06 Sep Age, Sex and Genetics Can Identify Groups at Higher Risk of Alzheimer’s Disease
MedicalResearch.com Interview with:
Ruth Frikke-Schmidt, Professor, Chief Physician, MD, DMSc, PhD
Department of Clinical Biochemistry
Rigshospitalet, Blegdamsvej &
Department of Clinical Medicine
Faculty of Health and Medical Sciences
University of Copenhagen
MedicalResearch.com: What is the background for this study?
Response: Alzheimer’s disease and other forms of dementia are devastating, neurodegenerative disorders affecting more than 47 million people in 2015, a number projected to triple by 2050 (1,2). Available curative treatments are lacking, and no useful risk prediction tools exist. The potential for prevention is however substantial, emphasized by the recently observed incidence decline in Western societies, likely caused by improved treatment and prevention of vascular risk factors (1,3,4). Population growth and aging, will however triple dementia prevalence by 2050, if no action is taken. Acting now with ambitious preventive interventions, delaying onset of disease by five years, is estimated to halve the prevalence globally (1,5).
Despite important preventive efforts over the last decades – resulting in decreased smoking, lower blood pressure and lower cholesterol levels in the general population – physical inactivity, overweight, and diabetes remain threats for our health care system, and in particular for cardiovascular disease and dementia. Intensifying preventive efforts in general is thus of crucial importance, and especially for those patients at highest risk who most likely will benefit the most from early and targeted prevention. Risk stratification and specific treatment goals according to the estimated absolute 10-year risk, has been implemented in cardiovascular disease for years (6,7). There is an un-met need for similar strategies in dementia, underscored by the publication of several randomized multicomponent trials that seem to improve or maintain brain function in at-risk elderly people from the general population (8-10)
MedicalResearch.com: What are the main findings?
Response: By mapping a combination of factors – age, sex and common genetic variants – subgroups of the general population with highest risk can be identified. These results have the potential to implement a more targeted and effective future prevention.
MedicalResearch.com: What should readers take away from your report?
Response: We still don’t know whether a targeted intervention would benefit high risk groups the most. While we wait for randomized clinical intervention trials to test this, there is sufficient evidence to say that “what is good for the heart is also good for the brain”.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Randomized clinical intervention trials, like the FINGER trial (8) – could in the future be designed according to specific high risk groups, as the present example given in CMAJ (11).
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- Prince M, Wimo A, Guerchet M, Ali GC, Wu YT, Prina M. World Alzheimer report 2015 – the global impact of dementia: an analysis of prevalence, incidence, cost and trends. London: Alzheimer’s Disease International, 2015.
- Satizabal CL, Beiser AS, Chouraki V, Chêne G, Dufouil C, Seshadri S. Incidence of dementia over three decades in the Framingham Heart Study. N Engl J Med 2016;374:523-532.
- Langa KM, Larson EB, Crimmins EM et al. A comparison of the prevalence of dementia in the United States in 2000 and 2012. JAMA Intern Med 2017;177:51-58.
- Sloane PD, Zimmerman S, Suchindran C et al. The public health impact of Alzheimer’s disease, 2000-2050: Potential implication of treatment advances. Annu Rev Public Health 2002;23:213-231.
- Conroy RM, Pyorala K, Fitzgerald AP et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the score project. Eur Heart J 2003;24:987-1003.
- Piepoli MF, Hoes AW, Agewall S et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice sixth joint task force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of 10 societies and by invited experts) developed with the special contribution of the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). Eur Heart J 2016;37:2315-2381.
- Ngandu T, Lehtisalo J, Solomon A et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): A randomized controlled trial. Lancet 2015;385:2255-2263.
- Richard E, Van den Heuvel E, Moll van Charante EP et al. Prevention of dementia by intensive vascular care (PreDIVA); a cluster-randomized trial in progress. Alzheimer Dis Assoc Disord 2009;23:198-204.
- Andrieu S, Guyonnet S, Coley N et al. for the MAPT Study Group. Effect of long-term omega 3 polyunsaturated fatty acid supplementation with or without multidomain intervention on cognitive function in elderly adults with memory complaints (MAPT): a randomized, placebo-controlled trial. Lancet Neurol 2017;16:377-389.
- Rasmussen KL, Tybjærg-Hansen A, Nordestgaard BG, Frikke-Schmidt R. Absolute 10-year risk of dementia by age, sex and APOE genotype: a population-based cohort study. CMAJ 2018 doi: 10.1503/cmaj.180066
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