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”