Dementia risk likely measurable among adolescents, young adults
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Alzheimer’s dementia risk factors may be measurable among adolescents and young adults, according to data presented at the Alzheimer’s Association International Conference 2020.
“By identifying, verifying and acting to counter those Alzheimer’s disease risk factors that we can change, we may reduce new cases and eventually the total number of people with Alzheimer’s disease and other dementia,” Maria C. Carrillo, PhD, chief science officer of the Alzheimer’s Association, said in a press release. “Research like this is important in addressing health inequities and providing resources that could make a positive impact on a person’s life. These new reports from AAIC 2020 show that it's never too early, or too late, to take action to protect your memory and thinking abilities.”
Associated risk factors included heart health factors, such as high blood pressure, high cholesterol and diabetes, as well as social factors, such as education quality, all of which disproportionately affect African-Americans.
African-American youth at increased risk for dementia
Results of the Study of Health Aging in African Americans, which included 714 African-Americans and was conducted by Kristen George, PhD, MPH, of the University of California, Davis, and colleagues, suggested high rates of high blood pressure and diabetes, or a combination of several factors related to heart health, among Black adolescents that appeared associated with worse late-life cognition.
“Most of the research assessing cardiovascular disease risk factors and cognition has focused on middle age or older adults,” George told Healio Psychiatry. “Much less is known about the effect of CVD risk factors developed in adolescence and young adulthood on late-life brain health. This is an especially important topic for Black Americans, who often have a higher prevalence of CVD risk factors and are at greater risk for dementia compared with other racial/ethnic groups.”
The investigators included 165 adolescents, 439 young adults and 110 adults and used in-person memory and executive function tests to measure cognition, with a mean age of 68 at cognitive assessment. Having diabetes, high blood pressure or two or more heart health risk factors in adolescence, young adulthood or mid-life was linked to statistically significant worse late-life cognition. The increased risk remained after accounting for gender, age, education and years since risk factors were measured.
“Efforts to promote a brain healthy lifestyle through prevention and treatment of CVD risk factors should include younger patients,” George told Healio Psychiatry.
Late-life dementia risk associated with early adult BMI
High BMI during early adulthood appeared associated with increased risk for dementia in late life, according to results of a study conducted by Adina Zeki Al Hazzouri, PhD, of Columbia University, and colleagues.
“The relationship between BMI in mid- or late-life and dementia risk has been well explored, but this is not the case for adult life BMI and dementia,” Zeki Al Hazzouri told Healio Psychiatry. “This is mostly due to a lack of large and diverse data sets with early life exposures and dementia outcomes, mostly occurring in late life.”
According to the authors, the current study is the first to report on this issue. They analyzed data of 5,104 older adults who were included in two studies — 2,909 from the Cardiovascular Health Study (CHS) and 2,195 from the Health, Aging and Body Composition (Health ABC) study. Among the total sample, 18% were Black and 56% were women. Zeki Al Hazzouri and colleagues estimated BMI starting at age 20 years for all older adults included in CHS and Health ABC using pooled data from four established cohorts that spanned the adult life course, including the two in the current study.
Results showed women had an increased risk for dementia if they had higher early adulthood BMI. Specifically, dementia risk was 1.8 times higher among women who were overweight and 2.5 times higher among women who were obese compared with women with normal BMI in early adulthood. Dementia risk for both women and men decreased with higher late-life BMI.
“Our study is associational, so we cannot infer causation,” Zeki Al Hazzouri told Healio Psychiatry. “However, our study does suggest that adult life obesity is an important factor for dementia risk.”
Education quality during early life affects dementia risk
Higher quality education during early life was linked to better language and memory performance, as well as lower risk for late-life dementia, according to a study conducted by Justina Avila-Rieger, PhD, a postdoctoral research scientist at Columbia University Irving Medical Center, and colleagues.
"The United States has a long legacy of denying Black Americans equal access to high quality education, and this legacy has been shown to have an impact on health of older adults," Avila-Rieger told Healio Psychiatry. "Segregation of schools in the South and the North was accomplished through local laws and state-level resources for public schools varied widely across states. However, little is known about the influence of these policies on an individual’s cognitive health and dementia risk later in life. We conducted this study to better understand how racial and geographic differences in early educational experience may play a role in late-life cognitive outcomes and dementia risk."
For up to 21 years, the researchers followed a group of more than 2,400 Black and white men and women 65 years and older who were enrolled in the Washington Height/Inwood Columbia Aging Project and had attended elementary school in the U.S. In a school-quality variable based on historical measures, the included mandatory school enrollment age, minimum dropout age, school term length, student-teacher ratio and student attendance.
Results showed those who attended schools in states with lower quality education exhibited more rapid decline in memory and language in older age. White women and Black women and men who attended schools in states with higher quality education had a decreased risk for dementia.
"Often when risk factors for dementia are discussed, the focus is on individual-level behaviors, like exercise, keeping your mind active, sleeping well and eating well," Avila-Rieger told Healio Psychiatry. "It may be tempting to think that our study suggests that kids should 'stay in school' and that parents should do all they can to increase the amount of education their kids get. That may be true, but the current findings suggest that the investment communities make in schools influences school quality, and in turn, benefits late-life cognitive health."