Tony Bayer - Dementia prevention
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Transcript of Tony Bayer - Dementia prevention
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Delaying demen,a and cogni,ve decline.
Tony Bayer School of Medicine Cardiff University
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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
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A global challenge
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Demen,a Risk Factors Across the Life Cycle
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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)
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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)
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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)
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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)
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Recent studies suggest falling demen1a prevalence
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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?
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Midlife risk profile, 20 year predic1on
Kivipelto et al, Lancet Neurology 2006
2%
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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)
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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
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What’s happening in Wales?
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“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”