Reducing the risk of dementia

Risk reduction of cognitive decline and dementia | The World Health Organisation

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Image source: apps.who.int/

These WHO guidelines provide evidence-based recommendations on lifestyle behaviours and interventions to delay or prevent cognitive decline and dementia.  Worldwide, around 50 million people have dementia and, with one new case every three seconds, the number of people with dementia is set to triple by 2050. The increasing numbers of people with dementia, its significant social and economic impact and lack of curative treatment, make it imperative for countries to focus on reducing modifiable risk factors for dementia.

These guidelines are intended as a tool for health care providers, governments, policy-makers and other
stakeholders to strengthen their response to the dementia challenge.

Full document: Risk reduction of cognitive decline and dementia

See also: WHO press release

Depression in type 1 diabetes and risk of dementia

Paola Gilsanz et al. | Depression in type 1 diabetes and risk of dementia | Aging & Mental Health | Volume 23:7, p880-886

Objective: Depression afflicts 14% of individuals with type 1 diabetes (T1D). Depression is a robust risk factor for dementia but it is unknown if this holds true for individuals with T1D, who recently started living to an age conferring dementia risk. We examined if depression is a dementia risk factor among elderly individuals with T1D.

Methods: 3,742 individuals with T1D aged over 50 were followed for dementia from 1/1/96-9/30/2015. Depression, dementia, and comorbidities were abstracted from electronic medical records. Cox proportional hazard models estimated the association between depression and dementia adjusting for demographics, glycosylated hemoglobin, severe dysglycemic epidsodes, stroke, heart disease, nephropathy, and end stage renal disease. The cumulative incidence of dementia by depression was estimated conditional on survival dementia-free to age 55.

Results: Five percent (N = 182) were diagnosed with dementia and 20% had baseline depression. Depression was associated with a 72% increase in dementia (fully adjusted HR = 1.72; 95% CI:1.12-2.65). The 25-year cumulative incidence of dementia was more than double for those with versus without depression (27% vs. 12%).

Conclusions: For people with T1D, depression significantly increases dementia risk. Given the pervasiveness of depression in T1D, this has major implications for successful aging in this population recently living to old age.

Psychosocial risk factors and Alzheimer’s disease

New study predicts that sleep disturbance, depression, and anxiety increase the hazard of Alzheimer’s disease | Aging & Mental Health

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Objectives: Alzheimer’s disease (AD) dementia is a neurodegenerative condition, which leads to impairments in memory. This study predicted that sleep disturbance, depression, and anxiety increase the hazard of AD, independently and as comorbid conditions.

Methods: Data from the National Alzheimer’s Coordinating Center was used to analyze evaluations of 12,083 cognitively asymptomatic participants. Survival analysis was used to explore the longitudinal effect of depression, sleep disturbance, and anxiety as predictors of AD. The comorbid risk posed by depression in the last two years coupled with sleep disturbance, lifetime depression and sleep disturbance, clinician-verified depression and sleep disturbance, sleep disturbance and anxiety, depression in the last two years and anxiety, lifetime depression and anxiety, and clinician-verified depression and anxiety were also analyzed as predictors of AD through main effects and additive models.

Results: Main effects models demonstrated a strong hazard of AD development for those reporting depression, sleep disturbance, and anxiety as independent symptoms. The additive effect remained significant among comorbid presentations.

Conclusion: Findings suggest that sleep disturbance, depression, and anxiety are associated with AD development among cognitively asymptomatic participants. Decreasing the threat posed by psychological symptoms may be one avenue for possibly delaying onset of AD.

Full reference: Burke, S. L. et al. |  Psychosocial risk factors and Alzheimer’s disease: the associative effect of depression, sleep disturbance, and anxiety | Aging & Mental Health | 2018 Vol. 22, issue 12 | p 1577-1584 |  DOI: 10.1080/13607863.2017.1387760

Half of UK adults can’t identify single key risk factor for dementia

Alzheimer’s Research UK | February 2019 | Half of UK adults can’t identify single key risk factor for dementia

Alzheimer’s Research UK, the the UK’s leading dementia research charity, has published its findings  from one of the most comprehensive surveys of UK-wide public perceptions of dementia. They have been published today (6 February) by Alzheimer’s Research UK. The Dementia Attitudes Monitor, which will be repeated biennially, includes data from 2,361 interviews conducted by Ipsos MORI between 15 June and 5 July 2018.

The charity’s findings highlight enduring misconceptions around the physical nature of the diseases that cause dementia as well as low understanding of the risk factors for dementia, which is now the leading cause of death in the UK.

Dementia attitudes
Image source: dementiastatistics.org

 

The Monitor reveals that just 1% of UK adults are able to name seven known risk or protective factors for the dementia (risk factors: heavy drinking, genetics, smoking, high blood pressure, depression and diabetes, protective factor: physical exercise) and 48% fail to identify any. With a third of cases of dementia thought to be influenced by factors in our control to change, the findings highlight a clear need for education around dementia prevention.

Key findings include:

  • More than half of UK adults (52%) now say they know someone with dementia.
  • Only half (51%) recognise that dementia is a cause of death* and more than 1 in 5 (22%) incorrectly believes it’s an inevitable part of getting older.
  • Only 34% of people believe it’s possible to reduce the risk of dementia, compared with 77% for heart disease and 81% for diabetes.
  • Three-quarters (73%) of adults would want to be given information in midlife about their personal risk of developing dementia later in life, if doctors could do so.

*Base: Adults 15+ in UK without a dementia diagnosis (2,354) (Source: Alzheimer’s Research UK)

Read the full news release at Alzheimer’s Research UK

Alzheimer’s Research UK Half of UK adults can’t identify single key risk factor for dementia

Read the full report here

See also:

Alzheimer’s Research UK’s Research Hub  Public attitudes towards dementia

In the news:

BBC News Dementia risk factors not known by half the population

Sleep Disturbances in Alzheimer’s Disease

Sleep requirements change throughout life. As part of normal aging, sleep generally becomes briefer and fragmented, with older people often having multiple naps throughout the day. In this article, Osman Shabir explains that this may not be the pattern of sleep seen in patients with Alzheimer’s disease and other neurodegenerative conditions, however. | via News Medical

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Most patients with Alzheimer’s develop sleep problems which worsen as the disease progresses. Some common sleep disturbances seen in patients with Alzheimer’s are:

  • Loss of the ability to stay asleep, despite being able to get to sleep
  • Increased sleep latency (duration required to get to sleep is longer)
  • Increased agitation before bedtime and throughout the night
  • Disorientation upon waking up (in the night, or in the morning)
  • Sleepy during the day, whilst being alert during the night (circadian abnormalities)
  • Periodic limb movement (PLM) is worsened in around 50% of Alzheimer’s patients
  • Shorter duration of both slow-wave-sleep (SWS) and rapid-eye movement sleep (REM) despite the total number of sleep cycles remaining unchanged

The article notes however that not all studies have shown a significant correlation between sleep disruption and Alzheimer’s disease, either in the pre-clinical stage or after symptoms develop. Therefore, not all Alzheimer’s patients suffer from sleep problems, and likewise, not all people suffering from sleep issues in older age necessarily have Alzheimer’s. However, it is now increasingly accepted that sleep loss may indeed be an important risk factor and symptom of Alzheimer’s disease. Whether sleep loss contributes to Alzheimer’s progression, or whether Alzheimer’s causes sleep problems, is yet to be determined.

Full article: Alzheimer’s Disease and sleep disruption | News Medical

Pre-eclampsia and risk of dementia

New research suggests  pre-eclampsia is associated with an increased risk of dementia, particularly vascular dementia. | BMJ | OnMedica

New research published in the British Medical Journal has shown women who had had pre-eclampsia in at least one pregnancy to have a more than three times greater risk of vascular dementia, as well as a modestly raised risk of Alzheimer’s disease and other/non-specific dementias, than women who had never had pre-eclampsia 

The authors of a new study suggest doctors should ask women about a history of pre-eclampsia to help identify those who might benefit from screening for early signs of dementia, allowing for early clinical intervention.

Abstract
Objective: To explore associations between pre-eclampsia and later dementia, overall and by dementia subtype and timing of onset.

Design: Nationwide register based cohort study.

Setting: Denmark.

Population: All women with at least one live birth or stillbirth between 1978 and 2015.

Main outcome measure: Hazard ratios comparing dementia rates among women with and without a history of pre-eclampsia, estimated using Cox regression.

Results: The cohort consisted of 1 178 005 women with 20 352 695 person years of follow-up. Women with a history of pre-eclampsia had more than three times the risk of vascular dementia (hazard ratio 3.46, 95% confidence interval 1.97 to 6.10) later in life, compared with women with no history of pre-eclampsia. The association with vascular dementia seemed to be stronger for late onset disease (hazard ratio 6.53, 2.82 to 15.1) than for early onset disease (2.32, 1.06 to 5.06) (P=0.08). Adjustment for diabetes, hypertension, and cardiovascular disease attenuated the hazard ratios only moderately; sensitivity analyses suggested that body mass index was unlikely to explain the association with vascular dementia. In contrast, only modest associations were observed for Alzheimer’s disease (hazard ratio 1.45, 1.05 to 1.99) and other/unspecified dementia (1.40, 1.08 to 1.83).

Conclusions: Pre-eclampsia was associated with an increased risk of dementia, particularly vascular dementia. Cardiovascular disease, hypertension, and diabetes were unlikely to mediate the associations substantially, suggesting that pre-eclampsia and vascular dementia may share underlying mechanisms or susceptibility pathways. Asking about a history of pre-eclampsia could help physicians to identify women who might benefit from screening for early signs of disease, allowing for early clinical intervention.

Full reference: Basit, S. et al. | Pre-eclampsia and risk of dementia later in life: nationwide cohort study | British Medical Journal | published 17 October 2018

See also:

Study finds correlation between atrial fibrillation and dementia

New research into atrial fibrillation (AF) and dementia has found that the heart condition may increase the risk of dementia when compared to those without AF | Neurology | Story via PHARMAfield

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A study published in the journal Neurology has found that people with atrial fibrillation may experience a faster decline in thinking and memory skills and have a greater risk of dementia than those without the heart condition.

In the study, researchers looked at data on 2,685 participants with an average age of 73 who were followed for an average of six years as part of a larger study. Participants were examined and interviewed at the start of the study and then once after six years for those younger than 78 and once every three years for those 78 and older. All participants were free of dementia at the start of the study, but 243 people, or 9 percent, had atrial fibrillation.

Through face-to-face interviews and medical examinations, researchers gathered lifestyle and medical data on participants at the start of the study and during each follow-up visit. All were screened for atrial fibrillation, for overall thinking and memory skills, as well as dementia.

Over the course of the study, an additional 279 people (11%), developed atrial fibrillation, and 399 (15%), developed dementia.

Researchers found that those who had atrial fibrillation had a faster rate of decline in thinking and memory skills than those without the condition and were 40% more likely to develop dementia. Of the 2,163 people who did not have irregular heartbeat, 278 people developed dementia (10%). Of the 522 people with irregular heartbeat, 121 developed dementia (23%).

Researchers also found that people who took blood thinners for atrial fibrillation had a 60 percent decreased risk of dementia.

Full story at PHARMAfield

Link to research: Mozhu Ding et al. | Atrial fibrillation, antithrombotic treatment, and cognitive aging | Neurology | Published ahead of print on October 10, 2018