Your otherwise excellent survey on the treatment of Alzheimer’s disease (‘This looks like the real deal’: are we inching closer to a treatment for Alzheimer’s?, 22 November) hardly mentions the most promising approach, which is disease prevention. Alzheimer’s has multiple causes, and identifying those causes that can be modified is the direction we need to take. Factors such as smoking, high blood pressure, high blood glucose, lack of exercise, poor nutrition and limited social interactions have already been identified. Many of these are modifiable by lifestyle choices and by specific dietary interventions.
For example, people with prodromal Alzheimer’s disease who had inadequate B vitamin status showed slowing of brain shrinkage and of cognitive decline when treated with high-dose B vitamins in an Oxford trial. A recent report found that members of the UK Biobank cohort who had diabetes (a risk factor for dementia) had less risk of developing dementia if they adopted healthy lifestyles. If a fraction of the amount spent by drug companies on Alzheimer treatment trials were to be spent on randomised trials of multidomain lifestyle interventions, there is every hope that much future Alzheimer’s disease could be prevented.
Prof A David Smith