Dementia epidemiology

Neurodegenerative conditions are predicted by the World Health Organisation (WHO) to become the world’s leading cause of death by 2040. This class of disease constitutes a group of progressively debilitating conditions with unique disease-specific profiles, characterised by the selective loss of distinctive neuronal groups.

What is dementia?

Neurodegenerative dementias represent a class of pathologies that have varying degrees of, but unarguably, the progressive decline in cognitive functions such that there is interference in an individual’s ability to perform everyday duties, impacting on their social function and/or their capacity to perform usual occupational tasks.

Types of dementia

The most common forms of dementia include Alzheimer’s disease (AD), Lewy body dementia (DLB), frontotemporal dementia (FTD) and vascular dementia. Both AD and DLB continue to be the leading cause of degenerative dementia in the elderly population (Figure 1).

Figure 1 – Dementia subtypes and prevalence

Representative data from the Alzheimer’s society’s (UK) envisaged proportions of the subtypes of dementia and their prevalence in the UK alone. Adapted from (https://www.alzheimers.org.uk/info/20091/position_statements/93/demography), published September 2014.

Dementia epidemiology

Dementia has emerged as an epidemic with aging being the predominant risk factor. By 2050, the number of people aged ≥60 years will have increased by 1.25 billion, accounting for approximately 22% of the total global population, with 79% living in less developed regions. Whilst the observed and projected increase in the number of people affected by dementia has largely been explained by the increase in population longevity, specifically in the developing world, dementia per seis not a natural part of the aging process.

Those affected by neurodegenerative dementias are principally aged 65 years and over with early-onset dementia accounting for only 2-5% of all cases, furthermore the prevalence nearly doubles with every additional 5 years of age following the age of 65 underscoring an increase in an age-related risk of developing neurodegeneration, in parallel with an increase in longevity.

In 2015 WHO reported 47.5 million people were afflicted worldwide by dementia, increasing from 35.6 million people in 2012 (WHO April 2012) and cases are predicted to rise by 7.7 million each year. It has been forecast that by 2050 the worldwide prevalence of dementia will reach 137.5 million. In the UK alone, 850,000 people are affected, this bestows a substantial burden on the economy with the cost of health care in the region of £26 billion, annually.

The broad-spectrum of dementia produces a gender bias with a predisposition towards females, 61% of dementia cases are seen in the female population when compared to 39% of males. This is a consistent observation that could be explained by the protracted longevity in females when compared to males. 

Global distribution of dementia

A systematic review contemplates the global prevalence of dementia and identifies a higher incidence in Latin-America and lowest in Sub-Saharan Africa with the greater proportion of dementia cases, being affiliated with low-middle range incomes. To corroborate this, more recent population-based studies on “high-income” countries have contradicted previous projections regarding dementia prevalence, indicating a decline in the age-associated risk of dementia. This has been attributed to various factors, largely surrounding the fact that higher levels of education and advances in treatment and diagnostics may lead to the early intervention of dementia indicators; these include cardiovascular risk factors such as obesity and diabetes. A recent UK based study on dementia has reported a 20% decrease in dementia incidence over the last two decades in males. If the previous projections are proving variable, then it is possible that the predicted figures may be regionally modulated in accordance with the scope of social health care support available and attainable by the general population.

REFERENCES

McHugh, P.C., J.A. Wright, and D.R. Brown, Transcriptional regulation of the beta-synuclein 5′-promoter metal response element by metal transcription factor-1. PLoS One, 2011. 6(2): p. e17354.

McKeith, I.G., et al., Diagnosis and management of dementia with Lewy bodies: third report of the DLB Consortium. Neurology, 2005. 65(12): p. 1863-72.

Sousa, R.M., et al., Contribution of chronic diseases to disability in elderly people in countries with low and middle incomes: a 10/66 Dementia Research Group population-based survey. Lancet, 2009. 374(9704): p. 1821-1830.

van der Flier, W.M. and P. Scheltens, Epidemiology and risk factors of dementia. Journal of Neurology, Neurosurgery & Psychiatry, 2005. 76(suppl 5): p. v2.

Prince, M., et al., The global prevalence of dementia: a systematic review and metaanalysis. Alzheimers Dement, 2013. 9(1): p. 63-75.e2.

Langa, K.M., Is the risk of Alzheimer’s disease and dementia declining? Alzheimer’s Research & Therapy, 2015. 7(1): p. 34.

Larson, E.B., K. Yaffe, and K.M. Langa, New Insights into the Dementia Epidemic. New England Journal of Medicine, 2013. 369(24): p. 2275-2277.

Matthews, F.E., et al., A two decade dementia incidence comparison from the Cognitive Function and Ageing Studies I and II. 2016. 7: p. 11398.

“4 Things Everyone Should Know About the Coronavirus”

I write this post for Fitness Savvy, a company that I provide writing services to and I thought I would share it on my website also.

Covid-19 is the third known zoonotic coronavirus disease, and the previous two were SARS and MERS [1]. There is a flurry of research to understand the mechanisms of infection and transmission. Here is what we know:

Should I take anti-inflammatory medicine?

There have been some conflicting reports relating to the use of anti-inflammatory medicines in the treatment for the Covid-19. For those that are able to use paracetamol to alleviate symptoms, it is certainly wise to do so. The reason there is a question mark hanging over the use of drugs such as ibuprofen is due to their effect on the immune system. Anti-inflammatory medicines suppress the immune system, which may be necessary to moderate the immune response [2]. It may in some cases, have a negative impact on the body’s ability to respond appropriately to infection.

We know how to avoid Covid-19, but what happens if you get it?

There are currently no specified treatments to prevent Covid-19, although much work is being performed globally. Antibiotics, are prescribed for a bacterial infection and will not help with a viral infection and should not be sought. If symptoms transition into a bacterial infection, such as pneumonia antibiotics may be prescribed.

It is essential that dehydration is prevented, take on plenty of fluids to reduce the risk. Stay hydrated despite how unwell you may feel, small sips during regular intervals may help.

A fever is a natural response to an infection and is the body’s natural way of fighting [3], but can become uncontrolled. Medications such as paracetamol can be taken to reduce a fever and the symptoms associated with it.

Covid-19 affects the respiratory tract [1] and in more severe cases, oxygen may need to be administered to assist with the appropriate supply of oxygen to cells.

What is meant by those ‘at risk’?

At risk persons are usually those that are already immunocompromised, in addition to the very young and the elderly. Immunocompromised include patients having chemotherapy treatment for cancer, patients having undergone organ transplantation and/or patients with existing lung disease such as COPD or cystic fibrosis. Furthermore, the response to infections decreases with age and therefore, elderly persons, with underlying health conditions may be considered at risk [https://www.gov.uk/government/news/major-new-measures-to-protect-people-at-highest-risk-from-coronavirus]. Conversely, young patients are still developing their immune systems and may be more susceptible to symptoms and pregnant women are also considered at risk.

Can you catch Covid-19 twice?

When exposed to an infection, such as a virus, the body will develop immunity against repeated infections. In principle, our immune cells will recognise components and fight repeat infections rapidly. This rapid response will mean that you may not be aware of the infection, as the body will fight it appropriately. It does not mean that you will not pick up the same infection twice, rather you will be better prepared for subsequent infections.

There are conflicting reports regarding Covid-19, and when the infection is under control, more detailed data will be available for analysis. What may appear problematic for one cohort of people, maybe less so for another? The guidelines issued by the government are based on the most available date and should be adhered to unless informed otherwise.

References

1.            Sun, P., et al., Understanding of COVID-19 based on current evidence. J Med Virol, 2020.

2.            Coutinho, A.E. and K.E. Chapman, The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Molecular and cellular endocrinology, 2011. 335(1): p. 2-13.

3.            Evans, S.S., E.A. Repasky, and D.T. Fisher, Fever and the thermal regulation of immunity: the immune system feels the heat. Nat Rev Immunol, 2015. 15(6): p. 335-49.

Scientific Writing

What is scientific writing

Scientific writing is an essential part of science with the documentation of ideas and demonstrable evidence of findings from qualitative and quantitative studies. How we gather, process and then communicate information is changing at the same time as technology is evolving, providing more platforms for scientific knowledge to be shared. This information needs to be delivered in a manner that is appropriate for its audience, thus, enabling its distribution and interpretation accordingly.

Styles of scientific writing

Scientific writing may be in a technical format, for example, the reporting of scientific observations and findings as a result of a study or notes in a lab book including methodology, research ideas and results. Conversely, scientific writing may include conveying information in a non-technical manner for a wider audience, for example, those that do not work in the science industry

Technical scientific writing

This is an example from a paper I published, written specifically for a scientific audience:

Non-technical scientific writing

Delivering complex scientific information to a non-scientific audience can be a difficult task and requires the breaking down of the information into bite-size and understandable chunks. Taking an extract from the example above, it has been re-written for a non-scientific audience:

Abstract:

‘Dementia with Lewy bodies (DLB) is the second most prevalent neurodegenerative dementia, where an accumulation of aggregated fibrillar alpha-synuclein in neurons of limbic and forebrain regions of the brain leads to visual hallucination, cognitive impairment of a fluctuating nature and extrapyramidal motor disturbances. Beta-synuclein counteracts aggregation of alpha-synuclein in vitro and in animal models; however, it is not clear whether this effect occurs in human Lewy body dementia (LBD) diseases.’

Re-written:

Dementia with Lewy bodies (DLB) is a common form of dementia caused by gradual loss of brain cells. The cells affected are in the cortex and regions involved in memory. DLB sees protein aggregates formed from the sticking together of proteins into clumps inside the cells; the loss of these brain cells leads to the changes that characterise dementia such as memory loss, behavioural and personality changes. Beta synuclein and alpha-synuclein are proteins in the brain; alpha-synuclein is found in the protein aggregates – called Lewy bodies and beta-synuclein is a similar protein that can prevent the aggregation of alpha-synuclein. It is not known whether this effect is seen in humans also.’

Essentially, the pitch of the writing will be appropriate to those that will be reading it; however, it is imperative, when conveying such information that the information is interpreted correctly before disseminating.

Tracey Evans Writing Services

To conclude, be aware of the audience and write the piece accordingly. Scientific writing can be fun and light-hearted, journalistic or formal. If you would like some help with scientific writing please contact me.

Looking to start a PhD?

Are you a student looking to take your studies to the next level and start a PhD? If so, the key to finding a suitable PhD is being pro-active in advance and networking. Here are a few tips from someone who has been there and done that!

Speak to other PhD students

It is important to establish what you are letting yourself in for. A PhD is tough, and supervisors will expect 100% prod can be hard work. Some are nice, and others are not so nice, you need to be resilient and prepared. If you are interested in a particular group, talk to other members of that group. Ask questions and be sure to establish how well the group works together.

Lecturers and course leaders

Speak to course leaders or lecturers of the modules that you are interested in. Ask about their current group research projects; areas of interest and whether any opportunities are coming up. There may be grant applications in progress, if the grant is awarded get your foot in the door and note your interest.

Reach out to other Universities

When you are networking, ask about other research group leaders from other universities that may be of interest. Make contact with them, if you are not sure about contact details you can usually find email addresses on university portals. Email and ask whether it would be possible to meet with them and discuss their research and any future opportunities. Before you go, read some of their papers and make sure you are familiar with their field of research.

Leave your details

Leave your email and contact details with whomever you speak. When I was still undertaking my Master’s degree, I contacted the Professional Investigator at a hospital; they collaborated with the University of Bristol. I expressed an interest in their research, and they agreed to meet with me. Some six months later, I received an email asking why I had not yet applied for their current vacancy for a PhD student. As it was, I had already accepted a PhD position, but it goes to show, networking does work!

Universities will advertise positions themselves, but I also found findaphd.com very useful. In the meantime, please visit Tracey Evans Writing Services should you require help with your PhD covering letter or CV.

I wish you every success!

Dr Tracey Evans

Fading memories

My memories may be fading

they are no longer clear to me

be assured they are only hiding

warm and safe you just can’t see.

***

For they are tucked up safely in my heart

a treasure trove so precious

each hold a special place

with beauty that leaves me breathless.

***

My eyes may no longer sparkle

but please be sure to know

these eyes watched in wonder

as I nurtured and saw you grow.

***

Now don’t be sad my darling

my heart still holds you close

this shell is just the wrapping

of a life filled with those I love the most.

Social media and reality

I recently read an article in the Independent regarding a survey that Nuffield Health performed. They report that a third of 18-35-year olds lacked the confidence to join a gym and that social media contributed to this self-consciousness. So, is social media insightful and helpful for those wanting to join a gym? or does it produce a layer of expectation that a certain physical appearance is necessary? I began thinking about this and when, in my past life, I was a fitness manager.

When I worked in the health and fitness industry, I would see people of all different shapes and sizes coming into the gym or to classes. Some would come with full make-up and not produce a bead of sweat – putting me who is very much a sweaty Betty to shame. Others would come in wearing super modern kit compared to maybe an old pair of shorts and once-white t-shirt. Some users would appear with huge baggy T-shirts, whilst others would be wearing a thong over skimpy shorts – yes in the late 90s that was a thing.

BUT the important consideration, regardless of appearance, is that each person has their own reasons for going to a gym. Whilst it is very easy to judge, I was fortunate enough to interact with many of our members and very often I would get to know their story. I learnt very quickly that appearances are very deceptive.

Surprisingly to many, when talking to a few of the ‘skinny’ girls, I would learn that she was wanting to lose weight because when she looked in the mirror, she saw a fat body. This is the very real pain of living with an eating disorder (for males and females). These particular users had to be managed very carefully as their energy expenditure far exceeded their calorific intake leading to potential fainting fits and subsequent injury. Additionally, I would learn that other members, ate, vomited and exercised (not necessarily in that order) – a vicious cycle of distress.

I would talk to friends and colleagues outside of work, they wanted to lose weight before joining the gym – yes, this is very common and many will associate with this concept that you need to lose weight before joining a gym. Of course, the truth be told, the gym will accelerate this progress and provide so many more benefits at the same time. The most difficult step, is that very first step into the gym.

Often sessions would be cancelled, this may be because on a particular day the gym user did not feel comfortable in their own skin, whilst others would spend much time doing their hair and make-up before a session. I would hear comments about people wearing make up to the gym, what is the point?  well there any many people that do this to improve their confidence – or as I think of it, put their public mask on.

Of course, then we have the body builders – yes, they should celebrate their bodies but they are mighty intimidating for the users that are not confident with weights. The cacophony of grunts and snorts as they push themselves to max! This is an important component of training for some, I know a guy that is a power lifter and in order to succeed in his competitions, he doesn’t care how much anyone else is lifting, he is breaking his own body limits today! Weight lifting generally is an essential component of general health and fitness but not everyone needs to max out on the weights, it depends on personal preference. So, to the person that wants to have a go but has been putting it off, approach a gym member and ask them to show you the correct technique. Just pick a few exercises to start with and then add a few more as your confidence builds.

I personally have been the user that got off the treadmill feeling hopeless and went home because I felt so slow next to the user next to me. I completely get it, but I also know that the sprinter was probably focusing on his breathing, desperate to complete this scheduled and gruelling training run – the 4th of the week. I reflect on how I let my own assumptions that I was a rubbish runner, make me throw the towel in that day!  Walk, jog, run – it is OK just move and get that heart pumping.

Some users would just come in, get their head down and power through a session so they could get home again, whilst others came in for the social element and a good catch up alongside a workout. All in all there are very many reasons for people to gym – including but not limited to: goal-specific training, general health and wellbeing, weight loss/maintenance/gain, mental health management (definitely me!), injury rehabilitation, recovery from a heart attack or management of other health conditions such as diabetes, to pass a military fitness test, improve flexibility, socialising, to stick two fingers up at the ex – always loved to work with those users – and of course, just for fun. Whatever the reason, embrace it and go for it because trust me – with time your self-confidence will improve!

So, personally I believe that if someone is feeling confident enough to put up a post on social media – applaud them and help them celebrate their achievement. Like the post, tell them how great they are doing, ask them about their routine. Their post is by no means a reflection of you so, how you let their post make you feel about yourself is your own responsibility. If it makes you feel bad, do something positive and regain control of your confidence. You may not be that amazing person in the picture – but you are you AND you are amazing too!

The Kite Dance

by Tracey Evans

Tickled by fingers of the wind

bouncing on the tide of warm air

a tender massage

from exhalations of breath.

 

Soaring and diving

dancing and waving

swishing and swaying

in tune with nature’s melody.

 

In harmony with leaves

synchronised with trees

to the sound of the beat

of Mother Earth’s heart.

 

In the final breath

a tender embrace

a grand gesture and bow

in thanks for the dance.

 

Book Magic

Books

“Books are a uniquely portable magic.” – Stephen King

Do you grieve for a book that you have finished? lament over the life you lived during the turning of pages – the passion, the pain, the joy and the hope? This brief (perhaps) experience is sometimes the perfect salve from the drama of our own lives. Pick up a book and live the life you want through the turning of the pages and the exploration of another known or indeed, unknown world.

“A reader lives a thousand lives before he dies . . . The man who never reads lives only one.” – George R.R. Martin

A ‘feel good’ romantic comedy may help soothe the soul; a classic, such as a Jane Austin, may leave us ladies sitting taller or behaving in a coyer manner whilst a Dan Brown book could leave us curious and pensive. The feeling will be based on your affinity with the book and should be cherished. A unique and personal relationship is developed with the characters and this lives on in us after the book has sung its final chapter.

Having read hundreds of books, some have long since been forgotten. A selection may be worthy of at least a second read and others best left at their place in time so as to avoid any marring of cherished memories. Whether to feed our spirit or to bathe in the art of relaxation, each book has a purpose and for that may we always truly love the magic brought to us with each turn of the page.

Ageing, Exercise and Neurodegeneration

by Tracey Evans 

Ageing is thought to be the highest risk factor for neurodegenerative conditions, such as dementia. Dementia is characterised by the progressive decline in cognitive functions and memory. WHO predicts that worldwide approximately 47 million people suffer with dementia, the most common form being Alzheimer’s disease and it is envisaged that this number is set to triple by 2030. In an era of increased longevity, what can we do to minimise the risk of developing dementia, a condition for which there is presently no cure?

Lifestyle choices are frequently cited as being a prerequisite for a number of neuronal and systemic disease processes. Lack of physical activity, dietary choices, alcohol consumption and smoking, each may singularly impart an increased mortality rate. Most likely the risk factors for dementia are multifarious and include factors other than lifestyle, such as genetics. However, any lifestyle choice that has an impact on the brain could potentially impact on the processes that accelerate neurodegeneration away from the normal ageing process.

Could exercise be a modifier of the ageing process by decreasing the risk of developing dementia and moderating the symptoms. It is already well established that moderate exercise has multiple benefits on our physiological and mental wellbeing. Growing evidence is now supporting a positive role for physical activity in both the ageing process and in a protective capacity in relation to dementia. Various studies have demonstrated that physical activity, in particular, aerobic exercise, may act to attenuate the risk of developing dementia and slow the process of cognitive decline. Patients with Alzheimer’s disease that exercise for one hour twice a week show a slower decline in activities of daily living (i.e. eating, bathing, dressing etc.) [1], walking in elderly men has been shown to reduce the risk of developing dementia [2] and finally, but importantly, those that exercised pre-diagnosis saw an increase in cognitive decline when they decreased their exercise levels when compared to those that maintained their physical activities [3].

Whether physical activity alone can alter the course of dementia progression or if other lifestyle factors also contribute, remains to be established. It is an intriguing concept that physical activity may either slow the development of cognitive changes associated with dementia, delaying the on-set of the disease or ultimately prevent the initiation of the pathology. In the meantime, exercise has many benefits that may protect the body during the advancing years and help alleviate some of the symptoms following diagnosis. Some of the benefits include:

  • Improved strength, core stability and flexibility
    • Strength and flexibility declines with age.
    • Falls and postural instability are observed in ageing and dementia-related conditions; strengthening and core exercise may temper this risk
  • Improved bone density due to weight bearing activities, such as walking and yoga
    • Bone density decreases with age, increasing the risk of fractures.
    • Reduces the risk of osteoarthritis.
  • The neurotransmitter release during exercise has a positive impact on our mental well being
    • Depression is often observed in conditions such as Alzheimer’s disease and Parkinson’s disease.
  • Exercise is important for cardiovascular health and prevention of other conditions such as type II diabetes and strokes.

 

Collectively, exercise leads to physiological, psychological and biochemical improvements. Exercise may not be a cure for dementia, but if followed during one’s lifetime it may ensure that the balance of a healthy lifestyle provides protection against some of the declines seen in ageing and the risk of developing a neurodegenerative condition. It cannot be excluded that there may be limitations in the ability to exercise due to pre-existing conditions or if the dementia is progressing the decline in cognitive function may preclude certain activities. In addition, there are still many unanswered questions and future research will establish the required duration, intensity and frequency required. In the meantime, I shall just tie up my laces and consider that I am keeping myself brain-fit as well as heart-fit.

 

  1. Rolland, Y., et al., Exercise program for nursing home residents with Alzheimer’s disease: a 1-year randomized, controlled trial. J Am Geriatr Soc, 2007. 55(2): p. 158-65.
  2. Abbott, R.D., et al., Walking and dementia in physically capable elderly men. JAMA, 2004. 292(12): p. 1447-1453.
  3. Soni, M., et al., Physical activity pre- and post-dementia: English Longitudinal Study of Ageing. Aging Ment Health, 2017: p. 1-7.

 

Top tips for essay writing

Obtain as much information relating the subject area as possible and then plan the essay. A good review article will provide a wealth of references and whilst controversial, Wikipedia will also provide a basic understanding and some useful references to explore further.

Plagiarism is not cool and it is simply not worth taking the risk, reference all cited information that is provided by others.

An essay follows a structured format: the introduction, the main body of the text and a conclusion:

Introduction

The subject of the essay is introduced clearly and succinctly. You will state the key points that will be discussed to address the essay topic or question, giving the reader a brief but clear understanding of the subject area and how you will approach it.

The introduction is not always written first but this is a personal choice.

Main text

The main body of the text will be built from paragraphs that will form an argument and/or discussion based on a review of the literature/material available on the subject area. A careful balance between presenting facts, your interpretation of the facts and the interpretation of others is required. You must ensure that all cited factual statements are appropriately referenced. Your argument will be carefully considered and you will demonstrate a critical analysis of the literature rather than the ability to recall facts.

The use of transition words, will allow the sentences and paragraphs to knit together seamlessly. For example:  firstly, in addition, moreover, furthermore or similarly, likewise, equally. These provide a connection between ideas and paragraphs enabling the reader to follow a logical argument.

Conclusion

This is aimed at drawing the whole essay together. Do not introduce any new ideas in the conclusion, it is a brief summary enabling the reiteration of the key points raised and areas that require further explanation or research.

Remember to include your reference list/bibliography and finally, pay attention to detail before handing your work in.