November brings cooler weather, the anticipation of the fall and winter holidays, and reflections regarding the year that is wrapping up. It is also National Alzheimer’s Awareness Month, giving me the opportunity to provide updates on the amazing progress that was made this year!  In my 20 years in this field, I have never been more optimistic that major breakthroughs are right around the corner. The last 2-4 years have been jam-packed with milestones and I believe the next 2-4 years will be pivotal in our quest for a world without Alzheimer’s and related dementias. For those of you who may have read this November awareness blog before, when the “solution” occurs, I plan to throw a party for the entire world.  Of course, you will all be invited so watch for your invitation – I am serious when I say it will be coming sooner than many of you might ever imagine!

As always, a quick reminder of the reason that Alzheimer’s/dementia is my passion. Just as I was at the peak of my corporate career, three of our four parents in my immediate family were diagnosed with Alzheimer’s.  The diagnoses all came in within about 18 months and we were completely ignorant about the subject and how to begin what would turn out to be a decades-long journey through the complicated world of dementia.  Our folks lived for 16, 14, and 11 years with the disease and to say it changed every aspect of our lives would be a vast understatement. I could never have predicted that the news would result in my completely reinventing myself in this field. While some may find it hard to imagine a silver lining to anything remotely involved with Alzheimer’s, this could be a case in that I found my special purpose, (although a bit later in life.) Everything I now do both professionally and philanthropically revolves around what is officially called Alzheimer’s Disease and Related Dementias. (ADRD).

Where do I begin to brief you on the many new flashes from the past 12 months?  First, I have literally waited 20 years to be able to tell you all that there is now a viable treatment for Alzheimer’s disease!

In January of 2023, the FDA granted accelerated approval for a drug called lecanemab, (brand name Leqembi.) Here is a rundown of the key facts about the drug.

• For early-stage Alzheimer’s patients only – not for other types of dementia
• Reduces toxic build-up of beta-amyloid in the brain
• Trials showed a 27% slowing of cognitive decline
• Side effects are fewer than preliminary 2021 treatment but can be serious
• Physicians will qualify patients based on verification of early-stage status
• Qualification will also depend on the patient’s health and tolerance for side effects
• This is not a cure – the drug will not restore lost function
• The intent is to help mark time until the next big thing comes along – (soon!)
• Twice monthly injections in a clinical setting – (we are working on at-home treatments)
• About 600,000 – 700,000 patients could benefit annually from this drug
• Sense of urgency is acute – 2,000 people move from early to middle stage every day
• Availability may vary depending on practice/health system adoption in year 1
• Cost is high – $26, 500 annually plus required PET scans

At this point, let me interrupt myself to mention that Medicare/Medicaid had decided not to cover the drug earlier in the year, but that decision was reversed in July 2023 when the FDA granted full approval for the drug.  Yeah!

And…as I teased earlier, there is already a more promising Alzheimer’s treatment on the horizon. Donanemab is expected to be announced by the end of this year. It shows a 35% slowing of decline and in the first year of the trial, 47% of participants showed no further cognitive decline. After 18 months in the trial, 72% quit taking the drug as there was not enough build-up of amyloid in the brain to warrant it. This is incredible preliminary news, I can’t wait to see the actual “reveal” and learn more about this breakthrough.  Stay tuned!

In addition to drug news, in the past 12 months, studies have confirmed that 40% of our risk for dementia is due to modifiable factors. This is the best news ever.  It means that we have control over almost half of our risk. 60% is due to non-modifiable factors like gender, (women make up 2/3 of Alzheimer’s patients), age, race, and ethnicity.  (African Americans are twice as likely to develop Alzheimer’s and Latinos 1.5x more likely.)

Of course, you know I will never write this blog without listing the ten real things each of us can do to reduce our dementia risk so that will be included at the end!

On the gene front, there is a mutant deterministic gene for Alzheimer’s that is carried among about 200 families in the world. Most of those family members will, unfortunately, develop full-blown dementia in their 40’s, 50’s, or 60’s. One gentleman from Columbia is now 72 and is just beginning to show signs of cognitive decline. Researchers have long wondered what has been protecting his brain from the destructive mutant gene he carries and it was found this year in the form of a gene in his DNA!  Studies will now go forward to verify this finding -just think of the impact this discovery will have on all of us.

To wrap up this science/medical news summary, news approaches continue to be investigated. Just this month, I read an article about a UK study that appears to shed light on why Alzheimer’s disease kills brain cells (neurons). This has been a question for the ages. The study reveals evidence that the cause of this cell death may be connected with a gene called MEG3 that is prevalent in brains with amyloid buildup. This gene may be sending a signal to the body to destroy unwanted cells. Studies will now go forward to suppress this gene in patients in hopes of preventing cell destruction.  Exciting!  (Yes I know, I am a nerd)

I also want to report that in my role as a member of the Colorado Department of Health and Environment Dementia Action Coalition, we have written the state’s Alzheimer’s/Dementia Plan and are currently working on implementation.  For those of you who live in Colorado, your state is all over this topic!

As I wrap up, I am pleased to continue in my ninth year on the Mines and Associates team, providing Employee Assistance Plan dementia coaching and client training.  I teach a class titled, Alzheimer’s/Dementia 101 – Facts, Care, Research, Risk Reduction, Treatment that includes everything we all need to know about this hot topic. It is estimated that 1 in 3 working Americans are dealing with dementia in their families. 1 in 2 of us will provide some type of caregiving for someone with some type of dementia in our lifetimes. And because for the first time, we have treatments, denial is a dangerous option. Denying the warning signs for dementia in our loved ones could lead to them being denied critical early-stage drug therapies.

As you may know, I also teach at the University of Denver and do a monthly 75-minute version of my class via Zoom that is open to the public throughout the US. Please reach me at dementiafriendlycolorado.com to receive the registration link for the next session.

In closing and in observation of National Alzheimer’s Awareness Month, let’s all do two things.  First, let’s reduce the stigma surrounding dementia, Stigma is defined as a mark of disgrace relating to a circumstance, quality, or person.  With regard to dementia, let’s all pledge to be a part of the solution, not the problem!  (Thank you!)  Secondly, let’s all make a commitment to take care of our brains. Please join me in being an ambassador, if you will, for this topic. Spread the news. No longer is there nothing we can do about dementia!

Don’t hesitate to reach out to us at Mines and Associates if you are dealing with dementia issues in your family.  We stand ready to help. (800.873.7138)

And finally, as promised, here come the all-important “Dementia Tens”, the Ten Warning Signs, the Ten Risk Factors, and Ten Risk Reducers:

The Ten Dementia Warning Signs

1. Memory loss that interferes with daily life
2. Challenges with planning or problem-solving
3. Difficulties performing familiar tasks
4. Confusion with time or place
5. Visual and spatial issues
6. Problems with words
7. Misplacing things
8. Decreased or poor judgment
9. Withdrawal from work or social activities
10. Changes in mood or personality

The Ten Dementia Risk Factors

1. Age
2. Health Factors (cholesterol, blood pressure, diabetes, inflammation)
3. Lifestyle Factors (inactivity, poor diet, poor sleep, obesity, smoking, alcohol, stress)
4. Family History
5. Genetics
6. Gender (2/3 of Alzheimer’s patients are women)
7. Race/Ethnicity (African Americans 2x more like to develop Alzheimer’s – Latinos 1.5 x)
8. Social Isolation
9. Lifecourse Factors (childhood diet, rural/urban healthcare, education, stress, poverty)
10. Traumatic Brain Injury

The Ten Dementia Risk Reducers

1. Exercise – Regular cardiovascular exercise is the closest thing we have to a silver bullet while we await a cure. Be sure to check with your doctor to make sure it is safe for your overall health.
2. Diet – Adopt a Mediterranean-type diet high in vegetables, fruits, and lean proteins. Avoid salty, sugary, fatty, and fried foods. Blueberries are awesome for your brain! You can reduce your lifetime risk for dementia by up to 23% by adopting this type of diet!
3. Sleep – Good sound, natural sleep is critical in allowing your brain to rid itself of toxins. Put your devices in another room, make them cool and dark, and discuss sleep issues with your doctor before taking sleep aids. If you are older, ask your doctor about avoiding a class of drugs called anticholinergics that may increase the risk for dementia.
4. Heart and Inflammation Health – There is a correlation between dementia and cardiovascular disease, high blood pressure, diabetes, and obesity. If it is good for your heart, it’s good for your brain! Air pollution affects your cardiovascular system so mask up as appropriate. Studies also show a correlation between cognitive issues and brain inflammation. Choose salmon, broccoli, walnuts, avocado, berries, and other anti-inflammatory foods in your diet. Discuss inoculations with your doctor to avoid viral illnesses which can increase neuroinflammation. Simply by getting your annual flu shot, studies show you may decrease your risk for dementia by up to 40%!
5. Smoking/Alcohol – There is a direct correlation between Alzheimer’s disease and smoking. Enough said! If you drink alcohol, always practice moderation.
6. Mental Health – Depression, stress, and other emotional conditions can negatively affect cognition. Discuss these with your doctor for treatment. Manage your stress through safe exercise, yoga, meditation, or music.
7. Hearing/Sight Decline – There is an increase in Alzheimer’s/dementia among those with untreated hearing loss in middle to older age. You can reduce your risk by up to 48% simply by wearing hearing devices to treat age-related loss. There should be no stigma regarding hearing devices! Treat cataracts and maintain good vision as you age. Your brain cannot process what you never heard or saw to begin with.
8. Social Interaction – Involvement with others is critical for brain health. Socialize, (safely of course), by volunteering, taking dance lessons, and enjoying activities with family and friends.
9. Continual Learning/Brain Engagement – Learn a new language, instrument, or hobby or take classes. While not every brain game may have science behind it, (some do, some don’t – I do them all), exercise your brain through games, puzzles, and new challenges. Games of strategy and those that challenge your peripheral vision are best.
10. Helmets/Seatbelts – Always use your seatbelt and wear helmets when skiing, snowboarding, during contact sports, and while biking or riding a scooter. Protect your most precious and important asset, your brain!

To Your Wellbeing,

JJ Jordan – The MINES Team

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