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Livingston G, Huntley J, Liu KY, Costafreda SG, Selbæk G, Alladi S, Ames D, Banerjee S, Burns A, Brayne C, Fox NC, Ferri CP, Gitlin LN, Howard R, Kales HC, Kivimäki M, Larson EB, Nakasujja N, Rockwood K, Samus Q, Shirai K, Singh-Manoux A, Schneider LS, Walsh S, Yao Y, Sommerlad A, Mukadam N. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet 2024; 404:572-628. [PMID: 39096926 DOI: 10.1016/s0140-6736(24)01296-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 08/05/2024]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | - Jonathan Huntley
- Department of Clinical and Biomedical Sciences, University of Exeter, Exeter, UK
| | - Kathy Y Liu
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway
| | - Suvarna Alladi
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - David Ames
- National Ageing Research Institute, Melbourne, VIC, Australia; University of Melbourne Academic Unit for Psychiatry of Old Age, Melbourne, VIC, Australia
| | - Sube Banerjee
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Carol Brayne
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Nick C Fox
- The Dementia Research Centre, Department of Neurodegenerative Disease, University College London, London, UK
| | - Cleusa P Ferri
- Health Technology Assessment Unit, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil; Department of Psychiatry, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Laura N Gitlin
- College of Nursing and Health Professions, AgeWell Collaboratory, Drexel University, Philadelphia, PA, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA
| | - Mika Kivimäki
- Division of Psychiatry, University College London, London, UK; Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Eric B Larson
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Noeline Nakasujja
- Department of Psychiatry College of Health Sciences, Makerere University College of Health Sciences, Makerere University, Kampala City, Uganda
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Kokoro Shirai
- Graduate School of Social and Environmental Medicine, Osaka University, Osaka, Japan
| | - Archana Singh-Manoux
- Division of Psychiatry, University College London, London, UK; Université Paris Cité, Inserm U1153, Paris, France
| | - Lon S Schneider
- Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Leonard Davis School of Gerontology, University of Southern California, Los Angeles, CA, USA
| | - Sebastian Walsh
- Cambridge Public Health, University of Cambridge, Cambridge, UK
| | - Yao Yao
- China Center for Health Development Studies, School of Public Health, Peking University, Beijing, China; Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing, China
| | - Andrew Sommerlad
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
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Zahr NM. Alcohol Use Disorder and Dementia: A Review. Alcohol Res 2024; 44:03. [PMID: 38812709 PMCID: PMC11135165 DOI: 10.35946/arcr.v44.1.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
PURPOSE By 2040, 21.6% of Americans will be over age 65, and the population of those older than age 85 is estimated to reach 14.4 million. Although not causative, older age is a risk factor for dementia: every 5 years beyond age 65, the risk doubles; approximately one-third of those older than age 85 are diagnosed with dementia. As current alcohol consumption among older adults is significantly higher compared to previous generations, a pressing question is whether drinking alcohol increases the risk for Alzheimer's disease or other forms of dementia. SEARCH METHODS Databases explored included PubMed, Web of Science, and ScienceDirect. To accomplish this narrative review on the effects of alcohol consumption on dementia risk, the literature covered included clinical diagnoses, epidemiology, neuropsychology, postmortem pathology, neuroimaging and other biomarkers, and translational studies. Searches conducted between January 12 and August 1, 2023, included the following terms and combinations: "aging," "alcoholism," "alcohol use disorder (AUD)," "brain," "CNS," "dementia," "Wernicke," "Korsakoff," "Alzheimer," "vascular," "frontotemporal," "Lewy body," "clinical," "diagnosis," "epidemiology," "pathology," "autopsy," "postmortem," "histology," "cognitive," "motor," "neuropsychological," "magnetic resonance," "imaging," "PET," "ligand," "degeneration," "atrophy," "translational," "rodent," "rat," "mouse," "model," "amyloid," "neurofibrillary tangles," "α-synuclein," or "presenilin." When relevant, "species" (i.e., "humans" or "other animals") was selected as an additional filter. Review articles were avoided when possible. SEARCH RESULTS The two terms "alcoholism" and "aging" retrieved about 1,350 papers; adding phrases-for example, "postmortem" or "magnetic resonance"-limited the number to fewer than 100 papers. Using the traditional term, "alcoholism" with "dementia" resulted in 876 citations, but using the currently accepted term "alcohol use disorder (AUD)" with "dementia" produced only 87 papers. Similarly, whereas the terms "Alzheimer's" and "alcoholism" yielded 318 results, "Alzheimer's" and "alcohol use disorder (AUD)" returned only 40 citations. As pertinent postmortem pathology papers were published in the 1950s and recent animal models of Alzheimer's disease were created in the early 2000s, articles referenced span the years 1957 to 2024. In total, more than 5,000 articles were considered; about 400 are herein referenced. DISCUSSION AND CONCLUSIONS Chronic alcohol misuse accelerates brain aging and contributes to cognitive impairments, including those in the mnemonic domain. The consensus among studies from multiple disciplines, however, is that alcohol misuse can increase the risk for dementia, but not necessarily Alzheimer's disease. Key issues to consider include the reversibility of brain damage following abstinence from chronic alcohol misuse compared to the degenerative and progressive course of Alzheimer's disease, and the characteristic presence of protein inclusions in the brains of people with Alzheimer's disease, which are absent in the brains of those with AUD.
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Affiliation(s)
- Natalie M Zahr
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California. Center for Health Sciences, SRI International, Menlo Park, California
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Pacholko A, Iadecola C. Hypertension, Neurodegeneration, and Cognitive Decline. Hypertension 2024; 81:991-1007. [PMID: 38426329 PMCID: PMC11023809 DOI: 10.1161/hypertensionaha.123.21356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Elevated blood pressure is a well-established risk factor for age-related cognitive decline. Long linked to cognitive impairment on vascular bases, increasing evidence suggests a potential association of hypertension with the neurodegenerative pathology underlying Alzheimer disease. Hypertension is well known to disrupt the structural and functional integrity of the cerebral vasculature. However, the mechanisms by which these alterations lead to brain damage, enhance Alzheimer pathology, and promote cognitive impairment remain to be established. Furthermore, critical questions concerning whether lowering blood pressure by antihypertensive medications prevents cognitive impairment have not been answered. Recent developments in neurovascular biology, brain imaging, and epidemiology, as well as new clinical trials, have provided insights into these critical issues. In particular, clinical and basic findings on the link between neurovascular dysfunction and the pathobiology of neurodegeneration have shed new light on the overlap between vascular and Alzheimer pathology. In this review, we will examine the progress made in the relationship between hypertension and cognitive impairment and, after a critical evaluation of the evidence, attempt to identify remaining knowledge gaps and future research directions that may advance our understanding of one of the leading health challenges of our time.
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Affiliation(s)
- Anthony Pacholko
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY
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Jaisa-aad M, Muñoz-Castro C, Serrano-Pozo A. Update on modifiable risk factors for Alzheimer's disease and related dementias. Curr Opin Neurol 2024; 37:166-181. [PMID: 38265228 PMCID: PMC10932854 DOI: 10.1097/wco.0000000000001243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
PURPOSE OF REVIEW All human beings undergo a lifelong cumulative exposure to potentially preventable adverse factors such as toxins, infections, traumatisms, and cardiovascular risk factors, collectively termed exposome. The interplay between the individual's genetics and exposome is thought to have a large impact in health outcomes such as cancer and cardiovascular disease. Likewise, a growing body of evidence is supporting the idea that preventable factors explain a sizable proportion of Alzheimer's disease and related dementia (ADRD) cases. RECENT FINDINGS Here, we will review the most recent epidemiological, experimental preclinical, and interventional clinical studies examining some of these potentially modifiable risk factors for ADRD. We will focus on new evidence regarding cardiovascular risk factors, air pollution, viral and other infectious agents, traumatic brain injury, and hearing loss. SUMMARY While greater and higher quality epidemiological and experimental evidence is needed to unequivocally confirm their causal link with ADRD and/or unravel the underlying mechanisms, these modifiable risk factors may represent a window of opportunity to reduce ADRD incidence and prevalence at the population level via health screenings, and education and health policies.
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Affiliation(s)
- Methasit Jaisa-aad
- Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
| | - Clara Muñoz-Castro
- Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Universidad de Sevilla, Sevilla (Spain)
| | - Alberto Serrano-Pozo
- Massachusetts General Hospital, Boston, MA 02114
- Harvard Medical School, Boston, MA 02115
- Massachusetts Alzheimer’s Disease Research Center
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Gauthreaux K, Kukull WA, Nelson KB, Mock C, Chen Y, Chan KCG, Fardo DW, Katsumata Y, Abner EL, Nelson PT. Different cohort, disparate results: Selection bias is a key factor in autopsy cohorts. Alzheimers Dement 2024; 20:266-277. [PMID: 37592813 PMCID: PMC10843760 DOI: 10.1002/alz.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/14/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
INTRODUCTION Research-oriented autopsy cohorts provide critical insights into dementia pathobiology. However, different studies sometimes report disparate findings, partially because each study has its own recruitment biases. We hypothesized that a straightforward metric, related to the percentage of research volunteers cognitively normal at recruitment, would predict other inter-cohort differences. METHODS The National Alzheimer's Coordinating Center (NACC) provided data on N = 7178 autopsied participants from 28 individual research centers. Research cohorts were grouped based on the proportion of participants with normal cognition at initial clinical visit. RESULTS Cohorts with more participants who were cognitively normal at recruitment contained more individuals who were older, female, had lower frequencies of apolipoprotein E ε4, Lewy body disease, and frontotemporal dementia, but higher rates of cerebrovascular disease. Alzheimer's disease (AD) pathology was little different between groups. DISCUSSION The percentage of participants recruited while cognitively normal predicted differences in findings in autopsy research cohorts. Most differences were in non-AD pathologies. HIGHLIGHTS Systematic differences exist between autopsy cohorts that serve dementia research. We propose a metric to use for gauging a research-oriented autopsy cohort. It is essential to consider the characteristics of autopsy cohorts.
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Affiliation(s)
- Kathryn Gauthreaux
- National Alzheimer's Coordinating CenterDepartment of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Walter A. Kukull
- National Alzheimer's Coordinating CenterDepartment of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Karin B. Nelson
- National Institute on Neurological Disease and Stroke, National Institutes of HealthWashington, DCUSA
| | - Charles Mock
- National Alzheimer's Coordinating CenterDepartment of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
| | - Yen‐Chi Chen
- National Alzheimer's Coordinating CenterDepartment of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of StatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - Kwun C. G. Chan
- National Alzheimer's Coordinating CenterDepartment of EpidemiologyUniversity of WashingtonSeattleWashingtonUSA
- Department of BiostatisticsUniversity of WashingtonSeattleWashingtonUSA
| | - David W. Fardo
- Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
- Department of BiostatisticsUniversity of KentuckyLexingtonKentuckyUSA
| | - Yuriko Katsumata
- Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
- Department of BiostatisticsUniversity of KentuckyLexingtonKentuckyUSA
| | - Erin L. Abner
- Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
- Department of BiostatisticsUniversity of KentuckyLexingtonKentuckyUSA
- Department of Epidemiology and Environmental HealthCollege of Public HealthUniversity of KentuckyLexingtonKentuckyUSA
| | - Peter T. Nelson
- Sanders‐Brown Center on AgingUniversity of KentuckyLexingtonKentuckyUSA
- Department of PathologyDivision of NeuropathologyUniversity of KentuckyLexingtonKentuckyUSA
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Daly T. The iceberg of dementia risk: empirical and conceptual arguments in favor of structural interventions for brain health. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2023; 6:100193. [PMID: 39071741 PMCID: PMC11273093 DOI: 10.1016/j.cccb.2023.100193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 10/02/2023] [Accepted: 12/07/2023] [Indexed: 07/30/2024]
Abstract
While pharmacological interventions for dementia struggle to demonstrate improved outcomes for patients and at-risk populations, non-pharmacological lifestyle interventions have been proposed as a tool to achieve dementia risk reduction. In this review, it is argued that lifestyle modification alone is a surface-level intervention from the point of view of fair and far-reaching dementia prevention. Below the tip of this "iceberg of dementia risk," there are living conditions and social structures that represent deeper contributions to risk in the population. It is argued that alongside lifestyle modification, activist research and structural interventions are needed to make our society fairer and more dementia-resilient.
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Affiliation(s)
- Timothy Daly
- Correspondence at: Bioethics Program, FLACSO Argentina, Tucumán 1966, C1050 AAN, Buenos Aires, Argentina.
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Daly T. If deprivation worsens dementia outcomes, stimulation should improve them. Curr Med Res Opin 2023; 39:1391-1394. [PMID: 37725088 DOI: 10.1080/03007995.2023.2260741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/15/2023] [Indexed: 09/21/2023]
Abstract
It is still not known what causes Alzheimer's Disease (AD). In this period of uncertainty, an emerging literature on risk factors suggests that the concept of "stimulation" is a useful pragmatic tool both before and after diagnosis to improve cognitive health. Before diagnosis of AD, stimulation of the brain through education, exercise, and social stimulation provides fortification against later cognitive decline. After diagnosis, specific electrical stimulation of brain circuits may protect cognitive function, and non-specific stimulation through different kinds of environmental enrichment may help to compensate for cognitive decline. Pragmatic guidelines are offered here to maximise enabling stimulation (physical, cognitive, and social activity) and minimise disabling stimulation across the lifetime (e.g. stress, pollution, and poor diet). However, much deeper structural changes in society are needed to struggle against socioeconomic and environmental deprivation and the inaccessibility of education for women across the globe.
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Affiliation(s)
- Timothy Daly
- Bioethics Program, FLACSO Argentina, Buenos Aires, Argentina
- Science Norms Democracy UMR 8011, Sorbonne Université, Paris, France
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Wharton SB, Simpson JE, Ince PG, Richardson CD, Merrick R, Matthews FE, Brayne C. Insights into the pathological basis of dementia from population-based neuropathology studies. Neuropathol Appl Neurobiol 2023; 49:e12923. [PMID: 37462105 PMCID: PMC10946587 DOI: 10.1111/nan.12923] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/13/2023] [Accepted: 06/29/2023] [Indexed: 08/17/2023]
Abstract
The epidemiological neuropathology perspective of population and community-based studies allows unbiased assessment of the prevalence of various pathologies and their relationships to late-life dementia. In addition, this approach provides complementary insights to conventional case-control studies, which tend to be more representative of a younger clinical cohort. The Cognitive Function and Ageing Study (CFAS) is a longitudinal study of cognitive impairment and frailty in the general United Kingdom population. In this review, we provide an overview of the major findings from CFAS, alongside other studies, which have demonstrated a high prevalence of pathology in the ageing brain, particularly Alzheimer's disease neuropathological change and vascular pathology. Increasing burdens of these pathologies are the major correlates of dementia, especially neurofibrillary tangles, but there is substantial overlap in pathology between those with and without dementia, particularly at intermediate burdens of pathology and also at the oldest ages. Furthermore, additional pathologies such as limbic-predominant age-related TDP-43 encephalopathy, ageing-related tau astrogliopathy and primary age-related tauopathies contribute to late-life dementia. Findings from ageing population-representative studies have implications for the understanding of dementia pathology in the community. The high prevalence of pathology and variable relationship to dementia status has implications for disease definition and indicate a role for modulating factors on cognitive outcome. The complexity of late-life dementia, with mixed pathologies, indicates a need for a better understanding of these processes across the life-course to direct the best research for reducing risk in later life of avoidable clinical dementia syndromes.
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Affiliation(s)
- Stephen B. Wharton
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Julie E. Simpson
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | - Paul G. Ince
- Sheffield Institute for Translational NeuroscienceUniversity of SheffieldSheffieldUK
| | | | - Richard Merrick
- Cambridge Public Health, School of Clinical MedicineUniversity of CambridgeSheffieldUK
| | | | - Carol Brayne
- Cambridge Public Health, School of Clinical MedicineUniversity of CambridgeSheffieldUK
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Merrick R, Matthews FE. Time trends in neuropathology give clues to dementia risk reduction. Nat Rev Neurol 2023; 19:389-390. [PMID: 37173593 DOI: 10.1038/s41582-023-00812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Affiliation(s)
- Richard Merrick
- Cambridge Public Health, University of Cambridge, Cambridge, UK.
| | - Fiona E Matthews
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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10
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Sabayan B, Doyle S, Rost NS, Sorond FA, Lakshminarayan K, Launer LJ. The role of population-level preventive care for brain health in ageing. THE LANCET. HEALTHY LONGEVITY 2023; 4:e274-e283. [PMID: 37201543 PMCID: PMC10339354 DOI: 10.1016/s2666-7568(23)00051-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 05/20/2023] Open
Abstract
Over the past several decades, a worldwide demographic transition has led to an increasing number of older adults with chronic neurological conditions. These conditions, which have a profound effect on the cognitive function and physical ability of older adults, also have a long preclinical phase. This feature provides a unique opportunity to implement preventive measures for high-risk groups and the population as a whole, and therefore to reduce the burden of neurological diseases. The concept of brain health has emerged as the overarching theme to define overall brain function independently of underlying pathophysiological processes. We review the concept of brain health from the ageing and preventive care perspectives, discuss the mechanisms underpinning ageing and brain ageing, highlight the interplay of various forces resulting in deviation from brain health towards brain disease, and provide an overview of strategies to promote brain health with a life-course approach.
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Affiliation(s)
- Behnam Sabayan
- Department of Neurology, HealthPartners Neuroscience Center, St Paul, MN, USA; Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
| | - Sara Doyle
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Natalia S Rost
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Lenore J Launer
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, National Institutes of Health, Baltimore, MD, USA
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