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History and experience: the direction of Alzheimer’s disease

Reichman, William E. MD; Rose, Nathan S. PhD

Menopause: The Journal of The North American Menopause Society: July 2012 - Volume 19 - Issue 7 - p 724–734
doi: 10.1097/gme.0b013e31825a28f2
2011 NAMS/Pfizer — Wulf H. Utian Endowed Lecture

As the global population is projected to age substantially in coming decades, the number of individuals who will develop Alzheimer disease (AD) is expected to rise dramatically. We have come to understand that AD is likely to be multidetermined through interactions between heritable causal and susceptibility genes, environmental exposures, midlife health status, and lifestyle choices. In addition, mounting evidence suggests that the neuropathological processes characteristic of AD can be detected several years before the onset of clinical symptoms. Thus, AD is now considered to have presymptomatic, prodromal (mild cognitive impairment), and dementia phases. Through cerebrospinal fluid biomarkers, volumetric neuroimaging, functional neuroimaging, and cognitive stress tests, individuals at significant risk for developing dementia can now be identified with greater sensitivity and specificity. Consequently, there is growing attention to identify interventions to halt or delay the onset of AD. The biological capacities of neurogenesis and neuroplasticity and the related concepts of brain and cognitive reserve provide a rationale for developing techniques to maintain or enhance the cognitive abilities of older persons to sufficiently prevent dementia. This has led to the emergence of a new “brain fitness” commercial industry in which “products” are being marketed and sold to consumers to “keep your brain sharp.” However, most available brain fitness products have scant scientific evidence to support their effectiveness. Nevertheless, ongoing research advances do support the potential for memory and other intellectual functions to be strengthened and maintained through cognitive training, physical exercise, dietary choices, social engagement, and psychological stress reduction.

From the 1Baycrest Centre, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; and 2Rotman Research Institute, Baycrest Centre, Toronto, Ontario, Canada.

Received February 1, 2012; revised and accepted April 12, 2012.

Funding/support: The content of this article was presented by Dr. Reichman at the NAMS/Pfizer Wulf H. Utian Endowed Lecture last September 23, 2011, in Washington, DC at the Annual Meeting of The North American Menopause Society (NAMS). An endowment to NAMS from Pfizer established this annual lectureship, with faculty selected by the NAMS Scientific Program Committee.

Financial disclosures/conflicts of interest: Dr. Reichman is president and chief executive officer of Baycrest, which has a major equity stake in a new brain fitness company called Cogniciti, Inc., in which he is also a director.

Address correspondence to: William E. Reichman, MD, Baycrest, 3560 Bathurst Street, Toronto, Ontario, Canada M6A 2E1. E-mail:

© 2012 by The North American Menopause Society.