Alzheimer’s prevention: Does it exist?

Dementia is a term for several diseases that affect memory, thinking, and the ability to perform daily activities. Currently more than 55 million people have dementia worldwide, over 60% of whom live in low and middle- income countries. Every year, there are nearly 10 million new cases. Dementia results from a variety of diseases and injuries that affect the brain. Alzheimer disease is the most common form of dementia and may contribute to 60–70% of cases. Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older people globally. As life expectancies increase, the number of people living with dementia worldwide continues to rise.

Quite often we as Neurologists are asked “Is there a cure for dementia”. It reminds me of the famous quote from the best selling novel ‘Doctors’ by Erich Segal where the Dean during the introductory lecture to his medical students says “I urge you to engrave this on the template of your memories: there are thousands of diseases in this world, but Medical Science only has an empirical cure for twenty-six of them”. Although an inaccurate shorthand, the phrase holds aptly true for most of degenerative diseases.

A cure is when a treatment makes a health problem go away and it’s not expected to come back. For many people, cures represent the ultimate treatment goal. Unfortunately most diseases and conditions like Alzheimer’s aren’t curable. A treatment is something that health care providers do for their patients to control a health problem, lessen its symptoms, or clear it up. Preventive medicine tries to stop sickness before it starts. The phrase ‘prevention is better than cure’ attributed to the Dutch philosopher Desiderius Erasmus, are the golden words in preventive medicine.

While there’s no proven prevention or effective treatment for Alzheimer’s disease, there are lifestyle changes that may help reduce the risk of developing it. Although we can’t change our genes or stop ageing, there are changes that we can make to reduce our risk of dementia, either lifestyle changes as individuals or wider changes across society. This year on World Alzheimer’s Day lets take a pledge to try to take the modifiable risk factors for this disease out of our lives.

Proven modifiable risk factors for dementia:

The 2024 Lancet Commission on dementia estimates that 45% of global dementia can be attributable to 14 potentially preventable factors. These factors can contribute differently to various types of dementia, such as Alzheimer’s disease and vascular dementia, which can co-occur. The contribution of modifiable risk factors for dementia brings the importance of dementia risk reduction to the forefront. Increasing evidence shows that multidomain interventions, targeting several risk factors simultaneously, are feasible and effective for people with increased risk for dementia. These interventions rely on the application of the principle that one size does not fit all; therefore, to be effective and feasible, interventions should be tailored to risk profiles and adapted to geographically, culturally, and economically diverse populations globally.

1)Physical inactivity: Regular physical activity is one of the best ways to reduce your risk of dementia. It’s good for your heart, circulation, weight and mental wellbeing. It is recommended that adults aim for either 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity each week.

2) Smoking: Smoking greatly increases your risk of developing dementia. You’re also increasing your risk of other conditions, including type 2 diabetes, stroke, and lung and other cancers. It’s never too late – stopping smoking later in life also reduces the risk of dementia

3) Excessive alcohol consumption: Alcohol misuse and drinking more than 21 units weekly increase the risk of dementia. The harmful use of alcohol is a causal factor in more than 200 disease and injury conditions. There is a causal relationship between harmful use of alcohol and a range of mental and behavioural disorders, other noncommunicable diseases as well as injuries

4) Air pollution: A growing amount of research evidence shows that air pollution increases the risk of dementia. Policymakers should expedite improvements in air quality, particularly in areas with high air pollution.

5) Head injury: Head injuries are most commonly caused by car, motorcycle, and bicycle accidents; military exposures; boxing, football, hockey and other sports; firearms and violent assaults; and falls. Policymakers should use public health and other policy measures to reduce head injuries.

6) Infrequent social contact: It is well established that social connectedness reduces the risk of dementia. Social contact enhances cognitive reserve or encourages beneficial behaviours. There is not much evidence for any specific activity protecting against dementia. Joining a club or community group are good ways to stay socially active.

7) Less education: A low level of education in early life affects cognitive reserve and is one of the most significant risk factors for dementia. Policy should prioritise childhood education for all.

8) Obesity: Particularly in mid-life, obesity is associated with an increased risk of dementia. Obesity is also associated with other non communicable diseases and can generally be addressed through lifestyle changes such as diet and exercise.

9) Hypertension: Hypertension (high blood pressure) in mid-life increases a person’s risk of dementia, as well as causing other health problems. Medication for hypertension is the only known effective preventive medication for dementia.

10) Diabetes: Type 2 diabetes is a clear risk factor for development of future dementia. Whether any particular medication helps with this is unclear, but treatment of diabetes is important for other health reasons.

11) Depression: Depression is associated with dementia incidence. Depression is part of the prodrome of dementia (a symptom that occurs before the symptoms that are used for diagnosis). It is not clear to what extent

dementia may be caused by depression or the reverse, and both may be the case. In any case, it is important to manage and treat depression because is associated with increased disability, physical illnesses and worse outcomes for people with dementia.

12) Hearing impairment: People with hearing loss have a significantly increased risk of dementia. Using hearing aids seems to reduce the risk. As hearing loss is one of the risk factors which affects the most people, addressing it could result in a large impact on the number of people developing dementia.

13) Vision Loss: Correction with help of using spectacles for near and far vision and timely surgical intervention for cataracts or other causes of vision loss can keep this risk factor in check.

14) High LDL cholesterol: Reduction through diet modification, physical activity and drugs can help to reduce this risk factor.

Take good care of your body and your body will take good care of you.

 Prof. (Dr) Bashir Ahmad Sanaie Dr. Tanveer Hassan Baba Dept. of Neurology, Super Speciality Hospital, GMC, Srinagar