1-Introduction — From holy grail to what we can do
Holy Grail has two meanings — as defined by the Britannica Dictionary [1]
First meaning — “The cup that is said to have been used by Jesus Christ and that was sought by knights during the Middle Ages”. Suffice to say, it has never been found.
Second meaning — which is pertinent in this post — “Something that you want very much but that is very hard to get or achieve”. In this context, the world is looking for how we can delay or better still, prevent dementia.
2-Drug therapy
Much effort have been directed to find a therapeutic cure for dementia in the last 20 years. Several medications have been found useful in reducing the speed of progression for some patients, but none are able to reverse dementia. Hence, the new holy grail of dementia is still focused on prevention. Holly Payne, Jun 2021.[2]
1-Donapezil, and 2-Memantine are commonly used in everyday practice. Two new agents Aulhelm and Lecanemab are new kids on the block and they share in common the action of clearing the “plaques” and “tangles” seen on microscopy of the human brain affected by Alzheimer’s disease. Lecanemab is hailed as as “momentous breakthrough” by BBC News. [3] More of that in the next post.
3-Population attributable fractions (PAFs) reduction
Population attribution fractions (PAFs) are factors that contribute to the onset and progression of dementia. See Figure 1 for the list of 12 factors. The wisdom is to reduce each of these factors as much as possible individually. Alzheimer’s Society, UK [3] The PAFs are not of equal weight but it makes sense to reduce the risk of each of these as far as possible. PAFs also differ in prevalence from one country to another and from one region to another region. Mukadam N et al, 2019. [4]
4-Promoting cognitive activities that delay dementia
Two cognitive actives proven to be effective in delaying dementia are: 1-Singing. 2-Dancing. More of that in a later post.
5-Kim’s Game: Memory Training
Efforts spent in remembering new things are important. Historically Lord Baden Powell found that the African scouts learned to remember through memory training. He introduced this idea into the Boy Scouts’ training. and calls it the Kim’s Game. Essentially, a set of 10 things are laid on the table and every Scout has 1 minute to remember them. These are then covered with a cloth and the end in mind is how many of the ideas can be remembered by those participating in this Game. Ten out of 10 will be full marks. Try this Kim’s Game. It trains the memory to remember what you see. This may well be the secret how birds can fly vast distances and yet know how to return from where they came from. More about Kim’s Game and remembering the way in a later post.
6-Minimal cognitive impairment (MCI) — Diagnosis and preventing progression to dementia
Errorless learning may have a place here. More of it in another post.
7-Take home messages
The new holy grail of dementia is now becoming clearer. Three strategies are important and integrated:
- 1-Reduce the population attributable fractions (PAFs) that individually apply to each of us. There are twelve of these and Diet, Exercise, Weight control, Smoking cessation, and Spirits regulation (may be total avoidance) as well as avoiding loneliness are the key factors to get it right. The place of medications has been elusive. Whether medications that help to clear the plaques and tangles in our brain work will be great to follow their progress
- 2-Cognitive activities of singing, and dancing have proven evidence they help to protect against dementia, and
- 3-Memory training e.g., Kim’s Game, recounting and sharing current events from lived experience and current newspapers may well have a place in dementia prevention,
8-References
- 1-Brittanica Dictionary. Holy Grail. Two meanings. https://www.britannica.com/topic/Grail
- 2-Holly Payne. New holy grail of prevention of dementia, Jun 2021. https://medicalrepublic.com.au/prevention-rather-than-cure-the-new-holy-grail-for-dementia/46820
- 3-Gallagher J. Alzheimer’s drug lecanemab hailed as momentous breakthrough. BBC News, 2022 Nov 30. https://www.bbc.com/news/health-63749586
- 4-Mukadam N, Sommerlad A, Huntley J, Livingston G. Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data. Lancet Glob Health. 2019 May;7(5):e596-e603. doi: 10.1016/S2214-109X(19)30074-9. PMID: 31000129. https://www.sciencedirect.com/science/article/pii/S2214109X19300749.
Dr LG Goh
Dr GOH Lee Gan is a retired Associate Professor in the Department of Family Medicine, National University Health System. He has an interest in learning and teaching how we can age well everyday (AWE).
