While dementia cure remains elusive, experts from the medical and scientific fields are of the opinion that early intervention could reduce one’s risk of developing dementia-related disease. But how early? A new study suggests that it could be possible to spot signs of dementia up to nine years before diagnosis.
Published in Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association, the study analysed that future at-risk patients could be screened to “help identify those who might benefit from early interventions to reduce their risk of developing dementia-related diseases”.
“When we looked back at patients’ histories, it became clear that they were showing some cognitive impairment several years before their symptoms became obvious enough to prompt a diagnosis,” study author Nol Swaddiwudhipong, a junior doctor at the University of Cambridge, said as part of the study.
According to the study author, the impairments were often subtle but across a number of aspects of cognition.
“This is a step towards us being able to screen people who are at greatest risk – for example, people over 50 or those who have high blood pressure or do not do enough exercise – and intervene at an earlier stage to help them reduce their risk.”
Using data from the UK Biobank database, the study pinpointed problem solving and number recall as two of the early signs of developing dementia.
Senior author Dr Tim Rittman, also from the University of Cambridge, said: “People should not be unduly worried if, for example, they are not good at recalling numbers. Even some healthy individuals will naturally score better or worse than their peers. But we would encourage anyone who has any concerns or notices that their memory or recall is getting worse to speak to their GP.”
The study noted that people from the UK Biobank data, who went on to develop Alzheimer’s, scored more poorly compared with healthy individuals when it came to problem-solving tasks, reaction times, remembering lists of numbers, prospective memory (our ability to remember to do something later on) and pair matching. This was also the case for people who developed a rarer form of dementia known as frontotemporal dementia, the researchers found.
David Thomas, head of policy at Alzheimer’s Research UK, said: “It is increasingly clear that the best chance to affect the course of the diseases which cause dementia lies in intervening at their earliest stages. Health services don’t routinely offer the tests needed to detect changes in brain function that happen before symptoms are noticeable, like those alluded to in this study.
Let’s understand more about dementia
Dr Poonam Chandrashekhar Awatare, consultant – neurology, Manipal Hospital, Varthur Bangalore mentioned that dementia is a “syndromic term for a decline in cognitive abilities like memory, language, and executive functions of sufficient severity to interfere with functions during daily activities”.
What causes it?
Dr Sujit Kumar, senior consultant neurologist and epileptologist, Apollo Hospitals, Seshadripuram Bangalore noted that dementia is due to various causes. “It can be due to acquired causes like cerebrovascular ischemia or due to degenerative causes like Alzheimer’s Disease or frontotemporal dementia. Several tests can detect impending dementia at an earlier stage. Clinical tests such as neuropsychological tests for memory, cognitive function can reveal early subtle abnormalities,” said Dr Kumar.
So, is it possible to detect dementia early?
According to Dr Awatare, early presentation includes episodic memory impairment like what he ate for dinner, about his last trip, repetitive questions, loss of interest in hobbies, anomia (difficulty in naming objects), and impaired instrumental ADL (Instrumental activities of daily living). “Also, there is difficulty in recalling animals, objects, tools, landmarks and problem-solving are some of the early symptoms which must not be ignored. They also experience difficulty in recalling words, visuospatial skills decline like disorientation in unfamiliar places which hampers the patients day to day activities,” said Dr Awatare.
How is it diagnosed?
MRI or CT scan of the brain can detect the reversible or treatable cause of dementia. This method is the most effective way to detect the condition. Some of the other tests include:
• Functional brain imagining – Single Photon Emission Computed Tomography (SPECT) and FDG-PET
• Amyloid imagining
• Task-free functional MRI
• TAU Pet imaging
“Most of these tests are recommended only for research purposes and not in clinical practice until disease-modifying therapy is available,” said Dr Awatare.
How does early detection as the study suggests help future patients?
Cognitive dysfunction including memory loss in dementia is progressive in nature and at present, there is no cure. “It would be useful if we can identify people who are at a higher risk of developing it in future. Strategies to prevent it or slow down the disease process can be adopted in people identified to possess a higher risk of developing dementia,” said Dr Sudhir Kumar, a neurologist.
Referring to the study, Dr Kumar suggested that poorer overall health, increased number of falls, poorer handgrip strength and unexplained weight loss in the preceding year predicted a higher risk of developing dementia five to nine years later.
Loss of smell can be another early warning symptom of such a disease in older people.
These could include people aged 50 or more (especially with comorbidities such as high BP, diabetes or strokes) or those with a positive family history, suggested Dr Kumar.
“The people identified to have one or more warning signs or symptoms could be advised to adopt strategies meant to delay/prevent dementia– regular exercises, control of blood pressure, sugar and cholesterol, eating brain-healthy foods (dry fruits, fish, salmon, blueberries, etc) and consult a neurologist at the earliest if memory impairment is noted,” he said.
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