Cases of dementia are increasing with the aging of the world’s population, and yet another long-awaited treatment for Alzheimer’s disease, crenezumab, has proven ineffective in many of the latest clinical trials of disappointment. increase. Public health experts and researchers argue that it is a thing of the past to divert our attention to another approach. With van new drug.
A psychiatrist at the University College London, Lancet Committee on Dementia Prevention, Intervention and Care.. “But they are not the only way to move forward.”
Dr. Julio Rojas, a neurologist at the University of California, San Francisco, emphasizes modifiable risk (knowing how we change) is a “dramatic change in concept.” Represents. “We are changing the way we understand how dementia develops,” he said, by focusing on behaviors and interventions that are already widely available and have strong evidence.
The latest modifiable risk factors are Research on visual impairment in the United States Recently published in JAMA Neurology.Use data from Research on health and retirementThe researchers estimated that about 62% of current cases of dementia could have been prevented by risk factors as a whole, and 1.8% (about 100,000 cases) could be prevented by healthy vision.
This is a fairly small percentage, but it can be fixed relatively easily, says Dr. Joshua Ehrlich, an ophthalmologist, artificial health researcher, and lead author of the study at the University of Michigan.
This is because eye examinations, eyeglass prescriptions, and cataract surgery are relatively inexpensive and accessible interventions. “Globally, 80 to 90 percent of vision impairment and blindness can be avoided or not yet addressed by early detection and treatment,” said Dr. Ehrlich.
The influential Lancet Commission began to lead the modifiable risk factor movement in 2017. A panel of physicians, epidemiologists and public health experts have reviewed and analyzed hundreds of quality studies to identify nine risk factors that explain much of the world’s dementia. Decreased levels of education, hearing loss, smoking, obesity, depression, physical inactivity, diabetes, and reduced levels of social contact.
In 2020, the Commission added three more: Excessive alcohol consumption, traumatic brain injury and air pollution. The Commission calculated that if these factors were eliminated, 40 percent of dementia cases worldwide could theoretically be prevented or delayed.
“There can be significant changes in the number of people with dementia,” said Dr. Livingston. “So many people have dementia, which is so expensive that even a small percentage can make a big difference to individuals, families, and the economy.”
In fact, in wealthy countries, “as people get more education and smoke less, that’s already happening,” she pointed out. The probability of dementia increases with age, so the number of cases of dementia continues to increase as more people get older. However, the ratio is declining in Europe and North America. The incidence of dementia has decreased 13 percent every 10 years over the last 25 years.
Dr. Erich wants to add visual impairment to the list of correctable risks as the Lancet Commission updates its report, and Dr. Livingston said it would actually be on the Commission’s agenda. ..
Why does loss of hearing and vision contribute to cognitive decline? “The nervous system maintains its function by stimulation from the sensory organs,” explained Dr. Rojas, co-author of the companion. JAMA Neurology Editorial.. Without that stimulus, “neurons would die and the brain would be reorganized,” he said.
Loss of hearing and vision can also affect cognition by limiting older people’s participation in physical and social activities. “I can’t see the card, so I’ll stop playing with my friends,” said Dr. Erich.
The Relationship between dementia and deafnessThe only most important factor cited by the Lancet Commission as a modifiable risk is well established. Although there are few clinical data on its association with visual impairment, Dr. Erich is a collaborator in a study in southern India to determine whether providing eyeglasses to the elderly affects cognitive decline.
Of course, this approach to reducing dementia is “ambitious,” he admitted, “we are not going to eliminate low education, obesity, all of this.”
Some efforts, such as improving education levels and treating high blood pressure, should begin in adolescence or middle age. Other major policy changes are required. For example, it is difficult for individuals to manage air pollution. Changing your lifestyle, such as changing your habits, quitting smoking, reducing your drinking, and exercising regularly, is not easy.
Even fairly routine medical practices, such as measuring and monitoring high blood pressure and taking medications to control high blood pressure, can be difficult for low-income patients.
In addition, older Americans will find that routine vision and hearing care are two services that traditional Medicare does not cover.
It covers the cost of care associated with diabetic retinopathy, glaucoma, or age-related macular degeneration and is targeted for cataract surgery. But for more general problems that can be fixed with eyeglasses, “traditional Medicare doesn’t help much,” said David Lipschutz, associate director of the nonprofit Medicare Advocacy Center. It also does not cover most hearing aids and tests that are much more expensive.
Medicare Advantage programs offered through private insurance companies usually include sight and hearing benefits, but “check coverage,” Lipschutz warned. “They may apply $ 200, $ 300, or $ 500 to hearing aids.”-But at $ 3,000 to $ 5,000 for a typical pair, “they may still be out of reach. Hmm, “he said.
Extending traditional Medicare to include auditory, visual and dental benefits was part of the Biden administration’s buildback better law. But after the House passed in November, Republican and Democratic Senators Joe Manchin III scuttled it in the Senate.
Nevertheless, despite warnings and cautions, reducing the correctable risk factors for dementia can offer enormous rewards, and the Centers for Disease Control and Prevention has taken that approach. National plan to deal with Alzheimer’s disease..
Focusing on these factors can also help reassure older Americans and their families. Some important risks of dementia are beyond our control — genetics and family history, and aging itself. However, the changeable elements are something we can deal with.
“People develop dementia and have such a fear of losing your memory, your personality, and your independence,” said Dr. Livingston. “The idea that you can do a lot about it is powerful.”
Even delaying its onset can have significant benefits. “If you get at 90 instead of getting at 80, that’s a big deal,” she said.
Eye and hearing tests, exercise, weight management, smoking cessation, blood pressure medications, diabetes treatment — “We don’t talk about costly interventions, flashy surgery, or meet professionals hours away. No, “added Dr. Erich. “These are things you can do in the community where people live.”
