Transcript
Delaying demen,a and cogni,ve decline.
Tony Bayer School of Medicine Cardiff University
Public a)tudes to demen1a
9% 13% 14%20%
38%
Diabetes Stroke Heartdisease
Alzheimer'sdisease
Cancer
7%
15% 14%
31%
27%
Diabetes Stroke Heartdisease
Alzheimer'sdisease
Cancer
A3er cancer, Alzheimer’s disease is the condi1on people fear the most…
… but a3er age 55, Alzheimer’s disease is the most feared
MetaLife Survey 2010
A global challenge
Demen,a Risk Factors Across the Life Cycle
Developmental and early life risk factors
• Good infant health (larger skull size) • Good early life nutri,on (longer leg length) • Higher level of educa1on (and higher
occupa,onal aHainment)
?? May increase ‘cogni/ve reserve’
Metaanalysis for adjusted effect of educa,on on risk of incident demen,a (World Alzheimer Report 2014)
Psychological factors
• Early parental death • Mid and late life depression • Anxiety • Psychological distress (neuro,cism,
conscien,ousness) • Sleep disturbance (& benzodiazepine drugs)
Meta-‐analysis for adjusted effect of depression on risk of incident demen,a (World Alzheimer Report 2014)
Lifestyle factors
• Smoking • Excessive alcohol • Lack of physical ac,vity • Lack of cogni1ve and social s1mula1on • Lack of healthy, balanced diet • Significant head injury
Meta-‐analysis for adjusted effect of ex-‐smokers versus never-‐smokers on risk of incident demen,a (World Alzheimer Report 2014)
Cardiovascular risk factors
• Hypertension in mid-‐life • Obesity in mid-‐life • Hyperlipidaemia in mid-‐life • Diabetes mellitus in late-‐life
Forest plot for associa,on of diabetes in late life and incident demen,a (World Alzheimer Report 2014)
Recent studies suggest falling demen1a prevalence
Had men in the Caerphilly Cohort each been urged at
baseline 35y ago to adopt one addi/onal healthy behaviour, and if only half had complied,
there would have been 13% less demen+a
Opportunity missed?
Midlife risk profile, 20 year predic1on
Kivipelto et al, Lancet Neurology 2006
2%
Finnish Geriatric Interven1on Study to Prevent Cogni1ve Disability
2-‐year mul,centre RCT with 1260 par,cipants aged 60-‐77 years with Demen,a Risk Score > 6 Randomized (1:1) to: • mul,domain interven,on group (nutri,onal guidance, physical exercise, cogni,ve training and social ac,vi,es & management of vascular risk factors) or
• control group (regular health advice)
Finnish Geriatric Interven1on Study to Prevent Cogni1ve Disability
Preliminary results at 2 years show beneficial effect of interven,on on: • Overall cogni,ve performance (NTB) (p<0.001) • Memory (p<0.05) • Execu,ve func,on (p<0.05) • Psychomotor speed (p<0.05)
Effects more prominent in elderly (>70) and those with worse cogni,on at baseline Drop out rate was only 11% and par,cipants’ experiences were very posi,ve, despite musculoskeletal pain associated with exercise Kivipelto AAIC Presenta,on July 2014
What’s happening in Wales?
“If we can all enter old age with beBer developed, healthier brains we are likely to live longer, happier and more independent lives with a much reduced chance of developing demen/a”
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