There is increasing recognition that a mixture of genetic, lifestyle and health factors are likely to contribute to whether someone develops dementia at a particular age. The growing evidence base has linked a number of risk factors to dementia, including smoking, lack of exercise, low education, high blood pressure, and diabetes, with some studies now suggesting that up to 30% of Alzheimer’s cases may be preventable. However, there are still gaps in our understanding of dementia risk, with a lack of robust evidence to explain how these risk factors may contribute to the development of Alzheimer’s and other dementias.
There is an urgent need for more detailed and robust research in this area, however funding for prevention research studies is low compared to other research areas in the field, with risk reduction research accounting for an estimated 5% of UK dementia studies, and just 2% of dementia research globally.
This week ARUK published an academic paper in the Journal of Public Health on the challenges and opportunities to improving the evidence base around dementia risk reduction. The paper captures discussions and insights from a discussion-led workshop we hosted with leading researchers, clinicians, research funders and policymakers.
Through these discussions, several key barriers were identified, such as the challenge of the very long timescales involved. We are beginning to understand that what happens in mid-life, or even earlier, may well affect brain health, years before any clinical symptoms appear. Studying these relationships is very difficult within the usual timescale of 3-5 year research grants.
Because there are lots gaps in our knowledge of how diseases such as Alzheimer’s develop, it can be difficult to then understand why a particular risk factor may increase the risk of developing dementia. Much of the data has come from observational studies where large numbers of individuals are followed over time to reveal associations between particular risk factors and dementia risk. The difficulty comes when trying to confirm whether the factor has a direct, ‘causal’ effect on dementia risk. It is likely that many of the risk factors are inter-related, which makes it difficult to separate out their individual contribution to developing dementia.
Much of the dementia risk research has developed without much join -up with other researchers in the field. This means that different approaches and methods of research have developed. While this in itself is not a bad thing, it does hamper being able to pool or compare results of different studies, which can provide unique insights.
But the group have identified a number of potential solutions for overcoming these challenges, that go beyond simply investing more money into the area. In particular, there should be agreed international standards for study design, and there is much that can be learnt from other fields with more established risk reduction research, such as cardiovascular disease.
What are ARUK doing? Currently we are funding a project called Insight 46, which is building on a Medical Research Council funded project, that has regularly tracked over 5000 people since their birth in 1946. The latest stage of research involves detailed brain scans of 500 participants, which should reveal important insights into dementia. By having information about the whole of their life, together with brain scans may help us to better understand what factors in earlier life contribute to the development of dementia.
The recommendations from the workshop are being used to help inform Alzheimer’s Research UK’s own strategy around risk reduction and prevention, with further announcements on plans due later in the year.
If you want to know more about how to reduce your risk of developing dementia, we have a leaflet available that explains all the key risk factors.