Beneath Tokyo is a $2 billion flood water system, built to protect the city in future storms. The Japanese can’t stop the storms, but they hope to control the damage.
American health care has a similar problem. As more people age and live longer, the costs of dementia will soon threaten the system. We need flood walls and we need them soon.
The term “dementia” covers more than 70 brain-related conditions; Alzheimer’s is most common. It seems to work in two ways: killing brain cells; and blocking communication among them. As cells die and the flow of information slows, vital functions deteriorate.
Almost six million people in the U.S. have Alzheimer’s, including 10 percent of people over 65. For unknown reasons, Alzheimer’s is twice as common among African Americans as white people, and one and a half times as common among Latinos.
In Pierce County, about 15,000 people have Alzheimer’s, most cared for by family at home. We should all thank these unpaid caregivers, but even with their dedication, the annual medical cost of Alzheimer’s is almost $50,000 per person, or about $700 million a year in Pierce County alone.
That’s 20 times the budget of the Tacoma Pierce County Health Department. It’s about one third the annual revenue of MultiCare Health System. It’s a lot of money. It affects everyone’s health care cost. And it’s going up, as more people live with the disease and live longer.
We can’t cure Alzheimer’s, nor can we prevent it, at least not yet. What we can do is delay the symptoms so people live full, productive lives while the disease attacks their brains. How? Through a concept called cognitive reserve.
First defined in the 1990s, cognitive reserve is like a savings account for cognitive functions. It helps create alternative pathways among brain cells, so when neural paths are blocked, new ones are created.
Researchers believe cognitive reserve can delay the onset of Alzheimer’s symptoms for five years or more.
The benefits are obvious. People with Alzheimer’s gain years of normal life. And the financial impact may be cut dramatically.
The best way to build cognitive reserve? Work our brains like we work our hearts and lungs. Beginning in our 40s and continuing into old age, vigorous brain work can systematically build cognitive reserve.
While we can’t precisely define “vigorous,” it probably means chess rather than checkers, bridge instead of hearts. Just as cardio fitness involves sweat and discomfort, building cognitive reserve requires pushing ourselves mentally.
This is different, incidentally, from “brain training,” in which people practice solving particular types of problems. Building cognitive reserve means solving open-ended or multi-dimensional or unstructured problems. We’re not learning answers; we’re building the capacity to learn.
Not incidentally, in-person competition seems to matter. We’ll likely derive greater benefit from game play with others than by playing on the computer.
This year, for the first time in the U.S. (or the world, as far as we can tell), a coalition of community partners is building cognitive reserve community-wide. The effort began at the Health Department and is now a nonprofit organization.
It’s called The Game Campaign.
In libraries and senior buildings, YMCAs and church basements, people of all ages are playing backgammon, bridge, chess, Go and Scrabble to build the habit of mental workouts.
On Nov. 4, we cap off this inaugural campaign with game play and information sharing, from 10 a.m. to 2 p.m. at the University Y Student Center on the University of Washington Tacoma campus.
Everyone is welcome to play and to learn. The entire project is free to the public, thanks to the Bamford Foundation and individual contributors.
We hope you’ll join us and help make Pierce County a national model for healthier brains.
Susan Buell is director of adult healthy lifestyles & chronic disease, YMCA of Pierce & Kitsap Counties. Lyle Quasim is former secretary of the Washington Department of Social and Health Services, and co-chair of the Tacoma Pierce County Black Collective.