September is World Alzheimer's Awareness Month

List: 10 Potentially-modifiable risk factors for dementia

BY Mary Ellen Quiceno, Medical Director, Parexel - 9.16.19 -

Sunday, Sep. 21, 2019 is World Alzheimer's Day, a capstone to the World Alzheimer's Month campaign that occurs annually during the month of September.  This year marks the world's eighth recognition of World Alzheimer's Month, when the global community joins together to raise awareness and ameliorate the stigma surrounding dementia. 

The campaign is a key opportunity for enhancing access to information on dementia around the world as two out of three respondents to a global survey said they believe there is little or no understanding of dementia in their countries.  It ss a global problem requiring global action.

As part of Parexel's recognition of World Alzheimer's Day and World Alzheimer's Month, we've put together a short list of ten potentially-modifiable behaviors that can impact an individual's risk for developing dementia.  Please check out the list and pass it on to help us improve global understanding of dementia.

Infographic illustrating the 10 potentially modifiable risk factors for dementia.


Early life factors (age <18 years)

Education: Data indicates that individuals who do not complete high school or lack secondary school education are more likely to develop dementia later in life.

Mid-life factors (age 45–65 years)

Hearing loss: Even mild hearing loss may increase the risk of cognitive decline. Research indicates that almost 33% of adults older than 55 years live with mild hearing loss.  Hearing loss could lead to cognitive impairment due to increased cognitive load on a vulnerable brain, increase social disengagement or depression.  It is yet unknown whether correction with hearing aids could prevent or delay the onset of dementia.  

Hypertension: High blood pressure contributes to new cases of dementia.  Lowering systolic blood pressure to less than 120 mmHg, as compared to a target of less than 140 mmHg, may reduce the risk of mild cognitive impairment (MCI) and the combined risk of MCI and dementia, according to results from the SPRINT MIND trial.2

Obesity: Obesity leads to pre-diabetes and metabolic syndrome, which may be related to neuroinflammation and impaired clearance of amyloid protein from the brain.

Late life factors (age >65 years)

Smoking: Regardless of your age, quitting smoking is good for your health.  With advanced age, smoking increases the risk of cardiovascular disease, which contributes to cases of dementia.

Depression: The risk of developing dementia is related to the number of depressive episodes an individual experiences during their lifetime.  Depressive symptoms that increase later in life could be seen prior to the onset of dementia.  Depression could increase the risk for dementia by affecting stress hormones, neuronal growth factors, and hippocampal volume.

Physical inactivity: Observational studies have found an inverse relationship between exercise and risk of dementia.  Meta-analyses have shown that physical activity had a significant protective effect against cognitive decline, with high levels of exercise being the most protective.

Social isolation: Decreased social contact could increase the risk for dementia as much as hypertension and physical inactivity.  Isolation could also lead to depression and cognitive inactivity.

Diet: People who adhere to a Mediterranean diet (low intake of meat and dairy, high intake of fruit, vegetables, and fish) experience less cognitive decline, perhaps due to reduced vascular events, decreased blood glucose and reduced insulin resistance, all markers of oxidative stress and inflammation.

Diabetes: As with obesity, increased inflammatory markers, blood glucose, and insulin resistance contribute to the increased risk for cognitive decline.

References

  1. Dementia prevention, intervention, and care. Lancet 2017; 390: 2673–734.
  2. Effect of Intensive vs Standard Blood Pressure Control on Probable Dementia, A Randomized Clinical Trial. JAMA. 2019 Feb 12; 321(6): 553–561.  

About the Author:

Mary Ellen Quiceno, MD, Medical Director at Parexel.

Mary Ellen Quiceno, M.D., Medical Director, Parexel

Dr. Quiceno recently joined Parexel as a medical director and is a board-certified Neurologist specializing in Behavioral Neurology & Neuropsychiatry with a focus on the clinical care and research on older adults with memory problems and dementias.  She holds undergraduate and medical degrees from the University of Miami in Miami, Florida.

She began her medical career in Dallas, Texas, first as an Internal Medicine intern and then a resident in Neurology before receiving a fellowship in Behavioral Neurology & Dementia from the University of Texas Southwestern (UTSW) Medical Center. 

Before joining Parexel, Dr. Quiceno served on the faculty for the institutions listed below:

  1.  UTSW in Dallas (2006-2018) where she was Memory Clinic Director, inaugural Behavioral Neurology Fellowship Director, Leader of the Education, Outreach and Recruitment Core of the NIA-funded Alzheimer’s Disease Center (https://www.nia.nih.gov/health/alzheimers-disease-research-centers) and member of the steering committees of the Alzheimer’s Disease Cooperative Study (https://www.adcs.org/) and Alzheimer’s Therapeutic Research Institute (https://keck.usc.edu/atri/). She was a member of ADNI (Alzheimer’s Disease Neuroimaging Initiative, http://adni.loni.usc.edu/), TARCC (Texas Alzheimer’s Research and Care Consortia, http://www.txalzresearch.org/).
     
  2. University of North Texas Health Science Center (UNTHSC) in Ft. Worth, Texas (2018-present).
     
  3. Texas Christian University (TCU)/UNTHSC School of Medicine in Ft. Worth, Texas (2018-2019) where she was Course Director of Neurology and Musculoskeletal Medicine.

Dr. Quiceno also serves on the Texas Council on Alzheimer's Disease and Related Disorders and volunteers with the Alzheimer’s Association in Dallas & Ft. Worth, serving on the board of Dallas & Northeast Texas Chapter as vice chair of the Medical Research Advisory Committee. 


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