On 22 February, we hosted our second Alzheimer’s Association Academy meeting of the year. These online capacity-building workshops bring together representatives of national Alzheimer’s associations with members of the European Working Group of People with Dementia and European Dementia Carers Working Group, to learn about the latest advances in dementia research, policy, care and treatment from experts in those fields. The Academy meeting, which was moderated by Jean Georges, (Executive Director, Alzheimer Europe) was focused on the topic of modifiable risk factors for dementia and welcomed 58 participants from over 20 countries.
Sebastian Köhler, professor of Neuroepidemiology at the University of Maastricht was first to present, discussing the links between hearing loss, cognitive decline and dementia both in diagnosis and as a modifiable risk factor. He discussed the current research on the topic, concluding that hearing loss is gaining increased attention as a risk factor for cognitive decline and dementia with consistency in literature and general consensus amongst experts, but that evidence regarding hearing aid usage benefits remains inconsistent. Hearing loss as a modifiable risk factor continues to be researched and studies so far do not distinguish between the types of hearing loss (hearing loss versus impaired auditory analysis due to brain atrophies). It was also noted that the studies available did not investigate whether hearing loss leads to cognitive impairment or whether it is secondary to cognitive impairment.
Dr Neus Falgàs from the Hospital Clínic de Barcelona then spoke about sleep disturbances in Alzheimer’s disease (AD) and the ADIS project. She explained the importance of sleep for brain health and outlined the sleep alterations that occur in people with AD, noting that these are frequent and that they start from the early stage of AD. They also have a negative impact on the person and their family, becoming one of the main reasons for hospitalisation. Sleep disturbances are also common in Lewy body dementia (LBD) and follow a similar pattern to those in AD. Dr Falgàs also noted that therapeutic and preventative strategies are limited and have secondary effects. She noted that patient education should focus on developing a regular schedule of sleep, ideally following the circadian rhythm (sleeping at night and being awake during the day), adding that pharmacological sleep aids should be limited in use. Sleep apnoea was mentioned as a vascular risk factor that lowers resilience to stress and negatively impacts neural regeneration.
Nicola Veronese, Gerontologist and professor at University of Palermo, Italy then gave a talk on physical activity for the prevention and management of mild cognitive impairment (MCI) and dementia. He presented a study which demonstrated that the positive effect of exercise was comparable to that of donepezil and explained how the European Geriatric Medicine Society (EuGMS) plans to develop specific guidelines with the involvement of several European scientific and patient societies. The study found that physical activity should be promoted for primary prevention of AD. For MCI, mind-body interventions (tai chi or yoga) were shown to have a small positive effect in global cognition. Exercise in patients with MCI and AD has global positive effects and will help to decrease the rate of disability, he said. He shared the positive physiological effects of physical activity on memory, noting that it decreases stress, improves neuroplasticity and maintains hippocampal volume (which is negatively affected by social isolation). He recommended 30 minutes (minimum) of physical activity, at least two to three times per week, noting that getting patients involved in group physical activity could also help to combat social isolation.
Jeroen Bruinsma, Assistant Professor at the University of Maastricht discussed his work in the LETHE project with regards to lifestyle-related behaviour change for dementia risk reduction. He described the project’s research on preventive interventions of diet, exercise, cognitive training, monitoring vascular risks through sleep, social activity, relaxation, limiting or avoiding alcohol and cigarettes with a digital twin app based on the FINGER protocol. This app can be used on a smartphone and Fitbit watch, and it provides recommendations based on the FINGER protocol. Adherence is being monitored, following up with motivational messages and the data gleaned so far shows that dementia risk is considered abstract, leading to ambivalence towards changing behaviours. It also showed “all-or-nothing” thinking about lifestyle change, with people feeling that change had to be radical, resulting in a lack of tangible goal setting. Negative self-image and behavioural control, particularly where previous attempts had failed, reduced the willingness to make further attempts at lifestyle change. Jeroen Bruinsma acknowledged that lifestyle change for dementia risk reduction is complex, requiring more communication of risks, raising awareness and knowledge and the need to support participants. Personal contact and support is key to engagement, he stressed.
During a panel discussion, the speakers agreed that it is necessary to look at both individual interventions as well as public health initiatives, with the goal of making policy and environmental changes that will benefit people and encourage healthier living. They also acknowledged the fact that making changes at a national level is slow and often complicated to achieve. On an individual level, people should be encouraged to do what they find fun and feel that they can achieve. The speakers reiterated the need to present people with all of the options for lifestyle modification, giving as much choice and autonomy as possible to help people decrease their risk or slow progression.
