Dr. Yakir Kaufman is the director of neurology services at Herzog Hospital in Jerusalem and the founder of the Brain Health Center.
Dr. Kaufman’s connection to Canada is strong, however. After receiving his medical degree from Hebrew University in 1994 and completing his neurology residency at Hadassah Medical School, Dr. Kaufman spent two years in Toronto as a fellow in the behavioural neurology unit at the Baycrest Centre for Geriatric Care and its affiliated Rotman Research Institute.
An expert on Alzheimer’s disease, Kaufman was recently back in Canada to present a series of educational presentations called “Brain Health: Preventing Alzheimer’s Disease and Other Forms of Dementia.” He spoke with The CJN before presenting in Toronto.
What can people do to prevent the development of Alzheimer’s disease and dementia?
Dementia is one of the biggest threats of the world today and the threat is that it will triple itself in the next 30 years. Globally, we are close to one trillion dollars of expenses for dementia treatment each year. If we practice prevention we can save a lot of money and a lot of sorrow of disease and disability.
What one can do is be proactive. If a person has risk factors, and you intervene and change his lifestyle, you can actually reduce his chance of acquiring and developing dementia or Alzheimer’s. There are two major groups of risk factors. One is the well-known group of physical medical risk factors, such as smoking, obesity, hypertension, diabetes, low physical activity, inappropriate diet and so on. Then there is another group of risk factors that are called psychosocial risk factors. This includes meaninglessness, depression, stress, loneliness and low occupational well-being; these risk factors are very prominent. A person that has each of these risk factors has a 240 per cent chance of acquiring dementia. A lot of people develop this condition after retirement, since when one retires he often has a lower sense of meaning and is more socially isolated. Then comes depression and stress and less cognitive enhancement, less cognitive activity; all of these together can create dementia and Alzheimer’s.
The good news is if we identify these people proactively within the community and give them lifestyle coaching and bring them medical attention and treat these risk factors, especially the psychosocial risk factors, we can really make a big impact.
What research are you working on in Israel?
Although we’ve been researching dementia for close to 100 years, we still do not have a cure. I think that one of the reasons we don’t have a cure is that we are doing more of the same – we are looking for a pill. We are putting billions and billions of dollars into funding, looking for a pill. The real future is in prevention, and if we don’t wake up to that call and act upon it, we are going to be in deep trouble – we already are. In Israel, the cost of dementia treatment is more than three billion dollars a year and, as such a small country, we really can’t afford that.
How do we increase the quality of life including a sense of meaning to the person who has Alzheimer’s or dementia?
Increasing the quality of life and sense of purpose is through occupation. The real villain here is retirement. It has been shown that in countries where the average age of retirement happens at a later age, the average age of dementia onset is later; vice versa in countries where people retire earlier than the average age of dementia, the onset comes earlier. The real novelty here is people have to stay occupied. They have to stay working. They have to be active – occupationally active. I think retirement is one of the leading causes of disease, and even mortality in our society. I think we have to postpone the age of retirement and make a national plan for people who retire to continue to be occupied.
Explain mind-body mechanism and how that can work to enhance health.
Mind body has to do with psychosocial factors; for instance, we know that the longer people experience stress, the higher the chance they will be demented. One study shows that if you have stress for three decades, your chances for getting dementia are 240 per cent. This is a great example of the mind-body connection, and the same with depression. People who are depressed have about a two-folds chance of becoming demented. A healthy soul within a healthy body is one of the main ways to have a healthy mind, and a healthy body is being occupied.
What can one do in terms of changing lifestyle so dementia won’t progress and might even get better?
Retirement is one of the leading causes of disease, and even mortality in our society.
If someone is retired they should look for work, volunteer, get involved out of his or her home, get back to being busy and helping people and taking responsibility for something and giving back through what you are doing. That’s the most important factor in terms of lifestyle. But there are others: being physically active and eating a healthy diet, especially a Mediterranean diet. The other issue is polypharmacy. One of the big problems today with elderly people is they accumulate too many medications, and we know from studies that the more medications you get, the higher your chances of getting dementia and Alzheimer’s. Try and cut down through a good physician the drug load that a person takes – and of course not smoking and not too much alcohol. The more we enhance our physical, social, psychological and spiritual well-being, then we are healthier and can prevent dementia.
I did a study when I was in Baycrest with Dr. Morris Freedman on spiritual well-being and Alzheimer’s disease. We saw that Alzheimer’s progressed slower in people who had higher levels of spiritual well-being, so that has a real impact on primary and secondary prevention of Alzheimer’s disease.
A recent report on CNN said that a blood test can detect proteins linked to Alzheimer’s disease. What does that mean for prevention?
This is something new that just came out that may help us detect people who are high-risk for dementia and that may help us with prevention, because if a person is asymptomatic – meaning he doesn’t have any symptoms of disease – but the blood test is positive, he has more amyloid in the blood, which correlates with a high amyloid in the brain, which is one of the hallmarks of dementia and Alzheimer’s disease. If we can detect that, then we can intervene earlier by changing lifestyles and addressing the risk factors, and we can prevent dementia even more effectively.
Is Alzheimer’s hereditary?
Most of Alzheimer’s is not hereditary. There is a gene called APOE-E4, and if someone has two copies of that gene he has a higher risk of acquiring dementia, but it doesn’t mean he will have dementia. It also depends even more heavily on lifestyle and risk factors that are treatable. Family history is one risk factor, but it doesn’t mean if you have family history you necessarily have to get dementia. There were studies with identical twins that were separated at early stages and they found out that, although their genetic background was almost identical, they were very different in their healthy outcome and their healthy status – meaning that genetics is important, but it is only part of the whole picture.
This interview has been edited and condensed for style and clarity.