Lifestyle Choices & Alzheimer's Disease: Susceptibility, Not Inevitability

Knowledge isn't just power -- it can also mean the difference between debilitating stress and the equanimity that nurtures health. Through the experience of producing a documentary film series, The Alzheimer's Project, I lost my fear of developing the disease.

This was not the first time I was confronted with the prospect of facing the realities of Alzheimer's disease. Ten years ago my father, Emanuel Hoffman, died of Alzheimer's at the age of 80. Manny was a newspaper journalist and editor, and his decline into dementia was anguishing. With the sadness of my father's illness came fears about my own future. Would I share his fate? Was his father's senility just another word for the same condition? Not long after Manny's death, an executive at HBO asked if I thought the time was right for a film on Alzheimer's. My gut reaction was to say no. Why would I spend two years immersed in the disease that destroyed my father? But years later, circumstances brought me back to the subject and beginning on May 10, The Alzheimer's Project, a four-part documentary series, will premiere on HBO. The series explores, in great detail, the extent to which science had made advances of which the public was unaware. The more I learned, the less I wanted to hide my head in the sand.

How was it that such advances had escaped me? I read the Science Times avidly, I listen to NPR, I make science films! Yet I believed incorrectly that Alzheimer's disease research was still in its infancy, that the biggest controversy in the field revolved around the risks of cooking in aluminum pots (a long-disproved theory), and that the most I could do to minimize my chance of contracting the disease was to solve crossword puzzles -- which I do anyway.

I now know that I was not alone in my anxiety about developing Alzheimer's. According to a recent study, it's the second most feared illness among the general U.S. population, and the single most feared illness among women. These fears are not baseless. The baby boomers are seeing nearly 50 percent of their parents' generation struggle with Alzheimer's by the time they reach 85 years old, and in 2011 the first boomers will themselves reach retirement age, setting off a precipitous rise in the incidence of the disease, which already affects some five million Americans.

Yet as my colleagues and I sifted through hundreds of research papers and began speaking with more than 200 of the most active American scientists and physicians working on Alzheimer's, my personal qualms about the project subsided. We learned about research being conducted in multiple areas of basic science, drug development, and, to our surprise, lifestyle factors that can mitigate the expression of the disease.

In the course of this project, I discovered that while the general population has a 10 percent chance of developing Alzheimer's disease by age 85, my father's illness increases my risk to 20 percent. Optimist that I am, I interpret this statistic to mean that I have an 80 percent chance of not developing Alzheimer's. I find further comfort in the new term "susceptibility genes" to describe the role genetics plays in personal risk. Late-onset Alzheimer's accounts for 97 percent of cases and is not completely determined by inheritance. Rather, a number of small genetic variations appear to enhance late-onset risk. Susceptibility, not inevitability.

I have also been inspired by the prevailing view that the risk conferred by any single susceptibility gene is modified by the interaction of that gene with the environment. Studies suggest that following a diet low in saturated fats and simple sugars, as well as maintaining normal levels of blood sugar, cholesterol, and blood pressure may delay the onset of Alzheimer's disease or slow its progress. Exciting new research further indicates that aerobic exercise stimulates growth factors in the brain in the very areas initially affected by Alzheimer's disease.

If I had to reduce all the knowledge we gleaned from the scientists to one message, it would be that Alzheimer's is a disease of the entire body. Changes to any one system, such as the ability of insulin to deliver glucose to brain cells, may influence the metabolic pathways involved in Alzheimer's pathology. I'm fortunate that I don't have diabetes, but if I did, I'd be glad to know that there are ways to control the problem. I'm lucky that statins are available to keep my cholesterol in check because, for me, diet and exercise are not sufficient. I've been humbled to learn that my existence is a result of a complex, intricate, and delicately balanced system of metabolic pathways. Will my determination to keep these systems healthy have an impact on my old age? No one can yet be certain, but I find comfort knowing that I'm exerting control wherever I can. The more I learn the less frightening Alzheimer's becomes -- and the more I find myself making lifestyle choices that diminish my risk of contracting the disease.

It is my hope that the public can experience a similar enlightenment, not only by viewing the film, but also by examining our supplemental materials. As part of an overarching educational campaign that accompanies the film series, HBO has published a companion book, The Alzheimer's Project: Momentum in Science. With this, and our other multiplatform initiatives, the Alzheimer's awareness can continue, long after the film premiere.

John Hoffman served as Producer of The Alzheimer's Project, premiering on HBO beginning on May 10.

Comments

[iblogleft]

I watched the entire series, and it was very good.

I was extremely disappointed that nothing was said about the recent discoveries with Cannabinoids. Yes, Pot. The latest research shows very good signs that the wonder plant (evil weed) marijuana, has had incredible results in slowing the progression of the disease. I guess the Cannabis industry doesn't help with grants to make a film though :-)

[wordherder]

I'm thrilled with the amount of attention now being focused on Alzheimer's. Having said that, I wish more people would be aware that Alzheimer's Disease is a type of dementia. My grandpa got diagnosed with a different form of dementia, but hardly anyone knew what dementia was. We always got the question, "Is that like Alzheimer's?" Yes, it is, since they're both types of dementia. While Alzheimer's is truly a debilitating disease, let's not forget the other, similar cognitive disorders under the banner of dementia.

[Obama2008]

I watched Part 1 of the series on HBO Sunday evening, and I was sobbing when it was over. I haven't been able to bring myself to watch Part 2 yet. I am glad that the author (and the promos for the series) point to hope for this devastating illness. To see the impact it has on the lives of people is heartbreaking.

[Tena]

Well, I have too many friends who have parents with Alzheimer's to even watch that special cause it ain't that rosy.

I have my own plans if I'm ever diagnosed and they don't involve sticking around for my mind to deteriorate. My father in law had a variation of Alzheimer's called Pick's Syndrome.

NO THANK YOU.

[PiscesPrincess]

Alzeimer's Disease.
It truly is the One disease I fear. Crossword puzzles and less worry. ironic isn't it?
I get very little planned exercise in recent years but a regimen of regular sleep and moderate intake of wine; I make a studied effort to keep our intake of salt at low levels due to heart disease.
A husband who loves me dearly and deeply and a family that is supportive and kind.
and Memory Lane !! We sit and talk a lot about current events as well as the old time.
and btw, I am 70 and still working full time in a job that is Not stressful.
Oh, I am truly Blessed all around.

[Isabel Azevedo]

Very well done! And this same title could apply to most diseases of modernity, actually the most prevalent in adults of western or westernized countries. I would proceed a little bit more: live your life with respect for your body (plenty of physical activity, moderate eating of simple, healthy food, preferably with family/friends, interest and devotion to causes/projects, respect for chronobiology, taking the most of simple, free joys) and you'll be reducing the odds of all those diseases. Then, don't spoil your resources thinking in disease.

[AnnfromCA]

Good luck. Alzheimer's runs in my family.

We just poke fun at one another. Anyone who forgets?

We jab...."Oh good, it's you!"

[Aranxa]

Yeah, and I take vitamin C and wash my hands all the time and I still get the flu every winter.

[StillIRise]

Read "Still Alice," by Lisa Genova. An extraordinary insight into the journey of Alzheimer's.

[DrP]

John:
If you cannot control your cholesterol with diet and exercise, I suggest that you consider that you are on the wrong diet. Statins treat a symptom (high LDL),not the cause, which is possibly inflammation produced by high levels of insulin in the blood. (Statins will do nothing to lower high triglycerides, which is much more significant marker of insulin resistance) You are doing well to limit simple sugars, but since all carbohydrates metabolize as glucose, that is not enough. You probably need to reduce or eliminate all sugars, grains, and starches. Don't worry too much about saturated fat - it has never been proven to "cause" high cholesterol. I have excellent health and control of blood sugar, insulin levels, blood pressure, etc. (despite a strong family history of Type II diabetes) after 10 years of following a very-low carbohydrate diet and participating in regular, vigorous exercise. I am 56 years old, by the way.

[ICARAStudy]

I had a chance last night to watch Momentum In Science, part II, of the HBO series and it was great. It really showed why clinical studies are so important. Current Alzheimer's therapies treat the symptoms associated with the disease, not the disease itself. There is a new study that explores if Bapineuzumab (Bapi), an investigational drug mentioned in the HBO special, can help slow the progression of Alzheimer’s disease. Patients and families affected by Alzheimer’s can visit www.icarastudy.com to see if they might be eligible to enroll.

[B-Rock-C]

Watching the first in the series of these documentaries I was struck by the thought that we need to have more discussions on the 'right to end life'. Until there are better treatments those struck down with this disease, or at least in the advanced stages should be able to have made that decision for themselves. I know I (along with one person in the documentary) would not want to be a burden or be taken care of left to slowly diminish like that. ...

[Obama2008]

I absolutely agree. I was thinking the exact same thing as I watched on Sunday evening. I would never want to spend the last days of my life in the agony that some of these people were experiencing. And to imagine that your life savings could be used to provide care is a terrible thought.