiable and non-modifiable risk factors. Up to 30 percent of AD cases may be preventable through modification of risk factors and behavioral changes to mitigate the effect of those risk factors that can't be modified.

"We know what's good for the heart is good for the brain and we are changing people's blood profiles, controlling blood sugars, reducing inflammation, lowering blood pressure, and changing lipids and cholesterol," said Galvin. "Our patients say that they are in better overall health, their moods have improved and they are more physically fit than before."

Even if these precision approaches alone are not successful in preventing AD, Galvin believes that they may greatly improve the likelihood of amyloid- or tau-specific therapies reaching their endpoints by reducing comorbidities.

"Prevention of Alzheimer's Disease: Lessons Learned and Applied," was recently published in the Journal of the American Geriatrics Society.

Nationally, if the onset of AD and related disorders is delayed by five years, 25 years later there would be approximately 5.7 million fewer cases, collective family savings would approach $87 billion, and societal savings would approach $367 billion.

Explore further: A personalized approach to Alzheimer's disease prevention

Related Stories

A personalized approach to Alzheimer's disease prevention

August 9, 2017
Alzheimer's disease (AD) is a type of dementia that causes problems with memory, thinking, and behavior. It affects more than 5 million Americans. The Alzheimer's Association estimates that some 16 million people will develop ...

Does improving cardiovascular health reduce risk of dementia?

September 12, 2017
Researchers at Washington University School of Medicine in St. Louis are recruiting volunteers for a national study that is exploring whether strategies to improve cardiovascular health also reduce the risk of dementia in ...

Nine things that can affect whether you get dementia – and what you can do about them

July 21, 2017
Dementia is by no means an inevitable result of ageing. In fact, one in three dementia cases can be prevented, according to new findings published in The Lancet.

FAU site for first US clinical trial for Lewy Body dementia

April 21, 2016
Florida Atlantic University's Charles E. Schmidt College of Medicine is spearheading the South Florida site for the first U.S. clinical trial for Lewy body dementia (LBD), the second-most common dementia after Alzheimer's ...

Artificial intelligence predicts dementia before onset of symptoms

August 22, 2017
Imagine if doctors could determine, many years in advance, who is likely to develop dementia. Such prognostic capabilities would give patients and their families time to plan and manage treatment and care. Thanks to artificial ...

Rate of Alzheimer's deaths on the rise

June 15, 2017
The rate of death from Alzheimer's disease in the United States increased by more than 50 percent in the past 15 years, according to new data from the Centers for Disease Control and Prevention.

Recommended for you

Major cause of dementia discovered

December 11, 2017
An international team of scientists have confirmed the discovery of a major cause of dementia, with important implications for possible treatment and diagnosis.

Canola oil linked to worsened memory and learning ability in Alzheimer's

December 7, 2017
Canola oil is one of the most widely consumed vegetable oils in the world, yet surprisingly little is known about its effects on health. Now, a new study published online December 7 in the journal Scientific Reports by researchers ...

Genetics study suggests that education reduces risk of Alzheimer's disease

December 7, 2017
The theory that education protects against Alzheimer's disease has been given further weight by new research from the University of Cambridge, funded by the European Union. The study is published today in the BMJ.

Healthy mitochondria could stop Alzheimer's

December 6, 2017
Alzheimer's disease is the most common form of dementia and neurodegeneration worldwide. A major hallmark of the disease is the accumulation of toxic plaques in the brain, formed by the abnormal aggregation of a protein called ...

Alzheimer's damage in mice reduced with compound that targets APOE gene

December 6, 2017
People who carry the APOE4 genetic variant face a substantial risk for developing Alzheimer's disease.

Lithium in water associated with slower rate of Alzheimer's disease deaths

December 5, 2017
Rates of diabetes and obesity, which are important risk factors for Alzheimer's disease, also decrease if there is a particular amount of lithium in the water, says the study, published recently in the Journal of Alzheimer's ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.