[100-Year Brain Health③] Professor Choi Seong-hye "Is Dementia Incurable? There Is a Way to Overcome It"

Professor Choi Seonghye of Inha University Hospital Neurology on Overcoming Dementia

Alzheimer's Has No Cure, but Other Dementias Can Be Overcome

Proper Management of Risk Factors Like Stroke and Cerebral Infarction Can Reduce Dementia Prevalence by 40% and Maintain Cognitive Function
Hearing Loss Accelerates Brain Atrophy, So Hearing Aids Must Be Worn

Cognitive Intervention Therapy Has Practical Effects and Urgent Need for Insurance Coverage

Visiting Caregivers and Day-Night Care Center Policies Are Great Help
Regrettably, Sessions Are Only 3 Hours Each
Dementia Safety Centers Focus on Patient Management Over Screening

Professor Choi Seong-hye, Department of Neurology, Inha University Hospital

[Asia Economy Reporter Lee Chun-hee] Dementia is usually considered an 'incurable disease.' Is that true? Professor Choi Sung-hye of the Department of Neurology at Inha University Hospital firmly declared on the 9th that this is a 'misunderstanding.' Known as a 'dementia expert,' she emphasized that although it is true that there is no treatment for Alzheimer's disease, which accounts for the majority of dementia cases, other types of dementia can be overcome to some extent, and managing other dementia factors well can prevent additional cognitive decline.

- Is dementia really untreatable?

△ There are over 50 underlying diseases that cause dementia. Because there is no treatment for the most representative Alzheimer's disease, people tend to think that all dementia is untreatable. However, vascular dementia can maintain cognitive function if stroke, cerebral infarction, and other conditions are well managed, and alcoholic dementia can improve if alcohol consumption is stopped. Alzheimer's accounts for 70% and is the largest portion, but pure Alzheimer's-only dementia cases are about 30%. Many cases involve other vascular brain diseases as well. If dementia appears when 100 Alzheimer's pathologies develop in the brain, dementia can also appear when 50 Alzheimer's pathologies develop along with 50 other brain disease pathologies. Even though Alzheimer's is difficult to treat, progression can be slowed by properly managing accompanying brain diseases. It is important to manage the brain to prevent damage from causes other than Alzheimer's.

- Recently, controversy has grown regarding the cause of Alzheimer's dementia due to allegations of data manipulation in 'Amyloid Beta (Aβ)' papers. How do you see the possibility of treating Alzheimer's?

△ There have always been various opinions about the cause. The important thing is not just to prove that Aβ has decreased, but how much cognitive function has improved. Demonstrating clinical improvement is key. Actual treatment should be a 'cocktail therapy' that removes not only Aβ but also tau, and reduces inflammatory responses. Alzheimer's has a long asymptomatic period, starting 20 to 30 years before memory decline appears. Different drugs should be used at different stages together.

- Are there ways to manage so as not to develop dementia?

△ There are about 12 modifiable risk factors related to dementia. These include low education level, hearing loss, brain injury, hypertension, excessive alcohol consumption, obesity, smoking, depression, social isolation, lack of physical activity, air pollution, and diabetes. All risk factors are important, but hearing loss is particularly significant. When hearing deteriorates, the brain can shrink faster than in others. This is why hearing aids must be used if hearing loss occurs. Risk factors also vary by age group. Hypertension and obesity are more related in middle age, while in old age, those who are somewhat overweight tend to live longer.

Superbrain Cognitive Training Introduction Screen

- You serve as the chairman of the Cognitive Intervention Therapy Society and are developing the mild cognitive impairment (MCI) digital therapeutic (DTx) 'SuperBrain' with the DTx company Rowan. What led you to take an interest in cognitive intervention therapy?

△ Having cared for dementia patients for a long time, I often felt sorry. There was a limit because there was no treatment, so I wanted to do more for patients, which led me to take an interest in cognitive intervention therapy. I believe it is practically effective. A study involving 293 MCI patients showed that those who received cognitive intervention therapy had significantly improved cognitive function compared to the control group. Even after stopping treatment, the cognitive improvement effect lasted about six months. SuperBrain includes exercise, nutrition management, and motivational education, forming a comprehensive management program for modifiable risk factors. It showed effects such as improved cognitive function, increased brain-derived neurotrophic factor (BDNF) involved in brain cell activation, and reduced cortisol, a stress-inducing substance.

To activate cognitive intervention therapy, insurance coverage is necessary. In Korea, where elderly poverty rates are among the highest in the world, even if people know the treatment helps, financial burdens are inevitable. While coverage extends to actual expense insurance, many elderly currently do not have such insurance.

- Some overseas studies have reported low effectiveness of cognitive intervention therapy. What do you think?

△ Just like regular medication is ineffective if not taken daily on time, cognitive intervention therapy is the same. The key is how high the 'adherence' to treatment is. European studies likely showed low effectiveness because management was not thorough, and patients were only taught methods to do alone at home. In contrast, in our case, institutional therapy requires visits three times a week, and home-based therapy includes monitoring and visits every 1 to 2 weeks. As a result, SuperBrain showed over 90% adherence even in the home-based group.

- The government has launched the 'National Dementia Responsibility System' and various policies related to dementia treatment. What is your view?

△ Policy support such as visiting care workers and day and night care centers is very helpful. Many elderly people live alone even if they develop dementia. Even if they have children, it is often difficult to care for them, so many are sent to nursing homes. However, nursing homes lack social stimulation. It is better to live in the community with support from visiting care workers and day and night care centers. However, the current visiting care time of 3 hours per visit is short and regrettable. It is necessary to increase the time even if the patient's out-of-pocket cost rises slightly. The role of dementia safety centers should focus less on early dementia screening and more on supporting patients in the community. Screening should be left to hospitals, and the centers should concentrate on managing dementia patients who are difficult to handle in hospitals.

- When do you think humanity will be able to overcome dementia?

△ The Phase 3 clinical trial results of Biogen-Eisai's 'Lecanemab' and Roche's 'Gantenerumab' will be released in the second half of this year. If the results are good, the time to overcome dementia will be accelerated, but if not, it will take a very long time. However, I believe it will definitely be possible to overcome it someday. Developed countries are already reducing dementia prevalence by managing dementia risk factors. Proper risk factor management alone can reduce dementia prevalence by 40%.