Tag: alzheimers

Eliminating these 14 risk factors may prevent nearly half of dementia cases

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Key takeaways:

  • The Lancet Commission identified high cholesterol and vision loss as new risk factors for dementia.
  • The commission outlined 13 recommendations for individuals and governments to prevent dementia.

PHILADELPHIA — Tackling 14 risk factors for dementia beginning in childhood could prevent or delay nearly half of cases worldwide, according to a report from the Lancet Commission presented at the Alzheimer’s Association International Conference.

These include two risk factors — high cholesterol and vision loss — newly identified by the commission on dementia prevention, intervention and care.

An estimated 57 million people were living with dementia in 2019, Gill Livingston, MD, a professor of psychiatry at University College London, and colleagues wrote in the report. This number is expected to increase to 153 million by 2050, highlighting the need for risk reduction strategies.

The new report is an update to the commission’s 2020 report. Members of the commission adopted a triangulation framework that prioritized systematic reviews and meta-analyses. They also conducted new meta-analyses when necessary.

The researchers said their review supports the 12 potentially modifiable risk factors that were identified in the 2020 report: air pollution (RR = 1.1; 95% CI, 1.1-1.1); depression (RR = 2.2; 95% CI, 1.7-3); diabetes (RR = 1.7; 95% CI, 1.6-1.8); excessive alcohol use (RR = 1.2; 95% CI, 1-1.5); hearing loss (RR = 1.4; 95% CI, 1-1.9); hypertension (RR = 1.2; 95% CI, 1.1-1.4); lower education level (RR = 1.6; 95% CI, 1.3-2); obesity (RR = 1.3; 95% CI, 1-1.7); physical inactivity (RR = 1.2; 95% CI, 1.2-1.3); smoking (RR = 1.3; 95% CI, 1.2-1.4); social isolation (RR = 1.6; 95% CI, 1.3-1.8); and traumatic brain injury (RR = 1.7; 95% CI, 1.4-1.9).

The evidence also supports the addition of high LDL cholesterol (RR = 1.3; 95% CI, 1.3-1.4) and vision loss (RR = 1.5; 95% CI, 1.4-1.6).

If these 14 risk factors are eliminated, “nearly half of dementias could theoretically be prevented,” Livingston and colleagues wrote.

This has important implications for physicians, particularly family physicians, Livingston told Healio. She noted that diabetes, excessive alcohol use, hearing impairment, high LDL, hypertension, obesity, vision loss and smoking account for about one-quarter of all dementias.

“If we add depression, traumatic brain injury and physical inactivity, which family physicians also advise on, then it is a third of dementias,” she said. “Their active vigilance and advice potentially make a huge difference.”

Based on their findings, the researchers outlined 13 recommendations for individuals and governments to prevent dementia:

  • ensure children have access to good-quality education and encourage individuals in midlife to participate in “cognitively stimulating activities;”
  • reduce harmful noise exposure and make hearing aids accessible to those with hearing impairment;
  • treat depression;
  • promote helmets and other head protection during contact sports and when riding bicycles;
  • encourage exercise;
  • reduce smoking through education and by implementing policies that aim to control the cost of cigarettes;
  • prevent or reduce high blood pressure;
  • diagnose and treat high LDL;
  • maintain a healthy weight and treat obesity early;
  • reduce excessive alcohol use through price control and raising awareness about the risks of overconsumption;
  • reduce social isolation by encouraging activities and living with other people, prioritizing an “age-friendly and supportive community, environments and housing”;
  • ensure access to vision loss screening and treatment; and
  • decrease air pollution exposure.

“Although addressing risk factors at an early stage of life is desirable, there is also benefit from tackling risk throughout life; it is never too early or too late to reduce dementia risk,” Livingston and colleagues wrote.

References:

  • Livingston G, et al. Lancet standing commission on dementia prevention, intervention and care. Scientific advances in the 2024 commission. Presented at: Alzheimer’s Association International Conference; July 28-Aug. 1, 2024; Philadelphia.
  • The Lancet: Nearly half of dementia cases could be prevented or delayed by tackling 14 risk factors starting in childhood, including two new risks — high cholesterol and vision loss. www.eurekalert.org/news-releases/1052982. Published July 31, 2024. Accessed July 31, 2024.

Perspective

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Claire Sexton, DPhil

Dementia risk reduction is an important area of research. In this latest Lancet Commission report, they’re adding two more risk factors — high cholesterol and vision loss — to the list and calculating that, together, these 14 factors could account for around half of all worldwide cases of dementia. This illustrates the importance of our awareness of these types of risk factors.

It’s important for our understanding that these reports are not just informed by epidemiological studies, but further interventional studies. One of those, which is ongoing, is the U.S. POINTER study. Recruiting is complete, but evaluating the results of the study is still underway. They will be reported next year at AAIC 2025 in Toronto. This study is looking at multiple risk factors, including modifying diet, exercise, cognitive activities, social engagement and the management of heart health status, and whether these factors in combination can protect cognitive health.

Of note, for right now, the Alzheimer’s Association provides 10 Healthy Habits for Your Brain, which is a great resource for anybody who is thinking about their risk.

Claire Sexton, DPhil

Senior director of scientific programs and outreach

Alzheimer’s Association

Disclosures: Sexton reports no relevant financial disclosures.

Sources/Disclosures

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Source: 

Livingston G, et al. Lancet. 2024;doi:10.1016/S0140-6736(24)01296-0.

https://www.healio.com/news/psychiatry/20240731/eliminating-14-risk-factors-may-prevent-nearly-half-of-dementia-cases?utm_source=SMC&utm_medium=email&utm_campaign=Lunch%20Break&utm_content=Psychiatry

Researchers identify new therapeutic approach targeting astrocytes, the brain’s most abundant cells

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A team led by scientists at Case Western Reserve University School of Medicine has identified a new therapeutic approach for combating neurodegenerative diseases, offering hope of improved treatments for Alzheimer’s disease, Parkinson’s disease, Vanishing White Matter disease and multiple sclerosis, among others. 

Neurodegenerative diseases, which affect millions of people worldwide, occur when nerve cells in the brain or nervous system lose function over time and ultimately die, according to the National Institutes of Health. Alzheimer’s disease and Parkinson’s disease are the most common.

The research team’s new study, published online Feb. 20 in the journal Nature Neuroscience, focused on astrocytes—the brain’s most abundant cells, which normally support healthy brain function. Growing evidence indicates astrocytes can switch to a harmful state that increases nerve-cell loss in neurodegenerative diseases.

The researchers created a new cellular technique to test thousands of possible medications for their ability to prevent these rogue astrocytes from forming. 

“By harnessing the power of high-throughput drug-screening, we’ve identified a key protein regulator that, when inhibited, can prevent the formation of harmful astrocytes,” said Benjamin Clayton, lead author and National Multiple Sclerosis Society career transition fellow in the laboratory of Paul Tesar at the Case Western Reserve School of Medicine.

They found that blocking the activity of a particular protein, HDAC3, may prevent the development of dangerous astrocytes. The scientists discovered that by administering medications that specifically target HDAC3, they were able to prevent the development of dangerous astrocytes and significantly increase the survival of nerve cells in mouse models.

“This research establishes a platform for discovering therapies to control diseased astrocytes and highlights the therapeutic potential of regulating astrocyte states to treat neurodegenerative diseases,” said Tesar, the Dr. Donald and Ruth Weber Goodman Professor of Innovative Therapeutics and the study’s principal investigator.  

Tesar, also director of the School of Medicine’s Institute for Glial Sciences, said more research needs to be done before patients might benefit from the promising approach. But, he said, their findings could lead to the creation of novel therapies that disarm harmful astrocytes and support neuroprotection—perhaps improving the lives of people with neurodegenerative illnesses in the future.

“Therapies for neurodegenerative disease typically target the nerve cells directly,” Tesar said, “but here we asked if fixing the damaging effects of astrocytes could provide therapeutic benefit. Our findings redefine the landscape of neurodegenerative disease treatment and open the door to a new era of astrocyte targeting medicines.”

Additional contributing researchers from the Case Western Reserve School of Medicine, and from the George Washington School of Medicine, The Ohio State University and the University of Tampa included James Kristell, Kevin Allan, Erin Cohn, Yuka Maeno-Hikichi, Annalise Sturno, Alexis Kerr, Elizabeth Shick, Molly Karl, Eric Garrison, Robert Miller, Andrew Jerome, Jesse Sepeda, Andrew Sas, Benjamin Segal, and Eric Freundt.

The research was supported by grants from the National Institutes of Health, National Multiple Sclerosis Society and Hartwell Foundation, and philanthropic support by sTF5 Care and the R. Blane & Claudia Walter, Long, Goodman, Geller and Weidenthal families.