Expert opinion: can we beat the dementia epidemic?

It's estimated that a third of Britons born this year will develop dementia

WE FIND it “normal” that our thinking slows and we forget trivial things as we age, writes Professor Rudi Westendorp.

“Am I getting dementia?” we ask ourselves.
But if our ability to function in daily life isn’t affected, a doctor would not diagnose dementia on the basis of such complaints.
The definition of dementia is that the functioning of the brain is so impaired that day-to-day life is disrupted.
But most people struggle to remember things, sometimes even youngsters do.
However, memory problems in old age are often associated with a small amount of damage to the brain which shows up on a scan.
But what kinds of damage contribute to memory problems?
Damage that shows up on a scan can result from high blood pressure over a protracted period from atherosclerosis in the carotid arteries, from the remnants of a viral infection, lasting inflammation of the brain tissue, clumped proteins or from other biological processes we are still unaware of.

Not smoking, exercising and not being overweight keep the heart and blood vessels healthy for longer and are good for the brain.



Memory problems in old age are often associated with brain damage that appears on scans

Knowledge of the way this damage is caused can help make it possible to intervene early in disease processes.
The best thing would be to prevent the damage occurring in the first place but that is not likely to be possible in the near future.
What we can do is cut the pace at which damage accumulates.
Not smoking, exercising and not being overweight keep the heart and blood vessels healthy for longer and are good for the brain.
Also, blood pressure should not be too high because this can damage blood vessels in the brain causing a rapid rise in memory problems.
IQ, too, makes a big difference.
Intelligent people can handle more damage before their mental capacity starts to deteriorate and they have problems with day-to-day functioning.

This is called the “cognitive reserve theory”.
One view is that dementia occurs as the result of a gradual increase in various kinds of damage in the brain, caused by different biological mechanisms.
This contrasts with a widely held view among researchers that the cause of dementia is amyloids.
When proteins in the body become crumpled – misfolded or clotted due to damage – they can be deposited in the brain tissue and harm brain cells.
This leads to Alzheimer’s disease.
Some families have a genetic predisposition for producing many such amyloids or for making proteins that are quicker to misfold.
Their genetic make-up means amyloid proteins are deposited more rapidly in their brains than other people’s.




People with high IQs can stave off dementia for longer

Members of such families have a higher than average risk of getting dementia.
Sadly we can’t control the deposition of amyloids in the brain.
This particular disease process occurs in most patients who develop dementia before the age of 70.
However, they make up less than 10 per cent of dementia patients overall.
Unlike those with early-onset dementia, the bulk of patients who develop the condition in old age have a complex disorder with several biological mechanisms at play.

If so many factors combine to cause the problem, how can we go about finding a solution?
Many developed countries have predicted the numbers of dementia patients rising drastically in the coming years.
But those prognoses are based on the assumption that the statistical risk of getting dementia will remain the same.
But that is doubtful.
Dutch researchers have shown that the risk of getting dementia in old age is significantly lower since 2000.

Dementia figures are falling for the oldest in society

Brain scans after that year showed far less damage due to atherosclerosis, which would explain the reduced risk.
The epidemic of cardiovascular disease is declining, beginning with a fall in the number of heart attacks in middle age, followed by a drop in the number of strokes suffered by old people.
Now dementia figures are falling for the oldest in society.
Following a survey, researchers have reported a 30 per cent drop in the risk of getting dementia over the past 20 years.
An end to the epidemic is in sight.

? To order Rudi Westendorp’s book Growing Older Without Feeling Old, published by Scribe (£14.99) call The Express Bookshop on 01872 562310, send a cheque/PO payable to Express Bookshop to Express Bookshop, PO Box 200, Falmouth TR11 4WJ or visit expressbookshop.co.uk. UK delivery is free.