These numbers highlight an urgent need for preventative measures and innovation in dementia care. A recent study, published in The Lancet’s Healthy Longevity, revealed that interventions such as reformulating food products to reduce sugar and salt intake, reducing environmental pollution, and reducing alcohol intake could reduce the economic burden of the condition by up to £4bn. However, while cases may be rising, research and treatments in the field
have seen promising breakthroughs in recent years.
Research has now improved our understanding of the development of dementia, showing that chronic inflammation may drive the progression of the disease.
Equally, it is now understood that dysfunctional tau proteins, found in neurons, are a key hallmark of dementia. We also now know that genetics are a huge contributor to the development of the condition, and that lifestyle factors such as physical activity, diet, sleep, and social factors like loneliness, can play a vital role in decline in older age.
Equally, advances in blood biomarkers of dementia are setting the foundation for earlier diagnosis, and there is now an increasing amount of funding provided
to investigate the condition.
For example, researchers recently received a US$29m NIH grant to study dementia risk factors, prevention, and treatment as part of the Triangulation of Innovative Methods to End Alzheimer’s Disease project.
Technological advances are also transforming dementia care, with the integration of artificial intelligence and the rise of smart apps that can help dementia patients maintain their independence.
New drugs such as donanemab and lecanemab have shown success in slowing disease progression of Alzheimer’s, with regulatory decisions on the medicines expected from the UK’s National Institute for Health and Care Excellence (NIC) imminently at the time of writing.
A recent report from Lord Darzi’s Independent investigation of the NHS in England, which revealed shocking findings of chronic underfunding and inadequate care, is informing a new 10 year plan to reform the NHS. The Labour Government has confirmed that the plan will also consider how to best meet the needs of people diagnosed with dementia.
NR Times spoke with Professor of Biological Psychology, Loughborough University, Professor Eef Hogervorst, a neuropsychologist and epidemiologist who specialises in dementia research, about the latest advances in research and care.
Have you noticed any changing trends in incidence levels or demographics?
One of the concerning trends is the potential for a rapidly increasing prevalence of dementia in low- and middle-income countries (LMICs). In Indonesia, for example, recent estimates suggest that nearly 28 per cent of people over the age of 65 have dementia, but only a small fraction of these individuals have been formally diagnosed.
This figure is nearly two to three times higher than estimates from 15 years ago (2006), when dementia rates in Indonesia were comparable to those in Europe and the United States. The increase in prevalence could be attributed to several factors, including the possibility of bias due to use of oversensitive diagnostic tests
or unfamiliarity with cognitive testing protocols. Education levels could thus play a significant role in explaining the findings, with many people in LMIC having had little formal education.
Education and consequently higher socioeconomic positions can lead to better lifestyles as people can afford to engage with these (good diets, gyms, medical assessments etc) both in time and money.
However, maintaining physical activity and engaging in community-based activities could help mitigate some of the risk at any stage of the dementia journey. In Indonesia, many of these activities are run by trained volunteers in primary care centres, highlighting the importance of governmental and grassroots initiatives.
What is the latest understanding of how lifestyle can contribute to risk factors, or help reduce risk of dementia?
Keeping physically active has the potential to reduce dementia risk, with one study finding it reduces risk by 50 per cent. Staying physically active has the potential to reduce dementia risk across all stages: during primary prevention (before any symptoms appear), secondary prevention (when mild symptoms are present but do not affect daily activities), and tertiary prevention (once symptoms are evident, to slow progression). Stopping smoking and following a healthy diet – especially in midlife – can also help reduce dementia risk.
Can you tell us about any of the latest and most exciting developments in dementia research,?
Our research has shown that visual scanning tests can detect cognitive impairments up to 12 years before a formal dementia diagnosis. Perhaps such techniques could help earlier diagnoses and possibly using visual scanning techniques could reverse some of the dementia symptoms. Biomarkers are also increasingly being used to initiate early medical interventions. However, these may be less applicable in rural or resource-limited settings, so it is essential future research focuses on cross- culturally valid diagnostic tools.
What challenges are researchers and patients currently facing in dementia research and care?
The growing wealth-health gap in the UK seems to have resulted in more people living longer with risk factors for dementia, such as diabetes, depression, and cardiovascular disease.
Those in the most deprived groups are particularly affected by multi-morbidity— the presence of multiple chronic health conditions—which exacerbates their dementia risk and could result in this occurring at an earlier age.
The costs for long-term care will be very high and rising unless these systematic differences are addressed. Adopting a lifespan approach to health, focusing on prevention and management of these conditions early on in a person’s life, is essential to reduce both the risk of dementia and the economic burden on the healthcare system.
Are there any exciting research plans or clinical trials coming up?
The concept of visual scanning therapy is particularly exciting, as it suggests the possibility of stimulating the brain in ways that could potentially reverse some of the cognitive impairments associated with dementia. If proven effective, it could open up new avenues for dementia treatment and rehabilitation. •
