‘One pill’ is not the answer. Prevention key when it comes to dementia, Creighton prof says

But Dr. Rajesh Tampi says it’s time to remind people that no one pill will deliver a silver bullet to treat Alzheimer’s and other dementias. There’s a lot that individuals, health systems and society can do to prevent conditions that are growing in number nationally and worldwide and stand to result in significant costs, both on an individual and societal level. 

“There are other things we can do very early to slow down the onset of illness and decrease incidence of illness,” said Tampi, professor and chairman of psychiatry at Creighton University School of Medicine. “… As with diabetes and high blood pressure, one pill is not going to do that. You also have to do the lifestyle modifications that help. Whatever you’re doing to improve your heart health should be what you’re doing to improve your brain health.”

To help spread that message, Tampi co-authored an article in the July issue of Psychiatric Annals about the role social and economic factors, also known as social determinants of health, play in risk for Alzheimer’s and other dementias.

Evidence indicates that economic instability, poor access to education, unsafe neighborhoods, environmental pollution, lack of social engagement and racial discrimination increase the risk of developing such conditions. On the other hand, higher quality education, social connections and a sense of belonging to one’s community had a protective effect.

The reminder comes as the U.S. Food and Drug Administration earlier this month approved an intravenous drug called donanemab, under the brand name Kisunla, to treat early Alzheimer’s disease in adults with mild cognitive impairment or mild dementia. It follows another drug called lecanamab, or Leqembi, that received traditional approval a year ago. In studies, both slowed cognitive decline but did not reverse it. Nor are they cures. And while patients and families have greeted their arrival with excitement, the drugs come with some concerns about potential safety risks.

One hurdle when it comes to using such drugs has been diagnosing the condition. On Sunday, Swedish researchers in the Journal of the American Medical Association reported of a blood test that was 90% accurate in flagging the disease. The FDA, however, has not yet approved any blood test for the condition. 

But Tampi said at least a third of dementias are preventable. That’s a big number, given that the number of people with dementias — a category that includes Alzheimer’s, the most common type — is expected to double in the next 25 to 30 years, both worldwide and in the United States.

According to the Alzheimer’s Association, that’s because the risk of dementia increases with advancing age. The population of Americans age 65 and older is projected to grow from 58 million in 2022 to 82 million by 2050. Currently, some 6.9 million Americans over age 65 are living with Alzheimer’s. That includes 36,000 in Nebraska and 66,000 in Iowa. 

Health systems, Tampi said, aren’t geared to take care of that many people. The new medications, which target a protein that accumulates as plaques in the brains of older adults, are expected to benefit only those in the earliest stages of the disease. 

Tampi noted concerns about access to the drugs by people of different socioeconomic groups. The Centers for Medicare and Medicaid Services has expanded coverage for scans to diagnose the condition and will cover the cost of the drugs if prescribing physicians participate in a registry. But patients may face copays for the therapies, follow-up visits and infusions. 

Tampi said CHI Health — he practices with CHI Health Behavioral Health Services — has decided to hold off for the time being. Not enough patients are asking for it, and the health system doesn’t have the necessary institutional support.

“Prevention is always better than a cure,” he said.

Dr. Daniel Murman, director of Nebraska Medicine’s memory disorders and behavioral neurology program, noted last year that rollout of the drugs likely would be slow. The health system began infusions of Leqembi in February and so far has started 15 patients on the drug, he said in a message this week. Patients receive IV infusions every two weeks. 

The health system anticipates beginning infusions of the newer drug, Kisunla, in September, said Murman, who has been involved in multiple clinical trials of the drugs. It will be given as a monthly IV infusion. Medicare and Medicaid cover the cost of the therapies for patients with mild cognitive impairment to mild Alzheimer’s, but many private insurers do not.

Tampi said prevention efforts start at an individual level. Individuals need to eat healthfully, get regular exercise, minimize midlife obesity and appropriately treat hypertension, cholesterol and diabetes. 

On the mental health front, they should identify and treat depression, maintain their educations and learn new skills, he said. Those who don’t like puzzles, a standard recommendation, can read a book, take a class or learn how to cook a new recipe. A key is to mix things up: If you like watching or reading westerns, try a thriller instead. Today, many simple educational programs are available for older adults to download even if they can’t drive to a class, from learning about mindfulness to how artificial intelligence works.   

“These are all things that actually can help with preventing or slowing down the onset of the dementias and can help maintain functioning for a long time,” said Tampi, who also has written special reports on how to improve outcomes for geriatric populations.

The Alzheimer’s Association, in fact, noted in a 2024 report that a number of recent studies have indicated that the incidence of Alzheimer’s and other dementias appears to have declined in recent decades, a shift attributed to improvements over the 20th century in modifiable risk factors such as increased prevention and treatment of hypertension and greater educational attainment.

Families have to support members’ ability to follow those steps, Tampi said. They also can play a big role in helping maintain social connections, the lack of which are a risk factor highlighted in the Psychiatric Annals article.

Individuals should make sure they’re not isolated, particularly if they’re in caregiver roles, and that their parents and other older adults in their lives aren’t either. Pets are good for alleviating isolation, he said, and some recent research indicates even robot companions can play a role. Cell phones and tablets also have the power to help maintain connections. 

At the health system level, some now have the ability to look more closely at social determinants through their electronic health records and make referrals for healthy food and other types of assistance, he said.

Of course, the kinds of help older adults might need may fall into different categories based on their age and fitness. Those unable to drive significant distances may need to be connected to therapy through telehealth or to nutritional programs such as Meals on Wheels.

Said Tampi, “I keep saying to all my patients, ‘We have to work together to improve your health.'”