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22nd November 2024
Maintaining a good level of fitness could help prevent dementia, especially among people who are genetically susceptible to the disease, new research suggests.
The study published in the British Journal of Sports Medicine found that people with a genetic predisposition to dementia can reduce their risk by up to 35% by increasing their cardiorespiratory fitness. High levels of fitness are also associated with better cognitive ability, the researchers noted.
Involving 61,214 people, the study is one of the largest to assess the effect of fitness on cognitive function and dementia risk. Researchers at the Karolinska Institutet in Sweden used data from the UK Biobank to identify people without dementia between the ages of 39 and 70 and tracked their health over 12 years.
At enrolment, all participants took part in a fitness test that involved cycling on a stationary bike for six minutes. Cognitive function was also assessed using neuropsychological tests, and genetic susceptibility to dementia was determined using a genetic risk score for Alzheimer’s disease.
Over the 12-year study period, 553 people (0.9%) were diagnosed with dementia, identified through patient medical records. The researchers used statistical methods to calculate the link between physical fitness and cognitive health, as well as how genetic predisposition influenced the development of the disease.
Participants who had a higher level of cardiorespiratory fitness had a 40% lower chance of developing dementia compared to people with low levels of cardiorespiratory fitness. High levels of cardiorespiratory fitness were associated with a delayed onset of all dementia by 1.48 years.
For people who had a moderate or high genetic risk of developing dementia, high levels of cardiorespiratory fitness reduced all dementia risk by over a third.
Professor Weili Xu, professor in geriatric epidemiology at the Karolinska Institutet and author of the paper, said: ‘Our study shows that higher fitness is linked to better cognitive function and reduced dementia risk. In addition, high fitness could attenuate the effect of genetic risk for all dementias by up to 35%.’
The researchers cautioned that the study was observational only, and suggested that the rate of dementia cases may be underestimated by the UK Biobank population, which tends to be healthier than the average population.
Acknowledging the need for further research, Professor Xu added: ‘Our findings suggest that maintaining good fitness may be a strategy to prevent dementia, even among people with high genetic susceptibility.’
A version of this article was originally published by our sister publication Nursing in Practice.
2nd August 2024
High low-density lipoprotein (LDL) cholesterol and untreated vision loss have been identified as new risk factors for dementia by a major new report.
The 2024 update of the Lancet Commission on dementia, suggested that 45% of cases could be prevented or delayed by tackling 14 risk factors, starting in childhood.
A previous dementia commission in 2020 identified 12 of those risk factors – which included hypertension, smoking and traumatic brain injury – while the two new risks were revealed yesterday.
The report, written by 27 dementia experts, brought together findings of new research since 2020, with a focus on systematic reviews and meta-analyses.
It states that if high LDL cholesterol and untreated vision loss were eliminated, there would be a 7% and 2% decrease in dementia cases for the two risk factors respectively.
Based on this and other findings, the Lancet commission has made 13 recommendations to individuals and governments to reduce dementia risk, such as detecting and treating high LDL cholesterol from around 40 years of age and making screening and treatment for vision impairment accessible for all.
Other recommendations include treating depression effectively, using head protection in contact sports and improving air quality.
According to the research, the number of people with dementia is set to almost triple by 2050 as people live longer.
However, the authors pointed out that in high-income countries such as the UK the proportion of older people with dementia has fallen.
They suggest that this reduction is due to people building ‘cognitive and physical resilience’ as well as having ‘less vascular damage’ as a result of healthier lifestyles.
The 14 dementia risk factors are now as follows:
The report also estimated that the risk factors associated with the greatest proportion of people developing dementia in the global population were hearing impairment, high LDL cholesterol, less education in early life and social isolation in later life.
Professor Gill Livingstone, the lead author from University College London, said the report ‘reveals that there is much more that can and should be done to reduce the risk of dementia’.
She continued: ‘We now have stronger evidence that longer exposure to risk has a greater effect and that risks act more strongly in people who are vulnerable.
‘That’s why it is vital that we redouble preventive efforts towards those who need them most, including those in low- and middle-income countries and socio-economically disadvantaged groups. Governments must reduce risk inequalities by making healthy lifestyles as achievable as possible for everyone.’
NHS England’s national clinical director for dementia Dr Jeremy Isaacs said the report’s findings ‘offer real hope’ for reducing the number of people who live with the illness.
He said: ‘This research is really important as it suggests there are additional risk factors for dementia, which means that there are more opportunities for all of us to take action throughout our lives to reduce our risk of developing dementia or delay its onset.’
Dr Isaacs also emphasised the importance of a ‘timely diagnosis’ of dementia and said NHS staff have ‘worked hard’ to ensure the number of people with a diagnosis has risen to ‘a record level’ over the last year.
A version of this article was originally published by our sister publication Pulse.
25th April 2023
Type 2 diabetes increases the risk for developing dementia. Both elevated HbA1c levels and diabetic complications also linked to an increased dementia risk. Moreover, intensive glycaemic control does not seem to reduce cognitive decline. But how long-term glycaemic control affects the risk of dementia is uncertain and was the subject of the current study.
Using a large US healthcare database, researchers looked at type 2 diabetics older than 50 with HbA1c levels recorded over time. Researchers categorised HbA1c measurements as < 6%; 6% to < 7%; 7% to < 8%, 8% to < 9%, 9% to < 10% and 10% or more. They also identified those diagnosed with dementia during follow-up.
HbA1c levels and development of dementia
There were 253,211 eligible participants with a mean age of 61.5 years. The participants were followed for a mean of 5.9 years. During this time, participants with the majority (i.e., > 50%) of HbA1c measurements between 9 and 10%, had an increased the risk of dementia (hazard ratio, HR = 1.31, 95% CI 1.15 – 1.51). Similarly, with most measurements of 10% or above, the risk was also significantly higher (HR = 1.74, 95% CI 1.62 – 1.86).
In contrast, among participants with more than 50% of HbA1c measurements that were less than 6%, the dementia risk was lower (HR = 0.92, 95% CI 0.88 – 0.97). This also held true for HbA1c levels of 6 to 7% and between 7 and 8%. Thus in type 2 diabetics, keeping cumulative HbA1c levels below 8% was associated with a lower risk for developing dementia. The researchers called for further research to determine if these associations were causal.
Citation
Moran C et al. Glycemic Control Over Multiple Decades and Dementia Risk in People With Type 2 Diabetes. JAMA Neurol 2023
12th September 2022
Adults who take just short of 10,000 steps/day, particularly if those steps are more intense, have a reduced dementia risk according to a study by a team from Denmark and Australia.
Dementia describes a syndrome in which there is a deterioration in cognitive function beyond what might be expected from the usual consequences of biological ageing and which according to the world health organisation, globally, affects around 55 million people.
In a 2020 report published in The Lancet, it was noted how there is a growing body of evidence that supports the nine potentially modifiable risk factors for dementia, one of which is physical inactivity. The authors recommended keeping cognitively, physically and socially active in midlife and later life although little evidence exists for any single specific activity protecting against dementia.
In an analysis of 15 cohort studies with over 47,000 adults, researchers concluded that taking more steps per day was associated with a progressively lower risk of all-cause mortality. Despite this benefit, evidence also suggests that step cadence, i.e., the number of steps per minute, or step intensity does not appear to be significantly associated with mortality.
With a lack of supportive evidence for the value of greater physical activity in reducing the risk of developing dementia, in the present study, researchers examined the association between daily step count as well as intensity and dementia risk.
They used data held within the UK Biobank where a cohort of over 100,000 individuals had agreed to wear an accelerometer on their dominant wrist 24 hours a day and 7 days a week, to measure physical activity. All were free of dementia at the start and as well as recording total daily steps, the researchers also examined step cadence.
This was divided into incidental steps, defined as fewer than 40 steps/minute, such as walking between rooms at home, purposeful steps, which > 40 steps/minute, for instance, while exercising and finally, peak 30-minute cadence, which was the average steps/minute recorded for the 30 highest, but not necessarily consecutive, minutes in a day.
The researchers estimated the optimal dose of steps, where the maximum significant dementia risk reduction was observed and the minimal dose, which was defined as the number of steps at which the risk reduction was 50% of the maximum. In regression models, adjustments were made for age, sex, lifestyle and co-morbidities.
Dementia risk and daily steps
The overall cohort included 78,430 individuals with a mean age of 61.1 years (55.3% female) and who were followed for a median of 6.9 years. During the follow-up period, 866 participants developed dementia at a mean age of 68.3 years.
The optimal dose of daily steps was 9826 and this led to a 51% lower risk of developing dementia (hazard ratio, HR = 0.49, 95% CI 0.39 – 0.62) and the minimal dose of 3826 steps/day (HR = 0.75, 95% CI 0.67 – 0.83).
For peak 30-minute cadence, the optimal dose was 112 steps/minute (HR = 0.38, 95% CI 0.24 – 0.60) and 6315 for purposeful steps.
The authors concluded that taking more daily steps was associated with a reduced dementia risk with the optimal dose just short of 10,000 steps/day and also that step intensity led to stronger associations. They suggested that future guidelines for dementia prevention should promote step-based recommendations.
Citation
del Pozo Cruz B et al. Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK JAMA Neurol 2022
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