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After cancer, Alzheimer’s and other pathologies linked to dementia are the diseases which frighten Europeans the most in the polls. This is not surprising, because the irreversible decline of intellectual capacities is obviously an absolute tragedy for patients and their loved ones. However, the trend could be reversed. The public health institute Sciensano released figures at the beginning of December that caused a stir: dementia has become the leading cause of death in Belgium. Tied, in fact, with coronary heart disease, the most common form of heart disease. But while the latter are less and less frequent (-43% since 2004), dementia is more and more so (+ 74%). Today, it kills more people than cancers of the lung, trachea and bronchi combined, or any other cancer, as well as cardiovascular diseases, including strokes.
“The most important risk factor is that of age”, asks the professor of biomedical sciences (UCLouvain) Jean-Noël Octave. The aging of the population therefore naturally leads to an increase in the number of patients. “At age 65, the prevalence of the disease is around 2%. It is similar to Parkinson’s disease or any other neurodegenerative disease.” After the age of 65, the prevalence doubles every 5 years. “There is a one in three chance of getting Alzheimer’s at the age of 85.”
Four forms of dementia
70% of dementia cases involve Alzheimer’s disease. Three other forms exist: “Lewy body” dementia, a dementia similar to Parkinson’s with symptoms of tremor, vascular dementia following a stroke which damages brain tissue. Finally, frontotemporal dementia, a neurodegeneration that affects the frontal and temporal lobes, and leads to a change in personality.
An environmental cause
Aging is not the only explanation for the increase in deaths from dementia. This is all the more true since, according to the WHO, 9% of cases are “early”, that is to say that the first symptoms appear before the legal retirement age. Studies point to many risk factors. For example, people with low levels of education are 60% more likely than someone without this risk factor to develop dementia before age 45. Hearing loss, head trauma, hypertension, obesity and even consumption alcohol (more than 21 glasses per week) increase the risks during middle life (45-65 years) while depression and anxiety, also on the rise following successive crises, the consumption of tobacco, social isolation, diabetes or physical inactivity increase this risk factor after age 65. In addition, the disease can be hereditary and linked to genetic mutations.
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New studies tend to prove the impact of atmospheric pollution on the rise in cases of dementia. According to a summary of 70 studies published by a British health agency, cognitive decline in the elderly is likely to be accelerated by exposure to atmospheric pollutants such as fine particles. These were already a risk factor for cardiovascular and pulmonary diseases. They are also responsible for 10% of cancers in Europe. “The results are heterogeneous with respect to other cognitive domains such as executive functions, attention, memory, language and mild cognitive impairment. Particles can affect the heart and blood vessels, including the brain”, write the researchers. Other studies, notably from the American Alzheimer Association, converge. Research from the University of Western Ontario has linked dementia to the amount of road traffic in the region. According to this, the risk would be increased by 3% for each increase in exposure to fine particles (“PM 2.5” type) caused by road traffic of one microgram per cubic meter.
Slow advances in research
On the treatment side, research is still in its infancy. “We are progressing more slowly than for cancer for example, because it is approximately twenty times less funded”, concludes the Leuven professor. All the same, a new American-Japanese drug (Lecanemab-Eisai) in particular was presented. It would reduce the cognitive decline of patients by 27%. And to remove the amyloid plaques, responsible for the typical lesions of Alzheimer’s disease. It would pave the way for better care in the future, but on a relatively distant horizon all the same. No specialist dares date the day when we will be able to “cure dementia”, as doctors do today for cancerby 2030.
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“Currently, there is no treatment that can cure dementia or change its course. Multiple new treatments are currently being tested in various stages of clinical trials”, confirms the WHO. In the meantime, the Organization advises to act by prevention. “Studies show that you can reduce the risk of dementia by exercising regularly, not smoking, avoiding the harmful use of alcohol, controlling your weight, eating a healthy diet, and maintaining healthy levels of blood pressure, cholesterol and blood sugar.“For us, the problem would be crowned with a political stake. Faced with the figures from Sciensano, the Alzheimer League Flanders is calling for a national framework, a “dementia plan”, similar to the Cancer Plan. However, she notes that the latter seems difficult to implement, because if doctors, hospitals and the reimbursement of treatment depend on the federal government, rest and care homes, carers and care for the elderly are the responsibility of the communities. But everyone should work hand in hand.