New healthy aging goal added to the National Plan to Address Alzheimer’s Disease

The National Alzheimer’s Project Act (NAPA) was signed into law by President Obama on January 4, 2011. The act created the National Plan to Address Alzheimer’s Disease (and related dementias).  The plan has been updated annually, and the most recent update was published two weeks ago. There have been five broad goals: 1) prevent and effectively treat Alzheimer’s disease and related dementias (ADRD) by 2025, 2) optimize care quality and efficiency, 3) expand supports for people with Alzheimer’s disease and their families, 4) enhance public awareness and engagement, and 5) track progress and drive improvement. This year a sixth goal was added: accelerate action to promote healthy living and reduce risk factors for ADRD. The graphic below taken from this latest update shows how these now 6 goals apply throughout the course of the disease.

I am excited that this new goal might help focus attention on the earliest stages of Alzheimer’s disease, before there has been any cognitive impairment. In my opinion, this is likely to be our most successful target for intervention, at least in the near future. As I have discussed many times in this blog, there is ample and growing evidence that risk-factor reduction can be effective in slowing the progression of Alzheimer’s and lowering the chance of developing dementia. But the lifestyle modifications, getting regular aerobic exercise, eating a Mediterranean-style diet, staying intellectually and socially active, getting enough sleep, and managing cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes, and smoking, all important for healthy aging, need to be started early, preferably in midlife.  It is also possible that new medications like anti-amyloid monoclonal antibodies that attack Alzheimer’s pathology, might be most effective in the earliest stages, even before cognitive impairment begins.  At least one clinical trial, TRAILBLAZER-ALZ 3, is already recruiting subjects to test this hypothesis. The key to conquering Alzheimer’s may turn out to be prevention.