Cardiff University Healthy Ageing Conference & Public Lecture The importance of a healthy lifestyle A Conference and a Public Lecture Thursday 30th October 2014 http://medicine.cardiff.ac.uk/event/healthy-ageing-conference-public-lecture/

1. Delaying
demen,a
and
cogni,ve
decline.
Tony
Bayer
School
of
Medicine
Cardiff
University

2. Public
a)tudes
to
demen1a
9%
13% 14%
20%
38%
Diabetes Stroke Heart
disease
Alzheimer's
disease
Cancer
7%
15% 14%
31%
27%
Diabetes Stroke Heart
disease
Alzheimer's
disease
Cancer
A3er
cancer,
Alzheimer’s
disease
is
the
condi1on
people
fear
the
most…
…
but
a3er
age
55,
Alzheimer’s
disease
is
the
most
feared
MetaLife Survey 2010

3. A
global
challenge

4. Demen,a
Risk
Factors
Across
the
Life
Cycle

5. Developmental
and
early
life
risk
factors
• Good
infant
health
(larger
skull
size)
• Good
early
life
nutri,on
(longer
leg
length)
• Higher
level
of
educa1on
(and
higher
occupa,onal
aHainment)
??
May
increase
‘cogni/ve
reserve’
Metaanalysis
for
adjusted
effect
of
educa,on
on
risk
of
incident
demen,a
(World
Alzheimer
Report
2014)

6. Psychological
factors
• Early
parental
death
• Mid
and
late
life
depression
• Anxiety
• Psychological
distress
(neuro,cism,
conscien,ousness)
• Sleep
disturbance
(&
benzodiazepine
drugs)
Meta-­‐analysis
for
adjusted
effect
of
depression
on
risk
of
incident
demen,a
(World
Alzheimer
Report
2014)

7. Lifestyle
factors
• Smoking
• Excessive
alcohol
• Lack
of
physical
ac,vity
• Lack
of
cogni1ve
and
social
s1mula1on
• Lack
of
healthy,
balanced
diet
• Significant
head
injury
Meta-­‐analysis
for
adjusted
effect
of
ex-­‐
smokers
versus
never-­‐smokers
on
risk
of
incident
demen,a
(World
Alzheimer
Report
2014)

8. Cardiovascular
risk
factors
• Hypertension
in
mid-­‐life
• Obesity
in
mid-­‐life
• Hyperlipidaemia
in
mid-­‐life
• Diabetes
mellitus
in
late-­‐life
Forest
plot
for
associa,on
of
diabetes
in
late
life
and
incident
demen,a
(World
Alzheimer
Report
2014)

9. Recent
studies
suggest
falling
demen1a
prevalence

10.
Had
men
in
the
Caerphilly
Cohort
each
been
urged
at
baseline
35y
ago
to
adopt
one
addi/onal
healthy
behaviour,
and
if
only
half
had
complied,
there
would
have
been
13%
less
demen+a
Opportunity
missed?

11. Midlife
risk
profile,
20
year
predic1on
Kivipelto
et
al,
Lancet
Neurology
2006
2%

12. Finnish
Geriatric
Interven1on
Study
to
Prevent
Cogni1ve
Disability
2-­‐year
mul,centre
RCT
with
1260
par,cipants
aged
60-­‐77
years
with
Demen,a
Risk
Score
>
6
Randomized
(1:1)
to:
•
mul,domain
interven,on
group
(nutri,onal
guidance,
physical
exercise,
cogni,ve
training
and
social
ac,vi,es
&
management
of
vascular
risk
factors)
or
• control
group
(regular
health
advice)

13. Finnish
Geriatric
Interven1on
Study
to
Prevent
Cogni1ve
Disability
Preliminary
results
at
2
years
show
beneficial
effect
of
interven,on
on:
• Overall
cogni,ve
performance
(NTB)
(p<0.001)
• Memory
(p<0.05)
• Execu,ve
func,on
(p<0.05)
• Psychomotor
speed
(p<0.05)
Effects
more
prominent
in
elderly
(>70)
and
those
with
worse
cogni,on
at
baseline
Drop
out
rate
was
only
11%
and
par,cipants’
experiences
were
very
posi,ve,
despite
musculoskeletal
pain
associated
with
exercise
Kivipelto
AAIC
Presenta,on
July
2014

14. What’s
happening
in
Wales?

15. “If
we
can
all
enter
old
age
with
beBer
developed,
healthier
brains
we
are
likely
to
live
longer,
happier
and
more
independent
lives
with
a
much
reduced
chance
of
developing
demen/a”