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The three biggest risk factors for dementia


A newly published research article has determined what modifiable factors may increase the risk of dementia and Alzheimer’s disease. These researchers compared modifiable risk factors for dementia and determined how these factors appear to affect brain regions that are susceptible to Alzheimer’s disease, dementia, and schizophrenia.

This research could help physicians and other healthcare workers to advise patients to improve certain health conditions that may lead to a lower risk of dementia and Alzheimer’s disease.

As I am prone to do, I will analyze the study and determine if there is something to it.

man standing beside woman on swing dementia risk
Photo by Pixabay on Pexels.com

All about Alzheimer’s disease

Before proceeding, it’s important to describe what we know about Alzheimer’s disease (AD). It is a chronic neurodegenerative disease that usually starts slowly and worsens over time. It accounts for 60-70% of dementia cases, even though the terms are sometimes used interchangeably.

Actually, Alzheimer’s disease is a form of dementia. The other forms of dementia include Lewy body dementia, frontotemporal disorders, vascular dementia, and mixed dementia, which is a combination of two or more of the different forms of dementia.

Amyloid plaques (caused by amyloid beta, or Aβ), phosphorylated tau tangles (pTau), and neurofibrillary tangles are often observed in microscopic analysis of brain tissue from autopsies of those potentially afflicted by AD. These plaques and tangles seem to affect nerve functioning which leads to the long-term decline of the neurological functioning of the individual. Despite these observations, the precise pathophysiology, or physiological development, of the disease is not known.

Since amyloid plaques are often identified in patients with Alzheimer’s disease, a large amount of research is focused on attacking those plaques as a way to reverse the effect on nerves which leads to AD.

The causes of AD are unknown (notice how much we do not know about this disease). However, it is speculated that there is a genetic component along with modifiable risk factors.

Since we have no clear understanding of the etiology and pathophysiology of AD, there are no effective treatments available today for the disease, although there are some drugs that target the amyloid plaques, they have not been shown to change the course or outcomes of AD.

There are a couple of medications that may help manage some of the symptoms of the disease, but they are certainly not cures. There are several drugs at the very earliest stages of development that may hold out hope to treat the underlying disease.

One more thing that needs to be made clear. There are no biological tests for Alzheimer’s disease — usually, you can only find the amyloid plaques and other pathologies in post-mortem autopsies. Unfortunately. in the absence of an autopsy, clinical diagnoses of AD are “possible” or “probable”, based on other findings, such as memory tests and other methods.

In the United States, about 10.7% of seniors (≥65 years) currently have Alzheimer’s dementia, and the incidence of dementia and Alzheimer’s disease is expected to rise substantially in the coming decades due to population aging, making it imperative to identify modifiable risk factors that may help mitigate its impact. The economic burden of AD is expected to surpass $2.8 trillion by 2030.

The dementia and Alzheimer’s disease risk study

In a paper published on 27 March 2024 in the respected journal Nature Communications, Gwenaëlle Douaud, Ph.D., FMRIB Centre, Wellcome Centre for Integrative Neuroimaging (WIN), Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK, and colleagues examined brain scans of nearly 40,000 adults, between ages 44 and 82, in the United Kingdom. The compared the scans to modifiable risk factors and genetic information to determine what might be linked to a higher risk of dementia and Alzheimer’s disease.

The study examined 161 modifiable risk factors, including blood pressure, cholesterol, diabetes, weight, alcohol consumption, smoking, mood, inflammation, pollution, hearing, sleep, socialization, diet, physical activity and education.

What were the researchers’ findings:

  1. The three most detrimental risk factors were: diabetes, air pollution, and alcohol consumptions. These three had almost twice the increased risk as the other risk factors.
  2. The next highest risk factors were amount of sleep, obesity, smoking, and blood pressure. Of course, these risk factors are often linked.
  3. The researchers also identified seven genetic clusters that may affect vulnerable parts of the brain that are associated with Alzheimer’s disease or dementia. Of course, genetic risk factors are not modifiable.

Of course, there are some concerns about this study. The biggest one is that all of the individuals in the study live in the UK, which has a better healthcare system than many countries (especially the USA), so risk factors found in some countries would not be visible in the results of this study.

Finally, this study did not provide information as to whether genetic factors were more critical than modifiable risk factors, like diabetes or alcohol consumption.

Summary

The more I read about the risk factors for dementia and Alzheimer’s disease, the more I come to the conclusion that it is very complicated. We have data that diet and exercise, which can reduce your risk of obesity and diabetes, are also important risk factors for the diseases.

Summing up all of the available evidence I think that eating healthy, remaining active, and have a lot of social interactions are all important to reducing your risk of Alzheimer’s disease. But it’s clear that alcohol consumption, smoking, diabetes, and air pollution also increase the risk.

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Michael Simpson

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