Science Versus Pseudo-Science — What Really Works to Prevent Cognitive Decline ?

If you’re in your sixties, you’re familiar with this scene. A group of friends is having dinner. As the conversation progresses, one by one each person fails to come up with a word they want—the name of a favorite dish, or a town visited on a trip, an actor or the movie he appeared in, a person in the news. Everyone laughs and groans. “God, this aging thing sucks.”

People are living longer. During the later parts of their lives, they are healthier and more productive compared to previous generations. If there’s something that can be done to preserve mental acuity, there’s a whole generation of aging baby boomers eager to try it.

Two years ago, the National Institute on Aging commission a study from the National Academy of Sciences: “Preventing Cognitive Decline and Dementia: A Way Forward.” This comprehensive and multi-national collaboration determined there were three interventions that held meaningful promise for delaying or slowing age-related cognitive decline. Evidence for the effectiveness of these interventions was termed “encouraging but inconclusive.” The three interventions receiving that cautiously optimistic endorsement are the intensive treatment of blood pressure, cognitive training and increased physical activity.

Now, a just-published research report in the Journal of the American Medical Association (JAMA) offers additional support for intensive treatment of blood pressure in reducing the risk of developing mild cognitive impairment.

Blood pressure is monitored by tracking two numbers, systolic over diastolic. For example, 135/87.  Systolic pressure is the first number in the pair. Intensive treatment of blood pressure means shooting for a target number of 120 or lower for the systolic blood pressure reading. This is a change from traditional guidelines that targeted 140 or lower for the systolic pressure.

That’s the current state of the science. If you want to manage the factors that are within your control to prevent or delay age-related cognitive decline, spend some time and energy focusing on these three things:

  1. Try to get your systolic blood pressure down to 120 or below. If you have hypertension this likely means taking one or multiple medications, losing weight, exercising and reducing sodium intake (ditching chips, pretzels and deli meats is a place to start).
  2. Increase your physical activity. There is no strong evidence that one kind of activity or another is the key. Don’t worry about what you do, just get more active. Find something you like to do so you’ll keep doing it. Reduce your sitting time.
  3. Stimulate your brain. Again, there’s no evidence that formal brain training programs are better than ad hoc activities. Just find and keep doing something you enjoy—crossword puzzles, learning a new language, reading challenging books. Keep the oxygen and blood moving in your brain by using it.

Meanwhile, while watching the news you see advertisements for supplements to improve brain health and cognition. Something to do with jellyfish? If you want to spend some money you can buy proprietary supplement products with great names like Alpha Brain®, Qualia Mind or Bulletproof®  brain octane oil.

Numerous generic and widely available supplement ingredients have been touted as being brain-boosting or neuroprotective. Among these are fish oil, reservatrol (present in purple and red foods), caffeine, phosphatidylserine, acetyl-L-carnitine and ginkgo baloba.

An opinion piece in the same issue of JAMA reporting the new blood pressure study warns of the rise of pseudomedicine, especially in the arena of brain health. Pseudomedicine is defined as legal health interventions, such as promoting supplements, that lack scientific evidentiary support. Testimonials substitute for carefully designed studies. Material supporting the claims for efficacy masquerade as scientific research but fail to meet basic tests for scientific validity. Simply put: currently, there is “no known dietary supplement [that] prevents cognitive decline and dementia.” This is not to say that future research won’t reveal a positive impact from diet or supplements. We’re just not there yet.

There is a lot of emotion involved here. Ten thousand baby boomers reach age 65 every day. Most of them feel strong and vital. They don’t want to bow out, retire from the world or cease being productive. And they are scared of mental and physical deterioration. As educated as they might be, they are vulnerable to promises like those made in the pseudomedicine world promoting supplements as a way to protect your brain and prevent dementia.

The supplement market is large. Estimated at $133 billion in 2016, it is expected to reach $220 billion by 2022. The overall supplement market is predicted to grow at a compound annual growth rate (CAGR) of 8.8%  between 2017 and 2022.

But the segment of the supplement market relating to “brain health,” valued at $2.3 billion in 2015, is pegged to grow to $11.6 billion by 2024, achieving a CAGR of 19% between 2016 and 2024. Why is the anticipated CAGR more than double for the brain sector? A growing aging population that wants to live well in the decade or two or three remaining and especially fears cognitive decline.

There’s a downside to taking supplements even if they don’t work. First, supplements are not always harmless. They are not tested by the FDA or any other oversight agency for safety and efficacy. Vitamin E, for example, is linked to an increased risk of certain kinds of stroke. Second, investing in an intervention that does not work can divert people from doing the things they can do that may actually make a difference in their brain health.

How can an investor resist a market segment that anticipates a CAGR of 19%? Let’s hope they can for the sake of the greater good. Pseudomedicine is not illegal but it is unethical. It hurts people by wasting their money, causing unnecessary risk and diverting attention from health interventions and behaviors that actually can work.

Brain science and prevention of cognitive decline is at an early and rapidly evolving stage of knowledge. We can anticipate promising, scientifically reliable and profitable developments in the immediate years ahead.

We’re in the midst of an alarming cultural trend that has veered away from reliance on the scientific method and scientific evidence in favor of compelling, emotionally vivid testimony, groupthink and conspiracy theories. Growing up, there was a lot of superstition and squirrely beliefs based on emotion rather than reason in my family. I remember when I first learned about the scientific method in grade school. I was so excited that there was actually a way to figure out whether something was true or not!

Admittedly, that kind of excitement doesn’t often pervade rigorous study. But we would do well to remind ourselves of the value of the scientific method and reconsider science when making decisions about our health or how we invest our money.

source: forbes.com