Maintaining wellbeing - prevention of dementia

Sube BanerjeeExecutive Dean & Professor of Dementia

Faculty of HealthUniversity of Plymouth

Figure 1

Source: The Lancet 2013; 382:1405-1412(DOI:10.1016/S0140-6736(13)61570-6)

CFAS I and CFAS II age-specific dementia prevalence

The prevalence of dementia in China 1990-2010Chen et al, Lancet 2013

1990

2010

Increasing prevalence of dementia in China?

3.5%

5.1%46% increase1990-2010

Dementia prevention, intervention, and care

Gill Livingston, Andrew Sommerlad, Vasiliki Orgeta, Sergi G Costafreda, Jonathan Huntley, David Ames, Clive Ballard, Sube Banerjee, Alistair Burns, Jiska Cohen-Mansfield, Claudia Cooper, Nick Fox, Laura N Gitlin, Robert Howard, Helen C Kales, Eric B Larson, Karen Ritchie, Kenneth Rockwood, Elizabeth L Sampson, Quincy Samus, Lon S Schneider, Geir Selbæk, Linda Teri, Naaheed Mukadam

The Lancet, Vol. 390, No. 10113

Published: July 19, 2017

The Nun Study

The Nun Study

• A historical cohort study of elderly Milwaukee nuns who wrote a biography at age 18 on entering holy orders– Biography analysed for

• Idea density • Grammatical complexity

– Related to• 83 nuns - Late-life cognitive function• 24 nuns - Post mortem brain pathology

Snowdon - JAMA 1996

The Nun study - neuropsychology

Poor scores on ¯

Low idea density

High idea density

Odds ratio

MMSE 35% 2% 30.8 (2.6-362)

Delayed word recall

41% 3% 15.3 (3.0-78.3)

Verbal fluency

21% 3% 8.9 (1.7-47.2)

Snowdon - JAMA 1996

The Nun study - neuropathology

Low idea density N=10

High idea density N=14

% with >= 1 NFT 90% 29%

Mean no. of NFTs/ 0.6 mm2

9.4 0.5

Mean NFT density adj. for age at death and yrs of education

8.8 (6.1-11.5) 1.0 (0.0-3.4)

Snowdon - JAMA 1996

The Nun Study

• low linguistic ability in early life (low idea density & low grammatical complexity in autobiographical essays) was associated with the development of AD neuropathology (but not cerebrovascular pathology) in later life

• Central importance of building and maintaining COGNITIVE RESERVE

Modifiable risk factors

for dementia – Lancet

Commission

INTENSIVE INTERVENTIONNutritionExercise

Cognitive training Vascular risk monitoring

years 2

REGULAR HEALTH ADVICE

N= 126060-77 years

Primary: NTB total score(Composite z-score)

Red - interventionBlue - control

Lines = estimates for change from baseline to 1 & 2 years Error bars = standard errorsP-values = difference in trajectories over time between groups

Ngandu, Kivipelto et al. Lancet 2015

Summary of FINGER findings

25% higher improvement

p=0.03 0.00

0.05

0.10

0.15

Baseline 12months

24months

Executive functioning

0.00

0.05

0.10

0.15

Baseline

12 months

24 months

Processing speed

83% higher improvement 150% higher improvement

p=0.04 p=0.03

Memory (complex tasks)

p=0.04

40% higher improvement

• Lower risk for cognitive decline

• 30% lower risk for functional decline (IADL) (Kulmala et al., manuscript)

• Better health related quality of life (Strandberg et al, Eur Ger Med 2017)

Maintaining brain health – health promotion

• Integrate with Non Communicable Disease prevention agendas– Tobacco control, salt, alcohol, inactivity, CVRF management– Its never too early….. (education, nutrition, hypertension)– Its never too late….. (smoking, diabetes)

• Central importance of building and maintaining COGNITIVE RESERVE

• Lancet Commission recommendation - Be ambitious about prevention. We recommend active treatment of hypertension in middle aged (45–65 years) and older people (aged older than 65 years) without dementia to reduce dementia incidence. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity might have the potential to delay or prevent a third of dementia cases.

Thank you!