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NEUROLOGY
emerging to identify the factors that can contribute to the risk of developing symptoms. It is estimated that a third of dementia cases could be a result of factors within the control of individuals. Lifestyle improvements – such as taking regular exercise and not smoking – could reduce the risk of developing symptoms, which means there is significant potential for prevention. Unfortunately, public awareness and understanding of the risk factors remains poor. According to the findings from the British Social Attitudes survey, commissioned by Public Health England (PHE), more than a quarter (28%) of the British public are unable to correctly identify any potentially modifiable risk factor for developing dementia.5 The survey, carried out by the National Centre for Social Research (NatCen), asked the public if they could identify any of the following risk factors: heavy drinking, smoking, high blood pressure, depression and diabetes as well as the protective factor of taking regular exercise and found just 2% of the public is able to identify all of them. Also, more than 1 in 4 people (27%) in Britain incorrectly believe that there is nothing anyone can do to reduce their risks of getting dementia. Respondents were asked whether they agreed with the statement “there is nothing anyone can do to reduce their risks of getting dementia”. 27% incorrectly agree that there is nothing anyone can do; a further 26% neither agree nor disagree; and only 43% correctly disagreed with the statement. Older people are more likely to agree that there is nothing anyone can do to reduce their risk of developing dementia: 33% of those aged 65 and over said this compared with 26% of those under 65. Dr Charles Alessi, senior dementia advisor at PHE, said: “In the absence of a cure for dementia, prevention is the best means we have to reduce its impact on the public. The findings highlight the importance of PHE’s work on the NHS Health Check dementia pilot and campaigns like One You, which raise awareness of the fact it is never too late to take control of your health and provide adults with personalised tools with which to do it.”
Research findings: risk factors
There is now a large volume of research underway into identifying the risk factors and among the recent findings is evidence highlighting an increase in dementia risk for people who experience orthostatic hypotension – i.e. unusually high drops in blood pressure when standing up suddenly.6
Researchers in the Netherlands and the US conducted a 24-year study, working with over 6,000 people with an average age of 68 who had no history of dementia or stroke. Of this group, 18.6% were classified as experiencing orthostatic hypotension when they were found to experience either a 20mmHg or greater drop in their three minutes of standing from a resting position. In monitoring the participants’ health for an average follow-up period of 15.3 years, the researchers identified a 15% increase in the risk of developing dementia over the next 25 years for those found to have orthostatic hypotension when compared to those without. The study included all diagnoses of dementia including Alzheimer’s disease, vascular dementia and dementia caused by Parkinson’s disease. The authors suggest that repeated instances of reduced blood flow could result in a lack of oxygen that contributes to damage in the brain.6 “This study highlights the important role of the blood supply, not just in contributing to vascular dementia, but potentially playing a role in other forms of dementia too,” commented Dr Laura Phipps, Alzheimer’s Research UK. “While many studies have focused on the risks of high blood pressure, this study suggests that transient low blood pressure could also have a long-term impact on the brain.”
She added that, while the risks found in the study are reasonably small compared to other known risk factors for dementia,
While many studies have focused on the risks of high blood pressure, this study suggests that transient low blood pressure could also have a long-term impact on the brain.
FEBRUARY 2017
it adds to a growing and complex picture of how blood pressure changes throughout life can impact the brain.6
Making changes to lifestyle can make a difference, as the latest evidence suggests. An interventional trial of exercise has shown a small but significant improvement in memory and thinking skills in people with early memory problems due to vascular cognitive impairment. In this randomised controlled trial, 70 people with vascular cognitive impairment were put into two groups, one undertaking a programme of aerobic exercise and the other given education in a healthy diet but no specific information regarding exercise. The exercise programme consisted of three hour-long sessions per week and lasted for six months. The programme was led by an instructor and involved a 10min warm-up, a 40min outdoor walk and a 10min cool down.7 The researchers found that people in the exercise group showed small improvements in blood pressure after six months. Exercise was associated with a small but significant improvement in one measure of memory and thinking at six months but that benefit was no longer apparent six months after the programme ended. The improvement was seen on a measure of memory and thinking ability, although the study did not show benefits on a measure of how well someone can function in their day-to-day life.7 Dr Rosa Sancho, head of research,
Alzheimer’s Research UK, commented: “We know that regular aerobic exercise can help improve cardiovascular health, but it has also been linked with a healthy brain and a reduced risk of developing dementia. This study suggests that an aerobic exercise programme may be beneficial for people who already have early memory problems. While many studies have found a link between physical activity and dementia
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