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Good news on the Alzheimer’s epidemic: Risk for older adults on the decline

NEJM perspective highlights effects of education, health and other changes in behavior on dementia and Alzheimer’s disease

ANN ARBOR, Mich. —   People are less likely to experience dementia and Alzheimer's disease today than they were 20 years ago – and those who do may be developing it later in life – says a new perspective article in the New England Journal of Medicine that examines the positive trends in dementia.

Authors examined five recent studies that suggest a decrease in the prevalence of dementia, crediting the positive trend to improvements in education levels, health care and lifestyle.

“We’re very encouraged to see a growing number of studies from around the world that suggest that the risk of dementia may be falling due to rising levels of education and better prevention and treatment of key cardiovascular risk factors such as high blood pressure and cholesterol,” says co-author Kenneth Langa, M.D., Ph.D., a professor of Internal Medicine at the U-M Medical School and research investigator at the Center for Clinical Management Research (CCMR), VA Ann Arbor Healthcare System.

“Our findings suggest that, even if we don't find a cure for Alzheimer's disease and dementia, there are social and lifestyle factors we can address to decrease our risk.”

Read a related blog post by Dr. Langa: "On the list of possible dementia busters: An educated mom, robust social life and delaying retirement"

Authors also include Eric B. Larson, M.D., M.P.H., executive director of Group Health Research Institute and Group Health’s vice president for research; and Kristine Yaffe, M.D., a professor of psychiatry, neurology, and epidemiology and biostatistics at the University of California, San Francisco. Larson is also an adjunct professor at the University of Washington Schools of Medicine and Public Health.

Authors point to two key factors that may explain the decreased risk of dementia over the last few decades: People are completing more years of school, which helps the brain fight off dementia; and there’s more awareness and focus on preventing heart disease, another big risk factor for Alzheimer’s.

Dr. Kenneth Langa
Dr. Kenneth Langa

“The growing number of older adults in the U.S. and around the world means we will undoubtedly see a significant growth in the number of people with dementia, however the good news is they appear to be living longer without experiencing it,” says Langa, who is also a member of the U-M Institute for Social Research, Institute of Gerontology, School of Public Health and Institute for Healthcare Policy and Innovation.

“We are seeing a positive trend that suggests that improving our physical and mental health go hand in hand with fighting off this devastating condition.”

In 2008, Langa and Larson reported one of the first studies suggesting a decline in U.S. dementia rates, using information from the U.S. Health and Retirement Study. They found that decline tracked with education and improvements in health care and lifestyle. Since then, several studies in Europe have confirmed this trend—and the reasons behind it.

Other research has also shown that other factors decreasing risk include early and ongoing education, physical activity, retiring later, educated parents (especially an educated mother), maintaining social activities and getting treatment for depression. 
 
On Dec. 11, the NEJM will post a podcast of Larson discussing the perspective piece.

For more on the study, see a news release from Group Health.

Additional Information:

The Group Health Research Institute is the research arm of Seattle-based Group Health Cooperative, a consumer-governed, nonprofit health care system. For more information, visit the website.

Disclosures: None

Reference:  “New Insights into the Dementia Epidemic,” NEJM, Nov.27, 2013.

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