The Politics of Dementia

Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050

Via The Lancet Public Health: Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019. The summary and then another link and a comment: 

Background  

Given the projected trends in population ageing and population growth, the number of people with dementia is expected to increase. In addition, strong evidence has emerged supporting the importance of potentially modifiable risk factors for dementia. Characterising the distribution and magnitude of anticipated growth is crucial for public health planning and resource prioritisation. This study aimed to improve on previous forecasts of dementia prevalence by producing country-level estimates and incorporating information on selected risk factors.  

Methods  

We forecasted the prevalence of dementia attributable to the three dementia risk factors included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 (high body-mass index, high fasting plasma glucose, and smoking) from 2019 to 2050, using relative risks and forecasted risk factor prevalence to predict GBD risk-attributable prevalence in 2050 globally and by world region and country. Using linear regression models with education included as an additional predictor, we then forecasted the prevalence of dementia not attributable to GBD risks. To assess the relative contribution of future trends in GBD risk factors, education, population growth, and population ageing, we did a decomposition analysis.  

Findings  

We estimated that the number of people with dementia would increase from 57·4 (95% uncertainty interval 50·4–65·1) million cases globally in 2019 to 152·8 (130·8–175·9) million cases in 2050. Despite large increases in the projected number of people living with dementia, age-standardised both-sex prevalence remained stable between 2019 and 2050 (global percentage change of 0·1% [–7·5 to 10·8]). We estimated that there were more women with dementia than men with dementia globally in 2019 (female-to-male ratio of 1·69 [1·64–1·73]), and we expect this pattern to continue to 2050 (female-to-male ratio of 1·67 [1·52–1·85]). 

There was geographical heterogeneity in the projected increases across countries and regions, with the smallest percentage changes in the number of projected dementia cases in high-income Asia Pacific (53% [41–67]) and western Europe (74% [58–90]), and the largest in north Africa and the Middle East (367% [329–403]) and eastern sub-Saharan Africa (357% [323–395]). v

Projected increases in cases could largely be attributed to population growth and population ageing, although their relative importance varied by world region, with population growth contributing most to the increases in sub-Saharan Africa and population ageing contributing most to the increases in east Asia.  

Interpretation  

Growth in the number of individuals living with dementia underscores the need for public health planning efforts and policy to address the needs of this group. Country-level estimates can be used to inform national planning efforts and decisions. Multifaceted approaches, including scaling up interventions to address modifiable risk factors and investing in research on biological mechanisms, will be key in addressing the expected increases in the number of individuals affected by dementia.

See also this comment on the study. It offers the cold comfort of assuming the numbers of old people with dementia will be smaller than the study predicts—because the current pandemic will have killed many of them before dementia appears.

Number of people with dementia set to jump 40% to 78 mln by 2030 -WHO

Via Reuters: Number of people with dementia set to jump 40% to 78 mln by 2030 -WHO. Excerpt:

GENEVA, Sept 2 (Reuters) - More than 55 million people worldwide are living with dementia, a neurological disorder that robs them of their memory and costs the world $1.3 trillion a year, the World Health Organization (WHO) said on Thursday. 

The progressive condition can be caused by stroke, brain injury or Alzheimer's disease. With populations ageing, the number of sufferers is projected to rise to 78 million by 2030 and 139 million by 2050, the WHO said in a report. 

Only one in four countries has a national policy in place to support dementia patients and their families, it said, urging governments to step up to the public health challenge. 

"Dementia robs millions of people of their memories, independence and dignity, but it also robs the rest of us of the people we know and love," said Tedros Adhanom Ghebreyesus, WHO director-general.

"The world is failing people with dementia, and that hurts all of us," he said. 

Health ministers agreed in 2015 on a global action plan, including early diagnosis and providing care, but are falling short on meeting targets by 2025, it said.

"Dementia truly is a global public health concern and not just in high-income countries. In fact, over 60% of people with dementia live in low- and middle-income countries," Katrin Seeher, an expert in WHO's department of mental health, told a news briefing. 

Medication, hygiene products and household adjustments for dementia patients are more accessible in wealthy countries, which have a greater level of reimbursement than in lower-income countries, the report said.

The mystery of 9/11 first responders and dementia

Via The Washington Post: The mystery of 9/11 first responders and dementia. Excerpt:

More than a decade after the twin towers fell, Ron Kirchner began forgetting things. Buckling his belt. Closing his car door. Once, while visiting a preschool class on the 13th anniversary of 9/11, he even neglected to wear his customary necktie and New York City Fire Department hat. “He was in a panic,” says his wife, Dawn. “He used to like to bring the kids something, like coloring books. And he couldn’t find anything.” 

This was unlike Ron, who had always been devoted and dutiful. He frequently wrote Dawn love notes, hiding them around their house. He made time after work to play with his two children, Luke and Ava. He mopped the floors before going to bed, whistling while he pushed the handle. “He did it joyfully,” Dawn says. “Ronnie was a giver.” 

Ron brought the same enthusiasm to his job as a firefighter in Queens, where he obsessively cleaned his truck, stayed up all night waiting for calls, and — according to unit lore — once smashed an Xbox with an ax because he thought that some of his younger colleagues were spending too much time playing video games. “Dad thought they should be reading up on fire stuff, training and procedures,” Luke says with a laugh. 

Ron was one of the tens of thousands of police, firefighters, construction workers and others who worked amid the ruins of the World Trade Center in Lower Manhattan following 9/11. Like many of those responders, he later paid a price. Diagnosed with asthma and a lung disease both linked to Ground Zero exposure, Ron retired on disability in 2009 and moved to Arizona. 

At first, life in the desert was good. Ron landed a comfortable job working private security for a wealthy client. He and Dawn visited the Grand Canyon. They saw the red rocks of Sedona. Ron would wheeze while hiking, and sometimes at night, but a nebulizer made his breathing less strained. 

By 2014, however, Ron’s troubles with thinking and memory were becoming unmanageable. Back in New York, he had deftly maneuvered a fire engine along the city’s crowded streets; now, he struggled to parallel park the family’s SUV inside two spaces. He would put toothpaste on his toothbrush and not know what to do with it. He was let go from his security job — in part, Dawn says, because he struggled to use a smartphone. 

One day in early 2015, Dawn received a call from her husband’s naturopathic doctor, who had given Ron the Montreal Cognitive Assessment, a brief test that screens patients for cognitive disorders. Ron had scored poorly, unable to draw a simple clock face with the correct time. Dawn took him to a neurologist, who diagnosed him with dementia. Ron was 51. The neurologist, Dawn says, told her that a magnetic resonance imaging scan of his brain was comparable to that of an 85-year-old. 

Today, Ron suffers from seizures. He can no longer speak coherently, cut his own food or bathe himself. He requires round-the-clock care and supervision from his wife and children, lest he wander into the streets around his family’s home in Oceanside, N.Y., where they moved in 2017. 

“He doesn’t really know who I am,” Dawn says, “or who he is, or what his favorite thing in the world — the fire department — is.” 

She doesn’t think Ron knew he was being photographed for this article, and believes it would have been impossible to explain it to him. But Dawn feels that it’s important to share his story as a way of helping others — and that her husband, if he could still understand, would feel the same. 

Ron’s condition is almost unheard of for a 59-year-old man, and it points to an emerging medical mystery: Twenty years after 9/11, Ground Zero first responders are suffering from abnormally high rates of cognitive impairment, with some individuals in their 50s experiencing deficiencies that typically manifest when people are in their 70s — if at all. 

“That is the most extraordinary thing with these cognitive issues, and what blows me away,” says Benjamin Luft, director of Stony Brook University’s World Trade Center Health and Wellness Program, which cares for and studies responders. “You don’t expect this to occur in your 50s, because it doesn’t occur. And a lot of these people are in their early 50s.” 

Although most cases are not as severe as Ron’s, the number of responders showing memory loss and other signs of impairment has been rising over time. Scientists and doctors are now asking: Is 9/11 to blame?

WHO: World failing to address dementia challenge

A news release from WHO: World failing to address dementia challenge. Excerpt:

Only a quarter of countries worldwide have a national policy, strategy or plan for supporting people with dementia and their families, according to the WHO’s ‘Global status report on the public health response to dementia’, released today. Half of these countries are in WHO’s European Region, with the remainder split between the other Regions. Yet even in Europe, many plans are expiring or have already expired, indicating a need for renewed commitment from governments. 

At the same time, the number of people living with dementia is growing according to the report: WHO estimates that more than 55 million people (8.1 % of women and 5.4% of men over 65 years) are living with dementia. This number is estimated to rise to 78 million by 2030 and to 139 million by 2050. 

Dementia is caused by a variety of diseases and injuries that affect the brain, such as Alzheimer’s disease or stroke. It affects memory and other cognitive functions, as well as the ability to perform everyday tasks. The disability associated with dementia is a key driver of costs related to the condition. In 2019, the global cost of dementia was estimated to be US$ 1.3 trillion. The cost is projected to increase to US$ 1.7 trillion by 2030, or US$ 2.8 trillion if corrected for increases in care costs. 

“Dementia robs millions of people of their memories, independence and dignity, but it also robs the rest of us of the people we know and love,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. 

“The world is failing people with dementia, and that hurts all of us. Four years ago, governments agreed a clear set of targets to improve dementia care. But targets alone are not enough. We need concerted action to ensure that all people with dementia are able to live with the support and dignity they deserve.”

Scientists warn that Covid will accelerate ‘dementia pandemic’

Via the Financial Times: Scientists warn that Covid will accelerate ‘dementia pandemic’.

The degenerative effect on the brain of coronavirus will add fuel to the “pandemic of dementia” that will affect an estimated 80m by the end of the decade, scientists and psychiatrists have warned. 

Alzheimer’s Disease International, the global federation of dementia associations, on Wednesday unveiled a specialist working group to understand better the scale of the problem and recommend ways to combat it. 

“We don’t want to scare people unnecessarily,” said Paola Barbarino, ADI chief executive, “but many dementia experts around the globe are seriously concerned by the link between dementia and the neurological symptoms of Covid-19”. 

Alireza Atri, a cognitive neurologist and chair of ADI’s medical and scientific advisory panel, continued: “Covid-19 can cause damage and clotting in the brain’s micro vessels, immune dysfunction and hyperactivation, inflammation, and, last but not least, direct viral brain invasion through the olfactory pathways. 

“While there is still a way to go in understanding this, we know that anything that diminishes your cognitive reserve and resilience is going to allow neurodegenerative processes to accelerate, which can cause symptoms of neurological disorders, such as dementia, to show earlier.” 

There is mounting evidence that Covid-19 can cause long-term brain damage. One piece is that similar biochemical changes are observed in some coronavirus patients and in people with Alzheimer’s — indicating neuronal injury and inflammation.

Another is the growing number of studies showing that many people with so-called long-Covid suffer from cognitive problems including “brain fog” as well as difficulties with memory, concentration and language. In most patients, such symptoms are expected to resolve themselves over time but the fear is that it may tip some into progressive dementia. 

Besides formal scientific studies, clinicians such as Atri and Gill Livingston, professor of psychiatry at University College London, say they have noticed more patients whose dementia is progressing unexpectedly fast after coronavirus. 

To make matters worse, Livingston said, “increased isolation because of Covid and social distancing is itself a risk factor for dementia. People are missing the cognitive stimulation that can help delay the onset of symptoms.” 

Epidemiologists point out that Covid-19 would not be unusual among viral infections in causing progressive neurological disorders. The 1918 Spanish flu increased survivors’ long-term risk of developing Parkinson’s disease by a factor of two to three, Barbarino pointed out. Paola Barbarino of the Alzheimer’s Disease International warns of an ‘oncoming pandemic of dementia’ © Pete Jones/ADI 

Some 55m people are currently living with dementia, according to World Health Organization estimates, which is predicted to rise to about 80m by 2030 as the elderly population increases. 

Though it is too soon to quantify the exact effect of Covid-19 on future dementia cases, “it could have a large impact”, said Atri, who is also director of the Banner Sun Health Research Institute in Arizona. “This is a nasty, vicious virus and I’m sure it will tip some people over into dementia sooner than would otherwise be the case.” 

Barbarino urged “the WHO, governments and research institutions across the globe to prioritise and commit more funding to research and establish resources . . . to avoid being further overwhelmed by the oncoming pandemic of dementia”.

Can older adults walk their way out of dementia?

Via Medscape Medical News: Can Older Adults Walk Their Way Out of Dementia? Excerpt:

DENVER ― Low to moderate levels of physical activity in later life significantly mitigate the increased risk for age-related dementia, new research suggests. 

New data from the English Longitudinal Study of Aging (ELSA) show that adults aged 80 years and older who engaged in moderate to high levels of physical activity were at lower risk for all-cause dementia than inactive adults who were in their 50s and 60s. 

"These findings have important public health implications, because we know that age is the strongest risk factor for all-cause dementia and sedentary behaviors are increasing, both in younger people and older people who may have difficulties in achieving the recommended levels of physical activity," said lead investigator Natan Feter, PhD, Federal University of Pelotas, in Pelotas, Brazil. 

"Even moderate-intensity physical activity once per week can reduce the risk of dementia. We had previously shown this effect on people with mild cognitive impairment. Here, we showed this effect for the overall older population," Feter told Medscape Medical News. 

The findings were presented here at the Alzheimer's Association International Conference (AAIC) 2021. 

Attenuating, Eliminating Risk 

As part of the ELSA study, adults aged 50 years and older were followed between 2002 and 2019. On the basis of responses to a validated questionnaire, participants were classified as being inactive or engaging in low or moderate to high levels of physical activity. 

Feter reported data for 8270 ELSA participants (mean age, 64 years; 56% women). 

Over 17 years of follow-up, about 8% of these participants developed dementia. The risk for dementia increased by 7.8% for each year increase in age.

However, risk for all-cause dementia was reduced for those who engaged in low (odds ratio [OR], 0.30; 95% CI, 0.25 – 0.36) and moderate to high (OR, 0.13; 95% CI, 0.10 – 0.16) levels of physical activity compared with their inactive peers.

Feter said it is particularly noteworthy that adults aged 80 and older who engaged in moderate to high levels of physical activity were at lower risk for dementia than inactive adults aged 50 to 69 years.

"In our opinion, this is the study's main finding," he said.

Although aging is the strongest risk factor for dementia, "we showed that moderate-intensity physical activity once per week can attenuate, or even eliminate, the risk of dementia associated with aging," Feter noted. "In fact, older adults engaging in regular physical activity have a lower risk of dementia than adults aged up to 30 years younger."

However, he noted several study limitations, including the way that physical activity and dementia were assessed and that reverse causality and residual confounding "might not be ruled out from our findings."

Speech‐in‐noise hearing impairment is associated with an increased risk of incident dementia in 82,039 UK Biobank participants

Via Alzheimer's & Dementia: Speech‐in‐noise hearing impairment is associated with an increased risk of incident dementia in 82,039 UK Biobank participants. The abstract:

Introduction 

Little is known about the association between speech-in-noise (SiN) hearing impairment and dementia. 

Methods 

In 82,039 dementia-free participants aged ≥60 years were selected from the UK Biobank. Cox proportional-hazards models were used to investigate whether SiN hearing impairment is associated with an increased risk of incident dementia. 

Results 

Over 11 years of follow-up (median = 10.1), 1285 participants developed dementia. Insufficient and poor SiN hearing were associated with a 61% (hazard ratio [HR] = 1.61, 95% confidence [CI] 1.41–1.84) and 91% (HR = 1.91, 95% CI 1.55–2.36) increased risk of developing dementia, respectively, compared to normal SiN hearing. The association remained similar when restricting to follow-up intervals of ≤3, >3 to  <6, >6 to <9, and >9 years. There was limited evidence for mediation through depressive symptoms and social isolation. 

Discussion 

SiN hearing impairment is independently associated with incident dementia, providing further evidence for hearing impairment as a potential modifiable dementia risk factor.

FDA grants historic approval to Alzheimer’s drug from Biogen

Via STAT: FDA grants historic approval to Alzheimer’s drug from Biogen. Excerpt:

The Food and Drug Administration on Monday approved the first new treatment for Alzheimer’s disease in nearly two decades, a landmark decision that has been eagerly awaited by millions of Americans diagnosed with the condition but that will be hotly contested by some in the scientific community who doubt the drug’s effectiveness. 

 While other drugs treat symptoms of Alzheimer’s, the new medicine, called Aduhelm, is the first to attack what some believe is an underlying cause of the disease and slow cognitive decline, albeit marginally. It does so by eliminating clumps of a toxic protein believed to destroy neurons and cause dementia. Aduhelm is not a cure for Alzheimer’s, and it doesn’t reverse the disease’s progression. 

The drug — which just two years ago was declared a stunning failure — is now expected to generate billions of dollars in revenue for its maker, Biogen. 

“This historic moment is the culmination of more than a decade of groundbreaking research in the complex field of Alzheimer’s disease,” Biogen CEO Michel Vounatsos said in a statement. “We believe this first-in-class medicine will transform the treatment of people living with Alzheimer’s disease and spark continuous innovation in the years to come.” 

But the approval of Aduhelm, also known by its scientific name aducanumab, is all but sure to become one of the most controversial and disputed decisions on a drug application in recent years. The FDA granted marketing clearance to the drug over the strong objections of a panel of independent experts it convened in November. Those advisers reviewed Biogen’s clinical data and concluded overwhelmingly that there was insufficient evidence that the treatment had significant benefits for patients. They argued the drug should not be approved, as have many outside experts. Others saw enough evidence of efficacy — and a desperate need for new treatments. 

Instead of judging Biogen’s treatment solely on its effects on cognition, the FDA granted a conditional approval based on Aduhelm’s ability to clear the toxic proteins, called beta-amyloid. In order to continue marketing the drug, Biogen will need to complete a large clinical trial to confirm that removing the plaque has cognitive benefits, the FDA said. If that study fails, the FDA has the authority to rescind its approval. 

In approving the drug on a conditional basis, the agency departed from decades of regulatory precedent, setting a new bar for treatments with considerable potential but unproven benefits — a standard that could also be applied to other devastating diseases. 

“I’m quite surprised. The most compelling argument for approval was the unmet need but that cannot, or should not, trump regulatory standards,” said Caleb Alexander, a Johns Hopkins epidemiologist who served on the FDA’s advisory panel and voted against the approval of Aduhelm. “It’s hard to find any scientist who thinks the data are persuasive. Unmet need is an important contextual factor but it’s not an evidentiary threshold.” 

Aduhelm’s development has sharply divided Alzheimer’s experts. Now that Aduhelm is approved, they face a new challenge: prescribing the drug without overselling its effects. 

“For patients who qualify, I’m hopeful for them,” said Ronald Petersen, a neurologist who leads the Mayo Clinic Alzheimer’s Disease Research Center. “Now we have a potential treatment for them that may modify the underlying disease course. But the largest responsibility for us is to educate patients and physicians as to what this means. This is not going to be penicillin for Alzheimer’s disease.”

Dementia patients are at greater risk for COVID-19, particularly African Americans and people with vascular dementia

Via The Conversation: Dementia patients are at greater risk for COVID-19, particularly African Americans and people with vascular dementia. Excerpt:

New research is shedding light on how dementia can increase people’s risk for developing COVID-19, particularly among two groups: African Americans and people with vascular dementia. 

The headline findings of a recent study revealed that dementia patients overall face twice the risk for developing COVID-19 as adults without dementia. But two other results from that study deserve more attention than they have received so far. 

One is that African Americans with dementia had three times the risk of developing COVID-19, and when they did, it was more likely to be life-threatening. African Americans with both dementia and COVID-19 had a higher hospitalization rate than white patients with dementia – 73% compared with 54% – and a higher death rate – 23% compared with 19% for whites. In view of the health disparities already borne by people of color, this is particularly troubling. 

The study also found that patients with vascular dementia had the highest risk among dementia patients for COVID-19. This type of dementia is associated with strokes or small blood vessel damage, resulting in lower blood flow to the brain’s white matter, and injuries to the connections among neurons. This damage is visible on MRI scans. If enough damage occurs, cognitive function can be impaired.

Gait variability across neurodegenerative and cognitive disorders

Via Alzheimer's & Dementia: Gait variability across neurodegenerative and cognitive disorders: Results from the Canadian Consortium of Neurodegeneration in Aging (CCNA) and the Gait and Brain Study. The abstract:

Introduction 

Gait impairment is common in neurodegenerative disorders. Specifically, gait variability—the stride‐to‐stride fluctuations in distance and time—has been associated with neurodegeneration and cognitive impairment. However, quantitative comparisons of gait impairments across the cognitive spectrum of dementias have not been systematically investigated. 

Methods 

Older adults (N = 500) with subjective cognitive impairment, Parkinson disease (PD), mild cognitive impairment (MCI), PD‐MCI, Alzheimer's disease (AD), PD‐dementia, Lewy body dementia, and frontotemporal dementia, as well cognitive normal controls, who were assessed for their gait and cognitive performance. 

Results 

Factor analyses grouped 11 quantitative gait parameters and identified four independent gait domains: rhythm, pace, variability, and postural control, for group comparisons and classification analysis. Among these domains, only high gait variability was associated with lower cognitive performance and accurately discriminated AD from other neurodegenerative and cognitive conditions. 

Discussion 

Our findings indicate that high gait variability is a marker of cognitive‐cortical dysfunction, which can help to identify Alzheimer's disease dementia.

COVID-19: ‘We are going to keep you safe, even if it kills your spirit’

An opinion piece in The New York Times: ‘We Are Going to Keep You Safe, Even if It Kills Your Spirit’. Excerpt:

On a recent morning, Bill Williams, 87, awoke to learn of a terrible virus that had spread everywhere and was killing people. “Well, we’ve got this virus,” an aide at his nursing home in Broken Bow, Neb., told him. A few minutes later, he had forgotten about the virus, and so the nursing aide told him again. And then again. She would have to tell him the next day, too. 

“It’s pretty quiet in here,” Mr. Williams said, biting the inside of his lip a little. 

“Well, we’ve got this virus.” 

On most days, after Mr. Williams forgets again about the virus, he gets out of his armchair and into his wheelchair and goes down the hallway at Brookestone View Skilled Nursing and Rehabilitation. Like other residents with Alzheimer’s disease or dementia, he is “noncompliant” with mask-wearing protocols. He says the masks fog up his glasses. Or he thinks: What mask? He is also “noncompliant” with social-distancing measures. 

In other care facilities and in hospitals, too, “wanderers” with dementia are believed to have spread the virus and caused outbreaks — but what are administrators to do? They can’t just lock people up. 

“Stay in your room,” the nursing aides tell Mr. Williams. But he doesn’t stay. Whenever he gets out, an aide redirects him back to his armchair. Then again and again, until someone gets exasperated and lets him sit in the hallway for a while, so that he can watch the comings and goings. 

Because the thing is, it’s boring to sit in an armchair all day — even though Mr. Williams, a former crop duster, likes to watch planes taking off from a nearby airstrip, through his window. The dining hall is closed. Visitors are mostly prohibited. “Life enrichment” activities, like bingo, have been canceled. Mr. Williams knows that the choreography of the nursing home is off, but he isn’t sure why. “Everybody got busy doing stuff, I guess,” he told me.

People with dementia at higher risk for COVID-19, study finds: Research documents more cases, hospitalizations and deaths

Via ScienceDaily.com: People with dementia at higher risk for COVID-19, study finds: Research documents more cases, hospitalizations and deaths, with odds of both infection and worse outcomes higher for African Americans. Excerpt:

A study led by Case Western Reserve University researchers found that patients with dementia were at a significantly increased risk for COVID-19 -- and the risk was higher still for African Americans with dementia. 

Reviewing electronic health records of 61.9 million adults in the United States, researchers found the risk of contracting COVID-19 was twice as high for patients with dementia than for those without it -- while among those with dementia, African Americans had close to three times the risk of being infected with COVID-19 as Caucasians did. 

In addition, patients with dementia who contracted COVID-19 had significantly worse outcomes in terms of hospitalizations and deaths than those who had COVID-19 but not dementia. The study was published Feb. 9 by the peer-reviewed Alzheimer's & Dementia: The Journal of the Alzheimer's Association and highlights the need to protect people with dementia -- particularly African Americans -- as part of the strategy to control the pandemic. 

An estimated 5.8 million Americans age 65 and older and 50 million people worldwide are living with Alzheimer's and other dementias, according to the Alzheimer's Association. 

"Our results emphasize how important it is to protect those with dementia from acquiring SARS-CoV2, for they are at higher risk for severe disease than those without dementia," said study co-author Pamela Davis, dean emerita of the Case Western Reserve School of Medicine. "These patients may constitute another vulnerable category. However, more work is required to understand the mechanism by which this occurs."

The chronic neuropsychiatric sequelae of COVID‐19: The need for a prospective study of viral impact on brain functioning

Via Alzheimer's & Dementia: The chronic neuropsychiatric sequelae of COVID‐19: The need for a prospective study of viral impact on brain functioning. The abstract:

Introduction 

The increasing evidence of SARS‐CoV‐2 impact on the central nervous system (CNS) raises key questions on its impact for risk of later life cognitive decline, Alzheimer's disease (AD), and other dementia.  

Methods 

The Alzheimer's Association and representatives from more than 30 countries—with technical guidance from the World Health Organization—have formed an international consortium to study the short‐and long‐term consequences of SARS‐CoV‐2 on the CNS—including the underlying biology that may contribute to AD and other dementias. This consortium will link teams from around the world covering more than 22 million COVID‐19 cases to enroll two groups of individuals including people with disease, to be evaluated for follow‐up evaluations at 6, 9, and 18 months, and people who are already enrolled in existing international research studies to add additional measures and markers of their underlying biology. 

Conclusions 

The increasing evidence and understanding of SARS‐CoV‐2's impact on the CNS raises key questions on the impact for risk of later life cognitive decline, AD, and other dementia. This program of studies aims to better understand the long‐term consequences that may impact the brain, cognition, and functioning—including the underlying biology that may contribute to AD and other dementias.

See also this report from NPR.

Money trouble can precede dementia diagnosis by years, study finds

Via The Washington Post: Money trouble can precede dementia diagnosis by years, study finds. Excerpt:

The anecdotes Lauren Nicholas was hearing were all similarly alarming: People with dementia were experiencing “catastrophic financial events” — often before they or their loves ones knew there was anything wrong with them. 

“Once you miss a bunch of payments, the bank owns your house or you can’t get credit anymore, so I think we were kind of concerned about why this is able to happen,” said Nicholas, a health economist and associate professor at the Johns Hopkins Bloomberg School of Public Health. Deteriorating financial capabilities have long been considered one of the earliest signs of cognitive decline, but Nicholas noted that experts still had “relatively limited understanding of how frequent it is and when it’s happening.”  

New research published Monday by Nicholas in collaboration with experts from the Federal Reserve Board of Governors and the University of Michigan Medical School suggests that adverse financial events associated with Alzheimer’s disease and related dementias, or ADRD, can start happening years before people are clinically diagnosed. 

The study, published in JAMA Internal Medicine, is described by the researchers as one of the first of its kind to connect the health data of more than 80,000 Medicare beneficiaries with federal consumer credit reports.Its findings, according to the researchers, could potentially have broad implications on health and financial policies while also highlighting the potential benefits of early detection of conditions that are estimated to affect almost 15 percent of American older than 70.  

“Some of these financial symptoms are popping up as early as six years before formal clinical diagnosis,” said Nicholas, the study’s lead author. “That suggests that it actually does affect your life for a lot longer than we thought, and that even if we can’t slow the cognitive impacts, we can still protect you from some of the financial losses.”

Are infections seeding some cases of Alzheimer’s disease?

Via Nature.com: Are infections seeding some cases of Alzheimer’s disease?.

Two years ago, immunologist and medical-publishing entrepreneur Leslie Norins offered to award US$1 million of his own money to any scientist who could prove that Alzheimer’s disease was caused by a germ.  

The theory that an infection might cause this form of dementia has been rumbling for decades on the fringes of neuroscience research. The majority of Alzheimer’s researchers, backed by a huge volume of evidence, think instead that the key culprits are sticky molecules in the brain called amyloids, which clump into plaques and cause inflammation, killing neurons. 

Norins wanted to reward work that would make the infection idea more persuasive. The amyloid hypothesis has become “the one acceptable and supportable belief of the Established Church of Conventional Wisdom”, says Norins. “The few pioneers who did look at microbes and published papers were ridiculed or ignored.”  

In large part, this was because some early proponents of the infection theory saw it as a replacement for the amyloid hypothesis. But some recent research has provided intriguing hints that the two ideas could fit together — that infection could seed some cases of Alzheimer’s disease by triggering the production of amyloid clumps. 

The data hint at a radical role for amyloid in neurons. Instead of just being a toxic waste product, amyloid might have an important job of its own: helping to protect the brain from infection. But age or genetics can interrupt the checks and balances in the system, turning amyloid from defender into villain. 

And that idea suggests new avenues to explore for potential therapies. To test the theory further, scientists are now developing animal models that mimic Alzheimer’s disease more closely. “We are taking the ideas seriously,” says neuroscientist Bart de Strooper, director of the UK Dementia Research Institute at University College London.  

Choked by clumps 

The amyloid hypothesis holds that Alzheimer’s results from a build-up of sticky, soluble proteins — amyloid-β peptides — in the spaces between brain cells. These peptides are cleaved from another protein embedded in the membranes of neurons. Once floating free, they clump together into larger structures which, if not cleared efficiently enough by special enzymes, aggregate into plaques. The plaques then trigger a deadly cascade: they provoke neuroinflammation and spawn bundles of stringy proteins called tau tangles. Faced with this litany of insults, neurons die. 

Critics of the hypothesis note that the brains of many people who did not have Alzheimer’s disease have been shown to contain plaques on post-mortem. And they point to the failure of many clinical trials of treatments designed to dissolve amyloid plaques, none of which has slowed the disease. Researchers who support the amyloid theory counter that although the density of the plaques varies a lot between individuals, the density of tau tangles that they trigger correlates tightly with the severity of disease. And clinical trials probably failed, they say, because the treatments were given too late in the course of disease. 

They also have strong evidence on their side. There are certain rare and aggressive forms of Alzheimer’s disease that emerge early — between the ages of 30 and 60 — and run in families; these conditions are caused by mutations in genes that govern the amyloid-making process and inflammation in the brain. Scores of other genes have been associated with the risk of the more common late-onset form of the disease. Several code for proteins that comprise elements of the amyloid cascade, and some are involved in the innate immune system — a group of mechanisms that activate quickly to prevent the spread of pathogens in the body, and which drive inflammation.  

Agents of infection 

Researchers hoping to test the infection hypothesis have gone hunting for microbes in thousands of post-mortem brains from people with Alzheimer’s. In many, they have found them. “But these studies only show correlations which may have explanations that have nothing to do with mechanisms,” says de Strooper.  

Ruth Itzhaki, a biophysicist at the University of Manchester, UK, who reported observations of herpes simplex virus 1 (HSV1) in post-mortem Alzheimer’s brains in the 1990s1, bristles at such criticisms. She thinks that the presence of microbes in the brain must indicate a role for them, and she and others think they have good evidence that viruses are a linchpin in Alzheimer’s. “Most of us always acknowledged that amyloid was a very important feature of Alzheimer’s — but it is just not the cause,” she says.

'Dementia in football is rife and the game is not doing enough to help'

Via The Guardian: 'Dementia in football is rife and the game is not doing enough to help'. Excerpt:

Ten days ago the Chilton family were at breaking point. Chris Chilton, 77, was diagnosed with Alzheimer’s disease and vascular dementia in 2012. Eight years later he needs a level of care his family cannot afford. 

They did not know where to turn, or what to do. They felt utterly alone. This even though he was one of the best forwards in England in the 1960s. He scored a record 222 goals for Hull City, where he formed a famous strike partnership with Ken Wagstaff. The Professional Footballers’ Association (PFA) paid for Chilton to spend four weeks in a care home and the family had pulled together enough from their savings to pay for a fortnight more. But that was about to run out.  

“We couldn’t just keep limping along like this,” says his son Gary. His mother, Margaret, is 72, and has health problems of her own. Chris had been caring for her until he became ill. So Gary, who stayed nearby to help, decided it was time to sell his house and use the money to pay for care. “I said we’ll get maybe £100,000 and we’ll do it that way.” It was either that or else he would have to quit his job and move in to be a full-time carer. 

It was Wagstaff’s daughter, Francesca Sharp, who found a solution. “She popped in to see me and my mum,” Gary says. “And she just looked at us and said: ‘You two look like you’re finished.’ And we are, to be honest. My dad’s at a stage now where he needs more than we can give him. 

“We’ve tried to get through the last eight years as best we can on our own, keeping him at home. But we’ve got to that point now where he’s lost all the skills you learn when you’re a little child. It’s like looking after a five-year-old again basically, but a five-year-old who can pick up knives and leave the gas burner on, or put lit cigarettes in the bin.”  

Wagstaff set up a GoFundMe page. In seven days it raised more than £30,000. “The support from fans, locally, nationally, and abroad, has blown us away,” Gary says. “My dad was quite a humble bloke, never sought the limelight. He’s got quite a career behind him, with all those records, but this has been unbelievable, a show of love and support we never ever thought we’d see.” 

Some former Hull players helped out – Nick Barmby, Steve McClaren, Dean Windass – and so did some famous fans, such as Sir Tom Courtenay, who has supported Hull since he was a boy. The club launched a clothing and merchandise line, the 222 Collection, and donated the proceeds. 

“You can understand,” Gary says, “it’s been a very emotional week.” But those emotions are bittersweet. Because you have to ask why the family are relying on crowdfunding, and whether the football authorities could be doing more to support them instead of leaving it to the fans.  

Chilton’s illness has never been officially tied to his career but the family believe there is a link; that, like so many of the men he played with and against, he is living with dementia caused by playing football. 

“We’ve talked about it, me and my mum and my sister,” Gary says. “Dad was a big, old-school No 9, heading was his forte and the balls they played with were just absolutely brutal.”  

Gary describes his dad as “a very similar sort of player to Jeff Astle”. Chilton was also a teammate of Alan Jarvis. Astle and Jarvis had dementia caused by heading the ball and coroners ruled both men were killed by an industrial disease. “Just like a miner,” says Gary. Nobby Stiles, who died on Friday, also had dementia. And on Sunday Sir Bobby Charlton’s wife, Norma, confirmed he has the condition, too. 

“It feels like it’s rife, absolutely rife,” Gary says. “It’s not just that England team from 66; quite a few of the Hull City side my dad played in have it too. Dad’s in the pot of players from that era who have this illness and that pot is getting bigger all the time. Like it’s rampant and it’s absolutely devastating for families. It’s torn ours apart. It’s such a cruel, cruel disease, just absolutely evil. 

“And for football it is the big elephant in the room. And the authorities are doing their best to divert attention away from it by giving little soothers to keep families pleasant, like a ‘you’re OK’ type of thing.”

Long-term effects of PM2·5 on neurological disorders in the American Medicare population: A longitudinal cohort study

Via The Lancet Planetary Health: Long-term effects of PM2·5 on neurological disorders in the American Medicare population: a longitudinal cohort study.

Background 

Accumulating evidence links fine particulate matter (PM2·5) to premature mortality, cardiovascular disease, and respiratory disease. However, less is known about the influence of PM2·5 on neurological disorders. We aimed to investigate the effect of long-term PM2·5 exposure on development of Parkinson's disease or Alzheimer's disease and related dementias. 

Methods 

We did a longitudinal cohort study in which we constructed a population-based nationwide open cohort including all fee-for-service Medicare beneficiaries (aged ≥65 years) in the contiguous United States (2000–16) with no exclusions. We assigned PM2·5 postal code (ie, ZIP code) concentrations based on mean annual predictions from a high-resolution model. To accommodate our very large dataset, we applied Cox-equivalent Poisson models with parallel computing to estimate hazard ratios (HRs) for first hospital admission for Parkinson's disease or Alzheimer's disease and related dementias, adjusting for potential confounders in the health models. 

Findings 

Between Jan 1, 2000, and Dec 31, 2016, of 63 038 019 individuals who were aged 65 years or older during the study period, we identified 1·0 million cases of Parkinson's disease and 3·4 million cases of Alzheimer's disease and related dementias based on primary and secondary diagnosis billing codes. For each 5 μg/m3 increase in annual PM2·5 concentrations, the HR was 1·13 (95% CI 1·12–1·14) for first hospital admission for Parkinson's disease and 1·13 (1·12–1·14) for first hospital admission for Alzheimer's disease and related dementias. For both outcomes, there was strong evidence of linearity at PM2·5 concentrations less than 16 μg/m3 (95th percentile of the PM2·5 distribution), followed by a plateaued association with increasingly larger confidence bands. 

Interpretation 

We provide evidence that exposure to annual mean PM2·5 in the USA is significantly associated with an increased hazard of first hospital admission with Parkinson's disease and Alzheimer's disease and related dementias. For the ageing American population, improving air quality to reduce PM2·5 concentrations to less than current national standards could yield substantial health benefits by reducing the burden of neurological disorders.

Dementia deaths rise during the summer of COVID-19, leading to concern

Via The Conversation: Dementia deaths rise during the summer of COVID, leading to concern. Excerpt:

Deaths from dementia during the summer of 2020 are nearly 20% higher than the number of dementia-related deaths during that time in previous years, and experts don’t yet know why. An estimated 61,000 people have died from dementia, which is 11,000 more than usual within that period. 

“There’s something wrong, there’s something going on and it needs to be sorted out,” Robert Anderson, chief of mortality statistics at the U.S. Centers for Disease Control and Prevention, said in a recent interview with Politico. “This is highly unusual.”  

As a geriatrician, I find this statistic sad but not shocking. I care for dementia patients in my clinical practice. I see firsthand how the isolation caused by the pandemic has changed their lives, whether they’re home alone, living with a caregiver, or in a long-term care facility. 

Deciphering the statistics is a challenge. Hiding within them are many factors that have contributed to the deaths from dementia during the pandemic. Here are four of them. 

Social isolation 

Social distancing – or staying at least 6 feet apart, wearing a mask and avoiding crowds – is a proven way to decrease COVID-19 risk, especially from people with the infection but without symptoms. But social distancing is different from social isolation, which leads to a sense of disconnection from the community. 

Social isolation, which essentially is little or no contact with others, is the last thing seniors with dementia need. But it’s what many have received, as caregivers are forced to limit visits during the pandemic. Social isolation is a risk for poor health outcomes, particularly as people age. And in the U.S., 28% of those over 65 (13.8 million) live alone. Socially isolated people have higher rates of not only dementia, but heart disease, high blood pressure, depression, cognitive decline and death. 

Caregiver burnout 

On the best of days, caregiving for a family member with dementia is difficult. Watching the decline of a loved one is hard. Having to help them with things that are basic and personal makes it even harder. The commitment, 24 hours a day, offers little time for breaks. Often the caregiver, unsung and overlooked, is suffering.  

And during COVID-19, caregivers have been isolated too. What help they had from the outside is now probably gone. Burnout becomes more likely. For dementia patients to get the best care, their caregivers also need care and support. 

Decreased access to medical care 

Throughout the U.S., hospitals and clinics have seen fewer people coming in. Many missed visits were for preventive care and treatment of chronic conditions. For dementia patients, accessing care may even be more problematic. Telemedicine, often an option for other patients, may not be manageable for those with dementia. Physicians and staff need to reach out to them. And agencies and volunteer groups are available in many communities to assist seniors who need access to technology.  

Staying home 

Because of COVID-19, some of my patients choose to stay home. They’ve decided a medical issue is not worth the risk of leaving the house. I also have patients living in facilities who choose to use the care available there instead of going to the hospital. This is a good example of something we doctors call goal-concordant care: when doctors understand a patient’s health goals, and then provide them with the best they can within the scope of those goals.

Canada failed to protect elderly in first wave of COVID-19 — will the same mistakes be made again?

Via CBC News: Canada failed to protect elderly in first wave of COVID-19 — will the same mistakes be made again? Excerpt:

As COVID-19 cases surge across Canada and outbreaks in nursing homes flare up once again, experts say vulnerable elderly populations are at extreme risk in the second wave due to a lack of government action.   

Long-term care facilities bore the brunt of the first wave of the pandemic in Canada, with more than 70 per cent of deaths from COVID-19 occurring in those aged over 80, about twice the average of rates from other developed countries. 

"That is one of the most damning failures that's taken place through the pandemic," said Dr. Andrew Boozary, executive director of health and social policy for Toronto's University Health Network.  

"If we were going to be judged by how we protected our most susceptible and people who are structurally vulnerable — we failed them."  

Dozens of COVID-19 outbreaks have recently been reported in nursing homes in Ontario, B.C., Alberta and Quebec as the second wave arrives in much of Canada.

In his address to the nation Wednesday night, Prime Minister Justin Trudeau said the situations experienced by "too many elders" in long-term care homes is "unacceptable."  

"That has to change and it will change," he said. "We will be working with the provinces and territories to set new national standards on long-term care."  

But Canada's systemic failures in long-term care are nothing new, and neither are the calls for action.   

Long-term care deficiencies a longstanding issue 

A July report from the Royal Society of Canada, an association that includes some of Canada's top scientists and scholars, described COVID-19 as "a shock wave that cracked wide all the fractures in our nursing home system." It called on the federal government to act "immediately" on creating national standards of care.  

Months later, no concrete action has yet been taken, and the second wave of COVID-19 infections is well underway in previously hard-hit provinces, such as Ontario, B.C. and Quebec. 

On Friday, Trudeau conceded during a press conference that problems in long-term care facilities "existed long before COVID-19." 

"The systems that we had were inadequate all across the country," he said. "They were not up to the task of protecting our seniors appropriately." 

But experts question why the process of fixing those systemic issues has only now just begun.  

"The writing is on the wall that this had to happen yesterday," said Boozary.   

"To not ensure that every measure, every resource is in place to protect these families and their loved ones — to me is just damning, it's egregious." 

Dementia patients are dying from isolation amid COVID-19 pandemic

In order to save the aged, it's become necessary to kill them. Via The Washington Post: Dementia patients are dying from isolation amid coronavirus pandemic. Excerpt:

If only Dan Goerke could hold his wife’s hand. 

Maybe she would talk again. Maybe she would look at him and smile as she used to. Maybe she would eat and stop wasting away. 

Since the pandemic began, Goerke’s wife, Denise — 63 years old and afflicted with Alzheimer’s disease — had declined dramatically. Left alone in her nursing home, she had lost 16 pounds, could not form the simplest words, no longer responded to the voices of her children.  

In recent weeks, she had stopped recognizing even the man she loved. 

Goerke, 61, could tell the isolation was killing his wife, and there was nothing he could do but watch. “Every day it gets a little worse,” he said. “We’ve lost months, maybe years of her already.”  

Beyond the staggering U.S. deaths caused directly by the novel coronavirus, more than 134,200 people have died from Alzheimer’s and other forms of dementia since March. That is 13,200 more U.S. deaths caused by dementia than expected, compared with previous years, according to an analysis of federal data by The Washington Post.  

Overlooked amid America’s war against the coronavirus is this reality: People with dementia are dying not just from the virus but from the very strategy of isolation that’s supposed to protect them. In recent months, doctors have reported increased falls, pulmonary infections, depression and sudden frailty in patients who had been stable for years. 

Social and mental stimulation are among the few tools that can slow the march of dementia. Yet even as U.S. leaders have rushed to reopen universities, bowling alleys and malls, nursing homes say they continue begging in vain for sufficient testing, protective equipment and help. 

“It’s like we as a country just don’t care anymore about older people,” said Goerke, as he drove to his wife’s nursing home in Atlanta’s northern suburbs. “We’ve written them off.”  

In recent weeks, Goerke has struggled with anger — at U.S. leaders and at people who continue to reject simple measures such as wearing masks. As long as the virus keeps spreading, Goerke knows there’s no way to safely visit his wife.  

His worst fear is that by the time he can hold her hand, it will be to say goodbye.