Living Up to the Promise of Preventing Dementia

Dementia Does Not Start in the Brain: A New Paradigm in the Prevention of Cognitive Decline: Prevention is the New Cure by Patrick Scott Smith, 2023, 224 pp. ISBN 9781916787858

The false hope offered by decades focused on pathology-removing therapeutics must be seen as leading to the recently approved therapeutics that result in questionable slowing of decline and risk of serious side effects. When added to the symptomatic focused cholinergic and glutaminergic drugs, the result of over four decades of conventional research has done little to change the course of dementia beyond a promise.

In contrast, over the same period, study of the natural history of Alzheimer’s disease (AD) has revealed the link to nutrition, exercise, stress, and meaning; the four pillars. Controlling these factors lowers AD to half or more. Add in discrimination, education, and pollution, and you can explain much of the ethnic prevalence differentials of Hispanic, African-American, and White America.

There are basically three implementations of these lifestyle changes. First is self-directed, through following the four pillars [1]. Second is physician guided with claims of actual reversal for the earliest forms of dementia [2]. While either approach can deliver benefits, one size does not fit all as many need the mentoring provided by a physician-directed program albeit with greater patient cost. Smith takes a third and middle course through modern technology to deliver mentorship. Smith further enlarges the perspective of AD to a systemic disease; a disease of the body that responds to fitness. This perspective places AD as heart disease, eminently treatable. Instead of focusing almost all efforts on a cure for a disease we barely understand, it is only prudent to offer treatment and prevention now.

George Perry, PhD

Department of Neuroscience, Developmental and Regenerative Biology, University of Texas at San Antonio, San Antonio, TX, USA. E-mail: