Q & A: Lowering Dementia Risk—What’s the Evidence?
BrightFocus Asks Dr. Kristine Yaffe
Kristine Yaffe, MD, a past grantee of the BrightFocus Alzheimer's Disease Research (ADR) program, is an expert on modifiable risk factors for Alzheimer's disease (AD) and other forms of dementia. Read more about Dr. Yaffe’s research at the end of this interview.
Q. We’ve been hearing about ways to reduce our risk of Alzheimer’s—is this idea being hyped, or is the evidence for real?
A. I do think that the evidence for lifestyle changes is more than just hype. The data are accumulating from a growing number of observational studies and clinical trials. It is true that we need more studies to understand who to target and how best to address lifestyle change, but overall the data have been consistent for a number of modifiable risk factors.
Q. Some evidence points to a 25-50 percent reduction in cognitive decline or Alzheimer’s risk from things like exercise, diet, and multiple lifestyle changes.* Would these results be convincing in a drug trial?
A. Such response rates are convincing, particularly because currently approved drugs for AD are very modestly effective. And more importantly, lifestyle changes are something that can be done right now while we’re waiting for the development of more effective drugs.
Q. Why then aren’t “lifestyle” factors taken more seriously?
A. It’s possible that taking a pill daily may be easier than changing lifestyle behaviors. Also, just considering the effects of individual lifestyle behaviors may not seem as powerful as a drug, but our research suggests that the greatest impact will come from addressing modifiable risk factors as a group.
Q. When should people begin to make changes, like exercising, eating, and sleeping right? Can everyone benefit?
A. Our findings seem to suggest that for some lifestyle behaviors, it’s never too early. Some of our recent work in a cohort of middle-aged adults suggests that a brain-healthy lifestyle is important even in early adulthood. In a study of older women, we found that physical activity in adolescence was beneficial for cognitive health in late life, but women who were physically activity later in life also benefitted.
Q. Ultimately, is a combination of drugs and lifestyle changes going to be needed?
A. It’s very likely that the prevention of AD and other adverse cognitive outcomes will be similar to the model for heart disease prevention, and lifestyle changes will be coupled with effective drug therapies.
Q. What are some of the newest developments that you’re hopeful about?
A. The latest developments from multidomain trials [like FINGER and MAPT*] are very exciting. These studies are demonstrating the importance of a multi-pronged approach for AD prevention and targeting several modifiable risk factors as a group.
Q. You must be incredibly busy with research and the hundreds of articles you’ve published on this topic. And don’t you also see patients? What drives you to work so hard against this disease?
A. I see patients and run a memory evaluation clinic. It's my direct work with these individuals that helps drive my research so that we can better understand AD and help improve the health of our patients.
Q. Will you continue your research into AD risk factors? Do you see this as your life’s work?
A. Understanding AD risk and prevention is a major part of my research on brain health and aging. I believe that prevention is a key component of reducing the burden of AD for both individuals and society and I will continue to concentrate my efforts on addressing this critical public health issue.
Kristine Yaffe, MD, a past ADR grantee, is renowned for clinical and basic research into the impact of cardiovascular disease, diabetes, depression, poor sleep, post-traumatic stress disorder, and other conditions on Alzheimer’s risk. A neurologist and psychiatrist by training, Yaffe is a professor at the University of California, San Francisco, and is chief of Geriatric Psychiatry and director of the Memory Evaluation Clinic at the San Francisco Veterans Affairs Medical Center. Along with research, teaching, and seeing patients, she has published more than 350 peer-reviewed articles on modifiable Alzheimer’s risks. With a 2010-14 ADR grant, Yaffe investigated the impact of diabetes on cognitive aging (see publications at end). She currently serves on the ADR Scientific Review Committee.
READ MORE ABOUT HER RESEARCH
Science News Article
BrightFocus ADR-Funded Research
Yaffe, K, Lindquist K, Schwartz A, et al.. Advanced glycation end product level and accelerated cognitive aging: findings from the Health ABC Study. Neurology. 2011.
Falvey, C, Rosano, C, Simonsick, E, Harris, T, Strotmeyer, E, Satterfield, S, Yaffe, K. Macro and micro-structural MRI changes associated with diabetes in non-demented older adults. Diabetes Care. 2013
Yaffe K, Falvey CM, Hamlton N, et al. Association between hypoglycemia and dementia in a biracial cohort of older adults with diabetes mellitus. JAMA Intern Med. 2013. Read our press release.
Yaffe K, Falvey CM, Hamilton N, et al. Diabetes, glucose control, and 9-year cognitive decline among older adults without dementia. Arch Neurol. 2012.
James BD, Leurgans SE, Hebert LE, et al. Contribution of Alzheimer disease to mortality in the United States. Neurology. 2014.
Yaffe K, Vittinghoff E, Pletcher MJ, et al. Early adult to midlife cardiovascular risk factors and cognitive function. Circulation. 2014. Read our summary.
Goveas JS, Rapp SR, Hogan PE, et al. Predictors of optimal cognitive aging in 80+ women: The Women's Health Initiative Memory Study. J Gerontol A Biol Sci Med Sci. 2016. Read our summary.