Public Health Policy


For a public health policy, the most efficient way to reduce the national burden of dementia is to use a “sieve”-type system in which most people respond to simple prevention, then the few who fail are treated at the earliest possible time, then the few who fail that, are evaluated more deeply, then the rare ones who fail that, are hospitalised and treated intensively. With this pyramid-type approach, you get the most reduction, and saving money for those most in need.

A few points that may provide direction:

1) For anyone who is far along the Alzheimer’s progressive path, all of the children who are 45 or older should be on active prevention with PreCODE. It’s easy, relatively inexpensive, and can save many thousands by avoiding future nursing homes.

2) For those early in the process, ReCODE is very successful.

3) For those in late stages of dementia, they should consider carefully whether they want to undergo extensive testing and a complicated protocol. It will not be right for many, but for some it may be. ReCODE protocols have had some success in patients with late-stage AD, although it is not nearly as common. 

4) Apollo Health is putting together a trial called SARA for severe Alzheimer’s reversal attempt, in which we would take people with late-stage illness and see if we could pull out all of the stops and produce turnaround in most. We know we can do this with those in the MoCA of 18-30 range, but we need to know more about what it takes to do it in the 0-15 range, where it is sometimes successful and sometimes not.

5) The key is to get people to start early, when it is easy, and you can almost guarantee success. The problem is that people are willing to listen when the loved one has severe dementia, when there is little to do, but those in the earlier stages are still going through the standard of care, getting nowhere. So, we need to change the public understanding.

Let’s keep pushing—there are many in need, and many who will be in need in the coming years.

Dr Dale Bredesen