Are large simple trials for dementia prevention possible?

William N Whiteley et al. | Are large simple trials for dementia prevention possible? | Age and Ageing | published 12th December 2019

  • Large simple trials have transformed care for heart attack and stroke. Lessons from these trials may be applicable to dementia prevention.
  • The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge. The reliable identification of higher risk populations is difficult but will be important.
  • Patients and families prioritise loss of function. Loss of functional abilities or clinical dementia are infrequent, but might be measured with lower variability than cognitive scores.

Abstract

New trials of dementia prevention are needed to test novel strategies and agents. Large, simple, cardiovascular trials have successfully discovered treatments with moderate but worthwhile effects to prevent heart attack and stroke. The design of these trials may hold lessons for the dementia prevention.Here we outline suitable populations, interventions and outcomes for large simple trials in dementia prevention. We consider what features are needed to maximise efficiency. Populations could be selected by age, clinical or genetic risk factors or clinical presentation. Patients and their families prioritise functional and clinical outcomes over cognitive scores and levels of biomarkers. Loss of particular functions or dementia diagnoses therefore are most meaningful to participants and potential patients and can be measured in large trials.

The size of the population and duration of follow-up needed for dementia prevention trials will be a major challenge and will need collaboration between many clinical investigators, funders and patient organisations.

Full article: Are large simple trials for dementia prevention possible?

New life-saving treatment and diagnosis technology

Diseases could be detected even before people experience symptoms, thanks to a pioneering new health-data programme as part of the government’s modern Industrial Strategy

Businesses and charities are expected to jointly invest up to £160 million, alongside a £79 million government investment, as part of the Accelerating Detection of Disease programme. The project will support research, early diagnosis, prevention and treatment for diseases including cancer, dementia and heart disease.

The pioneering initiative will recruit up to 5 million healthy people. Volunteered data from the individuals will help UK scientists and researchers invent new ways to detect and prevent the development of diseases.

Full story: UK to innovate new life-saving treatment and diagnosis technology | Department of Health & Social Care

Light, physical activity reduces brain aging

Incremental physical activity, even at light intensity, is associated with larger brain volume and healthy brain aging, according to new research | JAMA Network Open | via scienceDaily

stretching-3098228_1920Considerable evidence suggests that engaging in regular physical activity may prevent cognitive decline and dementia. Active individuals have lower metabolic and vascular risk factors and these risk factors may explain their propensity for healthy brain aging. However, the specific activity levels optimal for dementia prevention have remained unclear.

The new 2018 Physical Activity-Guidelines for Americans suggest that some physical activity is better than none, but achieving greater than 150 minutes of moderate-to-vigorous (MV) physical activity per week is recommended for substantial health benefits.

Using data from the Framingham Heart Study, researchers found that for each additional hour spent in light-intensity physical activity was equivalent to approximately 1.1 years less brain aging.

According to the researchers, these results suggest that the threshold of the favorable association for physical activity with brain aging may be at a lower, more achievable level of intensity or volume.

Full story at ScienceDaily

Full article: Nicole L. Spartano | Association of Accelerometer-Measured Light-Intensity Physical Activity With Brain Volume. JAMA Network Open, 2019; 2 (4)

Staying fit and mentally active linked with reduced dementia risk

Researchers in Sweden have found that women who exercise and stay cognitively active during midlife have a reduced risk of dementia in older age | Neurology | via Alzheimer’s Research UK

In 1968, Swedish researchers began studying a group of 800 women in midlife, between the ages of 38 and 54, and measured the amount of time they spent doing cognitively stimulating activities, including reading books and writing. The team also recorded how much physical activity the women did including walking, and intense training like swimming.

The team followed the volunteers until 2012 to see if they went onto develop dementia. They found that those who were more engaged in physical activity and spent more time doing cognitive tasks had a lower risk of developing the condition.

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Abstract
Objective:  To investigate whether cognitive and physical activities in midlife are associated with reduced risk of dementia and dementia subtypes in women followed for 44 years.

Methods:  A population-based sample of 800 women aged 38–54 years (mean age 47 years) was followed from 1968 to 2012. Cognitive (artistic, intellectual, manual, religious, and club) and physical activity were assessed at baseline. During follow-up, dementia, Alzheimer disease, vascular dementia, mixed dementia, and dementia with cerebrovascular disease were diagnosed according to established criteria based on information from neuropsychiatric examinations, informant interviews, hospital records, and registry data. Cox regression models were used with adjustment for age, education, socioeconomic status, hypertension, body mass index, cigarette smoking, diabetes mellitus, angina pectoris, stress, and major depression.

Results:  We found that cognitive activity in midlife was associated with a reduced risk of total dementia and Alzheimer disease during follow-up. Physical activity in midlife was associated with a reduced risk of mixed dementia and dementia with cerebrovascular disease. The results were similar after excluding those who developed dementia before 1990, except that physical activity was then also associated with reduced risk of total dementia.

Conclusion: Our findings suggests that midlife cognitive and physical activities are independently associated with reduced risk of dementia and dementia subtypes. The results indicate that these midlife activities may have a role in preserving cognitive health in old age.

Full story at Alzheimer’s Research UK

Full reference: Najar, J. et al. | Cognitive and physical activity and dementia. A 44-year longitudinal population study of women | Neurology | First published February 20, 2019

 

Regular problem solving does not protect against mental decline

The well known ‘use it or lose it’ claim has been widely accepted by healthcare professionals, but researchers in the Christmas issue of The British Medical Journal find that regularly doing problem solving activities throughout your lifetime does not prevent mental decline in later life. However, the results suggest that regularly engaging in intellectual activities boosts mental ability throughout life and provides a “higher cognitive point” from which to decline.

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Abstract
Objectives:  To examine the association between intellectual engagement and cognitive ability in later life, and determine whether the maintenance of intellectual engagement will offset age related cognitive decline.

Design: Longitudinal, prospective, observational study.

Setting:  Non-clinical volunteers in late middle age (all born in 1936) living independently in northeast Scotland.

Participants:  Sample of 498 volunteers who had taken part in the Scottish Mental Health Survey of 1947, from one birth year (1936).

Main outcome measures:  Cognitive ability and trajectory of cognitive decline in later life. Typical intellectual engagement was measured by a questionnaire, and repeated cognitive measurements of information processing speed and verbal memory were obtained over a 15 year period (recording more than 1200 longitudinal data points for each cognitive test).

Results:  Intellectual engagement was significantly associated with level of cognitive performance in later life, with each point on a 24 point scale accounting for 0.97 standardised cognitive performance (IQ-like) score, for processing speed and 0.71 points for memory. Engagement in problem solving activities had the largest association with life course cognitive gains, with each point accounting for 0.43 standardised cognitive performance score, for processing speed and 0.36 points for memory. However, engagement did not influence the trajectory of age related decline in cognitive performance. Engagement in intellectual stimulating activities was associated with early life ability, with correlations between engagement and childhood ability and education being 0.35 and 0.22, respectively.

Conclusion:  These results show that self reported engagement is not associated with the trajectory of cognitive decline in late life, but is associated with the acquisition of ability during the life course. Overall, findings suggest that high performing adults engage and those that engage more being protected from relative decline.

Full reference: Staff, R. et al. | Intellectual engagement and cognitive ability in later life (the “use it or lose it” conjecture): longitudinal, prospective study | BMJ | 10 December 2018

Related:

The effects of vitamin and mineral supplementation on cognitive function and the incidence of dementia in people with mild cognitive impairment.

This review investigated whether people with mild cognitive impairment can reduce their risk of developing dementia, or can prevent their memory or other thinking skills from deteriorating further, by taking vitamin or mineral supplements | Cochrane Database of Systematic Reviews

Vitamins and minerals have many functions in the nervous system which are important for brain health. It has been suggested that various different vitamin and mineral supplements might be useful in maintaining cognitive function and delaying the onset of dementia. In this review, the authors sought to examine the evidence for this in people who already had mild cognitive impairment (MCI).

The authors found eight randomised controlled trials (RCTs), which investigated four different types of vitamin or mineral pills by comparing them to a placebo (a dummy pill). The vitamins tested were B vitamins (vitamin B6, vitamin B12 and folic acid), vitamin E, and vitamin E and C given together. The only mineral tested was chromium.

However, the authors found the amount and quality of research evidence about vitamin and mineral supplements for treating MCI in people without nutritional deficiency is limited. They concluded that at the moment, it is not possible to identify any supplements which can reduce the risk of people with MCI developing dementia or which can effectively treat their symptoms.

Full reference: McCleery J, et al. |  Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment |  Cochrane Database of Systematic Reviews | 2018, Issue 11.

Can museums help prevent dementia?

New study suggests visiting museums may be a promising psychosocial activity to support the prevention of dementia | The British Journal of Psychiatry | via The Mental Elf 

A study published in the British Journal of Psychiatry has revealed that people who visited museums often were less likely to develop dementia. In the research, a large cohort of people 50 years-old and older, as part of the English Longitudinal Study of Ageing (ELSA) was used as a sample and tracked across 10 years. The participants in the study did not show any clinical symptoms of dementia at baseline.

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Two main measures were used:

  1. Firstly, the participants had to complete a self-report scale regarding the frequency they were visiting museums and art galleries, varying from “never” to “twice a month or more”.
  2. Secondly, the incidence of dementia was based on a diagnosis of dementia or Alzheimer’s disease or on a score above 3.38 on the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).

The sample consisted of 3,911 adults, equally divided to males and females, and the mean age was 64 years-old. 6.3% developed dementia during the follow-up period. A third of participants indicated that they never visited a museum, but around 1 in 5 reported attending once or twice a year and a further 1 in 5 reported attending every few months or more.

The incidence rate of dementia was higher than average for people who never go to museums, lower than average for people who make a few visits per year, while the lowest rate was found for those who frequently visit museums.

Other cognitive activities were taken under consideration by the authors, but were not significantly associated with the occurrence of dementia. Thus, the effect of museum-attendance is thought to be unique and distinct from other activities that have been suggested.

Full research: Fancourt, D., Steptoe, A., & Cadar, D. | Cultural engagement and cognitive reserve: Museum attendance and dementia incidence over a 10-year period |  The British Journal of Psychiatry | Volume 213, Issue 5 | November 2018 | pp. 661-663

Further detail at The Mental Elf