We can prevent dementia
Miia Kivipelto's message is clear: There are ways of preventing Alzheimer's, there are medicines that can alleviate the symptoms and just around the corner there are drugs or maybe even a vaccine that will change our current gloomy perception of the disease.
Professor Miia Kivipelto is used to being an optimist and is a doctor who perhaps more than anyone else has been in the spotlight in terms of spreading knowledge and giving hope. She does not preach a gospel based on faith, though. Her foundation is science: evidence-based studies that add one piece after another to one of medicine's biggest puzzles.
Her interest in dementia and Alzheimer's disease may well have been awakened when she was still a child growing up in Alajärvi in Ostrobothnia, Finland.
"I have always got on well with older people and I had a close relationship with my grandmother, who had Alzheimer's when I was young. There was no way of diagnosing it in those days and it was several years before the family found out what it was," Kivipelto tells Kmagasin, during a visit squeezed into her usual packed schedule.
She has just returned from a conference in Paris and will soon be off on her next assignment. Kivipelto is in great demand both in Sweden and abroad. With an increasingly ageing population, the number of people affected by different forms of dementia is rising, including in countries such as China and India. There is a clear positive trend, however, that the risk of being affected has moved further up the age range.
"Studies in Sweden, as well as in the USA, Canada and the Netherlands, are showing the same thing. The reasons are probably a reduced incidence of strokes, better treatment of high blood pressure, a reduction in smoking and the fact that in recent years we have had a higher level of education, which increases the brain's spare capacity and the ability to compensate for damage to the brain caused by illness or old age," explains Kivipelto.
She is most interested in preventive measures and this is also an area in which Swedish and Finnish researchers are global leaders. The FINGER* study, which Kivipelto led, was the world's first large multidimensional study of lifestyle interventions. The results have had a major impact on how dementia is viewed and FINGER's methodology will now be used for new studies in the USA, Singapore and China.
"I believe that at least 30% of Alzheimer's disease is related to factors that can be influenced, including blood pressure, depression, education and physical activity. This is a conservative estimate," says Kivipelto. She is actually more inclined towards 50% of the causes being influenceable.
Adopting the approach that dementia can be prevented has already led to a new way of looking at ageing. Thanks mainly to Kivipelto, newspapers, TV and social media have been full of advice about diet, exercise and brain training to keep the brain in shape in our later years. Her motto "What's good for your heart is also good for your brain" has attracted widespread recognition. The FINGER study also shows that individuals for whom Alzheimer's disease is hereditary have even more to gain by making lifestyle changes.
"Statistics are one thing, though," says Kivipelto frankly. "At an individual level, it is impossible to say exactly why one person is affected and another is not. I have met many patients who lived healthy lives and had no relatives with the disease who were nevertheless affected. The same is true of cancer. The causes are complex."
Kivipelto stresses that research does not currently have a homogeneous picture of the causes of Alzheimer's disease. It has long been said that the protein beta-amyloid, which forms plaques in the brain, is the underlying cause. There has been a lot less focus on tau, clumps of which within the nerve cells are the other indication of Alzheimer's disease. Then there are theories that the disease may be triggered by inflammations or blood vessel-related factors.
"We have already realised that Alzheimer's disease is more complex and that it cannot be treated using exactly the same method. Thus, just like cancer, there will be no single miracle method or miracle medicine, but a number of different treatments tailored to the exact diagnosis and subtype."
There has been no breakthrough yet in terms of finding an effective medicinal cure, however, despite billions spent and 200 studies carried out over the past 30 years. The drugs currently on the market either suppress the symptoms or help to stabilise the development of the disease to an extent. These are called anticholinesterases and they increase the levels of the neurotransmitter acetylcholine in the brain and help to maintain communication between the nerve cells.
"Unfortunately, pharmaceutical research has not had access to the tools necessary to conduct studies over a long period," says Kivipelto. "Patients arriving in the healthcare service already have such extensive brain damage that not much can be done. It is now easier to make an early diagnosis, however, thanks to biomarkers, and this also provides more opportunities for research into new drugs."
The lack of a medicinal cure also makes her sceptical of the large-scale screening of individuals in risk groups using PET scans or spinal fluid tests. This would create a great deal of worry and would probably do more harm than good, in Kivipelto's opinion. Examinations are also expensive to perform.
What about a vaccine for Alzheimer's disease? Will we ever see one?
"A vaccine sounds wonderful, but I couldn't say what will happen. They are testing a vaccine in the USA on groups with genetic mutations that can lead to the disease, but it will be a long time before these people may be given a diagnosis and we obtain any results as to the effectiveness of the vaccine."
"You should know that roughly every five years someone claims to have found the solution, although nobody ever has. But what I can say is that at the very least we will know an awful lot more in five years," says Kivipelto, before hurrying off to her next meeting.
Text: David Grossman, photo: Rebecka Falk.
The four measures in the FINGER study that gave the best results in terms of counteracting memory problems and cognitive decline:
- Dietary advice: largely the same as for reducing the risk of heart disease, but with additional emphasis on fish, unsaturated oils such as olive oil and rapeseed oil, fruit and vegetables and not too much sugar and salt.
- Physical activity: both fitness and strength, for example, by walking, aqua aerobics and going to the gym. Ideally include others, exercise together, be socially active.
- Individual monitoring: keeping a close eye on blood pressure, weight, blood sugar and cholesterol, for example.
- Memory training: training the memory and attention. Good examples include solving a crossword, reading, learning a new language or musical instrument. The important thing is to vary activities and find new challenges.
FINGER stands for Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability.
Thematic Head of Theme Aging at Karolinska University Hospital and Professor of Clinical Geriatric Epidemiology at Karolinska Institutet. She also holds an endowed professorship from Stockholms Sjukhem (Stockholm Nursing Home).
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