A general neurologist's perspective on the urgent need to apply resilience thinking to the prevention and treatment of Alzheimer's disease

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Abstract

The goal of this article was to look at the problem of Alzheimer's disease (AD) through the lens of a socioecological resilience-thinking framework to help expand our view of the prevention and treatment of AD. This serious and complex public health problem requires a holistic systems approach. We present the view that resilience thinking, a theoretical framework that offers multidisciplinary approaches in ecology and natural resource management to solve environmental problems, can be applied to the prevention and treatment of AD. Resilience thinking explains a natural process that occurs in all complex systems in response to stressful challenges. The brain is a complex system, much like an ecosystem, and AD is a disturbance (allostatic overload) within the ecosystem of the brain. Resilience thinking gives us guidance, direction, and ideas about how to comprehensively prevent and treat AD and tackle the AD epidemic.

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Epidemiology of Alzheimer's disease: occurrence, determinants, and strategies toward intervention

Chengxuan Qiu, Miia Kivipelto, Eva von Strauss (2009)

More than 25 million people in the world today are affected by dementia, most suffering from Alzheimer's disease. In both developed and developing nations, Alzheimer's disease has had tremendous impact on the affected individuals, caregivers, and society. The etiological factors, other than older age and genetic susceptibility, remain to be determined. Nevertheless, increasing evidence strongly points to the potential risk roles of vascular risk factors and disorders (eg, cigarette smoking, midlife high blood pressure and obesity, diabetes, and cerebrovascular lesions) and the possible beneficial roles of psychosocial factors (eg, high education, active social engagement, physical exercise, and mentally stimulating activity) in the pathogenetic process and clinical manifestation of the dementing disorders. The long-term multidomain interventions toward the optimal control of multiple vascular risk factors and the maintenance of socially integrated lifestyles and mentally stimulating activities are expected to reduce the risk or postpone the clinical onset of dementia, including Alzheimer's disease.

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Stress- and allostasis-induced brain plasticity.

Bruce McEwen, Peter J. Gianaros (2011)

The brain is the key organ of stress processes. It determines what individuals will experience as stressful, it orchestrates how individuals will cope with stressful experiences, and it changes both functionally and structurally as a result of stressful experiences. Within the brain, a distributed, dynamic, and plastic neural circuitry coordinates, monitors, and calibrates behavioral and physiological stress response systems to meet the demands imposed by particular stressors. These allodynamic processes can be adaptive in the short term (allostasis) and maladaptive in the long term (allostatic load). Critically, these processes involve bidirectional signaling between the brain and body. Consequently, allostasis and allostatic load can jointly affect vulnerability to brain-dependent and stress-related mental and physical health conditions. This review focuses on the role of brain plasticity in adaptation to, and pathophysiology resulting from, stressful experiences. It also considers interventions to prevent and treat chronic and prevalent health conditions via allodynamic brain mechanisms.

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Neural mechanisms of stress resilience and vulnerability.

Tamara B. Franklin, Bechara J. Saab, Isabelle M. Mansuy (2012)

Exposure to stressful events can be differently perceived by individuals and can have persistent sequelae depending on the level of stress resilience or vulnerability of each person. The neural processes that underlie such clinically and socially important differences reside in the anatomical, functional, and molecular connectivity of the brain. Recent work has provided novel insight into some of the involved biological mechanisms that promises to help prevent and treat stress-related disorders. In this review, we focus on causal and mechanistic evidence implicating altered functions and connectivity of the neuroendocrine system, and of hippocampal, cortical, reward, and serotonergic circuits in the establishment and the maintenance of stress resilience and vulnerability. We also touch upon recent findings suggesting a role for epigenetic mechanisms and neurogenesis in these processes and briefly discuss promising avenues of future investigation. Copyright © 2012 Elsevier Inc. All rights reserved.

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Author and article information

Contributors

Grazyna Pomorska

Journal

Journal ID (nlm-ta): Alzheimers Dement (N Y)

Journal ID (iso-abbrev): Alzheimers Dement (N Y)

Title: Alzheimer's & Dementia : Translational Research & Clinical Interventions

Publisher: Elsevier

ISSN (Electronic): 2352-8737

Publication date PMC-release: 12 September 2017

Publication date Collection: November 2017

Publication date (Electronic): 12 September 2017

Volume: 3

Issue: 4

Pages: 498-506

Affiliations

[1 ]Department of Neurology, University of Massachusetts Memorial Medical Group, Worcester, MA, USA

[2 ]Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA, USA

Author notes

[∗ ]Corresponding author. Tel.: 508-334-6641; Fax: 508-334-9034. Grazyna.Pomorska@ 123456umassmemorial.org

Article

Publisher ID: S2352-8737(17)30047-1

DOI: 10.1016/j.trci.2017.08.001

PMC ID: 5671621

SO-VID: 8ca31d88-41ad-4345-883c-a95ef7c43fe4

License:

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

A general neurologist's perspective on the urgent need to apply resilience thinking to the prevention and treatment of Alzheimer's disease

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Most cited references 59

Epidemiology of Alzheimer's disease: occurrence, determinants, and strategies toward intervention

Stress- and allostasis-induced brain plasticity.

Neural mechanisms of stress resilience and vulnerability.

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