In this week’s issue of Journal of the American Medical Association, a group of doctors from Australia attempted to look at the effects of exercise on cognition. They chose a smallish (170) group of youngish (avg. age 68.7) people who reported trouble remembering, but who had no definite evidence of dementia.
Half of the people were encouraged to perform at least 150 minutes of moderate home-based exercise each week. They also received a behavioral intervention to help keep them on track. The rest were given the usual “good health habits” advice, but with no specific information on physical activity.
After 18 months, the exercise group had a small but significant improvement in cognitive function, compared with the control group.
An accompanying editorial felt that the study was encouraging, and that the benefit of exercise was equal to or better than that seen with “cholinesterase inhibitor” drugs for dementia. (Doctors in other countries have a less favorable view of the value of these drugs than American doctors. I tend to agree with them.)
All well and good, but let’s step back a bit. This appears to be a good study, though it doesn’t break a lot of new ground as far as recommendations for healthy living are concerned. My beef is that this prominently featured article highlights a trend of medical journals in publicizing Alzheimer’s research that follows one of only two directions – prevention or cure.
These are admirable goals to pursue, but meanwhile a third research goal is, in my opinion, all but ignored by the medical profession: improving the lives of the millions of people who already have the disease or will get the disease in the coming decades. There is a wealth of literature around this, but it seems to be primarily the domain of psychologists and social workers. The medical journals (a) don’t touch it, and (b) perpetuate a medical view that assumes that between prevention and cure lies nothing more than a world of psychiatric drug treatment, institutionalization, generic interventions and custodianship.
Even many people who work for the charitable organizations have bought into a view of dementia as little more than tragedy. It’s hard to find people who talk of Alzheimer’s with words like life, engagement, growth, meaning and autonomy. “Quality of life” studies often measure only medical outcomes or quality of care.
Until we have a radical attitude adjustment and start to view people with dementia primarily as people rather than a disease, we will continue to be blind to myriad opportunities to enrich their lives to a far greater measure than any medication has ever accomplished.
— Al Power