The 3 Ways Cognitive Decline Can Go

There is not a “one-size fits all” model of cognitive decline, but when it comes to Alzheimer’s, there are three clear pathways that cognitive decline can take.

So, what are they?

This makes a big difference

Researchers (Dr.  Reisa Sperling et al.) found that people’s cognitive decline trajectories cluster into the following three groups:

1. Stable
2. Slow decline
3. Fast decline

Now, that may not sound groundbreaking, but the fact that it is three distinct clusters rather than a sliding scale is actually quite important.

This new information recontextualizes and adds extra relevance to what we wrote about here: Alzheimer’s: The Bad News And The Good ← this is our “Expert Insights” feature on Dr. Gayatri Devi, She’s a neurologist, board-certified in neurology, pain medicine, psychiatry, brain injury medicine, and behavioral neurology. She’s also a Clinical Professor of Neurology, and Director of Long Island Alzheimer’s Disease Center, Fellow of the American Academy of Neurology, and we could continue all day with her qualifications, awards and achievements but then we’d run out of space. Suffice it to say, she knows her stuff. In the above-linked article, we talk about how her work explores Alzheimer’s epidemiology, diagnosis, pathology, and planning, with a strong side of social destigmatization and a healthy dose of calm about it. If you like that, you should definitely also check out: The Spectrum of Hope: An Optimistic and New Approach to Alzheimer’s Disease and Other Dementias – by Dr. Gayatri Devi

Another reason that this matters is because it means we now know that current Alzheimer’s prevention trials are almost certainly underestimating treatment effects, because of how averaging all participants together can dilute the appearance of positive changes when participants from two out of three clusters don’t decline during the study window.

Dr. Sperling argues (convincingly) that future prevention trials should stratify participants by risk of decline, rather than treating all biomarker-positive individuals as progressing similarly.

About those biomarkers: higher plasma p-tau217, elevated tau PET imaging, and smaller hippocampal volume at baseline were the clearest indicators of quicker future decline, and these biomarker-based models predicted who would stay stable versus decline (and at which pace) with about 70% accuracy.

With this in mind, there are good possibilities for future avenue of research, for example asking such questions as:

❝What is different about certain patients that makes them more resilient—and can these insights be leveraged to slow down Alzheimer’s disease in others? ❞

~ Dr. Michael Donohue, press contact for the study

You can read the paper in full, here: Divergent patterns of cognitive decline in preclinical Alzheimer’s disease: Implications for secondary prevention trials

Want to improve your odds?

We’ve written quite a bit about reducing the risk of cognitive decline in general and Alzheimer’s in particular; here are just a few:

• Alzheimer’s Causative Factors To Avoid
• How To Reduce Your Alzheimer’s Risk
• How To Walk Away From Alzheimer’s
• How To Clean Your Brain (Glymphatic Health Primer)
• Take Care Of Your Lymphatic System To Beat Cognitive Decline
• Goodnight, Glymphatic System: How Your Sleep Position Changes Dementia Risk
• The 6 Dimensions Of Sleep (And Why They Matter)

Take care!