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Signs of impending dementia may be detectable as early as nine years before a formal diagnosis, according to a new study.
Subtle but unmistakable impairments may be found in people at greatest risk for developing dementia, which could lead to earlier intervention, according to the Cambridge University study published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.
“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,” said study author Nol Swaddiwudhipong, a junior doctor at the University of Cambridge..
“The impairments were often subtle, but across a number of aspects of cognition,” Swaddiwudhipong added. “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.”
The study looked at data from the U.K. Biobank.
If you are concerned about early signs of dementia, here’s what you need to know.
Researchers identified specific impairments across a range of conditions years before patients received an official diagnosis
They include difficulty with problem solving and remembering lists of numbers. People who went on to develop Alzheimer’s disease also scored more poorly compared with healthy individuals when it came to reaction times and memory. They were also more likely than healthy adults to have had a fall in the previous 12 months, the study found.
Researchers made the link between dementia and the results of tests conducted five to nine years before diagnosis.
The specific results may offer good news to people who are concerned that they are showing early signs of dementia.
“Even some healthy individuals will naturally score better or worse than their peers,” says Dr. Tim Rittman of the University of Cambridge: “People should not be unduly worried if, for example, they are not good at recalling numbers.”
Rittman adds: “We would encourage anyone who has any concerns or notices that their memory or recall is getting worse to speak to their [general practitioner].”
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Being able to identify patients at greater risk of dementia may offer physicians a chance to intervene earlier to delay the full onset of symptoms
Few effective treatments exist for the treatment of dementia, partly because the condition is often diagnosed only once symptoms appear.
“The problem with clinical trials is that by necessity they often recruit patients with a diagnosis, but we know that by this point they are already some way down the road and their condition cannot be stopped,” Rittman says. “If we can find these individuals early enough, we’ll have a better chance of seeing if the drugs are effective.”
“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,” says David Thomas, head of policy at Alzheimer’s Research U.K. “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,” he adds.
The findings may form the basis for early screening of patients at higher risk of dementia.
“This opens up the possibility of screening programmes in the future to help identify people at risk and who may benefit from interventions, and identify more people suitable for clinical trials for new dementia treatments, which are both so desperately needed,” says Dr. Richard Oakley, associate director of research at the Alzheimer’s Society.
“For some people who go on to develop Alzheimer’s disease, memory and thinking problems can begin up to nine years before they receive a diagnosis,” he adds.
“I think first it’s important, extremely important, to get a diagnosis and to get an accurate diagnosis, because to assume that it’s Alzheimer’s disease or that it’s a dementia that we can’t treat is doing the person a disservice,” says Dr. Carol Manning, a clinical psychologist and director of Memory Disorders Neuroclinical Trials for the University of Virginia Department of Neurology. “There are some dementias and there are conditions that are treatable, and we definitely want to treat them.”
“There are currently no approaches that have been proven to prevent Alzheimer’s disease and related dementias,” the U.S. Department of Health and Human Services says. “However, as with many other diseases, there may be steps you can take to help reduce your risk.”
Leading a healthy lifestyle may reduce the risk factors associated with dementia. These include controlling high blood pressure, managing blood sugar, maintaining a healthy weight, eating a healthy diet, keeping physically active, staying mentally active, staying connected with family and friends, treating hearing problems, taking care of mental and physical health, sleeping well, avoiding head injury, drinking less alcohol and quitting tobacco use, HHS advises.
“Brains do operate, to some extent, under the same principle of ‘use it or lose it,'” says Dr. Verna R. Porter, the director of programs for dementia, Alzheimer’s disease, and neurocognitive disorders at Providence Saint John’s Health Center in Santa Monica, California. “If brain cells are not used, those brain cells tend to lose function.”
Porter said this principle is related to a concept called “cognitive reserve.” The idea is based on a theory that a healthy, high-capacity brain has lots of cognitive reserve and healthy connections between brain cells. “Brains with low cognitive reserve do not have as many connections between brain cells, which often leads to cell ‘pruning’ and, therefore, fewer active/healthy cells,” Porter says.
