Potentially Modifiable Risk Factors in the Development of Alzheimer’s Disease
Potentially Modifiable Risk Factors in the Development of Alzheimer’s Disease
European Neurological Review, 2009;4(1):18-21
US Neurology Volume, 2010;5(2):17-20
Abstract
This article summarises empirical findings on major potentially modifiable risk factors in the development of Alzheimer’s disease (AD), drawing on data from longitudinal epidemiological studies on the incidence of AD or any-cause dementia. Risk factors investigated to date include cognitive ability, motivational ability, emotional health, physical activity, social activity and social network, vascular risk factors and nutrition. The authors find most empirical support for two main clusters of risk factors that also represent potential targets for prevention. First, an active and stimulating lifestyle including cognitive, social, and physical activities reduces the risk of AD. Second, the absence of vascular risk factors such as diabetes, hypertension, hypercholesterol and obesity reduces the risk of AD. More prevention trials are warranted to investigate the preventative effects of an active and stimulating lifestyle on the one hand, and vascular health on the other, in delaying the onset of AD or slowing its progression.
Keywords Alzheimer’s disease, risk factors, motivational reserve, cognitive reserve, social network, vascular risk factors, nutrition, prevention
Disclosure: The authors have no conflicts of interest to declare.
Received: 16 January 2009 Accepted: 26 August 2009
Correspondence: Simon Forstmeier, Department of Psychology, Division of Psychopathology and Clinical Intervention, University of Zurich, Binzmuehlestr. 14/17, 8050 Zurich, Switzerland. E: s.forstmeier@psychologie.uzh.ch
As the number of people over 65 years of age continues to rise worldwide, preserving the cognitive health of older adults has become a major societal challenge. The global prevalence of Alzheimer’s disease (AD) was estimated at 26.55 million in 2006 and is expected to quadruple over the next 40 years.1 However, research on successful ageing challenges the popular notion that ageing invariably involves a decline in cognitive functioning and quality of life, and has identified factors that can increase individuals’ ‘health span’ as they enter later life.2 If onset or progression of AD could be delayed by only one year, there would be 9.2 million fewer cases of the disease in 2050.1 The goal of current research on AD and other dementias is thus to identify both biological and psychological factors that may help people to maintain or enhance their cognitive health in older age and to prevent or postpone the development of dementia.
The most well-established risk factors f or AD and other dementias are old age, genetic susceptibility, familial aggregation and female sex. However, modifiable risk factors are more important for the development of prevention strategies. In this article, we summarise empirical findings on the major modifiable risk factors of AD. We base our overview and conclusions on several recent review papers as well as on a systematic review of our own, which aimed to include all published studies providing an estimate of the incidence of AD or dementia (‘relative risk’) associated with the risk factor examined (see Table 1). We included only longitudinal studies whose results were adjusted at least for age, sex, and education. Due to space restrictions, we cite only example studies and summarise the findings of our review in Table 1. The interested reader is referred to the reviewpapers presented in Table 1 and to more general overview articles.3–6 Note that in epidemiological studies, AD is usually diagnosed on the basis of clinical features rath er than neuropathological evidence.
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Alzheimer’s disease, risk factors, motivational reserve, cognitive reserve, social network, vascular risk factors, nutrition, prevention, diagnosis alzheimer's disease, treatment alzheimer's disease,
