The number of older people, including those living with dementia, is rising, as younger age mortality declines. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes.
Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.
We now add three more risk factors for dementia with newer, convincing evidence. These factors are excessive alcohol consumption, traumatic brain injury, and air pollution. We have completed new reviews and meta-analyses and incorporated these into an updated 12 risk factor life-course model of dementia prevention. Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.
The potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur. Our new life-course model and evidence synthesis has paramount worldwide policy implications. It is never too early and never too late in the life course for dementia prevention. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments.
Culture, poverty, and inequality are key drivers of the need for change. Individuals who are most deprived need these changes the most and will derive the highest benefit.
“We are learning that tactics to avoid dementia begin early and continue throughout life, so it’s never too early or too late to take action,” says commission member and AAIC presenter Lon Schneider, MD, co-director of the USC Alzheimer Disease Research Center‘s clinical core and professor of psychiatry and the behavioral sciences and neurology at the Keck School of Medicine of USC.
LOS ANGELES — Modifying 12 risk factors over a lifetime could delay or prevent 40% of dementia cases, according to an updated report by the Lancet Commission on dementia prevention, intervention and care presented at the Alzheimer’s Association International Conference (AAIC 2020).
Twenty-eight world-leading dementia experts added three new risk factors in the new report — excessive alcohol intake and head injury in mid-life and air pollution in later life. These are in addition to nine factors previously identified by the commission in 2017: less education early in life; mid-life hearing loss, hypertension and obesity; and smoking, depression, social isolation, physical inactivity and diabetes later in life (65 and up).
Schneider and commission members recommend that policymakers and individuals adopt the following interventions:
- Aim to maintain systolic blood pressure of 130 mm Hg or less from the age of 40.
- Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels.
- Reduce exposure to air pollution and second-hand tobacco smoke.
- Prevent head injury (particularly by targeting high-risk occupations).
- Limit alcohol intake to no more than 21 units per week (one unit of alcohol equals 10 ml or 8 g pure alcohol).
- Stop smoking and support others to stop smoking.
- Provide all children with primary and secondary education.
- Lead an active life into mid-life and possibly later life.
- Reduce obesity and the linked condition of diabetes.
‘Journal of Neurology, Neurosurgery & Psychiatry” (July 10, 2020):
We tested the hypothesis that apathy, but not depression, is associated with dementia in patients with SVD. We found that higher baseline apathy, as well as increasing apathy over time, were associated with an increased dementia risk. In contrast, neither baseline depression or change in depression was associated with dementia. The relationship between apathy and dementia remained after controlling for other well-established risk factors including age, education and cognition. Finally, adding apathy to models predicting dementia improved model fit. These results suggest that apathy may be a prodromal symptom of dementia in patients with SVD.
Cerebral small vessel disease (SVD) is the leading vascular cause of dementia and plays a major role in cognitive decline and mortality.1 2 SVD affects the small vessels of the brain, leading to damage in the subcortical grey and white matter.1 The resulting clinical presentation includes cognitive and neuropsychiatric symptoms.1
Apathy is a reduction in goal-directed behaviour, which is a common neuropsychiatric symptom in SVD.3 Importantly, apathy is dissociable from depression,3 4 another symptom in SVD for which low mood is a predominant manifestation.5 Although there is some symptomatic overlap between the two,6 research using diffusion imaging reported that apathy, but not depression, was associated with white matter network damage in SVD.3 Many of the white matter pathways underlying apathy overlap with those related to cognitive impairment, and accordingly apathy, rather than depression, has been associated with cognitive deficits in SVD.7 These results suggest that apathy and cognitive impairment are symptomatic of prodromal dementia in SVD.
From a PLOS Medicine online study:
Depression is associated with increased odds of dementia, even more than 20 years after diagnosis of depression, and the association remains after adjustment for familial factors. Further research is needed to investigate whether successful prevention and treatment of depression decrease the risk of dementia.
The risk of dementia is increased for decades after a diagnosis of depression, where those diagnosed with especially severe depressions are at increased risk.
Dementia is common among the elderly, causing severe individual suffering as well as societal strain. As the proportion of people aged 65 years and above is rapidly increasing in the world population, the number of individuals with dementia is expected to double within 20 years, and this condition was estimated to have a worldwide cost of US$604 billion in 2010. Effective treatments for dementia remain scarce; however, a preventive approach may be possible through the identification of high-risk individuals and potentially modifiable risk factors.
From a JAMA Network online release:
This systematic review and meta-analysis of 11 studies involving 21 517 physicians demonstrated an association between physician depressive symptoms and an increased risk for perceived medical errors (RR, 1.95; 95% CI, 1.63-2.33). We also found that the magnitude of the associations of physician depressive symptoms and perceived medical errors were relatively consistent across studies that assessed training and practicing physicians, providing additional evidence that physician depression has implications for the quality of care delivered by physicians at different career stages.
Medical errors are a major source of patient harm. Studies estimate that, in the United States, as many as 98 000 to 251 000 hospitalized patients die each year as result of a preventable adverse event.1–4 In addition, medical errors are a major source of morbidity5 and account for billions of dollars in financial losses to health care systems every year.6–9
Depressive symptoms are highly prevalent among physicians,10,11 and several studies have investigated the associations between physician depressive symptoms and medical errors.12–16 Although most studies on physician depressive symptoms and medical errors have identified a substantial association, their results are not unanimous, and questions regarding the direction of these associations remain open in recent literature.17
As societal stresses have increased, loneliness and social isolation have become silent killers. Dilip Jeste, MD, a geriatric neuropsychiatrist who specializes in successful aging, explains how loneliness has become an epidemic, the risk factors, helpful interventions, and how we can harness wisdom for compassion, self regulation, and more.
From a MD Magazine online release:
The investigators discovered that patients with a higher genetic risk for depression were more likely to be diagnosed with depression over the next 2 years. However, more physically active patients at baseline were less likely to depression, even after they accounted for genetic risks.
Increasing physical activity could pay dividends for people with a high risk of developing depression.
A team from Massachusetts General Hospital (MGH) recently discovered that several hours of weekly exercise result in a decreased chance to be diagnosed with a new episode of depression, even in patients with a higher genetic risk of developing Major Depressive Disorder (MDD).
The team examined the genomic and electronic health record (EHR) data of approximately 8000 patients in the Partners Healthcare Biobank, which represents the first study to show how physical activity influences depression despite genetic risk.
To read more: https://www.mdmag.com/medical-news/physical-activity-epressive-episode?eKey=bWljaGFlbDkyNjUxQHlhaG9vLmNvbQ==&utm_medium=email&utm_campaign=MDMagSS%20Daily%20Clinical%20eNews%20Sponsored%20Article%2011-5-19%20copy&utm_content=MDMagSS%20Daily%20Clinical%20eNews%20Sponsored%20Article%2011-5-19%20copy+CID_7326ad4f0f2426afa568130acb5dabae&utm_source=CM%20MDMag&utm_term=Physical%20Activity%20Reduces%20Odds%20of%20Depressive%20Episode