Prevention: the best means of tackling dementia
8 March 2021
5 mins to read
Dementia risk could be reduced by 40 per cent, if meaningful action is taken across a range of different measures across the life course.
Professor Clive Ballard, Executive Dean and Pro-Vice Chancellor of the Faculty of Health and Life Sciences, was part of the Lancet Commission collaboration which reached this conclusion based on mathematical modelling of what we know about key risk factors to determine the attributable risk. He said: “Forty per cent is staggering. If we could get the targeting and public messaging right, and deliver cost-effective public health interventions which can change behaviours and improve health, we could make a substantial difference to the number of people developing dementia. We’re now meeting the need for innovative new dementia prevention research, in part through our digital PROTECT programme, which must be prioritised alongside the search for effective therapies.”
Exeter’s work has concluded that a healthy lifestyle can reduce dementia risk, regardless of genetic predisposition to dementia. David Llewellyn, Professor of Clinical Epidemiology and Digital Health, who co-led the research, said: "It’s a really significant finding that indicates that you may be able to substantially reduce your dementia risk by living a healthy lifestyle, even if your genetics might indicate a high dementia risk."
"It’s a really significant finding that indicates that you may be able to substantially reduce your dementia risk by living a healthy lifestyle, even if your genetics might indicate a high dementia risk."
Professor David Llewellyn,
Professor of Clinical Epidemiology and Digital Health
How an online study is helping PROTECT the ageing brain
Exeter’s approach is to use innovative online platforms and digital opportunities to deliver new approaches in a cost-effective way.
The PROTECT study is an online cohort of people aged 50 and over, run in partnership between the University of Exeter and King’s College London. The study has 25,000 participates, with the majority entering their fifth year of follow-up. PROTECT sampling is entirely remote, involving a highly sensitive and well validated neuropsychology test battery which can be self-completed at home and which is free of learning effects, validated health and lifestyle questionnaires and DNA sampling. There is also an extensive programme of nested clinical trials running within the PROTECT cohort, many with more than 5000 participants. The cohort is exceptionally well characterised and the cognitive tests data allows for identification of individuals with pre-clinical cognitive deficits.
Dr Anne Corbett, Senior Lecturer in Dementia Research said: "PROTECT is a really exciting and innovative study that means people can take part in high-quality research and clinical trials from their own homes. We’ve already made significant contributions to understanding how we can meaningfully reduce dementia risk."
"PROTECT is a really exciting and innovative study that means people can take part in high-quality research and clinical trials from their own homes. We’ve already made significant contributions to understanding how we can meaningfully reduce dementia risk."
Dr Anne Corbett
Senior Lecturer in Dementia Research
Key findings generated from PROTECT
To date, PROTECT has generated a range of findings that progress understanding in dementia prevention, including:
- Delivering clinical trials that have identified evidence based brain training programmes to maintain cognitive health and function
- How wearing a hearing aid to address mid life hearing problems is linked to better brain function in later life
- Mild Behavioural Impairment, a concept which combines a number of different mental health elements such as apathy, irritability and mood symptoms, are potentially a very early indicator of higher risk of dementia.
PROTECT has international partnerships in the US, Norway, Spain, Iceland and Canada, with further international expansion planned. This large and expanding cohort, combined with emerging genetic data, will allow the team to specifically target those who are at higher risk of developing dementia.
A ready infrastructure for efficient and robust prevention research
The infrastructure means PROTECT can swiftly implement high-quality nested trials across the cohort. In one example, Professor Zahinoor Ismael, Associate Professor Psychiatry, Neurology and Epidemiology at the University of Calgary, and colleagues, rolled out a checklist to identify behavioural changes in older adults, now completed by more than 12,000 participants. Data shows that mild behavioural changes predict cognitive decline.
Professor Ismael said: “We found that persistent changes in behaviour or personality that emerge in later life can predict cognitive decline. If we can identify the onset of dementia before cognitive symptoms take effect., we have much more chance of effective prevention strategies and treatments.”
"We found that persistent changes in behaviour or personality that emerge in later life can predict cognitive decline. If we can identify the onset of dementia before cognitive symptoms take effect, we have much more chance of effective prevention strategies and treatments."
Professor Zahinoor Ismail
Associate Professor Psychiatry, Neurology and Epidemiology
University of Calgary
One ongoing study is looking at whether taking regular vitamin D supplements can help reduce dementia risk. It builds on research led by Professor David Llewellyn which found that people who were severely vitamin D sufficient are more than twice as likely to develop dementia. Professor Llewellyn said: “PROTECT has enabled us to move very quickly and cost-effectively from the discovery phase of our research to a clinical trial. We’re now excited to be conducting targeted research on the people most likely to benefit.”
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