Alzheimer’s Disease and Dementia. How to decrease personal risk? 7
Is there anything people can do to decrease the risk of getting Alzheimer’s disease? Dr. Anton Titov, MD. How to prevent Alzheimer’s disease? Maybe it is different for a certain subset of people. What can be done to prevent dementia? Professor Dr. Mark Pepys, MD. Well, I’m not a dementia specialist. I’m not necessarily the correct person to answer that. But, obviously I know about this field somewhat. We should probably in this context talk about dementia rather than Alzheimer’s disease. Alzheimer’s disease is a particular form of dementia. It is a specific disease with specific diagnostic criteria. Dementia is a broader problem. A very important cause of dementia is vascular problems. Dr. Anton Titov, MD. Dementia is related to atherosclerosis, vascular disease. It is the same thing that gives you heart attacks, brain strokes, and so on. There are many other causes of dementia too. There are blows to the head, for example. What can you do to mitigate risks of dementia? Professor Dr. Mark Pepys, MD. All the obvious advice around reducing risks of vascular disease and cardiovascular disease. This is critically important. All old people who are diagnosed with Alzheimer’s disease have inevitably got some atherosclerosis. This probably makes a more or less significant contribution to their dementia. Anything to mitigate atherosclerosis is obviously important. To prevent dementia it’s important to not smoke. It’s crucial not to have diabetes. Do not be overweight. Take physical exercise. Eat a balanced diet, and so on. All those things are healthy and sensible. Professor Dr. Mark Pepys, MD. Mitigation of cardiovascular risk will definitely make a significant contribution to reduction of dementia. Mitigation of vascular disease will definitely make a significant contribution to reduction of Alzheimer’s disease. Mitigation of atherosclerosis in the brain arteries as you get older will definitely make a significant contribution to reduction of dementia. Dr. Anton Titov, MD. Those are the things to do. There is a lot of interest in why do some people become more demented than others. There is a lot of interest in this fact that. If you keep your brain active, maybe that protects you from Alzheimer’s disease. Professor Dr. Mark Pepys, MD. My personal view about that is this. You may start off with a higher intelligence. Then you may lose a proportion of intellect. You’ve still got a higher cognitive function than if you started at a lower intelligence level and lower educational level. Then you lose 25% of it. Then you may be severely compromised. I’m not aware that there is compelling evidence that you can do brain exercise and keep your brain active. Your intellectual function might not be better than if you are not doing brain exercises. On the other hand, it is true that it is better to be more interested and alert, and perceptive. perceptive. Dr. Anton Titov, MD. That is better and one can train one’s brain to be better. One learns things all the time. You keep learning things. There are all sorts of tricks to keep one’s cognition better. Professor Dr. Mark Pepys, MD. But I’m just not convinced that there is going to be a route to protecting cognitive function by doing brain exercises. A large proportion of that evidence is observational. Smarter more educated people don’t get so much dementia. It is because they started at a higher level of intelligence. Sometimes you don’t smoke and you don’t have type 2 diabetes, and you control blood pressure. Professor Dr. Mark Pepys, MD. I wanted to mention that before. It is very very important to keep low blood pressure. All these things contribute very substantially to vascular disease. We know for a fact and irrevocably this. We must control control those blood pressure to prevent dementia. It is crucial to control levels of cholesterol. Dr. Anton Titov, MD. Statins are very very important. I know that statins is an extremely controversial area. Professor Dr. Mark Pepys, MD. I am a very powerful believer in the amazingly strong scientific evidence from placebo-controlled double-blind epidemiological clinical trials. Statins are good for you. Statins have side effects in a tiny minority of people. But statins are amazingly good medications to prevent vascular disease. So that is a crucial factor in reducing risks of vascular dementia. All factors that are protective against vascular disease and atherosclerosis are definitely good for preserving cognition as well. Professor Dr. Mark Pepys, MD. As for Alzheimer’s disease, we need to understand it itself. We have to understand more about what is Alzheimer’s disease. There’s now a flurry of interest in Alzheimer’s disease. Dr. Anton Titov, MD. Is there an infectious causes of Alzheimer’s disease? People have had ideas about all sorts of other causes of Alzheimer’s disease. Many of ideas are crazy. They are not substantiated. Some ideas remains to be seen as useful. We must understand more about the actual causes of Alzheimer’s disease. Professor Dr. Mark Pepys, MD. We have to understand more about the actual pathogenesis of Alzheimer’s disease. Then we will be able to devise treatments for Alzheimer’s disease. We will find prophylactic interventions too. The really compelling evidence for statins is exclusively related to lowering LDL cholesterol. There is a linear relationship between LDL cholesterol concentration in the plasma and cardiovascular risk. It is a linear relationship. It doesn’t matter where you are on a cholesterol level curve. If you lower the LDL cholesterol by 1 millimole per liter, you lower cardiovascular risk by X percent. That happens whether you are up here or down there on this straight line relationship. Professor Dr. Mark Pepys, MD. That is unequivocally true. Statins lower the LDL cholesterol. There is been a lot of controversy, a lot of discussion about other medications. This including C-reactive protein. This is another molecule I have worked on for more than 40 years. Dr. Anton Titov, MD. Statins and CRP link is all nonsense. It is not reproducible, not substantiable, and so on. The effect of statins is do with lowering LDL cholesterol. This is what really compelling evidence shows. Whether statins have other effects, I am sure they do have other effects. Professor Dr. Mark Pepys, MD. But whether those effects of statins are clinically significant, and therefore worth testing and using, I don’t know.
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