Samenvatting
Summary Healthy versus neurodegenerative brain aging
Summary of all lectures
[Meer zien]Voorbeeld 3 van de 24 pagina's
Voorbeeld 3 van de 24 pagina's
In winkelwagengesponsord bericht van onze partner
Voorbeeld van de inhoud
Introduction lecture- high income countries have had a 30% drop in incidence of AD in the last 30 years
- amyloid cascade hypothesis: too limited info, mitochondrial cascades?,
metabolism pathway?, vascular hypothesis → multiscale multicausality
(more causes are found for AD, not monocausal) → there are a lot of drugs
that target amyloid aggregation but they are not used in practice yet
(there are some drugs that are close to registration)
- AD mostly of old age → only 1% of cases is familial
- 40% of dementia prevalence can be explained by modifiable lifestyle factors
Typical AD: with atrophy
- heterogeneity in different AD cases
,Prevalence of dementia over the years (by Livingston)
- early life: less education
- midlife: hearing loss, hypertension, obesity, traumatic brain injury, alcohol
- later life: smoking, depression, social isolation, physical inactivity, air pollution,
diabetes
- maybe also sleep problems but this is not included in Livingston
Prevention of dementia
- dementia is the end stage of neurodegenerative brain disease → before
you actually have dementia, there are decades of neurodegenerative
brain aging which only in the end leads to cognitive impairment
- mechanistic perspective: primary prevention = before neurodegeneration, secondary
prevention = when neurodegeneration has started
- clinical perspective: primary prevention = before disease diagnosis, secondary
prevention = after disease diagnosis
Risk factors of Dementia
- diabetes (later in life)
- hypertension (mid-life - later life)
- obesity (mid-life)
- inactivity (mid-life)
- depression (later in life)
- smoking (mid-life - later-life)
- low education (in early life)
, - age (most important risk factor)
→ these risk factors are found in 30% of people with dementia
→ risk factors are not proven to be causal of the disease (but probably are) →
reversed causality: is depression a cause of dementia or is dementia a cause of depression?
→ hearing loss might also be a risk factor (or a consequence)
→ risk factors don’t have a linear relationship (higher BMI does not necessarily
mean more dementia risk)
Timing of prevention
- the effect of intervention is highest when the intervention is done in middle age to
prevent dementia
- the incidence of dementia in middle age is low
- the incidence of dementia in old age is high but the effect of intervention is low
- the optimal window for outcome assessment (of the intervention) is in old age
→ very long research span to see if intervention during middle age helped
prevent dementia in old age (almost impossible) → thus, do not look a dementia
as treatment outcome but at other factors that can be measured in middle age
like cognitive decline
- a lot of people die with dementia but not from dementia
Targeted clinical trials: clinical trials that research people with a high risk of
dementia (because it runs in the family) → most cases of dementia are not
familial so this type of research only helps a small group of the dementia
patients which has a low impact on population level, but the risk of getting
dementia in these patients is almost 100% (if they get old enough) → abnormal
biomarkers can be measured: CSF markers, MRI markers, stroke
Pragmatic clinical trials: large population studied, so it has a high impact on society
→ however, the risk factors in this population vary so the target outcomes vary:
demographics, anthropometrics, blood pressure (BP), family history, lifestyle
→ it might be more useful to do a pragmatic clinical trial as the risk is lower in
the study population so prevention might be more useful
- there is a higher increase in dementia patients expected in low-income countries
relative to high-income countries as the low-income countries start resembling the
higher-income countries more and more which leads to less healthy food, less
physical activity and a longer life span which leads to more risk factors of dementia
- risk factors for dementia are also risk factors of other (cardiovascular) diseases so
one prevention might actually prevent multiple diseases
Intervention and outcome
- dementia risk: measured with dementia risk score
- biological parameter: for example imaging, blood pressure, CSF →
biological markers do not always actually reflect the disease (you can look
if your intervention led to a lower BP but if it did, this does not necessarily
mean that the risk of dementia is gone)
- cognitive impairment: cognitive testing (like the 15 word test)
Voordelen van het kopen van samenvattingen bij Stuvia op een rij:
Verzekerd van kwaliteit door reviews
Stuvia-klanten hebben meer dan 700.000 samenvattingen beoordeeld. Zo weet je zeker dat je de beste documenten koopt!
Snel en makkelijk kopen
Je betaalt supersnel en eenmalig met iDeal, creditcard of Stuvia-tegoed voor de samenvatting. Zonder lidmaatschap.
Focus op de essentie
Samenvattingen worden geschreven voor en door anderen. Daarom zijn de samenvattingen altijd betrouwbaar en actueel. Zo kom je snel tot de kern!
Veelgestelde vragen
Wat krijg ik als ik dit document koop?
Je krijgt een PDF, die direct beschikbaar is na je aankoop. Het gekochte document is altijd, overal en oneindig toegankelijk via je profiel.
Tevredenheidsgarantie: hoe werkt dat?
Onze tevredenheidsgarantie zorgt ervoor dat je altijd een studiedocument vindt dat goed bij je past. Je vult een formulier in en onze klantenservice regelt de rest.
Van wie koop ik deze samenvatting?
Stuvia is een marktplaats, je koop dit document dus niet van ons, maar van verkoper kimvandenbroek83. Stuvia faciliteert de betaling aan de verkoper.
Zit ik meteen vast aan een abonnement?
Nee, je koopt alleen deze samenvatting voor €4,49. Je zit daarna nergens aan vast.
Is Stuvia te vertrouwen?
4,6 sterren op Google & Trustpilot (+1000 reviews)
Afgelopen 30 dagen zijn er 53068 samenvattingen verkocht
Opgericht in 2010, al 14 jaar dé plek om samenvattingen te kopen