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Identifying Ris..

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Dementia, a progressive disease affecting the elderly population, results in a progressive decline of cognitive abilities such as memory, language, and thoughtful thinking or planning. The majority of dementias are caused by degenerative changes in the brain that over time lead to a loss of independence. Treatment of individuals with dementia mainly involves improving cognition through the use of two pharmacological interventions:  cholinesterase inhibitors and NMDA receptor antagonists. However, the efficacy of these medications is mediocre at best and cannot stop or reverse the progression of this disease.1

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Numerous studies associate certain risk factors to the occurrence of dementia. Although the exact pathophysiology of dementia remains unknown, elimination of proven risk factors should lead to a reduction in the incidence of dementia. In the past, risk factor modification such as hand washing and controlling water supply effectively reduced the incidence of puerperal fever and cholera although treatment strategies were unavailable.2

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Carriere and colleagues2 conducted a prospective seven year cohort study of individuals aged 65 and older. They evaluated the impact of individual risk factors on the incidence of dementia in this general population cohort. Data were analyzed from 1433 participants. The mean age was 72.5 (SD 5.1) years and median follow up period was 7.31 years. The population attributable fraction (PAF) estimated the mean risk reduction over seven years that would be obtained if a specific exposure was entirely eliminated from the population while every other exposure remained unchanged.

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  • The investigators identified the following factors to correlate to the development of dementia
  • Neale adult reading score<20 (PAF 18%, HR=1.72, p<0.001)
  • Diabetes (PAF 4.88%, HR=1.85, p<0.002)
  • ApoE gene(PAF 7.1%, HR=1.47 and p=0.001)
  • Fruit and vegetable consumption
  • Depression (PAF 10.3%, HR= 1.39, p=0.002)

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            *Depressed women had a higher risk of dementia  than depressed men (p=0.03).

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Aside from genetic risk factors (ApoE), the investigators concluded that focusing public health strategies on increasing the Neale adult reading score and fruit and vegetable consumption along with reducing depression and diabetes would show the biggest impact on decreasing the incidence of dementia. The American Psychiatric Association (APA) and the Scottish Intercollegiate Guidelines Network (SIGN) both suggest the use of risk factor removal (i.e., increasing recreational and physical activity) as a non pharmacological intervention for the progression of dementia. However the guidelines did not make specific recommendations due to lack of sufficient evidence. Randomized controlled trials are needed to confirm the results of this observational study. Until then, first line pharmacological interventions such as Aricept and Memantine will continue to only slow dementia progression of the disease while the incidence would continue to rise.3 Risk factor removal may not only reduce the incidence of dementia but also decrease healthcare costs for the elderly.

1. Hanks G, Fallon M, Cherny NI, et al (eds). Oxford Textbook of Palliative Medicine. Oxford: Oxford University Press; 2010. ISBN-10: 0-19-857029-5, ISBN-13: 978-0-19-857029-5. STAT!Ref Online Electronic Medical Library. http://online.statref.com/document.aspx?fxid=109&docid=748. 9/22/2010 1:20:08 PM CDT (UTC ...

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