Reimagining Dementia in a Demented World

Reimagining dementia
in a demented world
Peter J. Whitehouse MD-PhD
Case Western Reserve University and
University of Toronto
Iain McGilchrist –need more right hemisphere
Left –focus and concrete Right – context and metaphor
Birth of the
Tree Doctor
Maine
Rachel Carson Anniversary
1962
The Vickerage
From Demedicalization to Renaturalization:
dementia and nature in harmony
Peter Whitehouse, Danny George, Johanna Wigg, and Brett
Joseph
Thomas Kuhn The Structure of Scientific Revolutions
1962
From paradigm shift to metaparadigm shift
The Journal of Prevention of Alzheimer’ Disease Volume 1 Number 1 2014
The Myth of Alzheimer’s and other
powerful stories
Tedx Presentation using Prezi
The Myth of Alzheimer’s
Memory loss is common with age and causes suffering.
But how we think and feel about cognitive aging is key
to flourishing.
What is the Myth (not very controversial except title)?
Alzheimer (’s) (s) is not one condition
They are related to (severe brain) aging
Asymptomatic Alzheimer’s disease –
Reisa Sperling (“its aging”)
Neuropathology – not definite but
“disengaged” –Brad Hyman “it’s aging”
Language Games ?
Alzheimer’s Disease Research Summit
May 2012 – effective treatment by 2020
Lifelong management of amyloid-beta
metabolism to prevent Alzheimer's
disease. Sam S Gandy
N Engl J Med 367(9):864-6 (2012)
Pharma wants a statin
for Alzheimer’s
The Cleveland Regional StoryBank
DSM 5 - Replacing dementia with
Major Neurocognitive Disorder
Changing perspectives regarding
late-life dementia – the dynamic polygon model
Majid Fotuhi, Vladimir Hachinski and Peter J. Whitehouse
Environmental Threats
to Healthy Aging
Greater Boston Physicians
for Social Responsibility
www.psr.org/Boston
Based on the report by
Jill Stein MD, Ted Schettler MD, MPH,
Maria Valenti and Ben Rohrer
Featuring The Intergenerational School
Used by Peter and others at Commonweal
Released by
Greater Boston Physicians
for Social Responsibility
and
The Science and Environmental
Health Network
Multiple factors
interact to
influence chronic
disease
Arc of life
Early life experiences can influence diseases of aging
Commonweal – Collaborative on Health and
Environment
The Healer’s Art at Commonweal
Western Disease Cluster Illnesses Increase Risks
of Neurodegenerative Disease
Environmental
Factors
Altered
Biological
Pathways
•Food System/Diet
•Sedentary builtenvironment/ transportation
•Fossil fuel energy
•Socioeconomic stress/disparities
•Toxic Chemicals
Western Disease
Cluster
Diabetes
Obesity
Cardiovascular disease
Metabolic syndrome
Neurodegenerative
Disease
Alzheimer’s/Dementia
Parkinson’s*
Influence of Nutritional Factors
• Increase risks
saturated and trans fats
high glycemic carbohydrate
lack of fruits/vegetables/omega 3s
Excess omega 6s?
• Reduce risks
fruits, vegetables
omega 3s
low glycemic carbohydrate
Mediterranean diet
Physical Activity
• Physical activity is linked to substantial reductions in the risk of dementia and
Alzheimer’s.
• Observational study – Physical activity at least twice a week in midlife associated
with > 50% reduction in the risk of dementia/AD in later life. Rovio 2005
• Randomized intervention - Older subjects at risk for AD who walked 50 minutes a
day 3 times per week showed improvements in cognition while the control group
showed no net change from baseline at 1.5 yrs. Latenschlager 2008
Western Disease Cluster Illnesses Increase Risks
of Neurodegenerative Disease
Environmental
Factors
Altered
Biological
Pathways
•Food System/Diet
•Sedentary builtenvironment/ transportation
•Fossil fuel energy
•Toxic Chemicals
•Socioeconomic stress/disparities
Western Disease
Cluster
Diabetes
Obesity
Cardiovascular disease
Metabolic syndrome
Neurodegenerative
Disease
Alzheimer’s/Dementia
Parkinson’s*
*Current evidence links environmental factors and the Western disease cluster to Alzheimer’s disease. Evidence also clearly links environmental factors to
Parkinson’s disease, but does not at this point show a clear relationship between Parkinson’s and all the diseases of the Western disease cluster.
Lead and otherd: cause impairment in
neuroplasticity with life long effects
Western Disease Cluster Illnesses Increase Risks
of Neurodegenerative Disease
Environmental
Factors
Altered
Biological
Pathways
•Food System/Diet
•Sedentary builtenvironment/ transportation
•Fossil fuel energy
•Toxic Chemicals
•Socioeconomic stress/disparities
Western Disease
Cluster
Diabetes
Obesity
Cardiovascular disease
Metabolic syndrome
Neurodegenerative
Disease
Alzheimer’s/Dementia
Parkinson’s*
*Current evidence links environmental factors and the Western disease cluster to Alzheimer’s disease. Evidence also clearly links environmental factors to
Parkinson’s disease, but does not at this point show a clear relationship between Parkinson’s and all the diseases of the Western disease cluster.
Socioeconomic inequality effects are hugh
High Inequality Results in More US Deaths than Tobacco, Car Crashes and Guns Combined
April 19, 2014
by Joshua Holland
•
•400
A casket at the Museum of Funeral Customs, Springfield, Illinois, 2006. (Wikimedia Commons: Robert Lawton.)
In 2009, the British Medical Journal (BMJ) published a study that revealed what seems to be a shocking truth: those who live in societies with a higher level of income
inequality are at a greater risk for premature death.
Here in the United States, our high level of income inequality corresponds with 883, 914 unnecessary deaths each year.
More specifically, the report concluded that if we had an income distribution more like that of the Netherlands, Germany, France, Switzerland
— or eleven other wealthy countries — every year, about one in three deaths in the US could be avoided.Socio
Science special issue- “science of inequality”
May 23, 2014
Multiple Interacting Influences
The Intergenerational Schools
The Intergenerational School fosters an
educational community of excellence
that provides skills and experiences for
life long learning and spirited citizenship
for learners of all ages.
Highest performing charter school in Ohio
Twice finalist in best intergenerational program in USA
Being introduced around the world including Toronto
Evidence of value to persons with ”cognitive
challenges”
Intergenerational relationships
“I have had a really great time talking to
Dr. Miller for the past two months. First
she didn’t like to say that much but now
everytime [sic] she comes she tells us
even more than we need to know. Today
we asked her one small question, how did
grown-ups make a living to pay bills and
take care of their children in her teenage
years, and she kept on talking about it for
about 10 to 15 minutes!”
Intervention
Intergenerational volunteering and QOL for
persons with mild to moderate dementia
Results
Qualitative results
Healthy Brains Healthy Communities
Intergenerational Health and Wellness
Practice (InterWell)
• School-base health center (NASBHC)
• Integrated nursing research and practice (FPB)
• Curriculum connected (TIS)
• Primary care (Family medicine)
• Brain health (University Neurological Institute)
• Health coaching/self-management (CWRU OB)
• Arts and music enriched (Center for Music and Medicine)
• Garden-based (Cleveland Botanical Garden)
• Individual and public health
Edible Forest
Garden
Kay Fuller
Freeway Fighter
1960’s environmental
activist
DREAM BIGGER
MAKE YOUR STORY A LEGACY PROJECT
1 World, 1 Book
ENGAGE
dreams / aspirations
7-Gen Resources
EXPLORE
needs / interests
Legacy Projects
ENABLE ACTION
assets / strengths
YOU 177 is a r/evolution in the way we think and
solve problems that strategically empowers and
connects youth, adults, and elders of all ages and
abilities for inspired lives, stronger communities, and
a sustainable world. 1 World, 7 Generations, 7 Billion
People and YOU.
Intergenerativity: a blend of innovation and
integration - learning “between” to create a
resilient and sustainable “beyond”
Metaphors: “think like a mountain; feel like water”
Limitations of evidence-based medicine
• RCT problem of generalizability
• RCT as gold standard – only those with gold can do them
• The more and bigger RCTs are done on an intervention, the less likely it is
consistently interpretable and even important
• Sense of purpose
• Rush epidemiological studies suggest those with strong purpose get less dementia
• Can we do an RCT with sense of purpose as the intervention?
• The anecdote (undocumented story) is the antidote (against poison)
From Neurodegeneration to Brain
Health: an integrated approach
October 25 and 26, 2013 Cleveland
Inflammation- Classic Concept
Defined by appearance.
“Calor, dolor, rubor, tumor.”
Heat, pain, redness, swelling.
http://pathmicro.med.sc.edu/ghaffar/innate.htm
Western Disease Cluster Illnesses Increase Risks
of Neurodegenerative Disease
Environmental
Factors
Altered
Biological
Pathways
•Food System/Diet
•Sedentary builtenvironment/ transportation
•Fossil fuel energy
•Socioeconomic stress/disparities
•Toxic Chemicals
Western Disease
Cluster
Diabetes
Obesity
Cardiovascular disease
Metabolic syndrome
Neurodegenerative
Disease
Alzheimer’s/Dementia
Parkinson’s*
*Current evidence links environmental factors and the Western disease cluster to Alzheimer’s disease. Evidence also clearly links environmental factors to
Parkinson’s disease, but does not at this point show a clear relationship between Parkinson’s and all the diseases of the Western disease cluster.