Dementia prevention in the 21 st century

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1 Dementia prevention in the 21 st century Stina Saunders, MRes 10 th Scottish Caring & Dementia Congress April 2018

2 Dementia rates In the UK, one person every three minutes develops dementia that is 1 in 6 people over the age of 80 have dementia Around the world, there are currently around 46.8 million people living with dementia, with numbers set to increase to 74.7 million by 2030 and million by 2050 There are over 9.9 million new cases of dementia each year worldwide, implying one new case every 3.2 seconds.

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5 Alzheimer s disease Disease of mid-life with a manifestation in later life Alzheimer s disease is a pathological process and Alzheimer s dementia is the clinical syndrome associated with Alzheimer s disease

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8 Alzheimer s disease pathology and corresponding stages in assessments

9 Alzheimer s disease a balance between life-long exposure to multiple risk and protective factors

10 Dementia risk factors Around 1/3 of Alzheimer's diseases cases worldwide might be modifiable risk factors reducing the prevalence of vascular risk factors (e.g. physical inactivity, smoking, midlife hypertension, midlife obesity, and diabetes) and depression Other risk factors are age, education and carrying the e4 allele of the APOE gene There is at least moderate evidence implicating the following environmental risk factors: air pollution; aluminium; silicon; selenium; pesticides; vitamin D deficiency; and electric and magnetic fields

11 The EPAD study The aim is to identify early changes that happen in the brain when dementia starts developing we want to know what these very early changes are so that we can intervene and stop the disease from progressing into dementia. EPAD is a major 64 million study, takes place all over Europe, led from the University of Edinburgh. One of the biggest dementia studies in the world right now hugely important we are able to recruit lots of volunteers into the study EPAD Coordinators: Serge Van der Geyten Craig Ritchie

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13 WP2 WP1 WP4/8 WP3/8 The EPAD Delivery Cluster WP4/8 WP2/4 WP 5-8: Supporting Work Packages

14 Chatting to the research team on the phone and asking questions about the study 20 min We ask that you come in to the centre for a consent visit together with your study partner This is the only time we ask that you have a study partner present On a separate day, we ask that you come back for your Study Visit 2 for a lumbar puncture 1,5h MRI scan (a little loud but you will see the team on the other side of the glass wall!) 50 min At the consent visit we ask both you and your partner if you agree to take part and to complete a number of questionnaires (1,5 h) Lunch 20 min We ask that you come back on a separate day for your Study visit 1 Throughout Study visit 1, we ask that you provide a saliva sample using a sample tube Cognitive assessments (your memory, attention and other processes) 1,5h At study visit 1, we take biological samples (we have asked that you have no breakfast): blood sample, saliva sample, urine sample 25 min We get you some breakfast! 15 min Seeing the study doctor (we take your medical history, note down any medications you use and perform a medical check such as ECG and blood pressure) 45 min Break 10 min EPAD study involvement: Consent visit is usually about 1,5h (this one is with you partner), Study Visit 1 5h and Study Visit 2 1,5h (these visits are repeated once a year)

15 Create the next generation of dementia researchers and thought leaders by creating and facilitating opportunities for junior researchers career advancement. Fair and efficient procedures for EPAD and non-epad research teams to access EPAD data, samples and research participants with the objective of deepening the understanding of Alzheimer s dementia onset and progression and the factors contributing to underlying processes. Support the EPAD academic output in terms of scientific publications, participation in conferences and development of guidelines and studies, and to maximise their visibility and impact.

16 The PREVENT Dementia study The study aims to identify the earliest signs of dementia which may occur in the brain decades before symptoms appear. Recruiting healthy volunteers in middle age (aged 40 59) to identify biological and psychological factors that may increase their risk of developing dementia in later life. Nation wide study and new volunteers needed!

17 Primary, secondary, and tertiary prevention of Alzheimer s disease and dementia

18 Dementia biomarkers Biological indicators of a process or condition. - cerebrospinal fluid (CSF), blood, urine and saliva - observed through brain imaging Recent Cochrane reviews show that amyloid-β levels had very low specificity but better sensitivity in predicting high risk population s risk of Alzheimer s dementia

19 Biomarker disclosure Uncertainty around validity and reliability of tests Ethical considerations - Why know of risk status?

20 Novel assessments Research moves to an earlier younger population so assessment methods need to adapt Spatial navigation - Four mountains - Supermarket trolley

21 Good Brain Health

22 Lifestyle advice What s good for your heart is good for your brain Don t smoke Seek early treatment for depression; be physically active; social; manage high blood pressure, obesity

23 Dementia prevention future perspective Incorporate accurate testing, disease modelling, and analytical tools to stratify at risk populations. This would allow us to develop interventions tailored to groups or even individuals. The ultimate aim is to prevent outwardly healthy or mildly impaired individuals from developing Alzheimer s dementia.

24 Thank you! Contact details Centre for Dementia Prevention Kennedy Tower Royal Edinburgh Hospital Morningside Park Edinburgh EH10 5HF Telephone

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