Vol XV, Jun `05

Foundation: What implications do your findings have for the future prevention and diagnosis of Alzheimer's disease?

Whitmer: One major implication is that we now know that obesity is linked to dementia. This is not that surprising, as other studies have shown that cardiovascular pathways have been connected to the development of dementia and that cardiovascular disease and obesity often co-exist. What we have learned is a good sign in the sense that--if other

In terms of diagnosis, it's a little tricky. I don't really know if this study will have much of an impact. However, it may give us something to watch for as a risk factor. Previous studies have shown low weight as a risk factor-people with dementia tend to weigh less that their non-demented counterparts. We now think that weight loss proceeds initial diagnosis and that early stages of disease actually cause one to lose weight. Now we suggest that weight gain earlier in life can be a risk factor that can be addressed long before the dementia develops. This may mean more in terms of prevention, rather than diagnosis.

Foundation: How can your findings be translated into practice?

Whitmer: They provide clinicians with another reason to speak with patients about weight loss earlier in life. This represents another negative effect of obesity and another reason to manage weight before it results in illness.

Foundation: What kinds of related studies regarding Alzheimer's disease would you like to see?

Whitmer: I would like to see other studies that help identify early risk factors for dementia and Alzheimer's disease, studies that take a 'life course' approach-looking at risk factors over time. We need to try to identify modifiable risk factors and actual mechanisms behind these links.

Foundation: What guidance or advice can you offer to other researchers about obtaining informed consent from patients with Alzheimer's disease or other dementias?

Whitmer: We always obtain informed consent from a proxy as well as the patient. Even when patients can consent themselves, they can become demented quickly or over time. It's not fair to take the first informed consent and apply it when patients no longer are capable to give consent. Getting consent from the patient's caregiver or decision maker ensures that patients' wishes or preferences are protected when they no longer can speak on their own behalf. This isn't perfect, but it's the closest we will get for a while.