A new study shows that dementia rates among people over 65 have declined from 11.6 percent in 2000 to 8.8 percent in 2012—a 24 percent drop. This means one million fewer people than expected suffer from the condition. Researchers say the declines seem to be associated with healthier life styles and higher levels of education. The news is decidedly welcome, but the overall public health challenge remains daunting. Five million Americans are diagnosed with dementia today and that number is expected to triple by 2050. Please join us for an update on new efforts to prevent, diagnose, and treat Alzheimer’s and other kinds of dementia.

Guests

  • Dr. Kenneth Langa Professor, internal medicine, University of Michigan
  • John Haaga Director, division of behavioral and social research National Institute on Aging, National Institutes of Health
  • Dr. Nancy Donovan Associate psychiatrist, Brigham and Women's Hospital instructor in psychiatry, Harvard Medical School

Transcript

  • 10:06:54

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. At last, a little bit of good news. A new study indicates that the rate of dementia among those over age 65 has declined. The research which tracks data from 2000 to 2012 shows a 24 percent decline. Here to talk about this study and other news in the efforts to diagnose, treat and prevent Alzheimer's and other forms of dementia, John Haaga of the National Institutes of health.

  • 10:07:31

    MS. DIANE REHMJoining us from a studio at WUOM in Ann Arbor, Dr. Kenneth Langa of the University of Michigan. And from a studio at Harvard, Dr. Nancy Donovan of Brigham and Women's Hospital and the Harvard Medical School. I know many of you will want to join us with your questions and comments. Give us a call at 800-433-8850. Send your email to drshow@wamu.org. Follow us on Facebook or send us a tweet. And thank you all for joining us.

  • 10:08:11

    DR. JOHN HAAGAThank you, Diane.

  • 10:08:13

    DR. KENNETH LANGAThanks, Diane.

  • 10:08:13

    DR. NANCY DONOVANGood to be here.

  • 10:08:14

    REHMDr. Langa, I'll start with you. Tell us about the study. You are one of the coauthors. How many people were involved?

  • 10:08:27

    LANGAWell, we used data from a large study that's been going on since 1992 called the Health and Retirement Study. It's funded by the National Institute on aging. And we looked at about 10,000 people who were 65 and older in 2000 and then again about -- a similar number, about 10,000 across the United States in 2012. And this Health and Retirement Study collects lots of detailed data on how people are thinking, their cognitive function and other things, other aspects of their health and incomes and social networks and things like that.

  • 10:09:06

    LANGASo we had a lot of information to try to understand this trend.

  • 10:09:11

    REHMSo the average age of the people you studied would've been what?

  • 10:09:19

    LANGAThe average age, probably in the late 70s or so for the full sample of the 10,000 in each year. It was from 65 up through 100.

  • 10:09:32

    REHMI see. So apparently, these results show a significant decline and I gather you've had these studies replicated elsewhere. My question is, is this just for this one period in time, from 2000 to 2012, because of the specific group you chose to focus on?

  • 10:10:09

    LANGAYeah. I think that's a great question, Diane. Our study is one of, actually, increasing number of studies from both the United States and other mainly high income countries around the world that have shown this kind of optimistic trend actually going back probably into the 1990s so about 25 years or so, I think. And, again, but your question's a good one because there were -- one of the really important things, we think, that was going on during this time period, excuse me, is that the level of education among people who were 65 and older was increasing significantly during this time, especially in the United States.

  • 10:10:54

    LANGAPart of that was sort of due to post World War II focus on increasing education access. So, again, we think that the level of education that one has has an important long term risk on -- or long term effect on dementia risk later in life. So, again, it could be that this education effect is what's driving much of this. We think there's other things going on, but actually in the United States, this -- education level is actually leveling off now over the next sort of in the cohorts coming, the baby boomers coming. So it could be that we did -- that his positive trend was going on for the last 20 years because of this big increase in education and it might not continue into the future.

  • 10:11:42

    LANGAThat's -- we're going to continue collecting data. We think, obviously, it's important to keep tracking this.

  • 10:11:47

    REHMDr. Haaga, at the National Institute on Aging, how importantly do you view this study?

  • 10:11:57

    HAAGAOh, it's very important. As Ken mentioned, there have been some previous studies, usually of smaller populations, you know, very important give us important clues, but nothing like this that's nationwide have we seen before. So this is very important news both for clues to what research we should be doing next and also for forecasting what the needs are going to be in the future.

  • 10:12:25

    REHMBut as the education level goes down in this country, doesn't that sort of reflect back and indicate that perhaps is kind of reduction in the level, as you're seeing, will, as Dr. Langa suggests, not be a permanent one?

  • 10:12:50

    HAAGAYeah. That's the big dark cloud above this silver lining. The education level isn't going down, but when we look at people in their late 20s, they've got pretty much the same education distribution as people in their late 60s. So the big expansion is kind of happened in this country. In other countries, the expansion of education happened later and they can expect continued improvement so that's good news for them. We need continued progress on other fronts, clearly, in this country.

  • 10:13:26

    REHMAnd to, Dr. Nancy Donovan, I have been wondering for a long time how the brain looks when one is diagnosed with Alzheimer's and how the brain may look somewhat different when one is diagnosed with dementia. What's the difference?

  • 10:13:56

    DONOVANOh, that's a great question and people often ask that. Alzheimer's disease is one cause of dementia. It accounts for about 65 or 70 percent of dementias. Another 10 or 15 percent dementias are attributable to vascular causes or a combination of Alzheimer's disease and vascular pathology. We know a great deal about how Alzheimer's disease affects the brain, just based on research that's been conducted over the last five or ten years. We've known what Alzheimer's disease looks like at autopsy, but just within the last five to ten years, we've been able to image the proteins that accumulate in the brains of people who are at risk of developing Alzheimer's disease.

  • 10:14:53

    DONOVANWe know that the first stage of Alzheimer's is characterized by the accumulation of a protein called amyloid in the brain and that accumulates for 15 or 20 years before people develop actual symptoms of dementia or cognitive impairment. And then, much closer to the time that people have symptoms, another protein called tau begins to accumulate and propagate across the brain and we think that that is most linked to neural dysfunction and loss of neural tissue of the cortex and other regions of the brain.

  • 10:15:37

    DONOVANAnd so it's been a really exciting time over the last several years to really be able to track these changes in living human beings.

  • 10:15:48

    REHMBut once again, the differences that you might see on images between vascular problems and full blown Alzheimer's, do they actually look different?

  • 10:16:07

    DONOVANOh, absolutely. However, we're also taking a broader view of vascular cognitive impairment and vascular dementia right now. We used to think that vascular dementia was mainly attributable to strokes or strategic infarcts or loss of tissue, often in the subcortex or in the cortex in either of the inner or outer layers of the brain. But now, we're really interested as well in vascular changes that occur in a very small blood vessels. And this can cause a thinning of the inner or sub cortex of the brain, which can affect speed of processing or efficiency of processing.

  • 10:16:57

    DONOVANSo there are quite distinct differences between what you see in Alzheimer's disease and in vascular cognitive impairment. But they also coexist in many people.

  • 10:17:11

    REHMSo then the question becomes how early, through imaging techniques that we have available today, a physician, a diagnostician could actually see the beginnings of Alzheimer's, Dr. Donovan.

  • 10:17:31

    DONOVANWell, we can actually do that right now. We can certainly do that in our research studies and here, we have an observational study of close to 300 people who we're following, who are age 65 and older and cognitively normal and we have been able to track the accumulation of amyloid and actually tau as well in these people.

  • 10:17:56

    REHMAll right. Dr. Nancy Donovan of the Harvard Medical School. Short break here. We'll be right back.

  • 10:20:01

    REHMAnd welcome back. As you can imagine, there are a great many questions out there about Alzheimer's and various forms of dementia, including one mentioned by our guest, Dr. Nancy Donovan who is at the Harvard Medical School. She's on the line with us. Also Dr. Kenneth Langa , professor of internal medicine at the University of Michigan. He was one of the coauthors of a new study we're talking about, which indicates that the rate of dementia among those over age 65 has declined.

  • 10:20:50

    REHMHere in the studio is John Haaga, director in the division of behavioral and social research at the National Institute on Aging. One question that has been put to us by Twitter from Cathy, says her mother suffered from dementia. Her father is bipolar. What are the genetics and how vulnerable is she, Dr. Donovan?

  • 10:21:31

    DONOVANWell, there are familial forms of Alzheimer's disease, inherited forms which usually have a early onset in people and those are -- those pose a much greater risk than more sporadic forms. For instance, if the caller, the questioner is at some increased risk, maybe a 10 percent increased risk as a result of having a parent with having had Alzheimer's disease or dementia. But less so than the early onset or familial forms.

  • 10:22:15

    REHMDr. Langa, what is it that you feel is key to your study and what are you saying to people about the long term implications of your study? It's my understanding that people who develop Alzheimer's or forms of dementia do so later on in life. And your group, you said the average was about 65. Might that indicate that later on in life, this same group might actually have the rate of dementia that's already been disclosed in this country?

  • 10:23:15

    LANGAWell, the -- in our study, actually, the average was about in the last 70s for each group. It was 65 and older. But it's, again, a great question in terms of what's coming in the future. Actually, we can -- what Dr. Donovan talked about in terms of the pathology in the brain, we can link that back to this key factor of education, I think. I think one of the interesting and fascinating things we're still trying to figure out about this education/dementia link is that it seems as though people with more education are able to compensate for more of that pathology that Dr. Donovan was talking about.

  • 10:23:57

    LANGASo they can continue to think normally and function independently with the same or even more of these problems related to the Alzheimer's protein or the vascular problems. So that's why we're hoping or we think maybe that that's one link to why education decreases risk. And as people have had more education over time, it could be that that's what's either putting off dementia to very later in life or even preventing it entirely when people die of something else before dementia.

  • 10:24:33

    LANGASo again, there's some optimistic evidence that, as you said, Diane, that even when people get dementia now in the United States and some other high income countries, they're getting it later in life or closer to the time of death, which is obviously -- it's not just how many people have dementia, it's how much time people are living with it that is going to determine the total burden on families and the country as a whole. So, again, we're optimistic that this -- the jargon we use is compression of morbidity or compression of illness later toward the end of life, that's one thing that his education process might be leading to.

  • 10:25:21

    REHMWhat you're also indicating, however, is that there may be a wealth gap, that those who are in jobs like bricklaying or like construction of some sort or services jobs may not have the education, may not have the resources for education and therefore be possibly more likely to contract Alzheimer's. Is that true, Dr. Langa?

  • 10:26:00

    LANGAWe do think there's sort of a unfortunate -- it seems as though, you know, disparity in risk, not related to both education and wealth in our country, actually which seems to be growing over time that there's actually been increases in life expectancy among -- pretty significant increases in life expectancy over the last 20 years or so among people with more education and more wealth, that has not been matched or even gone in the other direction among people with lower levels of education and lower wealth.

  • 10:26:38

    LANGATo me, that's one of the key issues that our study brings out a bit more, that trying to do the best we can to focus in on making sure people have access to education both early in life and then, again, as you're saying, Diane, I think it's -- we use the number of years of education really as a marker. It's much more likely that what you're doing with your brain throughout life really is what effects your risk, meaning are you staying engaged with the world, are you thinking about things, are you -- is your occupation something that's, you know, exciting to you and keeping you interested?

  • 10:27:17

    LANGAAll of those things, we think, are important.

  • 10:27:19

    REHMEducation would also lead to better choices in terms of diet and lifestyle, Dr. Haaga?

  • 10:27:29

    HAAGAYeah, I think what Ken said is very important, that we've actually seen a widening of the educational disparities in health at older ages. Not just for dementia, but for really the whole range of chronic illnesses. And it's a worrisome trend and one that we can't fully explain. There's an activary of research now on what we can, you know, what's the magic ingredient. It can't purely be knowing calculus at age 18 or something.

  • 10:28:02

    REHMI don't know calculus for sure.

  • 10:28:04

    HAAGAWell, there's good news for you and there's some very promising research when the effects of cognitive training at older ages. There's a big study going on now lead by our colleagues at AHRQ, the Agency For Health Research and Quality, being done at the University of Minnesota, reviewing all the evidence on what you can do to prevent Alzheimer's altogether, to delay.

  • 10:28:30

    REHMSuch as?

  • 10:28:31

    HAAGASuch as my money is on physical activity. There's promising results, but really need more research on cognitive training. Anything you can do that improves your cardiovascular health is going to have an impact on vascular dementia and the mixed form that Nancy Donovan referred to of dementia.

  • 10:28:55

    REHMAnd what about these so-called games or learning devices that we hear so much about? Is there any indication that they help to postpone the onset or even reduce the number of people who have Alzheimer's?

  • 10:29:17

    HAAGAThere's a very important study that was mounted over 15 years ago now, but they're pursuing the long term implications, the acronym was ACTIVE and it was particular types of targeted brain training on things like improving your recall, executive function, which is the ability to handle several things. And just last year, we had a report on long term follow up of active participants. Now, it's very difficult to keep -- you lose people and the rest over the years, but there was an indication of lower dementia in the treatment group there.

  • 10:30:00

    HAAGAHowever, there's an awful lot of things out there. There's an awful lot of claims. There's an awful lot of advertisements. I, personally, do the New York Times crossword puzzle, but I don't fool myself into thinking that's a huge deal for me mental health or cognitive health.

  • 10:30:18

    REHMNevertheless, it's fun to do.

  • 10:30:20

    HAAGAYeah, that's the reason for doing it.

  • 10:30:21

    REHMAbsolutely. Here's an email from Ann. "What are the benefits of early detection of Alzheimer's disease or dementia? Dr. Donovan.

  • 10:30:37

    DONOVANThat's a great question and I think that as time goes on, the benefits are only going to be greater. Right now, we are trying to diagnose people early and there are clinical trials that people can participate in. More importantly, I think that paying greater attention to some of these modifiable risk factors that we talked about, exercise, I think, is really important, diet, managing cardiovascular risk factors. One of the things that we didn't mention as well is mental health. There's quite a bit of evidence the people with depression are at elevated risk of prodromal forms of Alzheimer's disease as well as dementia.

  • 10:31:31

    DONOVANWe don't understand why that's the case. We're actively researching that. But I think, in addition to modifying lifestyle factors, planning is important and making decisions about, you know, quality of life in the years that one has.

  • 10:31:54

    REHMBut if one does have early diagnosis, having gone through clinical exams and imaging, there is no medication to reverse the situation, is there, Dr. Donovan?

  • 10:32:19

    DONOVANCurrently, there are not medications that attack the direct pathologies in the brain, medications that are FDA approved. We do have a couple of medications available that appear to slow the progression of the disease, at least in some people. So -- but this is an extremely active area of research now. In fact, not only are we actively engaged in clinical trials to remove this protein called amyloid from people's brains, people who are in symptomatic stages, but we've also initiated studies using these same agents in people who do not yet have cognitive impairment, but have evidence of amyloid in the brain.

  • 10:33:11

    DONOVANSo we're really targeting people farther and farther upstream in the disease process.

  • 10:33:17

    REHMAnd you're listening to "The Diane Rehm Show." We do have a question asking how people can participate in a clinical trial. Are there trials going on at the National Institute on Aging?

  • 10:33:41

    HAAGAFor the most part, we're funding trials being done all around the country and that's a great question. I’m delighted to hear it. If you go to our website, there's a prominent link -- that's National Institute on Aging, very prominent link to Alzheimer's information and there's a place there where people can get connected to studies. There's also a very important one that the Alzheimer's Association, which is very large and active and forward-thinking group working on this, they also connect people. I actually signed up through theirs so that's a good place to get connected to the research.

  • 10:34:22

    REHMYou signed up for what?

  • 10:34:25

    HAAGATo be contacted for studies that I, you know, am an eligible subject for. So I get -- periodically, I get emails. And there's a choice. I mean, there are things that, you know, might be nearby, more convenient to where someone lives. So it's a good thing to do. It's a good way to participate.

  • 10:34:45

    REHMSo Dr. Donovan, the question so many people have about dementia, Alzheimer's and other non curable diseases is do I really want to know.

  • 10:35:09

    DONOVANWell, I think it's an individual choice. I think that one has to consider that it's important not only for the individual who's suffering from the disease, but also the family who very much want to support, you know, the patient or that individual with dementia or cognitive impairment. And another thing to consider is that in Alzheimer's disease, unfortunately, as people progress, they can lose their awareness of their illness and they make very poor judgments about whether or not they can drive or whether or not they can live independently because they've last that ability to self observe.

  • 10:35:59

    DONOVANSo I think it's really in the interest of the person themselves, but also in the interest of the family to work together and to process this diagnosis and, you know, comes to terms with it and to do everything possible to try and attenuate the disease process and to live with the disease. People live for a very long time with this disease. They can live, you know, 8, 10, 12 years after the time of diagnosis and there can be a lot of quality of life. So it's not universally as bad as it sounds.

  • 10:36:32

    REHMDr. Haaga.

  • 10:36:34

    HAAGAThat’s especially important to give people a chance for advanced care planning. The one thing we sometimes worry about with screening tests is that people will over -- have too much confidence in a negative result and, you know, get -- find out that they don't have dementia or Alzheimer's disease or the early signs of any other chronic disease and then relax, not prepare, not purchase long term care insurance or otherwise get ready. It's really not an infallible guide.

  • 10:37:10

    REHMJohn Haaga is director in the division of behavioral and social research at the National Institute on Aging. When we come back, we'll open the phones, take you calls, your emails, your comments. I look forward to hearing from you.

  • 10:40:01

    REHMAnd welcome back. Time to open the phones. First to Tyler in Lakeland, Florida. You're on the air.

  • 10:40:10

    TYLERThank you, Miss Rehm. You will be sorely missed.

  • 10:40:14

    REHMThank you.

  • 10:40:14

    TYLERAs the story will bear out.

  • 10:40:16

    REHMThanks.

  • 10:40:16

    TYLERAbout five years ago, my wife, who is now 73, was put on a regimen of statins. And about a year after that, you have some people on your show that discussed statins and the effect of -- on people that were taking them. And them showing some forms of memory loss, which my wife began to show. So I took her off the statins, but her memory loss began to be worse. Now, she's got a Master's Degree, so she's in the educated class. We then went to a neurologist and he tested her, and basically said, yes, she has some form of memory loss, dementia.

  • 10:40:56

    TYLERBut her never told us what it was. The next year we went back, she performed much better than she had the first year. So, I questioned her, and what I think was is my son, as soon as he heard that she was having these problems, had her enroll in Lumosity and go through the testing procedures on that. And apparently, the testing procedures and question procedures used on that particular program mirrored what was used to test her for her loss in memory loss.

  • 10:41:36

    TYLERSo it kind of goes to the statements that your people were saying earlier about some correlation between A, intelligence, which, my wife is very intelligent. And is coping real well, and also the testing regime in the person that's being tested is not fighting the testing regime but is actually being able to answer the questions without worrying about what the heck does this -- how this testing goes on.

  • 10:42:08

    REHMInteresting. Dr. Langa, you can speak to both those issues, I think.

  • 10:42:19

    LANGAYes, I mean, the, I think one thing the caller's questions -- or description of what's gone on with his wife makes clear is that, you know, dementia and how people are thinking and trying to track that over time is an extremely complicated process. This is not a straightforward process. The brain, this sounds trite, but the brain's a really complicated place and lots of, lots of factors are gonna go into how one performs on a test in any specific day. And then also over time.

  • 10:42:54

    LANGAAnd it can be difficult to sort through exactly is this person declining? Are -- what's the cause? Is it because of that statin that they just started or is something else going on? And it -- again, just because of the complexity of the brain and the complexity of trying to understand and measure how people are functioning, you can certainly make mistakes and it's not entirely a clear cut process. The statins are an interesting issue. A bit complicated on the one hand, as we talked about and both Dr. Haaga and Dr. Donovan talked about.

  • 10:43:33

    LANGAWe think that controlling your cardiovascular risks is important in preventing dementia long term. But there are some studies that suggest that taking a statin, which again, in general we think does reduce cardiovascular risk. In some people might cause thinking problems. So again, part of this complexity that I'm talking about -- that we're talking about.

  • 10:43:56

    REHMAnd to you, Dr. Donovan, lots of people have turned to programs like Lumosity. In your view, how successful are those programs?

  • 10:44:13

    DONOVANI agree that the research is still out on the value of doing these particular cognitive training programs. I tend to recommend exercise more than cognitive training. And I also recommend activities and, you know, social engagement. And, you know, activities in daily life that are cognitively stimulating. I also think that rather than doing the same, you know, cognitive test and type of test, really trying to broaden and develop kind of new, new interests. And new, you know, cognitive activities can be more beneficial than some of these programs.

  • 10:45:05

    REHMAll right.

  • 10:45:05

    DONOVANI think -- and...

  • 10:45:08

    REHMI'm sorry. I didn't mean to interrupt. You wanted to say something else.

  • 10:45:12

    DONOVANNo, I just was mentioning that the caller mentioned that his wife's performance on the tests improved and that can also be because the tests that we're using to assess people are similar to the tests that they're practicing at home. And does that really reflect an overall improvement in their condition or just improvement on those specific tests?

  • 10:45:35

    REHMI see. All right, let's go to Raleigh, North Carolina. Rini, you're on the air.

  • 10:45:42

    RINIOh, Diane, it's such an honor to speak to you today.

  • 10:45:44

    REHMThank you.

  • 10:45:48

    RINICertain states have higher populations of Alzheimer's, like Arizona in particular. And has this been studied, or have you looked at that? Because, you know, they have a sunnier climate, people are exercising more than other parts of the country. A lot of people speak more than one language, which I understand is also a factor in prevention or the likelihood of having dementia or Alzheimer's. Can you speak to that?

  • 10:46:20

    REHMAll right. Dr. Haaga.

  • 10:46:23

    HAAGAWe don't have good state level estimates that, that is an important additional dimension that we'd like to work on is better geographic studies. The -- all the other chronic diseases, stroke, for example, that we would also expect to share some of the risk factors, those, those vary quite a lot by region. So that's part of the reason I was so excited that this was a nationwide study.

  • 10:46:55

    REHMAnd at the same time, I would wonder, Dr. Langa, whether older people tend to congregate in warmer climates. So going -- moving to Arizona, you might have an older population that might be more susceptible to Alzheimer's or some dementia.

  • 10:47:23

    LANGARight. Absolutely. That's a great point, Diane, that age is still the biggest risk factor for dementia. So, as you're saying, if there are, you know, movement of people to Florida or to Arizona, it's likely that -- it's likely that just the older age, on average, of the population, is, might be part of what's going on. If there is a higher rate of dementia, so you'd want to try to adjust for that age. But I think Rini does bring up an interesting point. And as John said too, trying to better understand these geographic variations is something we're looking forward to trying to do going forward.

  • 10:48:03

    LANGABecause it -- my hunch is that there certainly are things that affect you throughout life, things like, say, pollution or I think, as Rini was saying, the -- just the environment that allows you to get out and do exercise.

  • 10:48:19

    REHMSure.

  • 10:48:19

    LANGAAnd get physical activity. It seems to me very highly likely that that's going to affect long term dementia risk. We're also looking, again, part, well, thanks to Dr. Haaga and his -- and the National Institute on Aging, we're now trying to compare these rates of dementia actually in countries around the world. The National Institute on Aging has funded similar studies to the one that we are doing here in the United States, this health and retirement study in places like England and Mexico and India and China. So we'll be trying to understand the rates of dementia there, the risk factors there.

  • 10:48:56

    LANGAAnd trying to get at some of these potential geographic differences by collecting this information from other countries around the world.

  • 10:49:05

    HAAGAAnd just to, as a reminder, that most older people don't move and those who move very far, like to Arizona or to south Florida, tend to be the more educated. The parts of the country that really have the high percentages of older people are the ones where younger people have moved away. Appalachia, the Mississippi Delta, and we really have to -- and those also are, are showing up badly in a lot of the health statistics. So I think it's really important to remember the rural areas, the more isolated populations, and the less visible older population that is in those areas.

  • 10:49:46

    REHMDr. Donovan, a number of people are asking us about Lewy Body Dementia. Usually, I gather, related to Parkinson's Disease.

  • 10:50:00

    DONOVANThat's right. That's -- can co-occur with Alzheimer's disease or it can occur -- or it is related to Parkinson's. It's a different kind of protein accumulation. And has a different set of symptoms that progress. People with Lewy Body can have less memory problems, but other problems with reasoning or executive function. They also are more prone to have visual hallucinations, actually. And they usually do have some evidence of motor changes, motor symptoms similar to what you see in Parkinson's disease. We understand a lot less about that than we do about Alzheimer's disease.

  • 10:50:50

    REHMInteresting.

  • 10:50:50

    DONOVANAnd vascular dementia at this point.

  • 10:50:52

    REHMDr. Haaga.

  • 10:50:53

    HAAGAIt's a nice reminder. We, we're usually working on Alzheimer's disease and related dementias. There is a National Alzheimer's Plan of Action, which does cover Alzheimer's and related dementias. And that's guiding our efforts, not just in developing the research, but also in programs. So while we're working on finding the cure, there's an awful lot that can be done to improve life for persons living with dementia and for their caregivers. And this National Alzheimer's Plan of Action is ambitious, but thanks to the efforts of a lot of people working through organizations outside government, it's -- there's increase funding for research and development and we're really optimistic.

  • 10:51:40

    REHMIncluding the organization Us Against Alzheimer's, which is also working toward a cure, finding a cure by 2050. Is that a reasonable achievable goal in your mind?

  • 10:52:03

    HAAGAIt's a stretch goal, to use the jargon from performance review. The -- I'm not the right one to answer about the work on pharmaceutical developments. I think the situation might be like what we've seen in heart disease, which has been a fantastic success, medically, for the last 30, 40 years. Where it's not one thing. There are some excellent treatments. There's a variety of treatments, pharmacologic and surgical. We've also made progress on primary prevention.

  • 10:52:41

    HAAGAStopping people ever getting the disease. On secondary prevention, stopping the progression of a disease after someone's got something.

  • 10:52:49

    REHMNow, you're talking about heart disease?

  • 10:52:50

    HAAGAHeart -- about heart disease.

  • 10:52:51

    REHMHeart disease.

  • 10:52:52

    HAAGAYeah, and so I think, I think that's the optimistic future for Alzheimer's disease. There's, there's not going to be a single magic bullet. If there is, I'd be the first one dancing in the aisles. But that we might have a significant success in stopping the disease or delaying onset through a variety of fronts.

  • 10:53:14

    REHMAnd you're listening to The Diane Rehm Show. Dr. Haaga, is there any history of Alzheimer's or dementia in your own family?

  • 10:53:29

    HAAGAOh yes. Like most Americans, I have been touched. My mother had dementia for the last 12 years of her life. And my father was one of the now 12 million caregivers, unpaid, of course, and very active in that. It was a, I know from talking to him before his death that it was one of the things in his life that he was most proud of. That and the Normandy invasion were kind of right up there, so, yeah, millions of American families are dealing with this, and even if the science goes the way we all really want it to, we're still going to have a problem for years to come.

  • 10:54:12

    HAAGAWe have a very rapidly increasing population of -- at the oldest ages where the incidence is greatest.

  • 10:54:20

    REHMAnd to Laura in St. Louis, Missouri. You're on the air.

  • 10:54:25

    LAURAHi, Diane. I'm so excited to be on your show and I just love you so much.

  • 10:54:29

    REHMThank you.

  • 10:54:31

    LAURAI am -- this is striking a -- it's difficult, because I've been taking -- I took care of my grandmother for four years. 24/7, toilet, bathed her, fed her, she had dementia. She took care of her mother and now, I'm in the beginning of starting to take care of my dad. And I'm petrified of -- that this is going to happen to me. And just the realization of the disease has just gotten me, you know, day by day, right? And I just am appreciative of you having this show.

  • 10:55:10

    LAURAAnd having people hear the devastation that this is causing people and the lack of understanding when people hear that I have family members who have dementia. I almost feel like I have to hide it because they'll think that something's wrong with me or something's going to be wrong with me. So it's like there's a shame part, factor to it that is difficult. One people don't understand. But the one thing, the one, the one beautiful thing that I can say that I've learned about this is that life is not about the past or the future. It is about right now.

  • 10:55:45

    LAURAAnd I've learned that beautiful lesson from my dad and from my grandmother. And that is probably the shining star out of this whole horrible event, that it is right now that is so precious. And hi, Dad, I know you're listening to Diane. He listens to you every day. So, I'll get off the phone. Thanks so much, Diane, for talking about this.

  • 10:56:05

    REHMThank you, Laura. And good luck to you.

  • 10:56:09

    DONOVANI'd like to make a comment about that.

  • 10:56:11

    REHMJust to remind you, Laura, it's not inevitable. Dr. Donovan, go right ahead.

  • 10:56:21

    DONOVANWell, I just wanted to make the point that this is a very optimistic study that Dr. Langa and his colleagues have published. One of the things that I find really optimistic about it is that we don't quite understand why it is that rates have gone down. We know that improved cardiovascular health is a factor. We know cognitive reserve or higher education is probably a factor. But this is really a huge decrease in dementia rates and it just suggests that there are factors out there which we haven't really identified, which we haven't nailed yet.

  • 10:56:53

    DONOVANAnd I think that those of us who work in this field are really going to be motivated to try and understand what is that 25 percent decrease? You know, what is it attributable to? What have we not -- what do we not yet -- what have we not figured out yet?

  • 10:57:10

    REHMAll right. Well, I'm glad to end on that optimistic note, Dr. Donovan. Thanks so much for joining us. Dr. Nancy Donovan, Dr. John Haaga, and Dr. Kenneth Langa. And thanks to all of you for listening. I'm Diane Rehm.

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