Early preventative measures effective weapon to counter dementia, report finds

Alzheimer’s Disease International report says addressing personal risk levels can help delay brain degeneration

Hyperbaric oxygen therapy is being used at the Aviv Clinic in Dubai to reverse the effects of brain degeneration. Chris Whiteoak / The National

Identifying personal dementia risks can help to head off symptoms associated with Alzheimer’s disease and help more people to stay healthier in old age, doctors said.

As the latest global report by Alzheimer’s Disease International is published, medical professionals working with people with brain degeneration said it is never too early to take preventative measures.

By tackling 12 proven risk factors identified by scientific research, dementia could be delayed or its progression slowed, according to the report, released on World Alzheimer's Day.

“Some of these risk factors require a degree of personal choice from individuals, like smoking and excessive alcohol consumption, while others require government action, like air quality, and access to education,” said Paola Barbarino, chief executive of Alzheimer’s Disease International.

“The old adage states that prevention is better than cure – and in the absence of a cure, risk reduction is the best tool we’ve currently got available."

The Lancet medical journal in 2020 first drew up a hit list of 12 proven risk factors for the condition.

These were smoking, physical inactivity, excessive alcohol consumption, air pollution, head injury, infrequent social contact, less education, obesity, hypertension, diabetes, depression, and hearing impairment.

In up to 40 per cent of cases, the onset of dementia could be prevented altogether by identifying certain risk factors and taking precautions well in advance.

The World Alzheimer’s Report 2023 draws on insights from approximately 90 high-profile researchers, healthcare professionals, policymakers, people living with dementia and carers to help understand dementia risk.

If these risks are addressed, the measures could lead to a significant reduction in the number of global cases of dementia, the report said.

Dr Eleni Margioti, a clinical neuropsychologist at the Aviv Clinic in Dubai where hyperbaric oxygen therapy is being used to reverse the effects of brain degeneration, said research was helping medical professionals to diagnose dementia at an earlier stage.

“What I've seen over the last 15 years, is there are more Alzheimer's associations worldwide, including Dubai and the UAE,” said Dr Margioti, who has worked as a scientific supervisor in day care-centres for people with dementia.

“This is the key element for raising awareness and what we are missing. What we also need is better prevention.

“The preclinical stage of dementia starts almost 20 years before the age of 60, or before the onset of the disease.

“If in these 20 years we have the tools to identify symptoms, like for example, subjective cognitive complaints, they are very important.”

Subjective cognitive complaints refer to everyday memory and related cognitive concerns expressed by people.

“We have different symptoms that can give us a better estimation and understanding of the dementia,” Dr Margioti said.

“It is never too late, and never too early. This means that prevention is the most important key.”

Misdiagnosis

Currently, 55 million people worldwide are estimated to be living with some kind of dementia, while two thirds of people still mistakenly believe it is a normal part of ageing.

Post-diagnosis risk reduction can also help to slow the progression of dementia in those already diagnosed with the condition.

Doctors said it was vital that information and advice was clear and understandable, and that lifestyle changes were accessible and affordable for everyone to reduce the number of dementia cases in future.

Although the condition can be difficult to diagnose, dementia treatment is improving, Dr Margioti said.

“We explore the five main cognitive domains like memory attention, information processing speed, executive functions, frontal lobe functions like multi-tasking and cognitive flexibility, and language,” Dr Margioti said.

“We also assess their ability to speak, understand and comprehend.

“After this, we administer a mood and anxiety assessment because we want to see how is this person at the time of the assessment.

“There is what we call pseudodementia.

“Someone can have depression, and they cannot remember because of the depressive symptoms, not because of cognitive decline and the pathological, underlying conditions in their brain. We have to differentiate.”

Oxygen therapy

Early research conducted by the Aviv Clinic has shown promise in how hyperbaric oxygen therapy can reduce the effects of Alzheimer’s disease by improving cerebral blood flow and flooding the brain with oxygen.

Although ineffective in severe degeneration, research has shown it to be effective in delaying the worsening of conditions after an early diagnosis, but the treatment is expensive.

Despite recent advances in disease-modifying drugs, which have given hope to many people living with dementia, affordable treatments for all variants of the condition are some way off entering the mainstream.

Drugs used for heart problems – isosorbide mononitrate and cilostazol – have shown promise in treating a lacunal stroke that is associated with almost half of all dementias.

Meanwhile, the drug Leqembi has been approved for use in the US after research found it slowed progression of those with early signs of Alzheimer’s by up to 27 per cent.

“It is crucial that we continue to advance our arsenal of tools to prevent Alzheimer’s disease, even if only by a few years,” said Dr Howard Fillit, co-founder and chief science officer of the Alzheimer’s Drug Discovery Foundation.

“Any delay of disease onset makes a tremendous difference in patients’ lives.”