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P2. Preventing dementia

Detailed programme, abstracts and presentations

P2.1. Risk factors for dementia: A systematic literature review and Delphi expert consensus

Köhler Sebastian, Verhey Frans, van Boxtel Martin, de Vugt Marjolein, Deckers Kay, Irving Kate for the In-MINDD project team

Background:  Identifying the major midlife risk factors for dementia is crucial to effective preventive strategies and improve healthy late life cognitive functioning. There exists a considerable literature of potential risk factors for dementia, but the validity and status of individual factors are often uncertain, based on few studies, or inconsistent. Some important reviews have been published in recent years1 2. However, the field is rapidly evolving and hence this information might not be most up-to-date, and some novel risk factors might have emerged in the meantime. The FP-7 funded In-MINDD (INnovative Midlife INtervention into Dementia Deterrence) project uses two complementary approaches to summarise the best evidence on preventive factors: a systematic literature review and a Delphi expert study.

Methods: In the Delphi study, eight leading European and non-European dementia experts were asked for their opinion regarding important risk factors. Their responses were synthesised with information from an updated systematic review. The literature search was conducted in PubMed using the search strategy from Plassman et al. (2010) 1. All new publications between October 2009 and December 2012 were included if they fulfilled the following inclusion criteria: population-based cases and controls; sample size N>200, follow-up duration >1year; participants aged ≥ 45 years; prospective design; outcomes: incident dementia, incident cognitive impairment, cognitive decline on repeated measures. The search yielded 3,127 abstracts, of which 327 (10.5%) were included based on title and abstract for further scrutiny. From these, information on study design, exposure and outcome measurement and direction and magnitude of effects were extracted. Results were then pooled with the original review by Plassman et al. (2010) 1.

Results: All top-10 risk factors named by experts were among the best-documented risk factors based on the systematic review, and all were included among the most important risk factors from a previous review 2. There seems to be good evidence from prospective studies for the following midlife risk factors: hypertension, depression, diabetes, obesity, physical inactivity, smoking and alcohol consumption. In contrast, some candidate risk factors emerged from the review that require further validation. These include: hyperlipidemia, coronary heart disease, low cognitive activity, renal dysfunction and functional impairment.

Conclusions: There is considerable agreement among dementia experts and current best-evidence literature on the role of several risk factors for cognitive decline and dementia. This provide strong support for somatic and lifestyle factors in the etiology of dementia and flag several important targets for prevention in midlife. Some novel risk factors like renal dysfunction were detected that will be subject to further study within the In-MINDD project.

P2.2. Healthy memory, healthy aging: The importance of proper memory processing in age

Markowitsch Hans J., Staniloiu Angelica

Memory is defined as being composed of several systems, each with its distinct neural basis. Of these systems the episodic-autobiographical one is considered to have evolved latest and to be most vulnerable to brain damage, stress conditions, and the effects of age (Markowitsch and Staniloiu, Amnesic disorders.Lancet, 2012). Episodic-autobiographical memory allows mental time travelling into past and future and a synchronisation between emotional and cognitive aspects of events. Consequently, especially structures of the limbic system and the prefrontal cortex are regarded as essential for an appropriate processing of autobiographical events. The prefrontal cortex, however, is known to deteriorate with age and to affect more complex functions of memory such as free recall, metamemory, source memory, prospective memory. Positive feelings, on the other hand, are dominating over negative ones in healthy aging. Both factors interact and determine the well-being in age.

We will discuss variables and prerequisites for proper learning and memory during the life span with an emphasis on changes in memory processing in both healthy individuals and those with beginning memory deterioration – in particular with age-related degenerative diseases. Furthermore, we will use own results from functional brain imaging studies in normal subjects of different ages to depict the development of autobiographical memory across the life span and to argue for the importance of the ventromedial prefrontal cortex for an integrated binding of memory, based on aspects of time, self, and consciousness.

P2.3. Low cognitive activity as a risk factor in cognitive decline

McGarrigle Lisa, Boran Lorraine, Irving Kate, Verhey Frans, van Boxtel Martin, Kohler Sebastian

Aims: The main objectives of this research are to model the roles of cognitive activity in developing, as well as protecting against dementia by initially conducting a meta-analysis of cognitive dementia risk/protective factors, and then validating these models in a longitudinal ageing study data set. Low cognitive activity in middle age has been identified as a risk factor in cognitive decline; however the relative risk of this factor remains unknown. However, the impact of high cognitive activity as a protective factor against dementia is unclear. High levels of cognitive activity are thought to boost cognitive reserve (CR) or the brain’s capacity to cope with pathology in order to minimise symptomatology (Siedlecki et al, 2009). Even though models of CR have proved wanting because of the lack of evidence to address the issue of construct validity; Satz et al.’s (2011) four-factor conceptual model of reserve is empirically testable. This study therefore aims to investigate the role of cognitive activity in dementia risk and protection using Satz et al.’s (2011) conceptual model of CR.

Methods: The methodology will adopt a dual approach that will include both meta-analyses and validation of a risk and protective model. Two meta-analyses will be conducted to evaluate the role of low cognitive activity as a risk factor and high cognitive activity as a protective factor in cognitive decline. Satz et al. (2011) CR model will be tested against two longitudinal ageing study datasets – MAAS (N=1800) and DESCRIPA (N=880). The Maastricht Ageing Study (MAAS) is a 15-year follow-up study on cognitive ageing. The CR model will be developed using this large dataset of risk factors and cognitive decline/dementia outcomes. The model will then be validated using an independent dataset from the DESCRIPA study – a multi-centre European cohort study on ageing and dementia. This study will also have 15 years of follow-up at the time of analysis.

P2.4. Lipid soluble vitamins, lipids and body mass index in Alzheimer and vascular dementia

Koseoglu Emel, Baydemir Recep, Saraymen Recep, Cetin Aysun

Aim: This study is aimed to evaluate serum vitamin A,E,D and K, lipids and body mass index in people with Alzheimer and vascular dementia with respect to healthy control group; and the relations between these parameters, hoping to find a clue for the prevention of dementia.

Patients and Methods: Sixty people with Alzheimer dementia, 52 with vascular dementia  and, 61 sex and age matched healthy persons were involved into the study. In addition to the investigations for the evaluation of dementia; serum vitamin A,D,E,K and lipids’  levels (total cholesterol, trigliceride, LDL, HDL) were measured; body mass indexes were calculated in all subjects. The study groups were compared with respect to these parameters. Additionally, the relationships between the parameters were examined in all groups.

Results: Among the vitamins, only vitamin D was found to be lower in dementia groups with respect to the healthy group (p<0.001). No significant difference was found between Alzheimer and vascular dementia groups. With regards to lipids, only total cholesterol level was found to be significantly higher in dementia groups than that in healthy control group (p=0.001). No significant difference existed between Alzheimer and vascular dementia groups. There was not any significant difference among the study groups with regard to body mass index. On the evaluation of the relationships among the levels of vitamins and lipids, vitamin D was found to be negatively correlated with total cholesterol (p<0.05) in only healthy control group. There was not any significant relationship in dementia groups. On examining the relationship of body mass index with other parameters, it was detected to be correlated with triglyceride level in vascular dementia group (p<0.005) and   in the control group (p<0.05).

Conclusion: Low vitamin D level and high total cholesterol level were found to be associated with Alzheimer and vascular dementia groups. Body mass index appeared not to play any substantial role in dementia. The absence of the likely negative relation between vitamin D and total cholesterol in the dementia groups as found in the control group made us to think that the possible  regulatory mechanisms between vitamin D and total cholesterol was impaired in both Alzheimer and vascular dementia.

P2.5. Polyphenols in the prevention of Alzheimer's disease - some food for thought?

Camilleri Georgette-Marie

The production and accumulation of abnormally folded beta-amyloid peptides and microtubule associated protein tau in the brain is a major hallmarks in the pathophysiology of Alzheimer's disease. This poster aims to review the mechanisms through which several polyphenolic compounds, present in our diet, act to delay beta-amyloid plaque formation in the brain. This can in turn, delay the onset and progression of cognitive deterioration in Alzheimer's disease.

Epigallocatechin-3-gallate, the main polyphenolic constituent of green tea, was shown to reduce beta-amyloid plaque generation, possibly by promoting α-secretase cleavage of amyloid precursor protein, as well as by inhibting the activity of various pro-inflammatory cytokines.  Moderate consumption of red wine, rich in polyphenol resveratrol, decreases the level of reactive oxygen species in the brain, and can also act directly to promote beta-amyloid lowering activity. Based on the fact that the majority of polyphenolic compounds found in red wine are derived from the grape seed and skin, grape-seed polyphenol extract can also be used as a red wine alternative, to interfere with the assembly of amyloid beta plaques and possibly tau peptides into neurotoxic aggregates. Anthocyanins present in berries and curcumin found in turmeric have also been shown to be neuroprotective. All in all, Alzheimer's disease is a growing public health concern with potentially devastating effects. Simple measures, such as consuming a diet rich in polyphenolic compounds may help to prevent or slow the progression of cognitive impairment in our population.

P2.6. Epidemiology and genetics of Alzheimer´s disease

Povová Jana, Janout Vladimír, Sery Omar, Tomaskova Hana, Ambroz Petr, Pohlidalova Anna

Alzheimer´s disease (AD) is one of the most important diseases in the world affecting older population. Official statistics are likely to significantly underestimate the actual prevalence of AD. In the Czech Republic there is about 120,000 cases officially registered and etiology is not known only suspected in form of genetic, vascular and psychosocial risk factors.

In 2010 research project Epidemiology and Genetics of Alzheimer´s disease has been launched in the Czech Republic to asses the effect of those risk factors on the group of 800 cases of AD and group of 800 controls.

Pilot evaluation presents results from 361 cases and 130 controls. It is suggested, that patients with AD have more often cardiovascular disease in their history, they drink more alcohol and more smoke. In this pilot evaluation there has not been found statistically significant difference in diabetes mellitus, hypertension and cerebrovascular disease, probably because of small sample size. Relationship among the ApoE4 allele and the higher risk of AD has been found. Supported by the Czech Ministry of Health grant project no. NT11152-6/2010.



Last Updated: Monday 25 November 2013


  • Acknowledgements

    The 23rd Alzheimer Europe Conference in St. Julian's, Malta received funding from the European Union, in the framework of the Health Programme. Alzheimer Europe and the Malta Dementia Society gratefully acknowledge the additional support provided by foundations and companies.
  • European Union