The next frontier in the fight against dementia

Views differ on the value of cognitive screening of older adults in a primary care setting. Many providers cite the lack of modifying treatments for Alzheimer’s disease and related dementias (ADRD) as a reason for not universally screening older adults for cognitive deficits. If I have nothing to give my patients to get them better, what’s the point of revealing that they might be at risk for dementia or that they have an early disease? Is dementia a “normal” or “expected” part of aging? The answers to these questions are complex, but above all, much more hope than we think. It is true that age is the most important risk factor for a diagnosis of Alzheimer’s disease (AD), the most common form of dementia; 10% of people in their 60s will be diagnosed with Alzheimer’s disease, but by the time they reach the age of 80, up to 40% will be diagnosed with Alzheimer’s disease (resulting in approximately half a million cases each year). After age, genetics and family history play an important role in determining our risk of dementia. But after that, who we are and how we live our lives have the greatest impact on our likelihood of developing dementia. Thus, it is a misconception that without disease-modifying treatments, there is little we can do to fight this terrible disease that robs us of our most precious asset: our own identity.

Current scientific evidence shows that there is actually a lot we can do to ward off dementia. A study by a panel of international experts, commissioned by The Lancet, found 12 potentially modifiable risk factors that are responsible for up to 40% of dementia cases worldwide. Surprisingly perhaps, these relate to seemingly simple changes, many of which are already on our “radar”, such as being more physically active; controlling our weight, blood sugar and blood pressure; getting treatment for depression; maintaining meaningful social ties; treat hearing loss; and quit smoking. If we took all these steps today, we would reduce more than a third of dementia cases next year. This means that by taking better care of our own health, we could save 175,000 people next year the pain and suffering that follows a diagnosis of Alzheimer’s disease.

While these numbers are powerful, the statistics most important to us are about our loved ones and families. How can we change our future and their future? It turns out that taking care of our health and our lifestyle is the most important thing we can do to avoid an encounter with dementia down the road, and the time it takes to reap the benefits may surprise you. In 2015, Finnish researchers conducted a groundbreaking clinical trial, called the FINGER study, with over 2,500 older adults and demonstrated that engaging in an intensive multi-domain lifestyle intervention (which included physical exercise, nutritional advice, brain training and management of vascular risk factors) for two years reduced the risk of dementia (or prevented dementia) by up to 30% compared to good health advice at l ‘Ancient. This reduction in the risk of dementia is more powerful than any other currently approved treatment.

And even in the presence of cognitive deficits, the continuation of such healthy behaviors can reduce severity of disability. Maintaining healthy behaviors can help, among other things, prevent frailty, a condition affecting approximately 40 out of 1,000 older adults. Frailty presents as a vulnerability and decline in the function of multiple organs. Frail adults struggle with weakness and exhaustion and have a harder time coping with common stressors, ranging from a cold to a sprained ankle. Being fragile predisposes us to health problems and falls, and above all, robs us of our memory much faster. A recent study reported that older people with cognitive impairment and frailty develop dementia twice as fast as those who are not frail. The good news is that following brain-healthy habits like those already discussed, such as being more physically active and eating better, can combat some of the hallmark signs of frailty (weakness, sluggishness, exhaustion, weight loss, and low physical activity).

But how can we practically prioritize our health and lifestyle in the busy lives we lead today, and encourage patients to do the same? Although lifestyle interventions are powerful and widely available to most people, they also require sustained effort and dedication. Take exercise for example – there’s plenty of evidence for the brain health benefits of walking, a cost-effective and safe option for most, yet many people remain sedentary. Another important lesson from the FINGER study that likely contributed to its success was that the intervention was personalized for the individual. Participant uptake of the 2-year intervention was very high (greater than 85%), and a broader implication of these findings is that we need to develop frameworks to systematically increase access to these personalized multi-domain interventions. on lifestyle.

A promising option in this scenario is to make primary care providers (PCPs) more accountable, given that they are the first point of contact for many people in health systems and remain in constant contact with those who suffer from multiple morbidities. At a time of considerable health workforce burnout, the last thing we need is additional responsibilities for our PCPs. But an important consideration is that PCPs know their patients and are well placed to support behavior change in the most effective and early way possible. For example, a systematic review of 48 randomized controlled trials concluded that self-management support interventions in primary care effectively improved various health outcomes for a wide range of lifestyle-related chronic conditions, compared to the norm. usual care. Importantly, the authors identified the “active ingredients” that led to the positive results: improved knowledge, independent symptom monitoring, personalized action plan, stress management/coping, progress tracking, personalized feedback and improved problem solving/decision making. . This highlights a unique opportunity to translate lessons learned from other chronic diseases (such as hypertension, diabetes and obesity) into the care of SARDs, which, as mentioned above, are also related chronic diseases. to the way of life, although we do not systematically consider them as such.

Encouragingly, a recent global brain health survey shows that people want to take care of their brain health by adopting better lifestyle habits. In total, 70% of respondents indicated that memory problems would be a key motivation for them to improve their lifestyle if two conditions were met: 1) that the changes were effective and 2) that this advice came of their healthcare team, further reinforcing the argument made above. Thus, while the general The notion of the importance of healthier lifestyles might not be enough to stimulate meaningful behavior change, individuals seem more likely to pursue changes if they are more aware of the direct link to their brain health. A key part of this argument is that people’s motivation was directly related to their awareness of their own brain health, and this requires regular assessments of brain health. More proactive screening of cognitive performance empowers individuals and their care teams and enables faster translation of big science into better action and healthier lives.

A truly transformative impact on any given individual’s risk of dementia will require a societal and public health transformation that emphasizes the promotion of brain health across the lifespan and breaks the disease model. somewhat simplistic. Ultimately, the focus should be on helping individuals, not treating disease. An important part of this is empowering PCPs in their work to help their patients help themselves with proactive measures to protect brain health. At the same time, support will be needed through public health policies and incentives to ensure adoption and adherence, including personalized coaching and a strong social support network.

On an individual level, we need to realize that we – and our loved ones – don’t need to do a long list of things to protect our brain health, but rather recognize the transformative power that engages in healthier living. Additionally, being an “influencer” is not limited to social media platforms; there is scientific evidence that healthy behaviors are contagious and have the ability to spread through our communities. Essentially, for meaningful change to happen, we need to be both individual and collective brain health ambassadors.

About Joyce Gomes-Osman,

Joyce Gomes-Osman, PT, Ph.D. is vice president of interventional therapy at Linus Health and volunteer assistant professor of neurology at the University of Miami Miller School of Medicine.

About Alvaro Pascual-Leone

Alvaro Pascual-Leone, MD, Ph.D. is the Chief Medical Officer of Linus Health, Professor of Neurology at Harvard Medical School, Principal Investigator at the Hinda and Arthur Marcus Institute for Aging Research, and Medical Director of the Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife.

About Keith Johnson

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