A response to The New York Times article, “Years Later, No Magic Bullet Against Alzheimer’s Disease”, dated Aug 28, 2010 based on the NIH Report “Preventing Alzheimer’s disease and Cognitive Decline” from Dr. Peter Magaro.
In late spring 2010, the National Institute for Health (NIH) produced a review of research on Alzheimer’s disease (AD) and cognitive decline that will stand as a standard for at least a decade and this with an appreciation of the rapid proliferating of information with advanced telecommunication technology. The thoroughness of the group from Duke University who managed the review is without peer in the realm of medical research. As a former academic involved with years of research and who has worked through the National Institute for Mental Health (NIMH) research initiatives on schizophrenia, depression and psychotherapy, this is a milestone. As is obvious, I am not writing to criticize the report. What I am upset about is the public and professional reporting on the review. Especially the New York Times.
As the Director of the Memory Training Centers of America, I work everyday with people with AD and memory loss. We provide cognitive training and believe it is helpful and, more importantly we believe, the research supports this form of treatment more than any other. And guess what: That was the conclusion of the original report and the point the NY Times chose to ignore. The article in the NY Times painted a picture of no progress after decades of research. This is not correct. The review reported hopeful signs of a successful intervention, brain training.
It should be said right off; the NIH report is not light reading. It is 748 pages of charts and numbers. The purpose of the review was to evaluate the state of the research in this important area. They divided studies into two groups; those who examined the prevention of AD and those that examined brain decline. The quality of the research was divided into 3 categories; high, moderate and low depending on how studies met many specific research criteria such as appropriate control groups and dependent variables. The results of the review were divided into 4 categories; increased risk of AD or cognitive decline; decreased risk; no association between the variables and not enough information. In effect, you have a 34 matrix for each dimension, AD and cognitive/brain decline.
The NY Times story was titled “Years Later, No Magic Bullet” and the reporter went on to conclude that “nothing has been conclusively shown to reduce the risk of Alzheimer’s disease”. However, she leaves out the main findings and especially those results that are encouraging and could give people some choices on how to combat the illness, all within the Alzheimer’s Association warning that there is no definitive treatment. Of course in any research there is no definitive answer. Is there a definitive answer for prostrate cancer? As one researcher concluded for some types of prostate cancer in defined time periods, the best treatment may be to lose weight. In effect, AD like most chronic diseases is a set of multiple conditions that will require multiple treatments and the research needed is to determine what works with whom and when. This takes me to why I am writing this complaint against the NY Times.
The reporter neglected to report on half the review; the results on cognitive decline; the other 11 cells in the matrix. These should not have been left out because the missing half of the story is the most important half. . Each section in the NIH report is not exclusionary. Looking at the research on the risk of AD without considering the research on the risk of cognitive decline is like describing a coin without considering both sides.
Possibly a more important reason to consider both sides of the coin is that cognitive decline is a more viable indicator of the disease process than a risk for AD. Cognitive decline is the functional process that mirrors the structural decline. Risk for AD is a probability of an intervention to decrease a complex function. AD progression is a factor of multiple variables; socio/cultural events, diet, lifestyle, genetics and more. In a holistic concept of disease, the research examining one factor’s effect on the presence or progression of the disease usually measured by symptoms is extremely difficult and must assume large variance relative to all the other contributing factors. Cognitive decline has a lighter load to carry in terms of measurement and prediction and possibly real life meaning.
The clearest relationship in the treatment of AD today is the relationship between brain decline and AD. The NIH report found that the only treatment that showed a High level of Evidence and a Decreased Risk of Cognitive Decline is COGNITIVE TRAINING. Combine this with the finding in the “low level of evidence treatment of AD” section that found that cognitive training was also associated with decreased risk of AD. If we listen to the scientific evidence reported in the review, we have a combination of findings that says we should be prescribing cognitive training for all patients with signs of cognitive decline. Is it a cure? No. From a research perspective, is this the only treatment that makes any sense? Yes. Is it the final answers, no?
This review produced evidence that cognitive rehab should be considered as a treatment for every individual with a mild cognitive impairment. While the outcome will not be guaranteed, this is the most scientifically proven way to treat AD: Scientifically proven meaning the current weight of scientific evidence that can shift in time.
Quite a different statement than no treatment is available for AD, which was concluded and reported by the New York Times.
About Dr. Peter Magaro
Dr. Magaro has a long career in research with 6 books and over 80 articles in professional journals in cognitive psychology. His publications began in the early 1960’s and continue until today with a presentation this year at the NY State Psychological Association convention. His research on psychopathology and psychotherapy has given him a long-term perspective on findings over time. His last academic position was Full Professor and Director of Clinical Training at Ohio State University. He has been a research consultant at the Hispanic Institute at Fordham University and at Cornell University Medical School. At present, he is president of the Alzheimer’s Treatment and Memory Training Centers of America (ATMTCA). ATMTCA has partnered with SBT / HAPPYneuron to bring the Memory Treatment Program to patients suffering for memory related deficits due to Mild Cognitive Impairment, dementia and Alzheimer’s disease.
New York Times article: “Years Later No Magic Bullet against Alzheimer’s disease”
National Institute for Health report “Preventing Alzheimer’s Disease and Cognitive Decline”