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.

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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

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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

 

One in two women and one in three men will develop neurological disease

OnMedica | October 2018 | One in two women and one in three men will develop neurological disease

A research team from the Netherlands studied  lifetime risk of dementia, stroke and parkinsonism, in over 12,102 individuals (just over half of them women) who at baseline were aged at least 45 years (median 62.2 years), and free from these diseases, for 26 years,  between the years 1990 and 2016 in a  prospective population- based study.

Within this period over 1400 individuals were diagnosed with dementia, 1,285 with stroke and more than 250 with parkinsonism; and of these 438 people (14.6%) were diagnosed with multiple diseases. The researchers found that women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. Females over 45 years of age had a significantly higher lifetime risk of developing dementia and stroke than men (31.4% compared with 18.6% in men; and 21.6% compared with 19.3% in men, respectively); whereas lifetime risk of parkinsonism (4.3% in women and 4.9% in men) was not significantly different. They also saw similar patterns in sex-specific occurrence for Alzheimer’s disease and vascular dementia, ischaemic, haemorrhagic and unspecified stroke and Parkinson’s disease (Source: OnMedica)

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Read the full news story from OnMedica One in two women and one in three men will develop neurological disease

Abstract

Objective To quantify the burden of common neurological disease in older adults in terms of lifetime risks, including their co-occurrence and preventive potential, within a competing risk framework.

Methods Within the prospective population-based Rotterdam Study, we studied lifetime risk of dementia, stroke and parkinsonism between 1990 and 2016. Among 12 102 individuals (57.7% women) aged more than or equal to 45 years free from these diseases at baseline, we studied co-occurrence, and quantified the combined, and disease-specific remaining lifetime risk of these diseases at various ages for men and women separately. We also projected effects on lifetime risk of hypothetical preventive strategies that delay disease onset by 1, 2 and 3 years, respectively.

Results During follow-up of up to 26 years (156 088 person-years of follow-up), 1489 individuals were diagnosed with dementia, 1285 with stroke and 263 with parkinsonism. Of these individuals, 438 (14.6%) were diagnosed with multiple diseases. Women were almost twice as likely as men to be diagnosed with both stroke and dementia during their lifetime. The lifetime risk for any of these diseases at age 45 was 48.2%  in women and 36.2% in men. This difference was driven by a higher risk of dementia as the first manifesting disease in women than in men, while this was similar for stroke  and parkinsonism. Preventive strategies that delay disease onset with 1 to 3 years could theoretically reduce lifetime risk for developing any of these diseases by 20%–50%.

Conclusion One in two women and one in three men will develop dementia, stroke or parkinsonism during their life. These findings strengthen the call for prioritising the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the ageing population.

The full article is available to read at BMJ Journal of Neurology, Neurosurgery & Psychiatry 

Full reference: Licher SDarweesh SKLWolters FJ, et al. | 2018| 
Lifetime risk of common neurological diseases in the elderly population
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Stroke and dementia risk

Kuzma, E. et al. | Stroke and dementia risk: A systematic review and meta-analysis | Alzheimer’s & Dementia | 2018

This study analysed data on stroke and dementia risk from 3.2 million people across the world. The link between stroke and dementia persisted even after taking into account other dementia risk factors such as blood pressure, diabetes and cardiovascular disease. Their findings give the strongest evidence to date that having a stroke significantly increases the risk of dementia.

Introduction
Stroke is an established risk factor for all-cause dementia, though meta-analyses are needed to quantify this risk.

Methods
We searched Medline, PsycINFO, and Embase for studies assessing prevalent or incident stroke versus a no-stroke comparison group and the risk of all-cause dementia. Random effects meta-analysis was used to pool adjusted estimates across studies, and meta-regression was used to investigate potential effect modifiers.

Results
We identified 36 studies of prevalent stroke (1.9 million participants) and 12 studies of incident stroke (1.3 million participants). For prevalent stroke, the pooled hazard ratio for all-cause dementia was 1.69 (95% confidence interval: 1.49–1.92; P < .00001; I2 = 87%). For incident stroke, the pooled risk ratio was 2.18 (95% confidence interval: 1.90–2.50; P < .00001; I2 = 88%). Study characteristics did not modify these associations, with the exception of sex which explained 50.2% of between-study heterogeneity for prevalent stroke.

Discussion
Stroke is a strong, independent, and potentially modifiable risk factor for all-cause dementia.

Full document available here

See also: Stroke doubles dementia risk, concludes large-scale study | ScienceDaily

Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921

 Sibbett, R. A., Russ, T.C.,  Allerhand, M., Deary, I.J., &  Starr, J. M. | 2018| Physical fitness and dementia risk in the very old: a study of the Lothian Birth Cohort 1921 |BMC Psychiatry |  18 | 285 | https://doi.org/10.1186/s12888-018-1851-3

A new article in the BMC Psychiatry examines physical fitness and dementia risk in the very old (participants aged 79 at starting point of the study). Unlike previous studies whch have found an association with old age and dementia risk, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia.

Abstract 

Background

Previous studies have demonstrated that individual measures of fitness – such as reduced pulmonary function, slow walking speed and weak handgrip – are associated with an increased risk of dementia. Only a minority of participants included in these studies were aged over 80. The aim of this study was therefore to investigate the association between physical fitness and dementia in the oldest old.
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Methods

Subjects (n = 488) were enrolled in the Lothian Birth Cohort 1921 and aged 79 at baseline. Dementia cases arising after enrolment were determined using data from death certificates, electronic patient records and clinical reviews. Fitness measures included grip strength, forced expiratory volume in 1 s (FEV1) and walking speed over 6 m, measured at 79 years. Dementia risk associated with each fitness variable was initially determined by logistic regression analysis, followed by Cox regression analysis, where death was considered as a competing risk. APOE ε4 status, age, sex, height, childhood IQ, smoking, history of cardiovascular or cerebrovascular disease, hypertension and diabetes were included as additional variables. Cumulative incidence graphs were calculated using Aalen-Johansen Estimator.

Results

Although initial results indicated that greater FEV1 was associated with an increased risk of dementia (OR (odds ratio per unit increase) 1.93, p = 0.03, n = 416), taking into account the competing risk of mortality, none of the fitness measures were found to be associated with dementia; FEV1 (HR (hazard ratio per unit increase) 1.30, p = 0.37, n = 416), grip strength (HR 0.98, p = 0.35, n = 416), walking speed (HR 0.99, p = 0.90, n = 416). The presence of an APOE ɛ4 allele was however an important predictor for dementia (HR 2.85, p < 0.001, n = 416). Cumulative incidence graphs supported these findings, with an increased risk of dementia for APOE ɛ4 carriers compared with non-carriers. While increased FEV1 was associated with reduced risk of death, there was no reduction in risk for dementia.

Conclusions

In contrast to previous studies, this study found that lower fitness beyond age 79 was not a risk factor for subsequent dementia. This finding is not explained by those with poorer physical fitness, who would have been more likely to develop dementia, having died before onset of dementia symptoms.

The full article can be read at BMC Psychiatry

Living in greener neighbourhoods is associated with slower cognitive decline

Study shows a relation between neighbourhood green space and mental capacity after following 6,500 people in the UK for 10 years | Environmental Health Perspectives | via ScienceDaily

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Contact with greenspace is known to have beneficial effects for mental health. A new study by the Barcelona Institute for Global Health suggests that it may also play a positive role against cognitive decline in elderly. In particular, this research published in Environmental Health Perspectives shows that the loss in cognitive functions expected as part of the ageing process is slightly slower in people who live in greener neighbourhoods.

Researchers performed a 10 years follow-up of 6,500 people aged 45 to 68 from the Whitehall II cohort in the UK. At three different timepoints during the course of the study, participants completed a battery of cognitive tests that assessed their verbal and mathematical reasoning, verbal fluency and short-term memory, as well as the decline in these functions. Neighbourhood greenspace for each participant was estimated using satellite images.

The data revealed that the decline in the cognitive score after the 10-years follow up was 4.6% smaller in participants living in greener neighbourhoods.

There is evidence that the risk for dementia and cognitive decline can be affected by exposure to urban-related environmental hazards (such as air pollution and noise) and lifestyle (such as stress and sedentary behavior). In contrast, living near green spaces has been proposed to increase physical activity and social support, reduce stress, and mitigate exposure to air pollution and noise.

Full story at ScienceDaily

Full reference: Carmen de Keijzer et al. | Residential Surrounding Greenness and Cognitive Decline: A 10-Year Follow-up of the Whitehall II Cohort | Environmental Health Perspectives | 126 (7) | July 2018

Dementia risk now included as part of NHS Health Check

Healthcare professionals in GP surgeries and the community will soon give advice on dementia risk to patients as part of the NHS Health Check.

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Adding the dementia element to the NHS Health Check programme will enable healthcare professionals to talk to their patients about how they can reduce their dementia risk, such as by maintaining their social life, keeping mentally and physically active and stopping smoking.

It is estimated that over 850,000 people are living with dementia in the UK with little public understanding of how it’s possible to reduce the risk. While much of the NHS Health Check focuses on reducing cardiovascular disease (CVD) risk, the advice for preventing CVD is much the same as for dementia: ‘what’s good for the heart is good for the brain’.

Full story at Public Health England

Most deprived are nearly twice as likely to develop dementia

Older adults in England with fewer financial resources are more likely to develop dementia, according to new research | University College London | story via ScienceDaily

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Researchers analysed data from over 6000 adults born between 1902 and 1943 and found that the 20% most deprived adults were 50% more likely to develop dementia than the 20% least deprived adults.

The study, published in JAMA Psychiatry, is the first of its kind to determine which socioeconomic factors influence dementia and found limited wealth in late life is associated with increased risk of dementia, independent of education.

Professor Andrew Steptoe, senior author of the study, explained: “Our study confirms that the risk of dementia is reduced among well-off older people compared with those who have fewer economic resources. Many factors could be involved. Differences in healthy lifestyle and medical risk factors are relevant. It may also be that better off people have greater social and cultural opportunities that allow them to remain actively engaged with the world.”

Full story at ScienceDaily

Full reference: Cadar, D. et al. | Individual and Area-Based Socioeconomic Factors Associated With Dementia Incidence in England: Evidence From a 12-Year Follow-up in the English Longitudinal Study of Ageing.  | JAMA Psychiatry | published online May 16, 2018