Medical researchers who are furiously trying to develop new tests, vaccines and treatments for Alzheimer’s and other devastating brain diseases have pointed us toward something we can use immediately: a helmet.
We are not talking about some type of super-helmet with miraculous prophylactic powers. Just an ordinary helmet, suited to the activities many of us like to engage in. A bicycle helmet when we ride. A ski helmet when we ski. The ever-unpopular motorcycle helmet when we tool down the interstate to Bike Week in Florida or New Hampshire or South Dakota.
Researchers in Boston published a study suggesting that many cases of amyotrophic lateral sclerosis (also called A.L.S. or Lou Gehrig’s disease) are in fact a related but separate condition caused by repeated head trauma. Dementia pugilistica, or punch-drunk syndrome, has long been a prospect professional boxers face. Some medical professionals have suggested that Muhammad Ali’s case of Parkinson’s disease was precipitated by the abuse he took in the ring. And studies now show that small head injuries over time can dramatically raise the probability of developing Alzheimer’s disease.
Dr. Ann McKee, the lead neuropathologist on the recent A.L.S. study, was also a leader in recognising a condition called chronic traumatic encephalopathy (C.T.E.), which mimics the pathology of Alzheimer’s. McKee noticed a disproportionately high incidence of C.T.E. among professional football players and boxers. Though her sample size was initially small, it has grown steadily over the last few years. In autopsy, the athletes’ brains showed the “plaque and tangles” of proteins that are the signature of Alzheimer’s disease.
McKee explained, “To get this number in a sample this small is really unusual, and the findings are so far out of the norm. I only can say that because I have looked at thousands of brains for a long time. This isn’t something that you just see.”
Recently, researchers at the University of Pennsylvania solidified the link between repeated head injury and full-fledged Alzheimer’s. While it has long been understood that severe head trauma can trigger or hasten the condition, this study showed that mild, repeated trauma speeds up the disease’s process as well. For those studying a disease whose exact causes are still nebulous, it is a discovery that’s both sobering and potentially helpful.
Early detection is one of the biggest concerns in Alzheimer’s research today. A study published in the Archives of Neurology demonstrates the potential accuracy of testing cerebrospinal fluid, for example, which could prove a major boon. Knowing that patients who have suffered even mild head trauma are at risk can help ensure that early testing occurs. For years, there has been no way to tell that a patient has Alzheimer’s with certainty until post-mortem examination, but that is slowly beginning to change.
Part of this recent progress is the result of an unusual decision by researchers to make all their findings instantly available to one another. Several major organisations, including the Food and Drug Administration and the National Institutes of Health, formed an alliance in 2003 when they realised that no one company or institution would be able to make the rapid progress necessary to gain traction against Alzheimer’s.
And while this collaboration flies in the face of the typical way that medical research is conducted, it did not come a moment too soon. The cost of Alzheimer’s disease is immense. According to a report by the Alzheimer’s Association, the U.S. spends $172 billion annually on Alzheimer’s in patients 65 and over. Current trends and an ageing population imply that the figure could reach more than $1 trillion annually by 2050. The potential out-of-pocket costs for families, and the current uncertainty about who could be affected or why, are also the driving forces behind the long-term care insurance industry.
This is, of course, to say nothing of the enormous personal impact Alzheimer’s has on individuals and their families. Dementia caused by C.T.E. and Parkinson’s can be equally devastating. But early diagnosis may be able to help with treatment, and can certainly help with costs. Prevention is better still.
Earlier generations underestimated the importance of head protection. I myself was initially sceptical of the trend among modern parents to strap helmets to their children before every bike ride around the neighbourhood, though I did it with my own kids. I was also once a helmet-less skier, until my daughters joined me on the slopes. By that point, there were too many serious or fatal skiing accidents to ignore. (Actress Natasha Richardson recently provided a tragic example of the deadliness of seemingly benign head injury.)
Gone are the days of Lou Gehrig, who was notorious for playing through injuries that would bench even N.F.L. players today. And as more information about the long-term effects of head trauma becomes available, we are going to have to evaluate how we protect athletes, soldiers and children with an even closer eye. The cost of redesigning a helmet can’t compare to the staggering cost of Alzheimer’s alone.
For now, it seems the simplest and earliest preventative treatment for Alzheimer’s is to make an effort to protect the heads of children and young adults. We’ll take the ounce of prevention for now, and hope that the pound of cure is not too far away.
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