Ten years ago today, President Obama signed into law the National Alzheimer's Project Act (NAPA) (Public Law 111-375). As the law required, Health and Human Services (HHS) developed the National Plan to Address Alzheimer's Disease. The plan addressed many aspects of the challenge presented by the disease -- such as data tracking, public awareness, research funding, caregiving -- and including prevention. But it's not clear that we're preventing much of it yet.
So on December 27, 2021, HHS released an update to the plan that, among other things, strengthens its posture on prevention. I was encouraged by this because it places a lot more emphasis on the preventability of Alzheimer's disease through lifestyle changes. That includes lifestyle changes targeting dementia precursors such as diabetes and cardiovascular disease.
Recall that as many as 40% of all cases of Alzheimer's disease are preventable through appropriate lifestyle changes. If you read Beating the Dementia Monster you know what needs to be addressed: physical activity, sleep, social engagement, diet, head injury, mental activity, etc.
We briefly discussed the correlation between hearing loss and the advent of Alzheimer's disease in January 2020 and again in December 2020. The hypothesis is that hearing loss interferes with social engagement, and lack of social engagement is a risk factor for Alzheimer's disease. I wish I had devoted more space to this in the second edition of Beating the Dementia Monster, and perhaps I will in a future update. (I am currently working on a Spanish language edition.) So I was gratified to see that they are now addressing hearing loss in the updated action plan.
The lifestyle updates in the form of new actions in the plan are in Goal 6, and they are as follows:
- Action 6.A.1: Enhance the focus on risk reduction in existing research summits
- Action 6.A.3: Expand and diversify clinical research studies on promising interventions to reduce individual and community-level risk
- Action 6.A.4: Enhance research to better understand the varying levels of or types of dementia risk across demographic groups
- Action 6.A.6: Expand research on the impact of emerging potential risk factors such as COVID-19
- Action 6.A.7: Continue clinical trials on the most promising health promotion interventions
- Action 6.B.1: Educate the health care workforce about risk reduction
- Action 6.B.2: Increase access to hearing aids for individuals with hearing loss
- Action 6.C.1: Convene summit to establish public health priorities for reducing Alzheimer’s disease and related dementias risk factors
- Action 6.C.4: Improve nutrition by lowering sodium in the food supply
- Action 6.C.5: Promote physical activity among older adults
- Action 6.E.3: Reduce financial barriers to hearing aids for individuals with hearing loss
- Action 6.F.1: Target and coordinate public health campaigns aimed at reducing risk factors
- Action 6.F.3: Enhance the reach and effectiveness of public health messaging on blood pressure control
These are the new and updated actions. There are existing actions that more passively address lifestyle and Alzheimer's disease, but this is a significant upgrade. I've highlighted in red a couple of items that more strongly underscore what we said in Beating the Dementia Monster about lifestyle.
The number 1 goal of the NAPA action plan is to "prevent and effectively treat Alzheimer's disease and related dementias by 2025." But being overweight is a risk factor for Alzheimer's disease. I read about a recent survey saying that most Americans believe their weight is "about right," but 74% of us are overweight and 43% of us are actually obese according to the CDC. If the NAPA plan goal is to be realized, we will need to make some pretty big changes in lifestyle very soon!
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