Brown on Dementia: Progress, Lifestyle, Genes

Dementia almost feels like an epidemic that appeared overnight. Friends and relatives are being diagnosed, and “senior moments” suddenly seem less innocuous.

According to Dr. Gavin Brown, a general neurologist with 17 years of clinical experience, the reality is more nuanced. Brown, who works with Laureate Medical Group and serves as director of neurology for the Northside Healthcare System, stated, “Although the prevalence of dementia in cases has increased dramatically over the past few decades, the percentage of cases at a certain demographic has remained stable. Dementia risk increases sharply with age, and cases are on the rise because of longevity.”

Earlier diagnosis testing is another factor.

The numbers are sobering. Brown notes that nearly 7 million Americans are living with dementia and that total is projected to double by 2050. By then, the annual cost to the U.S. healthcare system could surpass $1 trillion.

Brown explained. “This staggering cost doesn’t count the caregiver burden, cost of care, lost wages, which nearly doubles the financial burden. Left unchecked, dementia is on track to become a serious economic and social crisis.”

Despite the gloom, Brown offer optimism. “Individuals have more [prevention] power than they realize. The most important message: You have real power to lower risk developing dementia, now believing that many cases are  preventable.”

Alzheimer’s disease is often intertwined with dementia, an umbrella term describing cognitive impairment severe enough to interfere with daily life.

“Alzheimer’s comprises 70 percent-plus of dementia cases — the second most common is vascular cognitive impairment, which broadly includes changes caused by stroke or hardening of the arteries supplying the brain.

Brown added, “It’s worth noting that many cases aren’t due to a single cause. Sleep, smoking, alcohol, medications, vascular disease and stress can all contribute to cognitive decline, making prevention important. A healthy diet, regular exercise, and quality sleep, controlling Diabetes and high blood pressure, and staying socially engaged, are among factors with the strongest evidence. These aren’t small, marginal effects, they add up to meaningfully lower your risk. You cannot slow chronological aging, but you can slow biological aging. We should view our health like an investment: steady contributions over time will yield great long-term rewards.”

Brown has few patients on newish anti-amyloid infusion therapy for Alzheimer’s. These drugs don’t reverse existing symptoms or restore lost cognition. Studies show that they can slow progression, particularly when treatment begins early. His experience with these treatments has been very positive. “Although you never know the ‘alternate universe’ — how a patient might otherwise progress without treatment, patients on therapy do seem to progress slower,” he said.

The medications aren’t appropriate for everyone and should be considered part of a broader treatment vs. a substitute for healthy living. According to Brown, blood biomarkers are also being used by neurologists and some primary-care physicians as approximately 90 percent accurate for helping rule Alzheimer’s in or out. Not intended to predict Dementia in healthy young people, they’re meant to screen symptomatic patients.

Find yourself blanking on a familiar name or putting something in an odd place? Brown offers reassurance. “It’s normal to occasionally forget names, misplace the keys, or forget where they parked. Sleep, stress, alcohol and certain medications can all affect everyday cognition.

“The concern comes when lapses become increasingly frequent or begin interfering with daily life. Genetics can also play a role. Having an affected parent or sibling roughly doubles the lifetime risk of developing Alzheimer’s disease. Brown emphasizes that genes are not destiny, pointing to the role of epigenetics, in which lifestyle and environment can influence risk.

Brown’s optimism ultimately comes from the rapidly changing field of neurology.

“The past decade has shown an explosion of promising research. I am very optimistic that, in the near future, we will have a more effective toolbox to diagnose and treat Dementia.”

His interest in neurology began during college after reading, “An Anthropologist on Mars,” by Oliver Sacks, and then meeting him. Brown grew up in Dallas, attended medical school at the University of Texas, and completed his neurology residency and fellowship at Emory University. He and spouse, Beth Halpern-Brown, have two children. In his free time, he jokes, “I do whatever my wife tells me to.”

Two things he takes seriously: nutrition and exercise!