Expert Insight: We are preventing some dementias now - But how?

It is well established that the risks for stroke and dementia include environmen

It is well established that the risks for stroke and dementia include environmental, socioeconomic, and individual risk and protective factors says Dr. Vladimir Hachinski (Western Communications)

Schulich Medicine & Dentistry Vladimir Hachinski and Potamkin Prize winner says a positive approach to brain health may help reduce incidences of stroke, heart disease and dementia

Schulich Medicine & Dentistry Vladimir Hachinski is a world-leading expert in the link between dementia and stroke and is the 2022 winner of the Potamkin Prize. Often called the "Nobel Prize of Alzheimer’s research," the Prize recognizes the achievements of scientific researchers who do innovative work to push forward the field of study in degenerative brain diseases.

This is an excerpt from his Potamkin lecture originally published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

Most dementias are untreatable and their prevalence is increasing around the world. However, the incidence of dementia is declining in some countries. We need to find out urgently why and how and apply the lessons promptly and widely.

We showed that over a 12-year period the incidence of stroke decreased by 32 per cent and that of dementia by seven per cent in the province of Ontario.

In a population of 14 million, that meant that thousands of individuals, their families, and the health-care system were spared the tragedies of stroke and/or dementia. The reasons remain unknown. One obvious potential explanation could be that a stroke doubles the chances of developing dementia and the decrease in the incidence of stroke reflected itself in the declining dementia incidence. However, this probably provides only part of the explanation.

It is well established that the risks for stroke and dementia include environmental, socioeconomic, and individual risk and protective factors. Decreases of both conditions could be the result of yet unknown combinations of these yet undiscovered factors or emergent qualities of a complex system.

Canada is fortunate to have a universal health-care system and reliable population data. Consequently, it is possible to look at all relevant factors at once at a reasonable level of detail. Our group comprises researchers from five of our universities, five provinces and four countries.

We have been funded to determine the reason for the declining incidence of stroke, heart disease, and dementia and make recommendations based on the findings by looking simultaneously at environmental, socioeconomic and individual risk and protective factors.

We will take a comprehensive, customized, and cost-effective approach to our findings and recommendations. Comprehensive, because although Canada is a big country with a national health-care system, it is also diverse. The problems of northern Canada are very different from southern Canada and to a lesser extent, between eastern and western Canada.

The comprehensive approach is required to identify the most important factors for each region. A customized approach can be developed to deal with the most important or modifiable factors, and it must be cost effective to warrant the costs in effort, time, and/or resources. A further qualification is that prevention has the best chance of success if it is addressed in actionable units. That means already established administrative units with a mandate for health.

Typically, this would be a county, a municipality, or other relatively small unit. Often there is a sense of community pride and change is more manageable in smaller units. Prevention should occur with expert advice, but through the established governmental, community and organizational leaders.

Conditions that occur together should be prevented together. To stem the tide of the terrible triad of stroke, heart disease, and dementia we need a broad but focused approach. We need to continue the search for target-specific drugs but expand both the number and nature of targets to include the aging process itself. Adopt and adapt the basics of lifestyle changes and implement a comprehensive, customized, and cost-effective approach

The pandemic has forced and fostered relationships among health authorities, health professionals, and the community. These could be built upon. The overall message needs to change from fear to hope. Rather than emphasizing the dire consequences of not following a healthy lifestyle, we should concentrate on optimizing brain health now not only to improve one’s life and productivity but with the realistic hope that we can postpone, mitigate, or prevent altogether a stroke, heart disease, or dementia through the positive message of brain health.

Read the full article here:

We are preventing some dementias now-But how? The Potamkin lecture, Vladimir Hachinski, Department of Clinical Neurological Sciences, Western University, Alzheimer’s & Dementia 2022; 1-6.

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