Medical Editor’s Column: The Alzheimer’s Prevention Plan: A Review of Gary Small and Gigi Vorgan’s Latest Guide

Published Thursday, June 21, 2012
by Marc E. Agronin, MD, Medical Editor, Geriatric Psychiatry News
Gig Vorgan and Gary Small, MD

In the opening to their new book, AAGP member Gary Small, MD, and his wife Gigi Vorgan describe a familiar scenario to many geriatric psychiatrists in which a minor memory lapse prompts concerns about a more insidious memory disorder. As the prevalence of Alzheimer’s disease increases, more and more individuals are scratching their heads and wondering what, if anything, they can do to actually reduce the risk. For these “worried well,” Small and Vorgan’s latest collaboration entitled The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life is perhaps the most practical answer to these concerns. Building upon their previously successful books The Memory Bible and The Memory Prescription, Small and Vorgan lay out the most practical, empirically-based plan to reduce the risk of Alzheimer’s disease.

The book opens with an introduction to the concept of Alzheimer’s prevention, followed by a handy series of ratings scales to assess “where you stand” in terms of memory, physical fitness, diet and stress. The scores from this chapter allow the reader to assess their relative strengths and weaknesses in each area and then tailor their lifestyle to better jibe with the Alzheimer’s prevention program outlined in the remainder of the book. Small and Vorgan then lay out each element of the prevention plan with chapters on memory enhancement, physical fitness, nutrition, stress reduction and attention to medical issues. One chapter presents a series of practical mental work-outs, while another outlines a seven-day program to jumpstart a preventative lifestyle. 

Unlike so many other books that tout anti-aging or anti-dementia strategies and supplements, The Alzheimer’s Prevention Program differs in that it is informed by the clinical work of one of the most distinguished geriatric psychiatrists in the United States, and is based on his interpretation of the latest empirical data. Together, Small and Vorgan bring their characteristic use-friendly writing style and organization to make it extremely readable and applicable to the lives of readers. Used as a tool in clinical practice, it can bridge the gap between the advice dispensed in an average memory work-up and the likely Internet research that many people engage in--research that often leads them astray in terms of supplements or expensive memory programs that offer little if any actual benefit. The book is perfect for the children or grandchildren of Alzheimer’s patients who worry about potential genetic links and want to be proactive in reducing their own risk.

I posed several questions to Dr. Small to highlight several of the more vexing issues that arise when counseling patients regarding risk reduction for Alzheimer’s disease:

GPN: As people are living longer we are clearly facing an explosion of Alzheimer's disease. If someone rigorously adopts the brain healthy techniques and lifestyle that you write about, what sort of risk reduction can someone realistically expect?

Small: In the book, we give an example of a hypothetical case to address this issue and base our estimates using some of the best epidemiological studies. These estimates assume a causal and additive relationship between behaviors and delaying symptom onset. Based on these assumptions, we might expect a four-year delay of symptom onset if someone engages in healthy behaviors over several years (the number of years depends on the particular study): e.g., eats a brain healthy diet, exercises regularly, and remains mentally active. For many people, that could mean never getting symptoms of Alzheimer's dementia during their lifetime.

GPN: Based on available evidence, do you think that physical exercise trumps everything else in terms of brain health?

Small: I agree that the scientific evidence supporting the role of cardiovascular conditioning in lowering the risk for developing Alzheimer's dementia is stronger than that for mental stimulation, stress management, social engagement, and nutrition. However, two of the key Alzheimer's prevention strategies--exercise and diet--are known to prevent diabetes, and a recent large-scale Japanese study found that diabetics are twice as likely to develop dementia compared with non-diabetics (Saaristo T, et al. Diabetes Care. 2010;33:2146-51; Ohara T, et al. Neurology. 2011;77:1126-34).

GPN: You have studied the impact of short-term brain healthy interventions on cognitive function. In addition to your book, what can the average geriatric psychiatrist recommend to patients to actually make a difference in their lives once they have early signs of a memory disorder?

Small: In my own practice, whether I am evaluating and treating someone with normal aging, mild cognitive impairment, or dementia, I not only address medical issues, but lifestyle as well. I review a patient's nutritional history, level of physical activity, sources of stress, etc. For example, I might be treating a patient with mild Alzheimer's dementia--I would start that patient on symptomatic drug treatments, but also encourage the family to take daily walks with the patient, which would improve cardiovascular conditioning, social engagement, and stress management. My impression is that patients and families who are able to embrace Alzheimer's prevention strategies do better initially and over time.

NOTE: Gary W. Small, MD, is the Parlow-Solomon Professor on Aging and a professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at UCLA. He is also the director of the UCLA Longevity Center and director of the Geriatric Psychiatry Division at the Semel Institute for Neuroscience and Human Behavior and the Stewart & Lynda Resnick Neuropsychiatric Hospital. His wife and co-author Gigi Vorgan has been a writer and producer for feature films and television. Read more about Dr. Small and his other works at www.drgarysmall.com.

The Alzheimer’s Prevention Program: Keep Your Brain Healthy for the Rest of Your Life is available through AAGP’s online bookstore at www.AAGPonline.org/bookstore.

Marc E. Agronin, MD, medical editor of Geriatric Psychiatry News, is the medical director of mental health services and clinical research, Miami Jewish Health Systems, and affiliate associate professor of psychiatry at the University of Miami Miller School of Medicine. He is also a member of the AAGP Board of Directors. Agronin can be reached at MAgronin@mjhha.org.

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