University of Southern California study: Forty percent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life

10 Aug

Kathleen Fifield wrote in the AARP Journal article, Dementia vs. Alzheimer’s: Which Is It? How to understand the difference — and why it matters:

What it is

Dementia 

In the simplest terms, dementia is a decline in mental function that is usually irreversible. It’s a syndrome, not a disease, notes neurologist Ron Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center and the Mayo Clinic Study of Aging in Rochester, Minnesota.

The catchall phrase encompasses several disorders that cause chronic memory loss, personality changes or impaired reasoning, Alzheimer’s disease being just one of them, says Dan G. Blazer, a psychiatrist and professor at Duke University Medical Center.

To be called dementia, the disorder must be severe enough to interfere with your daily life, says psychiatrist Constantine George Lyketsos, director of the Johns Hopkins Memory and Alzheimer’s Treatment Center in Baltimore.

What it’s not? Typical forgetfulness caused by aging — say, having trouble remembering the name of an acquaintance who comes up to you on the street. In fact, the earliest stage of dementia, known as mild cognitive impairment, is considered “forgetfulness beyond what is expected from aging,” Petersen says. With mild cognitive impairment, a person is still functioning normally — paying her bills, driving well enough, doing his taxes — though performing some of those tasks may take longer than they used to. When someone starts to need regular assistance to do such daily activities, “that gets into the dementia range,” Petersen says.

Alzheimer’s

Alzheimer’s is a specific brain disease that progressively and irreversibly destroys memory and thinking skills. Age is the biggest risk factor for the disease. Eventually, Alzheimer’s disease takes away the ability to carry out even the simplest tasks.

To help determine whether patients have this particular brain disease, doctors talk to the patients and their close family members about any recent challenges or changes in behavior or memory. They also administer a mental status exam in an office setting, and possibly do a short neuro-psych evaluation….

How it’s diagnosed

Dementia

A doctor must find that you have two cognitive or behavioral areas in decline to diagnose dementia. These areas are disorientation, disorganization, language impairment, mood change, personality change and memory loss. To make an evaluation, a doctor (often a specialist such as a psychiatrist, neurologist or geriatric medicine physician) typically takes a patient history and administers several mental-skill challenges.

Thanks to growing medical consensus that irritability, depression and anxiety often flag dementia before memory issues do (and official changes to the diagnostic criteria to reflect this), doctors also ask more about changes in mood or personality, Lyketsos notes….

Next, a standard and fairly brief round of memory and thinking tests is given in the same office visit. In the Hopkins Verbal Learning Test, for example, you try to memorize and then recall a list of 12 words — and a few similar words may be thrown in to challenge you. Another test — also used to evaluate driving skills — has you draw lines to connect a series of numbers and letters in a complicated sequence.

Alzheimer’s 

For decades, diagnosing Alzheimer’s disease has been a process of elimination based on looking at a person’s symptoms and mental-test scores, then ruling out other types of dementia, such as Parkinson’s dementia or vascular dementia.

With Alzheimer’s in particular, the progression and timing of symptoms is also important. To identify this degenerative brain disease, doctors are looking for “a gradual, insidious onset that is slowly getting worse,” Petersen says.

Until fairly recently, a conclusive diagnosis was not possible until an autopsy was performed and the brain examined for the physical hallmarks of the disease — beta-amyloid and tau, proteins that look like plaques and tangles in the brain.

Now, a patient can immediately request a PET scan or cerebrospinal fluid sampling that can show, with 95 percent accuracy, whether such plaques or tangles are present. But a high percentage of patients never get such a test, doctors say. PET scans aren’t normally covered by insurance, and treatments based on specifics such as whether you have more amyloid plaques or more tau tangles in your brain aren’t yet available.

What’s more, doctors say they are often confident, based on evidence such as memory tests, a patient’s age and the progression of symptoms, that a patient suffers from Alzheimer’s in particular. Having a PET scan done also doesn’t change the available treatment, which so far consists of only a handful of drugs used to briefly control symptoms of the disease. Without conclusive imaging, doctors will still act on what they call the strong assumption someone has “probable” Alzheimer’s….                                                                                                                    https://www.aarp.org/health/dementia/info-2018/difference-between-dementia-alzheimers.html?CMP=KNC-DSO-Adobe-Bing-Health-DementiaSpotlight&utm_source=bing&utm_medium=cpc&utm_campaign=Health%20%3E%20Dementia%20%3E%20Research%20%3E%20Exact&utm_term=dementia%20versus%20alzheimer%27s&utm_content=Dementia%20or%20Alzheimer&gclid=CJri45bkkesCFUrSfgodFWsCBA&gclsrc=ds

Resources:

Alzheimer’s vs. Dementia                                                                                                            webmd.com/alzheimers/guide/alzheimers-and-dementia-whats-the-difference#1

Alzheimer’s and dementia: What’s the difference?                                                                  https://www.mayoclinic.org/diseases-conditions/alzheimers-disease/expert-answers/alzheimers-and-dementia-whats-the-difference/faq-20396861

Dementia and Alzheimer’s: What Are the Differences?                                                            https://www.healthline.com/health/alzheimers-disease/difference-dementia-alzheimers

See,  https://drwilda.com/tag/dementia/

Science Daily reported in Forty percent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life:

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)….

Dementia affects some 50 million people globally, a number that is expected to more than triple by 2050, particularly in low- and middle-income countries where approximately two-thirds of people with dementia live, according to the report. Women are also more likely to develop dementia than men.

However, in certain countries, such as the United States, England and France, the proportion of older people with dementia has fallen, probably in part due to lifestyle changes, demonstrating the possibility of reducing dementia through preventative measures, Schneider says.

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.

The report also advocates for holistic, individualized and evidenced-based care for patients with dementia, who typically have more hospitalizations for conditions that are potentially manageable at home and are at greater risk for COVID-19. In addition, it recommends providing interventions for family caregivers who are at risk for depression and anxiety…..                                                                                                                                        https://www.sciencedaily.com/releases/2020/07/200730123651.htm

 

Citation:

Forty percent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life

Date:       July 30, 2020

Source:   University of Southern California – Health Sciences

Summary:

Forty percent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life, experts say.

Journal Reference:

Gill Livingston, Jonathan Huntley, Andrew Sommerlad, David Ames, Clive Ballard, Sube Banerjee, Carol Brayne, Alistair Burns, Jiska Cohen-Mansfield, Claudia Cooper, Sergi G Costafreda, Amit Dias, Nick Fox, Laura N Gitlin, Robert Howard, Helen C Kales, Mika Kivimäki, Eric B Larson, Adesola Ogunniyi, Vasiliki Orgeta, Karen Ritchie, Kenneth Rockwood, Elizabeth L Sampson, Quincy Samus, Lon S Schneider, Geir Selbæk, Linda Teri, Naaheed Mukadam. Dementia prevention, intervention, and care: 2020 report of the Lancet CommissionThe Lancet, 2020; DOI: 10.1016/S0140-6736(20)30367-6

Here is the press release from the University of Southern California:

NEWS RELEASE 30-JUL-2020

Forty percent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life

An update to the Lancet Commission on dementia prevention, intervention and care adds excessive alcohol intake, head injury and air pollution to nine previously identified modifiable risks

UNIVERSITY OF SOUTHERN CALIFORNIA – HEALTH SCIENCES

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).

“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.

Dementia affects some 50 million people globally, a number that is expected to more than triple by 2050, particularly in low- and middle-income countries where approximately two-thirds of people with dementia live, according to the report. Women are also more likely to develop dementia than men.

However, in certain countries, such as the United States, England and France, the proportion of older people with dementia has fallen, probably in part due to lifestyle changes, demonstrating the possibility of reducing dementia through preventative measures, Schneider says.

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.

The report also advocates for holistic, individualized and evidenced-based care for patients with dementia, who typically have more hospitalizations for conditions that are potentially manageable at home and are at greater risk for COVID-19. In addition, it recommends providing interventions for family caregivers who are at risk for depression and anxiety.

The commission members conducted a thorough investigation of all the best evidence in the field, including systematic literature reviews, meta-analyses and individual studies, to reach their conclusions.

###

For more information about Keck Medicine of USC, please visit news.KeckMedicine.org.

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Alzheimer’s and Dementia Alliance of Wisconsin described why early detection is important:

Early diagnosis is key.
There are at least a dozen advantages to obtaining an early and accurate diagnosis when cognitive symptoms are first noticed.
1. Your symptoms might be reversible.
The symptoms you are concerned about might be caused by a condition that is reversible. And even if there is also an underlying dementia such as Alzheimer’s disease, diagnosis and treatment of reversible conditions can improve brain function and reduce symptoms.

  1. It may be treatable.
    Some causes of cognitive decline are not reversible, but might be treatable. Appropriate treatment can stop or slow the rate of further decline.
    3. With treatments, the sooner the better.
    Treatment of Alzheimer’s and other dementia-causing diseases is typically most effective when started early in the disease process. Once more effective treatments become available, obtaining an early and accurate diagnosis will be even more crucial.
  2. Diagnoses are more accurate early in the disease process.
    A more accurate diagnosis is possible when a complete history can be taken early in the disease process, while the person is still able to answer questions and report concerns and when observers can still recall the order in which symptoms first appeared. Obtaining an accurate diagnosis can be difficult once most of the brain has become affected.
    5. It’s empowering.
    An earlier diagnosis enables the person to participate in their own legal, financial, and long-term care planning and to make their wishes known to family members.
    6. You can focus on what’s important to you.
    It allows the person the opportunity to reprioritize how they spend their time – focusing on what matters most to them – perhaps completing life goals such as travel, recording family history, completing projects, or making memories with grandchildren while they still can.
    7. You can make your best choices.
    Early diagnosis can prevent unwise choices that might otherwise be made in ignorance – such as moving far away from family and friends, or making legal or financial commitments that will be hard to keep as the disease progresses.
    8. You can use the resources available to you.
    Individuals diagnosed early in the disease process can take advantage of early-stage support groups and learn tips and strategies to better manage and cope with the symptoms of the disease.
    9. Participate or advocate for research.
    Those diagnosed early can also take advantage of clinical trials – or advocate for more research and improved care and opportunities.
    10. You can further people’s understanding of the disease.
    Earlier diagnosis helps to reduce the stigma associated with the disease when we learn to associate the disease with people in the early stages, when they are still cogent and active in the community.
    11. It will help your family.
    An earlier diagnosis gives families more opportunity to learn about the disease, develop realistic expectations, and plan for their future together – which can result in reduced stress and feelings of burden and regret later in the disease process.
    12. It will help you, too.
    Early diagnosis allows the person and family to attribute cognitive changes to the disease rather than to personal failings – preserving the person’s ego throughout the disease process….                           https://alzwisc.org/Importance%20of%20an%20early%20diagnosis.htm

AI’s role in treatment of Alzheimer’s is an example of better living through technology.

CONSULT A COMPETENT MEDICAL PROFESSIONAL FOR DIAGNOSIS AND TREATMENT OF ANY SUSPECTED DECLINE IN MENTAL FACULTIES

Resources:

What Is Alzheimer’s?                                                                           https://www.alz.org/alzheimers-dementia/what-is-alzheimers

Understanding Alzheimer’s Disease: the Basics  https://www.webmd.com/alzheimers/guide/understanding-alzheimers-disease-basics

What’s to know about Alzheimer’s disease? https://www.medicalnewstoday.com/articles/159442.php

Alzheimer’s Disease                                       https://www.cdc.gov/aging/aginginfo/alzheimers.htm

What is Artificial Intelligence?  https://www.computerworld.com/article/2906336/emerging-technology/what-is-artificial-intelligence.html

Artificial Intelligence: What it is and why it matters https://www.sas.com/en_us/insights/analytics/what-is-artificial-intelligence.html

Brain                                                                                                           https://drwilda.com/tag/brain/

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