Researchers: Improving vision may help prevent dementia

Dementia cases are on the rise with an aging world population, and another much-anticipated Alzheimer’s drug, crenezumab, has proven ineffective in clinical trials – the latest of many disappointments. Public health experts and researchers say it’s time we turn our attention to a different approach – focusing on eliminating dozens of known risk factors, like blood pressure High, hearing loss and untreated smoking, instead of paying too high a price, new drugs whiz-bang.

Dr Gill Livingston, psychiatrist at University College London and chairman of the The Lancet Commission on Dementia Prevention, Intervention and Care. “But they’re not the only way forward.”

Emphasizing modifiable risks – things we know how to change – represents “a dramatic shift in perception,” said Dr. Julio Rojas, a neuroscientist at the University of California, San Diego. Francisco, said. By focusing on behaviors and interventions that are widely available and have solid evidence, “we are changing the way we understand how dementia develops,” he said.

The latest modifiable risk factor identified in Research on visual impairment in the United States was recently published in the journal JAMA Neurology. Using data from Research on health and retirementThe researchers estimate that about 62% of dementia cases today could be prevented through risk factors and 1.8% – about 100,000 cases – could be prevented through marketing. healthy force.

Joshua Ehrlich, an ophthalmologist and population health researcher at the University of Michigan and lead author of the study, said that while it’s a fairly small percentage, it represents a relatively easy solution.

That’s because eye exams, prescription glasses, and cataract surgery are relatively inexpensive and accessible interventions. “Globally, 80 to 90 percent of vision impairment and blindness can be avoided through early detection and treatment, or remains unresolved,” said Dr. Ehrlich.

The influential Lancet Commission began leading the modifiable risk factors movement in 2017. A panel of physicians, epidemiologists and public health experts reviewed and analyzed hundreds of high-quality studies to identify nine risk factors that account for the majority of dementia in the world: high blood pressure, lower education, hearing loss, smoking, obesity, depression emotional, sedentary, diabetic, and low in social contact.

In 2020, the committee added three more: excessive alcohol consumption, traumatic brain injury, and air pollution. The committee calculates that 40% of dementia cases worldwide could theoretically be prevented or delayed if those factors were eliminated.

“It could make a big difference in the number of people with dementia,” said Dr. Livingston. “Even small percentages – because so many people have dementia and it’s so expensive – can make a huge difference to individuals and families as well as to the economy.”

In fact, in rich countries, “it happened as people got more education and smoked less,” she points out. Because dementia rates increase with age, as more and more people age, the number of dementia cases is constantly increasing. But the rate is decreasing in Europe and North America, where Dementia rates have decreased increased 13% per decade over the past 25 years.

Dr Ehrlich hopes the Lancet Commission will add vision impairment to its list of modifiable risks as it updates its report and Dr Livingston says it will indeed be on the agenda. of the committee.

Why do hearing and vision loss contribute to cognitive decline? “A nervous system maintains its function through stimulation from the sensory organs,” says Dr. Rojas, co-author of a new study. editorial in JAMA Neurology. “Without that stimulation, a neuron dies, a brain rearranges,” he said.

Hearing and vision impairment can also affect cognition by limiting older adults’ participation in physical and social activity. “You can’t see the cards, so you stop playing with your friends, or you stop reading,” says Dr. Ehrlich.

The link between dementia and hearing loss, the most important factor that the Lancet Committee considered modifiable risk, was well established. There is less clinical data on the association with vision impairment, but Dr Ehrlich was co-investigator of a study in southern India to see if the provision of eyeglasses to older adults affected affect cognitive decline.

Of course, this approach to reducing dementia is “aspirational”, he admits: “We’re not going to eliminate low education, obesity, all of this.”

Some efforts, such as improving education and treating high blood pressure, should begin at a young age or in middle age. Others demanded major policy changes; For example, it is difficult for an individual to control air pollution. Changing habits and making lifestyle changes — like stopping smoking, cutting down on alcohol, and exercising regularly — aren’t easy.

Even fairly conventional medical practices, like measuring and monitoring high blood pressure and taking medication to control it, can be difficult for low-income patients.

Furthermore, older Americans will likely find that routine vision and hearing care are two services that traditional Medicare does not cover.

It will cover care related to diabetic retinopathy, glaucoma or age-related macular degeneration, and it includes cataract surgery. But for more common problems that can be corrected with eyeglasses, “Traditional Medicare isn’t going to help you much,” said David Lipschutz, associate director of the nonprofit Medicare Advocacy Center. It also won’t cover most hearing aids or tests, which are much higher costs.

Medicare Advantage plans, offered through private insurers, often include some vision and hearing benefits, “but consider coverage,” warns Mr. Lipschutz. “They may apply $200 or $300 or $500 on hearing aids” — but with typically $3,000 to $5,000 a pair, “they can still be out of reach,” he says. .

Expanding traditional Medicare to include hearing, vision, and dental benefits is part of the Biden administration’s Building Better Back Act. But after the House passed it in November, Republicans and Senator Joe Manchin III, a Democrat, contested it in the Senate.

However, despite warnings and cautions, reducing modifiable risk factors for dementia can be of great benefit, and the Centers for Disease Control and Prevention incorporated that method into National plan to tackle Alzheimer’s disease.

Focusing on these factors can also help reassure older Americans and their families. Some of the key risks to dementia are beyond our control – genetics and family history, and age itself is increasing. However, modifiable elements are things we can act on.

“People have fears about developing dementia, your memory loss, your personality and your independence,” says Dr. Livingston. “The idea that you can do a lot about it is very powerful.”

Even delaying its onset can have a big effect. “If, instead of getting at 80, you get at 90, that’s a huge thing,” she said.

Eye and hearing screenings, exercise, weight control, smoking cessation, blood pressure medication, diabetes care – “we’re not talking about expensive interventions or fussy surgery or seeing doctors. therapists hours away,” added Dr. Ehrlich. “These are things people can do in the communities where they live.”

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