‘‘Preventing Dementia: Advice and Advances’’ Your Questions Answered

The panel at the Preventing Dementia conference

On the 29th of November 2017, The Centre for Dementia Prevention hosted its annual winter conference ‘‘Preventing Dementia: Advice and Advances’’ at Edinburgh’s Playfair Library. We were delighted the conference was sold out and that so many joined us in discussing how we can all manage our risk of dementia. Our speakers received some great questions from the audience and many who attended expressed an interest in engaging with our research. As promised, here we have summarised some more of the main topics discussed on the night in a Q&A format.

A  summary of key points from the from the night can be found here

Video highlights of the evening’s presentations and panel discussions are also available here

I have a parent with dementia and I am worried about my own and my daughter’s dementia risk. How can we make sure we are first in line to try newly available drugs to prevent dementia?

There currently aren’t any known treatments which can prevent dementia. The Centre for Dementia Prevention and other research institutions are working very hard to find interventions that can prevent or reduce someone’s risk of dementia by exploring the contributing risk factors. Finding treatments for the prevention of dementia is highly dependent on people’s willingness to take part in research. Participating in research studies will therefore help researchers improve their understanding of dementia and will increase their chances of finding an effective treatment which may benefit you in the future.

You should, however, not expect to clinically benefit from participating in a drug trial. The very reason why drugs are tested, is because we do not yet know if they have the required effect.  Additionally, researchers want to know if there is a change in the disease pathway that would not have occurred if someone had received a different drug or treatment, or no drug at all. For this reason, a drug is always tested against another treatment or a placebo, a substance with no active or therapeutic effect. When participating in a drug trial, there is always a chance of receiving a non-active substance. You may, however, derive benefits from receiving clinical assessments and consultations above your standard clinical care.

If you wish to contribute to dementia research, we suggest you sign up to our research register by contacting us here. Entering onto the register means that we can keep you informed of research we carry out and contact you to ask you if you might be interested in volunteering for specific research studies.

Which drug treatments are currently available for Alzheimer’s Dementia?

Disease-modifying treatments, or treatments which can prevent the development of dementia, don’t currently exist. Researchers – including those in the Centre for Dementia Prevention in Edinburgh – are working very hard to gain a better understanding of how disease underlying dementia develops and are designing trials to test existing and new drugs. For further information see our recent article published here

There currently are a number of symptomatic treatments available for Alzheimer’s disease, which aim to reduce dementia symptoms. The most common symptomatic treatment is provided by a group of drugs called cholinesterase inhibitors. We now know that people with Alzheimer’s disease have lower levels of acetylcholine, a neurotransmitter in the brain that is thought to promote memory and learning. Cholinesterase inhibitors, such as Rivastigmine, Galantamine, and Donepezil – Donepezil is also known by its brand name Aricept – slow the breakdown of acetylcholine in the brain, thereby increasing levels of the neurotransmitter. Research from various randomised controlled trials shows that 6 months of treatment with one of these drugs can improve cognitive function in people with mild to moderate Alzheimer’s disease. A small number of these studies further demonstrate a positive effect on activities of daily living and behavioural outcomes and suggests the effects of cholinesterase inhibitors may be similar for those with severe Alzheimer’s disease.

How can we use technology to ensure timely diagnosis and treatment of dementia?

 Timely diagnosis of dementia is essential in ensuring effective treatment and care provision. In line with advances in research, healthcare services must equally evolve to keep pace – as outlined in the recent Edinburgh Consensus. Current cognitive assessments used by GPs and memory clinics may not be adequately sensitive to detect very early changes in more complex activities or tasks (e.g. financial transactions, use of appliances, etc.) which are undertaken outside of clinical settings. We would ideally want to test people frequently on sensitive and specific, home-based measures.

Ivan Koychev, lecturer at the University of Oxford’s Department of Psychiatry, hopes that this type of data can in the future be provided by our smart phones. Current generations are inseparable from their mobile devices, which could generate a large number of potentially useful data.  Our phones could, for example, track the average speed at which we send a message or use an application, or the locations which we attend on daily or weekly basis. It can then also detect if we behave in a way that is consistently and significantly different from one’s usual recorded behaviour (e.g. if we are slower at sending messages or fail to visit our usual locations). Cognitive assessments could additionally be administered via our mobile phones at frequent intervals, thereby providing a more reliable and stable image of one’s cognition.

I have heard contrasting reports on the number of people living with dementia. Have dementia rates really gone up or down?

Quantifying disease is not easy. There are a number of different things that we can measure to try to understand disease frequency, the most important measures being disease prevalence and disease incidence. Disease prevalence refers to the number of people with a certain disease at a given time and therefore indicates how widespread the disease is. This measure is important to understand the number of people who are going to need health and social care now and in the near future.  Disease incidence refers to the number of new cases of a disease over a specified time period. This measure can help us understand whether or not we are successfully minimising risk factors for dementia.

It has been widely reported that the number of people living with dementia has grown over the past decades and will continue to grow rapidly in the future. There are a number of reasons why dementia prevalence has increased. Firstly, the Baby Boom generation is ageing. The more elderly people there are, the higher the number of dementia cases. Secondly, people in the UK live longer as a result of better health profiles, improved living conditions, advanced care systems, etc. Since the risk of developing dementia is higher at an older age, more people will live on to develop dementia symptoms. Because more people will develop dementia, health and social care demands will increase.

Dementia incidence rate provides an alternative measure, as it indicates the number of new cases per population in a given time period. A large UK study recently identified a 20 per cent reduction in dementia incidence in the population above 65 years of age. This age-specific drop was largely observed in men, but a small reduction was also seen for women. This means that dementia incidence overall has stayed relatively stable. Although it is difficult to say what exactly explains this drop, the authors note that it may be linked to a change in dementia risk factors. The past decades have seen a reduction in cardiovascular disease, but also an increase in education; improved cognition is thought to be a neuroprotective (brain-protecting) factor.

In summary, while dementia is more widespread than it was two decades ago, research suggests the true number of new dementia cases has remained relatively stable overall. There has been a drop in new dementia cases in people over 65 years of age, largely seen in men.