An Interview with Professor Matthew Kiernan & Catherine Taylor: Making Dementia Controllable

Are you caring for a loved one with dementia? You don't have to figure this out all on your own. Welcome to Truth, Lies Alzheimer's, the show that helps you reimagine a new relationship with your loved one, a relationship a little more free of stress and anxiety. Join host Lisa Skinner and her 30+ years of experience as she guides you on a new path to a better relationship with those you care for. Here's Lisa.

Welcome back, everybody. As promised, I'm here with another brand new episode of The Truth, Lies Alzheimer's Show. I'm Lisa Skinner, your host, and the information I'm going to share with you today is focused on the current theory that have been studied over the decades. I know things are constantly changing, but this is based on current information. And this article was submitted by Katherine Taylor very recently, Monday, September 16th, 2024. So just what, 6 months ago? And it's entitled, With dementia cases set to triple by 2050 in our region, there are 14 risk factors to watch for. And based on all my research, this is the most current information that we're sharing with people and some of the ways to reduce your risk of developing Alzheimer's disease by implementing lifestyle choices based on these risk factors. A gentleman by the name of Professor Matthew Kiernan, a neurologist and expert in neurodegenerative diseases, is an unlikely hit at dinner parties. When you mention anything about dementia, Everyone is interested, he says, Riley. It's a thing that we're all engaged with, and it's a thing that scares a lot of people. I read recently that for people age 55 and older, it's the one thing that they are consistently most frightened about. Is developing Alzheimer's disease. But Kiernan believes medical science is on the cusp of an important shift that could see dementia cases fall as treatments improve and risk factors are better understood. He says that over the course of my career, heart attack and stroke have shown linear decline in Australia. Why is that? It's because we understood these conditions were linked to vascular risk factors, and when the risks are adequately treated, strokes and heart attacks become less common. Well, that stands to reason. So his question is, could dementia become a controllable disease too? And his response to that is, Without doubt. And that research is— was the co-author of research published in The Lancet Regional Health Western Pacific, and they explore the risk factors for dementia in an area that includes Australia, China, Japan, as well as nations in the Pacific and Southeast Asia. Once again, Cases of dementia are projected to nearly triple by the year 2050 in that region. But from my research worldwide, it is right now the number one cause of death for seniors in the UK, in the Netherlands, and in Finland, and the seventh leading cause of death in seniors in the US. And it accounts for one of the world's largest and fastest-growing older populations, accounting for more than 50% of global cases. So he goes on to explain the risks you expect and the ones that you don't. Many of the risk factors for dementia— being female is one of them. Growing older, and of course, the genetic lottery, as he calls it, those cannot be avoided. Those are what we call the non-modifiable risk factors. Australian actor Chris Hemsworth learned in 2022 that he carries two sets of the gene APOE4, one from each of his parents. Making him 10 times more likely than average to develop Alzheimer's disease. Now I just want to add in, does that mean he will? No, it does not. But according to these statistics, it does increase his risk 10 times more than somebody who does not carry the two APOE4 genes. For someone aged 60 to 64 in Australia, The risk of dementia is now about 15 in 1,000, rising to 429 per 1,000 for those 90 years or older. All around us right now, a little over 40— 410 Australians are living with the 4 main forms of dementia: Alzheimer's disease, vascular dementia, frontotemporal dementia, and Lewy body dementia caused by Parkinson's disease. As Australia's population ages and expands, this figure is predicted to double by 2050. It is a reality that in particular poignant for women. Dementia is the leading cause of death for women. Who make up 63% of dementia cases in Australia. So very high, very high. One of the keys to reducing the odds of developing dementia is addressing 14 modifiable risk factors that can be tackled with lifestyle changes or medication and can be effective in preventing or delaying the onset of dementia in as many as 45% of cases. This is an updated statistic from what I more recently have researched, which was up to 40%. So it's now been increased to 45% of cases, not for everybody, but in some cases. The goal is to prevent the epigenetic changes that cause certain genes and chemicals to spring to life and drive the development of dementia. Many of the 14 risk factors are going to sound pretty familiar. These are some of them: excessive alcohol consumption, obesity, hypertension, smoking, diabetes, high LDL cholesterol, air pollution, and inactivity. Experience a traumatic brain injury is one of the other risks. The impact of a further— of further 4 risks based on studies and scientific research: differences in education in early life, social isolation, vision and hearing loss, which I know I've talked about before, but it still may surprise some of you. But the explanation is relatively straightforward. The more stimulation your brain receives, the more neural connections it makes, and the better placed it is to delay the impact of cognitive decline. Why? Because the more brain stimulation your brain receives, the more cognitive reserve is built up in your brain. And cognitive reserve is synonymous with protecting your brain. We know this. This is not new. Now, untreated depression is on that list. Another worrying risk factor driving dementia that appears on the list for the first time is depression. We saw that during COVID Growing rates of depression alongside dementia diagnoses driven by aging population are the perfect storm, Kieran says. The exact pathway that leads a person to develop depression is complex and not fully understood. But research does suggest part of the picture is inflammation, —of certain circuitry in the brain and damage from this inflammation may be what's driving the onset of dementia. Depression is a major modifiable risk factor for dementia, and treating depression more effectively through medications, therapy, and lifestyle changes could in fact reduce dementia risk, he believes. Psychiatric medicine is also hard at work finding solutions, and psychiatry is trialing anti-inflammatory treatments such as monoclonal antibodies that suppress the immune system to help treat dementia. That's where the field is now, and this research is just starting off. Mr. Cairnen says. We know from huge epidemiological studies that some of the inflammatory treatments are helpful, but we need more investment. There has been a 46% leap since 2014 in prescriptions issued in Australia to treat dementia. Four medications are routinely prescribed. However, there's always a however. There is not yet a magic pill available that can stop or reverse the condition. But Kiernan says promising new candidates are soon to hit the market, and the approach to dementia treatment is now very much in a therapeutic era. But based on recent information that I shared with you all, We have to figure out what causes it first, right? But according to his belief, that's why it's exciting. And he thinks the message to get out there is that these conditions are treatable. We don't know how though, right? The liver's powerful influence over our brains. This is really interesting. If you follow the Parramatta River west from Sydney's CBD, you'll reach the ANZAC Research Institute, where scientists and University of Sydney lecturer Nick Hunt, who leads the biogerontology group, is researching what's known as the brain-gut axis and how metabolic disease that leads to conditions like diabetes also affects our dementia risk. Hunt's team is researching new treatments that are delivered to the body using quantum dot nanoparticles. The liver, he says, is one of the main metabolic hubs of the body. The best way to think about it is a giant cleaning system for your blood, he says. Its job is to produce glucose, sense our insulin requirements, look at the nutrients it's got, and balance that relationship. Your ability to clear bad materials is the main challenge, and failure to do so is a potential accelerator for dementia. In fact, recent research suggests that as many as 1 in 8 people diagnosed with dementia may in fact be suffering from liver diseases such as cirrhosis of the liver. If the liver damage has not progressed too far, it is theoretically possible that symptoms of cognitive decline would disappear with treatment. For Hunt, diabetes research holds great promise in reducing the future development of dementia because The brain is one of the body's most important users of glucose. Conditions that reduce liver function, like diabetes, can quickly impact the brain. Diabetes is not just a condition that affects muscle or fat or the liver, Hunt says. That same glucose imbalance can happen in the brain as well. The pattern is so established that some actually want to give it the name type 3 diabetes. They want to give dementia— it has— it is referred to as type 3 diabetes by some scientists. I've read that many, many times. But the theory is that if there's too much insulin in the brain, the same enzyme that should be clearing amyloid beta, the substance that can build up causing Alzheimer's disease spends its time instead clearing the insulin. According to the amyloid beta hypothesis, that continual buildup of protein causes a lot of those Alzheimer's symptoms, he says, but the science is not proven. Research recently undertaken by the ANZAC Institute suggests an important role for the kidneys in clearing amyloid beta. However, new diabetes drugs that improve insulin sensitivity can help Alzheimer's patients by treating underlying metabolic issues. Ann Hunt says there is growing evidence that diabetes drugs like Ozempic, also now used for weight loss, may have potential as a treatment for Alzheimer's disease, with Phase 3 clinical trials already underway. That is really exciting. Can we reduce the risk to our kids? Whatever the outcome of research into treatments and risk factors, the bottom line for most people is ensuring that the next generation has less risk of developing dementia than the ones that came before. While parents are used to the message of avoiding obesity in children by promoting healthy diets, They are not used to the poor food choices they might make for their children could set them up for dementia when they are 65 or 75 years old. Nick Fuller, who is an expert in metabolic health at the University of Sydney's Charles Perkins Centre, says a cluster of metabolic illnesses including high blood pressure, high cholesterol, and elevated blood sugar can increase the likelihood of developing dementia by 12 to 30%. He says that is powerful and impactful. Whose new book, Healthy Kids, aims to teach parents how to pass healthy food, exercise, and sleep habits to their children. And cut the risk factors for developing this disease. A family with young children, particularly under the age of 5, has a golden window. This is, this is profound. Has a golden window to shape their food preferences for the rest of their lives. But too often we are giving into food demands. If you retain any doubt about the value of locking up the treat cupboard, then this British research might change your mind. It tracked 3,069 participants from the age of 4 years old to 70 years old. Only 8% of people who ate what was considered to be low-quality diets retained high cognitive ability at age 70. Of those who ate high-quality diets, 93% retained high cognitive ability. It's quite challenging to navigate the food environment because our favorite foods are on every corner of every block screaming out to us, "Eat me, eat me," every time we smell or see them. We are releasing dopamine, Fuller says. Regularly indulging in processed and packaged food switches on our hedonic reward pathway, making it harder to say no. Too many calories lead to a growing waistline, and before you know it, you're clinically diagnosed as being overweight or obese, then with metabolic syndrome, then type 2 diabetes and heart disease. He argues that while diet and exercise are vital in keeping metabolic syndrome in check and preventing the development of insulin resistance, sleep, they found out, is also essential. A good night of rest can help with mood the next day and make us more likely to make healthy food choices. Recent research has linked a diet of 2 or more weekly servings of processed meat from bacon and sausages to hot dogs and salami with a 14% greater risk of dementia. That's pretty scary. And this is likely because these foods are associated with causing inflammation, which in turn is linked to brain aging. Eating better is linked to be— to a lowered risk because it also lowers the incidence of high blood pressure and other conditions that are known to boost our dementia risk. And research also suggests that the amount of sleep you get is linked to our dementia risk. We're finding this out. Sleeping less than 6 hours a night when you are in your 50s and 60s, or oversleeping during those years, has been found to increase the risk of developing dementia by a whopping 30%. Disturbed sleep is believed to be one of the reasons why those with sleep apnea are known to be at a greater risk of developing dementia. So what should we do? If you're wondering how you can get started on reducing the risk of a future dementia diagnosis, then it doesn't have to be hard work. Saying yes to a dinner party invitation, eating well, of course, learning something new, And dosing up on social interactions is just the kind of lifestyle medicine that can actually help cut our dementia risk. If your hearing is a bit dodgy, then hooking up some hearing aids to keep brain pathways firing is the way to go. And you could do worse than ending the day with some quality shut-eye which will also allow the brain to reset and rid itself of amyloid beta buildup, which is found in Alzheimer's patients. Alongside new drug developments, the landscape for treating dementia is significantly changing. And says Professor Kiernan, this is incredibly exciting. So that's just another perspective on what we can do to lower our risk of developing dementia. And I love the way he presented the information. It makes so much sense. It goes into detail, gives us great examples of the things that we can easily do. And make a difference in our lives in 20 years, 30 years, 40 years, 50 years. Just by doing these things, it can mean the difference to all of us as to whether or not we end up with Alzheimer's disease or a healthy brain. I think that's worth chewing the fat over, no pun intended. So, This concludes this episode for the Truth Lies in Alzheimer's show. I'm Lisa Skinner, your host. And as always, I will be back next week with another new episode. So stay tuned. We never know what it's going to be about. I'm going to spend the next week researching something really fun and exciting for everybody to bring you the latest and greatest information. That pertains to living with these brain diseases that causes dementia. So my wish for everybody is to have a great rest of your week. Take good care of yourselves and each other. I hope that you'll all be back for another new and exciting episode of The Truth Lies in Alzheimer's Show. Take care and bye-bye for now.

Thank you for listening to Truth, Lies Alzheimer's. We hope you found something in today's episode that helps. We understand that caring for a loved one with dementia can be the challenge of a lifetime, but you don't have to do it alone. If you're ready for exclusive access to even more great content and resources, head on over to Facebook and join Lisa Skinner's Lisa Skinner's Minding Dementia support group. We're a community of like-minded caregivers, and we're here to help.