Potential for primary prevention of Alzheimer's disease: an analysis of population-based data

Norton, Sam; Matthews, Fiona E.; Barnes, Deborah E.; Yaffe, Kristine; Brayne, Carol

doi:10.1016/s1474-4422(14)70136-x

Cited by 2,049 publications

(1,804 citation statements)

References 25 publications

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“…Physical inactivity is an important risk factor for cognitive decline in aging and for Alzheimer's disease (Norton, Matthews, Barnes, Yaffe, & Brayne, 2014). Conversely, exercise can convey a protective effect (Ahlskog, Geda, Graff‐Radford, & Petersen, 2011; Geda et al, 2012; Ngandu et al, 2015; Wirth, Haase, Villeneuve, Vogel, & Jagust, 2014) even if initiated after midlife (Tolppanen et al, 2015).…”

Section: Lifestyle Associations and Interventions For Aging And Admentioning

confidence: 99%

Aging and Alzheimer’s disease: Comparison and associations from molecular to system level

et al. 2018

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Alzheimer's disease is the most prevalent cause of dementia, which is defined by the combined presence of amyloid and tau, but researchers are gradually moving away from the simple assumption of linear causality proposed by the original amyloid hypothesis. Aging is the main risk factor for Alzheimer's disease that cannot be explained by amyloid hypothesis. To evaluate how aging and Alzheimer's disease are intrinsically interwoven with each other, we review and summarize evidence from molecular, cellular, and system level. In particular, we focus on study designs, treatments, or interventions in Alzheimer's disease that could also be insightful in aging and vice versa.

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Section: Lifestyle Associations and Interventions For Aging And Admentioning

confidence: 99%

Aging and Alzheimer’s disease: Comparison and associations from molecular to system level

et al. 2018

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“…1,13,14 There is increasing evidence to support an association between Alzheimer's disease and cardiovascular risk factors such as hypertension and hypercholesterolaemia. [15][16][17] It has been argued that in older age groups Alzheimer's disease should be considered as a diffuse clinical syndrome representing the gradual accumulation of multiple pathologies rather than as a discrete neuropathological entity. 15 Health-care delivery for people with dementia and comorbidity Comorbidity among people with dementia presents particular challenges for primary and secondary care.…”

Section: Dementia and Comorbiditymentioning

confidence: 99%

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Bunn

Burn

Goodman

et al. 2016

Health Serv Deliv Res

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116

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BackgroundAmong people living with dementia (PLWD) there is a high prevalence of comorbid medical conditions but little is known about the effects of comorbidity on processes and quality of care and patient needs or how services are adapting to address the particular needs of this population.ObjectivesTo explore the impact of dementia on access to non-dementia services and identify ways of improving the integration of services for this population.DesignWe undertook a scoping review, cross-sectional analysis of a population cohort database, interviews with PLWD and comorbidity and their family carers and focus groups or interviews with health-care professionals (HCPs). We focused specifically on three conditions: diabetes, stroke and vision impairment (VI). The analysis was informed by theories of continuity of care and access to care.ParticipantsThe study included 28 community-dwelling PLWD with one of our target comorbidities, 33 family carers and 56 HCPs specialising in diabetes, stroke, VI or primary care.ResultsThe scoping review (n = 76 studies or reports) found a lack of continuity in health-care systems for PLWD and comorbidity, with little integration or communication between different teams and specialities. PLWD had poorer access to services than those without dementia. Analysis of a population cohort database found that 17% of PLWD had diabetes, 18% had had a stroke and 17% had some form of VI. There has been an increase in the use of unpaid care for PLWD and comorbidity over the last decade. Our qualitative data supported the findings of the scoping review: communication was often poor, with an absence of a standardised approach to sharing information about a person’s dementia and how it might affect the management of other conditions. Although HCPs acknowledged the vital role that family carers play in managing health-care conditions of PLWD and facilitating continuity and access to care, this recognition did not translate into their routine involvement in appointments or decision-making about their family member. Although we found examples of good practice, these tended to be about the behaviour of individual practitioners rather than system-based approaches; current systems may unintentionally block access to care for PLWD. Pathways and guidelines for our three target conditions do not address the possibility of a dementia diagnosis or provide decision-making support for practitioners trying to weigh up the risks and benefits of treatment for PLWD.ConclusionsSignificant numbers of PLWD have comorbid conditions such as stroke, diabetes and VI. The presence of dementia complicates the delivery of health and social care and magnifies the difficulties that people with long-term conditions experience. Key elements of good care for PLWD and comorbidity include having the PLWD and family carer at the centre, flexibility around processes and good communication which ensures that all services are aware when someone has a diagnosis of dementia. The impact of a diagnosis of dementia on pre-existing conditions should be incorporated into guidelines and care planning. Future work needs to focus on the development and evaluation of interventions to improve continuity of care and access to services for PLWD with comorbidity.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…Because an increasing amount of research supports the hypotheses that mid-life hypertension and obesity are risk factors for dementia [25], these variables were included as covariates in the analysis. Systolic (SBP) and diastolic blood pressure (DBP) were measured twice in HUNT1 according to a standardised method described elsewhere [20].…”

Section: Methodsmentioning

confidence: 99%

Alcohol Consumption and Risk of Dementia Up to 27 Years Later in a Large, Population-Based Sample: The Hunt Study, Norway

2015

The Gerontologist

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The relationship between alcohol consumption and dementia risk is unclear. This investigation estimates the association between alcohol consumption reported in a population-based study in the mid-1980s and the risk for dementia up to 27 years later. The entire adult population in one Norwegian county was invited to the Nord-Trøn-delag Health Study during 1984-1986 (HUNT1): 88 % participated. The sample used in this study includes HUNT1 participants born between 1905 and 1946 who completed the questionnaire assessing alcohol consumption. A total of 40,435 individuals, of whom 1084 have developed dementia, are included in the analysis adjusted for age, sex, years of education, hypertension, obesity, smoking, and symptoms of depression. When adjusting for age and sex, and compared to reporting consumption of alcohol 1-4 times during the last 14 days (drinking infrequently), both abstaining from alcohol and reporting consumption of alcohol five or more times (drinking frequently) were statistically significantly associated with increased dementia risk with hazard ratios of 1.30 (95 % CI 1.05-1.61) and 1.45 (1.11-1.90), respectively. In the fully adjusted analysis, drinking alcohol frequently was still significantly associated with increased dementia risk with a hazard ratio of 1.40 (1.07-1.84). However, the association between dementia and abstaining from alcohol was no longer significant (1.15, 0.92-1.43). Equivalent results for Alzheimer's disease and vascular dementia indicated the same patterns of associations. When adjusting for other factors associated with dementia, frequent alcohol drinking, but not abstaining from alcohol, is associated with increased dementia risk compared to drinking alcohol infrequently.

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Potential for primary prevention of Alzheimer's disease: an analysis of population-based data

Abstract: Background: Recent estimates suggesting that over half of Alzheimer's disease (AD) burden

Cited by 2,049 publications

References 25 publications

Aging and Alzheimer’s disease: Comparison and associations from molecular to system level

Aging and Alzheimer’s disease: Comparison and associations from molecular to system level

Comorbidity and dementia: a mixed-method study on improving health care for people with dementia (CoDem)

Alcohol Consumption and Risk of Dementia Up to 27 Years Later in a Large, Population-Based Sample: The Hunt Study, Norway

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