THINGS THAT MATTER: Alzheimer’s – Prevention is better than cure

John and Jane, both in their 80s, were having dinner with Jack and Jill – also octogenarians. After a dinner of steak and chips, cheesecake and chocolate eclairs, washed down with two bottles of wine, Jane and Jill repaired to the kitchen for some wife talk, while John and Jack took to the living room with a bottle of port and some Cuban cigars.

John said to Jack “You know, last week we had dinner at a wonderful restaurant.” “What was it called?” asked Jack. “I really can’t remember,” said Jack from his recliner chair, knocking back his second glass of port. “What’s the name of that flower that smells so sweet and has a lot of prickles?” Said Jack: “You mean a rose?” “Ah, yes,” said John, and he shouted out: “Rose, what’s the name of that restaurant where we had dinner?

This shaggy dog story carries several messages about Alzheimer’s Disease, which has become perhaps the biggest health and social burden of all, as populations age. It occurs in some 7 to 8 percent of those over 65, although prevalence does not increase in the older old, which may be explained by new understanding of the disease.

We’ve just marked International Day of Disabled Persons, on December 3rd, while a few weeks ago World Alzheimer's Day, September 21st, was a day committed to raising awareness about Alzheimer's and dementia. Because of the impact on ability to take care of oneself, Alzheimer’s is a most comprehensive form of disability and a huge public health problem. But what has become clear in recent years is the potentially huge role of prevention in curbing the epidemic.

Alzheimer’s is considered to account for three quarters of all cases of dementia. It causes problems with memory, thinking and behaviour. Symptoms develop slowly and get worse over time, interfering with daily tasks and eventually self-care. The burden on care givers is immense, costly and distressing.

Alzheimer’s is defined by the pathognomonic findings of specific proteins in the brain, accompanying shrinking of the brain, demonstrated on CT and MRI scanning. There’s a rare familial form while there’s a modest familial trend of other forms. But what has become clear in recent years is that it is in fact a multi-factorial condition, with multiple risk factors – and these risk factors are the very risk factors that affect the other main causes of morbidity and life expectancy.

The main culprits – what some have called a laundry list of Alzheimer risk factors – are chronic stress, lack of exercise, lack of adequate sleep, diabetes and insulin resistance, obesity, poor kidney function, high blood pressure, poor nutrition and unhealthy diet, heart disease and small strokes, lack of social connections, lack of mental activity and stimulation, inflammation from exposure to infections and other environmental causes including excessive alcohol and smoking, as well as genetic predisposition. They appear to be additive, and increase risk in those with the susceptible genes. And we can recognise most of these risk factors as those which shorten life. The corollary is that healthy life styles preserve both body and brain. The great majority of the subjects studied by Dr. Susan Archer in the Centenarians in Barbados study demonstrated the big five aspects of healthy living – lean body mass, healthy diets, physical activity and strong social connections, which included religious faith and participation.

Research teams in Finland and the USA in particular have reported preliminary studies with good results on improving and even reversing the clinical features of Alzheimer’s with rigorous life style changes, concentrating on these factors – exercise, healthy eating, keeping lean and strengthening social and mental activity. Our own intensive efforts of the Barbados National Commission for Chronic Non Communicable Diseases (NC-CNCD), the George Alleyne Chronic Disease Research Centre, The Heart and Stroke Foundation and other NGOs have had only modest results, but perhaps these new data will prick the consciousness of those who are eating themselves today in front of the television. Who wouldn’t want to avoid needing total care at the end of life, when it can be prevented?

So let’s all make 2019 the year of healthy living for happy endings!

Bouquets: Some very, very big bouquets to retiring Director of Music of the Royal Barbados Police Force – Mr. Keith McDonald Ellis, the Royal Barbados Police Band and our highly trained Acting Deputy Director Mr. Dexter Norville, MMus, BMus, LTCL, PGDip, LRSM, ATCL.

My wife and I were honoured to be invited to the Retirement Ceremony in honour of Mr. Ellis on Friday night at the Errol Barrow Centre for Creative Imagination, and we were “blown away”.

First of all we had the exhilarating pleasure of singing along with The Band playing our National Anthem. It’s been my passion and mission for years to persuade us all to sing the anthem every single time, to inspire and confirm our patriotism, and with the amazing energy and joie de vivre of that rendition, led by the dynamic conductor Mr. Norville. I was in heaven! And after the welcome by Acting Director Mr. Andrew Lynch and the citation regaling us of Mr. Ellis’s achievements, we were entertained by a wonderful selection of what Mr. Norville described as Mr. Ellis’s favourite compositions, including Colonel Bogey on Parade, Light Calvary Overture and a medley of Festive Songs of Christmas, an arrangement by American composer, conductor, arranger, writer, and trumpet player Frank Erickson. The energetic, dramatic, inspired conducting and the ecstatic music had everyone bouncing on the age of their seats, and when the Overture was completed the applause was deafening. I hope we can see and hear a great deal more of this, our most magnificent cultural icon, The Royal Barbados Police Band in the coming year. I understand that next year the band is celebrating 130 years, and celebrating St Cecelia week in October, and planning to host the first ever Regional Tattoo, inviting bands from Trinidad and St Lucia and local bands as well. It will be a magnificent first.

Thank you Mr. Ellis, Mr. Lynch and Mr. Norville and your dedicated, gifted musicians.

(Professor Fraser is past Dean of Medical Sciences, UWI, Professor Emeritus of Medicine and President Emeritus of the Barbados National Trust. Website: profhenryfraser.com)