dementia it’s coming · metabolic syndrome & dementia risk •diabetes/ raised fasting sugar...
TRANSCRIPT
DEMENTIA RESEARCH
Collaborative partnerships • Translating evidence • Research partnerships
Translating dementia research into practice
Dementia – it’s coming
What we can do about it
Professor Henry Brodaty Director
Dementia Collaborative Research Centre – Assessment and Better Care
© DCRC/Brodaty 2011
Bill’s story • 70 y.o. architect
• Married, 3 children + 5 GC
• Mistakes at work
• Repeats self, slower at grasping
concepts, less initiative
• Admits to anxiety 2 yrs
• Referred for assessment
• Alzheimer’s diagnosed
Translating dementia research into practice © DCRC/Brodaty 2011
What is dementia?
• Umbrella term (syndrome)
• Decline in cognitive abilities
such as memory, word-finding,
reasoning
• Interferes with daily function
Translating dementia research into practice © DCRC/Brodaty 2011
Over 100 causes of dementia
• Alzheimer’s disease is
commonest, >50%
• Vascular dementia
• Many others, rarely
reversible
Translating dementia research into practice © DCRC/Brodaty 2011
Projections of a tripling of world’s
dementia population by 2050
Translating dementia research into practice © DCRC/Brodaty 2011
World Alzheimer Report, ADI, 2009
© 2010 Brodaty © 2010 Brodaty
Quadrupling in Australia
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
2010 2020 2050
0.25 million
0.6
million
1
million
Access Economics for Alzheimer’s Australia, 2009
Translating dementia research into practice © DCRC/Brodaty 2011
Cost of dementia
Access Economics (2011). Caring places: Planning for aged care and dementia
2010-2050.
$AU billion
Cost of aged care (HACC,
community care, RACF) Number of RACF places
Can dementia be prevented?
• Cannot prevent but can delay
• What is good for your heart is good for
your brain!
• Alzheimer’s Australia MindYourMind
Translating dementia research into practice © DCRC/Brodaty 2011
BrainyApp: developed by Alzheimer’s Australia
to raise awareness of AD/dementia risk factors
Translating dementia research into practice © DCRC/Brodaty 2011
Barnes D & Yaffe K, 2011
Environment and AD
• Up to 50% of population attributable risk of
AD cases from 7 environmental factors
• If 25% lower prevalence of these risk factors
3 million fewer AD cases worldwide
Barnes & Yaffe, 2011
• 2% diabetes mellitus (type 2)
• 2% midlife obesity*
• 5% midlife hypertension
• 10% depression
• 13% physical inactivity*
• 14% smoking
• 19% cognitive inactivity/education#
How much AD can be attributed to
environmental factors?
Physical activity = protective
• Several studies show physical
activity protective against
cognitive decline, dementia,
Alzheimer’s, vascular dementia
• More is better – puffed, weights
• At least 3x per week; > 150 mins/wk
• Check with your doctor
1Jedrziewski et al (2007). Alz Dem; 3:98-108; 2 Lautenschlager et al (2008) JAMA; 300(9):1027-
1037; 3Ravaglia et al (2007) Neurology; 4Larson et al (2006) Ann Intern Med; 144:73-81; 5Laurin et al, Arch Neurol 2001;58:498-504; 6Middelton et al, PLos ONE 2008;3(9):e3124
Nutrition / Supplements
• Alcohol ? moderate
• Fish/Seafood/ omega 3?
• Vitamin D ?
Metabolic syndrome & dementia risk
• Diabetes/ raised fasting sugar
• Abdominal obesity
• High cholesterol
• High blood pressure
• 23% increased dementia risk for each component of metabolic syndrome
Yaffe et al (2009) Arch Neurol. 66(3):324-328
• 4895 older women
• 497 with metabolic syndrome
Walking 150’/wk for cognition
-1
-0.5
0
0.5
1
1.5
6 mths 12 mths 18 mths
me
an d
iffe
ren
ce o
n A
DA
S-C
og
fro
m b
ase
line
exercise group
control group
Improvement
Decline
Exercise
© DCRC/Brodaty 2010
Lautenschlager et al (2008) JAMA; 300(9):1027-1037 N =138 memory
complainers
The power of physical activity
Erickson et al., 2011
Can Alzheimer’s be treated?
• No cures
• Almost 1000 trials registered and 300
recruiting participants globally
• Drivers: Pharmaceutical industry
– World-wide ageing and longevity
– Baby boomers
– Awareness
– Society’s concern about costs
Developments in AD treatments
• Drugs to block enzymes that make toxic
protein that accumulates and causes damage
• Vaccines to attack toxic protein clumps
• Stem cell treatment
What are priorities?
• Research – fraction of cancer, diabetes, heart
disease; 1% of $6 billion = $60m pa
• Services
• Training
• Workforce
• Prevention
Other research developments
• Improve quality of life of people with dementia
• Decrease agitation
– Person centred care
– Humour therapy
• Decrease carer depression, enhance QoL
The Dementia Epidemic is here
The only thing more expensive than
knowledge is ignorance
www.dementiaresearch.org.au