Reduction in Dementia Predicted With Midlife Risk Factor Modification

Pam Harrison

April 02, 2010

April 2, 2010 — According to the calculations of UK experts, the prevalence of dementia could be reduced by between 15% and 20% with appropriate risk factor modification begun by the age of about 35 years. As Tom Russ, MD, and John Starr, MD, from the University of Edinburgh, Scotland, observe in an editorial published online April 1 in BMJ Clinical Evidence, limiting the financial and personal cost of dementia are key goals for healthcare systems.

"One strategy that has recently gained momentum is early intervention to prevent development of the disorder," the authors note. In a BBC-hosted dementia panel held on January 6, panellists discussed 4 main factors that may minimize the risk for dementia across populations.

These include increasing levels of exercise across all ages, controlling midlife obesity, optimizing midlife blood pressure, and reducing midlife cholesterol levels to recommended targets for various risk groups.

With the right interventions, the panel estimated dementia rates could be potentially reduced by 2% per year starting from 2012, provided the interventions occurred in midlife, as there is no evidence that lowering blood pressure or cholesterol later in life effectively prevents dementia.

"Obviously, this would have a huge impact on the population prevalence of dementia, not to mention the potential impact on other disorders, such as cardiovascular disease, which share the same risk factors," Dr. Russ told Medscape Neurology.

Indeed, there is evidence now suggesting that risk factor modification may help prevent damage to the brain not only in vascular dementia, where traditional CVD risk factors most likely contribute to the pathology, but even in Alzheimer's disease, despite its very different pathology, Dr. Russ added.

Mild Cognitive Impairment

As the authors point out, between 11% and 33% of patients with mild cognitive impairment (MCI) develop dementia within 2 years of MCI onset, and MCI may be considered almost a precursor of dementia. There is as yet no reliable way of determining who is likely to progress to dementia and who will not, but some researchers feel that the answer will lie in more detailed neuroimaging or neuropsychological testing than is currently used.

To date, however, there is no evidence that treatment of MCI halts progression to dementia, so the identification of MCI may be of limited clinical use, the authors note.

"It's not terribly new, we are simply suggesting that these risk factors should be controlled as well as possible at a population level and that people should practice healthy lifestyle habits from midlife onwards to reduce their risk of many diseases, including dementia," Dr. Russ observed.

The Alzheimer's Research Trust recently estimated that dementia costs the United Kingdom £23 billion a year.

Dr. Russ' post is supported by Alzheimer Scotland.

BMJ Clinical Evidence. Published online April 1, 2010.

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