Exciting Glimmer of Hope in Fight Against
Alzheimer’s in U.S. but World Epidemic Grows
New data on fewer new cases in U.S. and other
developed nations suggests possibility of prevention and risk reduction;
reports from Alzheimer’s Association International Conference
Claudia L. Satizabal,
Ph.D., of the Boston University School of Medicine discusses new
data from the Framingham Heart Study showing decline in
new cases of dementia over four successive time periods. During
the same time periods, the researchers saw improvements in
education and better overall management of heart health risk. -
here to see video of her report
July 15, 2014 – Older Americans have become
accustomed to assuming that Alzheimer’s disease in becoming more common
among senior citizens and is destined to increase rapidly due to the
increased incidence rate and the explosion in longevity. New reports
today at the Alzheimer’s Association International Conference 2014
suggest the possibility of reducing risk and maybe even preventing the
disease most feared by most seniors. Some of the best news was found in
studies from the United States.
This was the message of hope that emerged in
several research studies: while the global epidemic of Alzheimer’s
continues to grow, there is new data on lower incidence in the “youngest
old” from developed countries in Europe and the U.S.
Scientists at the 2014 meeting in Copenhagen
suggest higher education levels and more aggressive treatment of
cardiovascular disease may be the key.
Certainly some of the most encouraging news –
especially for U.S. seniors – came from a very old and well known study
– the Framingham Heart Study.
New Cases of Dementia Decline Over Three Decades
in the Framingham Heart Study
At AAIC 2014, Claudia L. Satizabal, Ph.D. of Boston
University School of Medicine and colleagues reported on the results of
a study of dementia trends among participants in the Framingham Heart
Study, an ongoing, long-term (since 1948), multi-generational
cardiovascular health study of residents of Framingham, Massachusetts,
to which dementia tracking has been added since 1975.
Framingham Study participants undergo comprehensive
assessments for cardiovascular risk factors every two to four years, and
remain under intensive surveillance for dementia and stroke. Study
researchers defined four non-overlapping five-year time windows (epochs)
across the past three decades, each beginning with a baseline
examination, and studied new cases of dementia among all dementia-free
participants age 60 and older.
After adjusting for age at entry and gender, the
researchers found that compared with the first epoch, the second epoch
had a 22 percent reduction in new cases of dementia, the third had a 38
percent reduction, and the fourth had a 44 percent reduction. The
reduction was strongest in participants between age 60 and 69.
For clarity following are the definitions of
prevalence and incidence:
Prevalence – the number or proportion of
cases of a disease in a population. (i.e., How many people have
Alzheimer’s disease in the U.S. right now?)
Incidence – the number of new cases of a
disease in a population over a given time. (i.e., How many new cases of
Alzheimer’s are there this year in Denmark?)
The researchers found the decrease in dementia
incidence was greatest in women across all epochs, while men showed a
more gradual decrease over time. The decreasing trend in dementia
incidence was true for individuals with a higher educational level,
defined as having a high school diploma, whereas individuals without a
high school diploma did not appear to benefit from this reduction.
During that 30-year time period, the researchers
observed among the participants a substantial improvement in educational
achievement, better management of blood pressure, higher levels of HDL
cholesterol, and a considerable decline in smoking, heart disease and
stroke across the same epochs. However, an increasing trend in obesity
and diabetes was seen in this population.
“These reductions in age-specific rates of new
cases of dementia in the Framingham Study participants might be partly
explained by the beneficial trends we observed in educational attainment
and heart health risk factors,” said Satizabal.
“This leads us to cautious optimism that some cases
of dementia may be preventable. However, one of the limitations of this
work is that the Framingham sample is largely of European descent.
Additional studies are needed in populations of different racial and
More Video Reports
M.D., Ph.D., of the University of Michigan, reports that the
global Alzheimer's epidemic is growing, but new data hints that
rising levels of education and more aggressive treatment of
heart health risk factors may be reducing new cases of
Alzheimer's and dementia in certain regions and the world. Still
to be determined is the impact of rising obesity and diabetes.
Ph.D., vice president of medical and scientific relations for
the Alzheimer's Association, talks about the global number of
cases of Alzheimer's disease and dementia, and the implications
of new data from a handful of countries.
Review of Recent Data Suggests Fewer New Cases
of Alzheimer’s in the United States and Europe
Worldwide prevalence of Alzheimer’s disease is
projected to increase in the decades ahead as the planet’s population
ages, but recently published studies from the United States, the
Netherlands, Sweden, and England suggest a decline in incidence or
prevalence of dementia (or both) in those countries, according to a
review of recent research conducted by Kenneth Langa, M.D., Ph.D., of
the University of Michigan and the VA Ann Arbor Center for Clinical
Management Research, and reported at a plenary session at AAIC 2014.
Langa observed from the studies that a number of
factors, especially rising levels of education and more aggressive
treatment of cardiovascular risk factors such as hypertension and high
cholesterol, may be leading to improved brain health and consequent
decline of numbers of new cases of Alzheimer’s disease and dementia in
certain countries or regions of the world.
“Whether this trend will continue in the face of
rising levels of obesity and diabetes, and whether it is also true in
low- and middle-income countries, are key unanswered questions,” said
“The answers will have enormous implications for
the extent of the future worldwide impact of Alzheimer’s disease and
dementia in the decades ahead.”
Alzheimer’s May Be Underreported in Developing
Countries, regions of Asia and Africa
Pointing in the other direction, researchers
reported at AAIC 2014 that incidence and prevalence of Alzheimer’s in
developing countries such as Colombia, and large regions of Asia and
Africa, may be severely underreported. They also raise questions about
the effects of the growing incidence of obesity and diabetes in
developed countries, both of which are associated with increased risk of
cognitive decline and dementia.
“The good news is that recent trends in developed
countries in Europe and the U.S. suggest that reduction and possibly
even prevention of Alzheimer’s disease might be possible – but, at the
same time, we must acknowledge the growing worldwide epidemic,” said
Maria Carrillo, Ph.D., Alzheimer’s Association vice president of Medical
and Scientific Relations. “We must continue efforts to halt this
terrible scourge that devastates families and economies.”
“According to new data reported at AAIC 2014,
Alzheimer’s and dementia incidence and prevalence in developing
countries may be much higher than previously thought, and rising rates
of obesity and diabetes pose an unknown but potentially serious threat
to cognitive health throughout the world. Many questions remain, and the
only way we can get the answers is through more research,” Carrillo
There are hints in the literature that engaging in
more challenging mental activities, such as higher levels of education
or intellectually demanding occupations, may increase cognitive reserve
and thereby reduce the risk of developing Alzheimer’s or another
With the support of the Alzheimer’s Association and
the Alzheimer’s community, the United States created its first National
Plan to Address Alzheimer’s Disease in 2012. The plan includes the
critical goal, which was adopted by the G8 at the Dementia Summit in
2013, of preventing and effectively treating Alzheimer’s by 2025. It is
only through strong implementation and adequate funding of the plan,
including an additional $200 million in fiscal year 2015 for Alzheimer's
research, that we’ll meet that goal. For more information and to get
Extent of Dementia in Asia and Sub-Saharan
Africa May Be Severely Underestimated
In 2009, Alzheimer’s Disease International (ADI)
published data on global prevalence of dementia based on a review of 154
worldwide studies and United Nations (U.N.) population projections. ADI
carried out an update on that data for the December 2013 G8 Dementia
Summit in London, focusing primarily on new evidence from Asia and
Sub-Saharan Africa, and presented the results at AAIC 2014.
Based on a meta-analysis of Chinese and Sub-Saharan
African studies combined with the latest U.N. population projections,
ADI concluded that the 2009 estimates of worldwide Alzheimer’s disease
were too low. ADI now estimates that 44.35 million people in the world
were living with dementia in 2013, significantly up from the earlier
estimate of 36 million people living with dementia in 2010. They project
that the number will rise to 75.62 million in 2030 — 15 percent higher
than the 2009 estimate — and 135.46 million in 2050, which is 17 percent
higher than the 2009 ADI estimate.
Specifically in the two focus regions, the
researchers found that dementia prevalence increased for East Asia from
about 5 percent to about 7 percent, and in Sub-Saharan African regions
from a range of roughly 2 to 4 percent to 4.76 percent.
“Dementia, including Alzheimer’s disease, is one of
the biggest global health challenges facing our generation,” said Marc
Wortmann, executive director, Alzheimer’s Disease International. “As
more and better data becomes available, the effect we’ve seen is a
reduction in the variation of prevalence between world regions.”
“In addition, newly available data suggests that
the current burden and future impact of the global dementia epidemic has
been underestimated, particularly for the Asia and Sub-Saharan Africa.
Especially in light of these revised estimates, there is an urgent need
to develop policies to face this disease in all countries of the world,
and to enhance our efforts in finding a cure or treatment that can delay
the onset of dementia,” Wortmann added.
In Colombia, Dementia and Alzheimer’s Disease
Might Be Underestimated by Up to 50 Percent
To date, Colombia has had only one study, known as
EPINEURO, which attempted to estimate the country’s dementia prevalence
from representative samples of the population 20 years ago. Using
updated population estimates and prevalence estimates published in the
international literature, Yuri Takeuchi, M.D. of Universidad Icesi
(Colombia) and colleagues estimated the number of people with dementia,
and especially Alzheimer’s disease, in Colombia by stage of the disease.
The results were reported at AAIC 2014.
The researchers created three models for
Alzheimer’s prevalence in the country, each using different projections
for the proportion of people with mild, moderate, and severe disease,
and different theoretical assumptions on the transitions between stages.
They found that the number of people with Alzheimer’s in Colombia could
be as many as 220,000 in 2015, and 260,000 in 2020. The scientists
calculate that current estimates for Alzheimer’s disease and other
dementias in Colombia might be too low by as much as 50 percent. (The
prevalence estimate of dementia for Colombia in people over 65 used in
the study was 6 percent, according to Takeuchi.)
“To our knowledge, this is the first attempt to
model and estimate dementia prevalence by stage of disease in the
developing world; it is certainly the first attempt in Colombia,” said
Takeuchi. “The fastest growth in aging is happening in developing
countries such as Colombia. This has profound implications not only for
older people themselves, but for their households, social and community
infrastructure, and social policy. These estimations by stage of disease
are key information for policymakers because both the social burden and
social costs are substantially different depending on the stage of
Dementia in Germany Declined between 2007 and
Gabriele Doblhammer, Ph.D. of the German Center for
Neurodegenerative Diseases (DZNE) and colleagues conducted a study
exploring short-term dementia trends in Germany, and reported the
results at AAIC 2014.
The research is based on claims data from the
largest public health insurance company in Germany which covers about
one-third of the total population aged 50+ and more than half of the
oldest-old. The data include complete records of the inpatient and
outpatient services, including dementia diagnosis. The complete insured
population of roughly 5 million people at risk of dementia and about
600,000 dementia cases was used to study the prevalence; a 2.5 percent
sample was the basis for the incidence study.
The researchers found that between 2007 and 2009,
the total number of people with dementia decreased significantly among
German women age 74 to 85. Dementia prevalence in 2009 was 3.6 percent
lower than in 2007 and 1.8 percent lower than in 2008. Over that period,
new cases of dementia decreased significantly for both men and women.
According to the researchers, over the last decade
there was reduction in new cases of cerebrovascular disease in Germany
and a “better treatment of vascular risk factors such as high blood
pressure, hypercholesterolemia, and diabetes mellitus.” Among the
elderly, increasing levels of education and wealth also were observed.
“This was the first study to explore dementia
trends in Germany,” said Doblhammer. “The ageing of the baby boomers and
the increasing life expectancy will lead to more dementia cases in old
age. It is necessary to explore the modifiable risk factors of dementia
in order to prevent the occurrence of the disease. In addition, more
research is needed whether the increasing obesity epidemic and related
diseases, such as the metabolic syndrome, may counterbalance the
positive trends we are observing today.”
The Alzheimer’s Association International
Conference (AAIC) is the world’s largest gathering of leading
researchers from around the world focused on Alzheimer’s and other
dementias. As a part of the Alzheimer’s Association’s research program,
AAIC serves as a catalyst for generating new knowledge about dementia
and fostering a vital, collegial research community. Scientists leading
the advancement of research gather to report and discuss the most
current data on the cause, diagnosis, treatment and prevention of
Alzheimer’s disease and related disorders.
About the Alzheimer’s Association
The Alzheimer’s Association is the world’s leading
voluntary health organization in Alzheimer care, support and research.
Our mission is to eliminate Alzheimer’s disease through the advancement
of research; to provide and enhance care and support for all affected;
and to reduce the risk of dementia through the promotion of brain
health. Our vision is a world without Alzheimer’s.
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