World Alzheimer's Day 2024: Can we delay or prevent dementia in our society?
Under the aegis of Alzheimer’s Disease International (ADI), people coming together from all around the world celebrate the month of September as World Alzheimer’s Month and commemorates World Alzheimer's Day every year on September 21st. This campaign advocates for an International awareness-raising effort for Alzheimer’s disease (AD) and other dementias.
The theme for World Alzheimer’s Day 2024 is “Know Dementia, Know Alzheimer’s.” Considering the ‘human longevity revolution’ and the ‘human ageing time bomb’; the dementia crisis has been designated as the “the epidemic of our century”. It is estimated that more than 57 million people have dementia worldwide. More than two-thirds of them were in low-and middle income countries (LMICs). In India, data From the Longitudinal Aging Study in India (LASI) estimated that 8.8 million Indians older than 60 years live with dementia. The two most common causes of dementia are Alzheimer´s disease (AD) and vascular dementia. AD accounts for 50-70% of all cases of dementia, about 20-30% have either vascular dementia (VaD) or a combination of VaD and AD, the other dementia syndromes being Frontotemporal dementia (FTD and Dementia with Lewy Body (DLB).
Although ageing is one of the main risk factor for dementia, Dementia is not inevitable with ageing and is best depicted as a disorder on the “continuum of aging casualty”. We need to re- think dementia to be a "lifestyle disorder." Research has shown that AD develops in the life-course of 20-30 years on the background of ageing intricately and inexorably interacting with lifestyle risk factors (LSRFs), behavioural risk factors (BRFs), and Vascular Risk Factors (VRFs) along with other metabolic risk factors resulting in dementia.
The dementia process and brain pathology associated with dementia inexorably creeps in from early-life (20-40 years age group) to mid-life (40-59 years age group). AD is therefore a slow neurodegenerative neuropathological process resulting from cumulative brain pathology over a decades-long process, and is not an event that occurred de novo as a in late-life disorder. By the time AD manifest as symptomatic dementia, the brain neurodegeneration can no longer be prevented. Current treatment into AD is ‘too late’ and offers symptomatic treatment only.
Being a neurologist trained in Memory/Cognitive Disorders and Dementia, I am not being a therapeutic nihilist when much research is underway for novel anti-dementia, anti-amyloid and other drug targets are in the pipeline. However, I wish to reiterate that until such effective, curative or disease modifying drugs are available, both in the developed and developing countries easily/cheaply, preventive neurology strategies will remain the Holy Grail in addressing the dementia epidemic. I fervently believe that Epidemics can only be eradicated by prevention, not by therapy!
Optimism for a life-course perspective to dementia prevention stems from evidence in a recent study published in 2020 as the Lancet Commission Report on dementia prevention. Similar to the much practiced Preventive cardiology and the evidence from the Framingham Risk Score (FRS) that estimates a patient's 10-year risk of cardiovascular disease (CVD); there is now research evidence to similar riskometer tools in dementia. This includes Mid-Life Dementia Risk Score and Late-Life Dementia Risk Index, which can accurately predict the likelihood of older adults developing dementia in the future life-course. This novel approach for the prediction of dementia risk could help to identify individuals who might benefit from intensive brain healthy lifestyle interventions that could stave off dementia in the future.
The evidence from the 2020 Lancet Commission report lends credence that about 40% of dementia cases worldwide could theoretically be prevented or delayed by eliminating 14 modifiable risk factors during an individual's life course. Hence, it’s never too early or too late to act, to make such risk factor strategies at any stage during early or mid-life course. The 14 risk factors cited in the 2020 Lancet Commission report are low education, hearing loss, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury (TBI), air pollution, social isolation, vision impairment, and high LDL cholesterol.
A life-span approach with a life-course approach focussing on Brain healthy Lifestyles, the promotion of Brain health and well-being, and healthy brain ageing (HBA) strategies would exert brain protection by preserving the brain’s cognitive reserve, brain neuroplasticity, brain resilience, and pave the route to a Dementia free life expectancy (DemFLE) operant on ‘The Scaffolding Theory of Aging and Cognition’ (STAC) conceptual model. The brain healthy lifestyles would mandate staying physically fit, adopting an active socially integrated lifestyle, (leisure activities, walking, bicycling, gardening ,playing musical instruments, social networking, visiting friends and relatives, going to movies, Hobbies) staying mentally and cognitively active( brain gym activities such as learning, reading, playing games, sudokos, puzzle games, meditation, yoga), being spiritually active, finding a ‘purpose in life’ (PIL or ‘Ikigai’) ensuring eudaimonic well-being (EWB), eating smart adhering to brain healthy diet (the Asian-Mediterranean diet, diets high in fish, fruit, and vegetables fruits), sleeping well, quitting tobacco and alcohol, and coping stress, depression and anxiety, and by promoting mental resilience for subjective psychological well-being.
In fact, the World Brain Day on July 22nd this year the German Society of Neurology and the German Brain Foundation lend some evidence that too much sugar can harm the brain and impact AD. We should also be ‘Heart Smart’ to be ‘Brain Smart’ by controlling high blood pressure, treating diabetes mellitus, and preventing obesity to maintain a healthy BMI. My advocacy underscores that by improving lifestyle choices apart from controlling the modifiable risk factors would indeed be a public health roadmap for preventing and staving off the risk for future dementia in the next generation, a promise for tomorrow’s generation for DemFLE
This article would not have a 360° perspective by not addressing a sustainable dementia education for our children, grandchildren and for the next generation. Dementia education in children, school professionals, teenagers, adults, and the elderly in our society is quintessential to ‘know dementia, know Alzheimer’s’ as a lifestyle disorder. Our communities and society should be made aware of the “cradle-to- grave’ life-course perspective in preserving brain health, and adopting proactive brain healthy lifestyles as a public health initiative to dementia prevention in India.
“When meditating over a disease, I never think of finding a remedy for it, but instead a means of preventing it”- Louis Pasteur; 1884
Prof Dr.B.P.Shelley, MBBS, MD, DM, FRCP
Fellowship in Behavioural Neurology, Institute of Neurology, London, UK
Fellowship in Cognitive Neurology, Addenbrooke’s Cambridge University Hospitals, UK
Professor and Head - Department of Neurology
Yenepoya Medical College
Yenepoya (Deemed to be University), Mangaluru, Karnataka
Let the Truth be known. If you read VB and like VB, please be a VB Supporter and Help us deliver the Truth to one and all.
Allu Arjun didn't leave theatre despite being told about woman's death: Hyderabad police
Hyderabad, Dec 22: Top Telugu actor Allu Arjun did not leave the theatre during the screening of 'Pushpa-2' on December 4 despite being told to do so in view of a stampede in which a woman died, police officials claimed on on Sunday.
Speaking at a press conference on the annual round-up of 2024, city police commissioner C V Anand showed a video, made by police, on the situation that prevailed when the stampede occurred.
The video was made by collating footage, including from news channels and cell phone clips. It suggests the actor remained in the theatre till the midnight.
Anand did not make any comment on the video, but said the media can draw its own conclusions.
A police official talked about the sequence of events on the fateful night of December 4.
He said that he and other police officials informed a manager of Allu Arjun about the death of the woman and told him that the situation was out of control. He indicated that they were not allowed to meet the actor.
Allu Arjun's staff members told them that they would convey the matter to the actor but did not do so, he said.
The official said he later managed to reach the actor, told him about the woman's death and asked him to leave the theatre so that the fans don't harm each other while trying to catch a glimpse of him.
The official also told the actor that security arrangements would be made for his exit.
However, the actor said he would go only after watching the film, the police official said.
Later, accompanied by a senior officer, the official went inside and brought the actor out, he said.
Amid allegations that bouncers hired by Allu Arjun pushed crowds as well as policemen when the stampede occurred at the cinema hall, the police commissioner warned that stringent action as per law would be taken if THE bouncers indeed misbehaved with the police on duty.
The VIPs would be made responsible for the behaviour of the bouncers hired by them, he said.
Asked if the police would appeal against the interim bail granted to Allu Arjun, the commissioner refused to give a direct response, just saying it is part of the investigation.
What course of action is taken would be known in the days to come, he said.
He also declined to comment when asked if the family of the deceased told him about Allu Arjun's team or film production team allegedly threatening them not to speak on the issue.
Meanwhile, state Cinematography Minister Komatireddy Venkat Reddy found fault with Allu Arjun responding on Saturday to the debate in the Legislative Assembly.
The minister, who observed that the actor should have respect for the government and the chief minister, demanded an apology from Allu Arjun to the government and the CM.
"This government is never vindictive. As Cinematography Minister, we allowed benefit shows and hiking ticket prices to promote the film industry," he said.
However, Union Minister of State for Home Bandi Sanjay Kumar found fault with CM Revanth Reddy for his comments on Allu Arjun in the Assembly on Saturday.
The comments of the CM sounded like character assassination of Allu Arjun and hurting the Telugu film industry, he alleged in a statement.
Later in the day, Sanjay Kumar visited a boy who is undergoing treatment in a hospital after being injured in the stampede.
"Consoled his father over the heartbreaking loss of his wife, Revathi. I pray to god that Sritej recovers at the earliest. Assured support to the family in this difficult time," Kumar said on X.
Earlier in the day, state DGP Jitender told reporters in Karimnagar district that film personalities and all others should understand that safety and security of citizens is utmost important, and also conduct themselves accordingly.
