Latest research updates on dementia.
Individuals with AF (irregular heart rhythm) have a higher risk of mild cognitive impairment (MCI) than those without AF, and those with AF and MCI were at greater risk of dementia. Atrial fibrillation is linked to an increased risk for dementia, particularly when diagnosed before age 65 years. Careful monitoring of cognitive function for patients with a younger AF onset age, particularly those diagnosed with AF before age 65 years, is important to attenuate the risk of subsequent dementia. (JAMA 8 Dec 2023).
Anemia is linked to over 50% higher risk of dementia.
People with essential or postural tremor have nearly three times increased risk of developing dementia compared with the general population (American Academy of Neurology (AAN) 2024 Annual Meeting on April 17, 2024).
More than 10 hours a day of sedentary behavior significantly increases the risk of dementia in older adults.
Playing chess or other board games slows cognitive decline and improves quality of life in older people.
Higher dementia risk is linked to heart disease. Adults diagnosed with coronary heart disease are at an increased risk for dementia, with the risk highest — at 36% — if onset is before age 45. (JAHA 29 Nov 2023).
Preventing dementia means doing physical activity. But it must be a 'good' form of physical activity, which hard physical work is not. Consistently working in an occupation with intermediate or high occupational physical activity work loads is linked to an increased risk of cognitive impairment. (Lancet 29 Aug 2023).
The risk for dementia before age 90 years is significantly higher among people taking anti-reflux medications - proton pump inhibitor (PPI) and is highest among those diagnosed before age 70 years regardless of when PPI treatment was initiated. ( Alzheimer’s & Dementia 24 Aug 2023).
Personality traits can influence dementia risk. High neuroticism, negative low mood, and low conscientiousness are risk factors for dementia, whereas conscientiousness, extraversion, and positive mood and outlook are protective. (Alzheimer’s and Dementia. 4 Oct 2023).
People who take vitamin D maybe at much less risk of developing dementia than those who did not take vitamin D.
Coffee boosts alertness and psychomotor performance.
Multivitamins may improve memory and slow cognitive ageing compared with placebo. (Am J Clinical Nutrition March 2024).
Healthy older men who lift weights strengthens the connections between their nerves and muscles, helping them maintain physical function.
Inhaling a pleasant aroma during sleep has been linked to a "dramatic" improvement in memory. (Frontiers Neuroscience 24 July 2023).
Functional assessment of the patient's level of independence for their life in society is what conceptually differentiates mild cognitive impairment from dementia.
Self-reported, regular internet use, but not overuse, in older adults is linked to a lower dementia risk.
Increases in muscle adiposity (fat deposits) and muscle weakness are associated with greater cognitive decline over time.
SuperAgers generally have been more active than control subjects during their middle years. Staying physically fit is essential, even if it just means going for a walk or taking the stairs.” SuperAgers also fare much better in tests on physical health than the control subjects. They suffer significantly less from anxiety or depression. SuperAgers are more socially engaged and involved. (The Lancet 13 July 2023).
Weak hand grip strength in older people is a good predictor of frailty, malnutrition and other comorbidities.
Ultraprocessed foods loaded with sugar, salt, fat, artificial colours, and preservatives are linked to poor brain health, including an increased risk of dementia, depression and anxiety. (JAMA Neurology 5 Dec 2022).
Losing as little as 1% of deep sleep each year has been linked to a 30% increase in dementia risk. Prioritising deep sleep — also known as slow-wave sleep may lower dementia risk.
Modifiable risk factors associated with an increased risk of developing dementia under 65 years include-lower formal education levels, lower socioeconomic status, having 2 apolipoprotein ε4 alleles versus none, social isolation and visiting family or friends once a month or less, high serum inflammatory marker - CRP (C-reactive protein levels >1 mg/dL), Vitamin D deficiency, weak hand grip strength, hearing impairment, postural hypotension, diabetes, heart disease stroke and depression. (JAMA Neurol 26 Dec 2023).
Regular moderate to vigorous physical activity predicts larger brain size in key regions, including gray and white matter and the hippocampus (memory centre). (J Alzheimer’s Disease 16 Jan 2024).
Older adults over 65 years with diabetes on insulin may have an increased risk for serious hypoglycemic events in extreme heat, which can cause delirium.
White matter hyper-intensities found on brain CAT scans or MRI brain scans are abnormal and are markers of poor brain function and cardiovascular health, relate to increased risk of stroke, depression, cognitive decline, gait and balance disorders and increased falls risk. Those periventricular white matter changes that join up in a confluent “ring of fire” are highly correlated with cognitive decline and falls in older people. These white matter changes are very common in Alzheimer’s dementia. They are not a normal finding in older people.
Pet ownership is associated with slower cognitive decline in old people who live alone. (JAMA Network 26 Dec 2023).
Intake of protein, especially from plants, in middle age is associated with higher odds of healthy ageing and positive mental and physical health status in older women.
Social isolation is associated with an increased risk for a pre-dementia syndrome characterized by cognitive decline and slowing of gait and mobility. Motoric cognitive risk syndrome (MCR), a pre-dementia syndrome, is characterized by subjective cognitive complaints and slow gait speed in individuals without dementia or mobility disability. Typical elderly people at risk include those going out less, not feeling confident, rarely visiting friends/family, not talking with others, and without live-in partner/spouse. (Alzheimer’s & Dementia 21 Dec 2023).
Playing chess or other board games slows cognitive decline and improves quality of life in older patients.
Having a healthy lifestyle, including regular exercise, eating fruits and vegetables, and minimal alcohol consumption, is associated with better cognitive function in older people. Lifestyle factors may provide cognitive reserve and improve cognitive abilities in older age and even in people with dementia.
Playing a musical instrument is associated with better working memory and executive function, and singing in a group is associated with better executive function in planning and organising your day. (Int J Geriatric Psychiatry 28 Jan 2024).
Cognitive decline increases the risk of car collisions. Motoric cognitive risk syndrome characterized by the presence of subjective cognitive concerns and slow gait, reflexes and movements are associated with car collisions and near-miss traffic incidents independent from objective cognitive impairment. (JAMA 5 Oct 2023).
Off-road screening tests can reliably identify older drivers with a strong probability of failing an on-road driving test. Off-road driver screening measures, including the Useful Field of View (UFOV), Trail Making B test, DriveSafe intersection test and 14 point Road Rule test. DriveSafe measures awareness of the driving environment. It takes approximately 20 minutes to administer in an office setting. A series of 13 images of the same 4-way intersection (roundabout) are projected on a screen to simulate the view through a windshield. DriveAware measures awareness of driving ability. The test consists of eight questions in which the client’s response is compared with the clinician’s rating using a structured marking guide.
There is a reduced risk of dementia among older adults who regularly use the internet for < 2 hours per day. General cognitive performance, memory and verbal reasoning tend to be better preserved among internet users. ( J Am Geriatric Soc 12 March 2023).
Use of statin drugs (for cholesterol lowering) is associated with improved mortality in older nursing home residents, regardless of dementia status. (Neurology 27 Feb 2024).
People living in the most disadvantaged neighbourhoods have more than 20% higher risk for dementia than those in other areas and measurably poorer brain health as early as age 45, regardless of their own personal income and education. (Alzheimers’ & Dementia 14 March 2024).
Dementia risk is more than three times higher in those who had just one episode of delirium, with each additional episode linked to a further 20% increase in dementia risk.
Cognitively active lifestyle may have a protective effect on brain function. “Either use it or lose it”. Cognitive exercises involves performing a definitive task or set of tasks where you increase attentional demands to improve concentration and memory. This may generate new synapses to enhance brain health and cognitive function. Neuroplasticity changes have been confirmed through neuroimaging, which has demonstrated that after cognitive training, there is more activation in the prefrontal cortex that correlates with new synapses. J Am Geriatr Soc.57:594-603. 2009.
High olive oil consumption of more than 7g per day is associated with a significant 28% lower risk for dementia-related mortality compared with never or rarely consuming olive oil, regardless of overall diet quality. JAMA Open Network. 2024;7(5):e2410021. doi:10.1001/jamanetworkopen.2024.10021.
Having two copies of the APOE4 gene may be the genetic cause of up to 20% of all Alzheimer’s cases. Almost all APOE4 homozygotes exhibited Alzheimer’s disease pathology and had significantly higher levels of Alzheimer’s disease biomarkers from age 55 compared to APOE3 homozygotes. By age 65, nearly all had abnormal amyloid (abnormal toxic protein) levels in cerebrospinal fluid, and 75% had positive amyloid scans, with the prevalence of these markers increasing with age, indicating near-full penetrance of Alzheimer’s disease biology in APOE4 homozygotes. The age of symptom onset was earlier in APOE4 homozygotes at 65.1 years. APOE4 may not be just a risk factor for AD but also a distinct genetic form of the disease. Nature Medicine. 6 May 2024.
Maternal history (at any age) and paternal history of early-onset memory impairment were associated with Amyloid Aβ burden in the brain among asymptomatic older individuals and increased risk for developing Alzheimer’s disease, depending on the number of affected relatives. JAMA Neurol. Published online June 17, 2024. doi:10.1001/jamaneurol.2024.1763.
Untreated vision loss and high LDL cholesterol are risk factors for dementia. Overall, around 45% of cases of dementia are potentially preventable by addressing 14 modifiable risk factors at different stages during the life course. Reducing vascular damage (eg, by reducing smoking and treating high blood pressure) is likely to have contributed to a reduction in age-related dementia incidence. The Lancet. July 31, 2024. DOI: https://doi.org/10.1016/S0140-6736(24)01296-0
The American Heart Association (AHA) has reported the link between heart failure, atrial fibrillation, and coronary heart disease and the increased risk for cognitive impairment and dementia. There is compelling evidence of the close link between heart health and brain health, which benefits from early intervention. AHA 2024.
More than 25% of older adults (age ≥75 years) have diabetes and may be at risk of adverse events related to aggressive diabetic treatment such as hypoglycaemia (low blood glucose) requiring hospital admission. This emphasises the need to re-evaluate diabetic treatment targets in older adults and to reconsider the use of anti-hyperglycaemic medications that may lead to hypoglycaemia, especially in setting of intensive glycaemic control. Springer Nature Link. Diabetologia. Published: 25 January 2021. Volume 64, pages 1093–1102, (2021).
Conditions like diabetes and dementia are common in patients who are admitted to long-term care facilities, but aggressive management of diabetes in long-term care residents is not recommended, according to a presentation given at the Family Medicine Forum (FMF) 2024.
Hypoglycemia hospital admission rates are twice as high in older patients (age, 75 years or older) as in younger patients (age, 65-74 years). JAMA Intern Med. 2014;174(7):1116-1124. doi:10.1001/jamainternmed.2014.1824.
Signs of frailty may warn of future dementia risk more than a decade before cognitive symptoms occur. Frailty levels significantly increased in the 4-9 years before dementia diagnosis. Frailty is associated with dementia risk. JAMA Neurol. Published online November 11, 2024. doi:10.1001/jamaneurol.2024.3774.
The combination of a history of infections and exposure to traffic-related air pollution with primary residence 50 meters or less from a major road increased the risk for Alzheimer’s disease (AD) by 177% in adults aged 60-75 years.
Older people who live past age 95 reach their highest weight around age 75, approximately 15 years later than those with conventional lifespans. Those people who don’t live as long reach their peak weight around age 60. The long-lived group also lose weight more slowly after reaching their peak. Body weight doesn’t matter; but rather what matters is when you reach the maximum peak, which becomes a marker of frailty or resilience. So maintaining weight or losing it slowly in the later years could be a sign that the body is holding up well. This study was presented at Gerontological Society of America 2024 Annual Scientific Meeting.
Higher neighbourhood disadvantage, lesser green space, air pollution, and homicide rate in the area are associated with greater odds of mild cognitive impairment. Journal of the American Geriatrics Society. 20 November 2024.