AN ANTHROPOLOGICAL TAKE ON

“ALZHEIMER’S”:
IDEAS AND ACTIONS FOR BRAIN HEALTH

Danny George, Ph.D, M.Sc

Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

History made in 1901
The original plaques and tangles
1910:  Alzheimer’s  becomes  a  disease  
“Kraepelin  s,ll  considers  that  the  
posi,on  of  these  cases  is  
unclear…  There  is,  then,  no  
tenable  reason  to  consider  these  
cases  as  caused  by  a  specific  
disease  process.”  
   ~Dr.  Alois  Alzheimer,    
 In  Zeitschri,  fur  die  Gesamte  Neurologie  and  
Psychiatrie  in  1911    
 Alzheimer’s through the 20th century:
Modern developments
 Medical and scientific innovations
 Public health programs
 Food supply
 Social welfare programs

Increased  Life  Expectancy  (30  yrs)  

 Alzheimer’s through the 20th century:

 National Institute on Aging

(1974)

 “I decided that we had to

make it [AD] a household
word. And the reason I felt
that, is that’s how the
pieces get identified as a
national priority. And I call
it the health politics of
anguish”
~ Dr. Robert Butler
NIA spending on AD research grants
ADI  Annual  Report:  2003-­‐2004  

ADI  World  Alzheimer’s  Report  2010  

Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

The complex human brain
Amyloid cascade hypothesis
Amyloid cascade hypothesis
 What does amyloid do?
•  Anti-oxidant
•  Encourages growth and
survival of neurons/
synapses
•  Cellular adaptation to
stress/injury (hypoxia, TBI)
•  Part of brain’s immune
response
Religious wars over “AD” etiology
Accepting the complex, age-related
nature of “AD”

-­‐Abnormal  neural  proteins  

-­‐Altered  glucose  metabolism  
-­‐Cardiovascular  defects  
-­‐Oxida,ve  stress  
-­‐Toxins  
-­‐Head  injuries    
Plaques   Tangles  
Existing drugs
  Cholinesterase inhibitors
  donepezil (Aricept)
  rivastigmine (Exelon)

  galantamine (Reminyl)

  tacrine (Cognex)

  Glutamate receptor antagonist

  Memantine (Namenda)
Aricept

Problems and limitations?

Diagnosis (of exclusion)

  Hypothyroidism -Parkinson’s disease

  stroke
-Huntington’s disease
-subdural hematoma
  vitamin B12 deficiency -normal-pressure
  folic acid deficiency hydrocephalus
  niacin deficiency -brain tumor
  hypercalcemia -malingering
  neurosyphillis depression
-schizophrenia
-HIV infection
  head trauma -persisting effects of a
  cerebrovascular disease substance (e.g. alcohol)
Mild Cognitive Impairment
Pre-Mild Cognitive Impairment
Earlier diagnosis?
Earlier diagnosis?

•  Unvalidated
•  False positives
•  False negatives
•  Social cost
•  Financial cost
•  Lack of viable treatment
The changing clinical encounter

  Emphasis on choice
  Acceptance of ambiguity

  Co-creation of the story of

brain aging
Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

Our cultural “narrative” about
Alzheimer’s
Alzheimer’s is…:
A  loss  of  self   A  burden  
-­‐a  living  death   -­‐caregiver  burden  
-­‐a  death  that  leaves  the   -­‐societal  burden  
body  behind  
-­‐a  disease  that  creates  a  
shell  of  a  person  

An  antagonist  
-­‐a  mind-­‐robber  
-­‐a  disease  that  creates  non-­‐
persons  
-­‐a  stealer  of  decades  
Fear  and  AD  

Met  Life  Survey,  2010  

SNgma  and  social  death  
From a “loss of self” to a “change in
self”
From “caregiver burden” to the
dynamism of caregiving
From “victimhood” to “personhood”
Changing diagnostic categories

  Due for publication in

2013
  Dementia may be
removed
  NeurocognitiveDisorders
of the Major and Minor
type
Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

Outline
  A brief history of Alzheimer’s
  Scientific challenges

  Social challenges

  Ideas and actions for the future

 Research on longevity and wellness
  Low stress
  Accessible and walkable cities
  Low smoking rates
  Low meat, plant-based diet with legumes,
moderation
  Humane treatment of the elderly
  Strong families and community affiliations
  Purpose, engagement, and contribution
Protective role of community
Reading mentor program
Intergenerational
reminiscence
Intergenerational
curriculum
Manners workshop
Intergenerational play
Community
partnerships
Intergenerational
music
Intergenerational
nature walks
Intergenerational volunteering and QOL for
persons with mild to moderate dementia
Results
Stress

A  mean  decrease  in  

stress  (-­‐2.50)  was  
observed  in  the  
intervenNon  group,  
while  an  increase  in  
stress  (+3.14)  was  
observed  in  the  
control  group;  
(Fisher’s  exact  
probability;  p=.01).    
Non-pharmacological approaches to
care
TimeSlips: the process
TimeSlips at Penn State College of
Medicine
Reframing “Alzheimer’s”?
  “There are, in human affairs, two kinds of problems:
those which are amenable to a technical solution
and those which are not.” ~ Dr. Atul Gawande
“AD” as a process not disease event
Prevention – “Looking upstream”
  Dietary patterns
  Environmental health

  Physical activity

  Lifelong learning

  Psychosocial factors

  Access to healthcare

  Political economy
“Health is other people”
The power of “let’s”
  -Go running or walking a 3-5 times a week
-Quit smoking
-Commit to eating a Mediterranean-like diet
-Only eat meat once a week
The power of “let’s”
  -Let's go running or walking a 3-5 times a week
-Let's quit smoking
-Let's commit to eating a Mediterranean-like diet
-Let's only eat meat once a week
Contact
  dgeorge2844@gmail.com
  www.themythofalzheimers.com

  www.facebook.com/themythofalzheimers