Wolfson Memorial Lecture explores dementia prevention

The residence system is an essential part of student life. As part of its efforts to improve and innovate, Professor of Clinical Neurology and the director of the Dementia Research Centre at the University College London in the United Kingdom (UK), Nick Fox, presented the 11th annual Wolfson Memorial Lecture on the University of Cape Town’s (UCT) medical campus at Groote Schuur Hospital on Thursday, 3 November.

The lecture was established in 2012 in honour of the late Lord Wolfson of Marylebone, who was the founder and former chairman of the Wolfson Foundation. In line with the foundation’s interest in championing science and health through education, the memorial lecture focuses on developments in various fields, including healthcare, engineering and climate science.

“The Wolfson Memorial Lecture highlights key global research in areas with immense social impact. UCT is proud to honour our strong partnership with the Wolfson Foundation and our shared commitment to the pursuit of excellence in education and research,” said UCT Deputy Vice-Chancellor for Research and Internationalisation Professor Sue Harrison.

This year’s instalment of the lecture was entitled “Preventing Dementia: Opportunities and Challenges” and focused on the causes and predictors of dementia as well as the possibility and advantages of presymptomatic treatment of the syndrome.

Professor Fox, who is an active consultant neurologist at the National Hospital for Neurology and Neurosurgery in London and a founding member of the UK Dementia Research Institute, is the global authority on dementia.

With interests in young onset and familial dementia, Fox’s research has focused on improving diagnosis in dementia as well as using imaging and biomarkers to assess novel therapies.

Lost connections and societal impact

Opening the lecture, Professor Harrison noted the importance of Fox’s work for neurology specialists and dementia patients in Africa. “Today we are going to focus on a growing health concern in Africa, which is Alzheimer’s disease and other forms of dementia.

“Worldwide, dementia is the fifth leading cause of death. The World Health Organization estimates that, by 2050, 150 million people will be living with dementia. This is an increase of 204% from 2017 and health practitioners predict that most of the increase will be felt by low- and middle-income countries in Africa,” she said.

Adding to this, Fox emphasised the impact that dementia has both on an individual and societal level and highlighted the opportunities that a better understanding of the syndrome present.

“Dementia is a disconnection on so many levels. It’s a loss of connection between the neurons, of which we each have 80 to 100 million that each have thousands of connections. They are the essence of what makes us a thinking human,” he explained.

“There is remarkable complexity, but also remarkable sensitivity to damage and degeneration. The loss of these connections leads to dementia and dementia leads to a loss of a whole lot of other connections.

“We lose connections with our past; our memories that make us who we are. We lose connections with our ability to do arithmetic, spelling, reading. We lose employment ability. Worst of all, the ultimate connection we lose is with people. So, it is a challenge, but it’s one worthy of a lot of effort.

“We need to improve diagnosis, care, support and treatments – the impact on health and social justice cannot be understated.”

“There is a new diagnosis worldwide every three seconds, most of which will have long courses and increasing dependence. The impact of this goes well beyond the individual; both families and society are adversely affected,” he added.

“A quarter of all hospital beds in the UK are occupied by dementia patients and more than three-quarters of those in residential care are affected by it. As our populations age, these numbers will increase dramatically. We need to improve diagnosis, care, support and treatments – the impact on health and social justice cannot be understated.”

The outlook for South Africa

According to Fox, when it comes to dementia, “The shape of a population [in terms of age distribution] determines the future.” This idea is well supported by research, volumes of which show that the risk of neurodegenerative diseases increases exponentially with age. In fact, the prevalence of dementia doubles for every six years of age over 65.

This presents a challenge for low- and middle-income countries like South Africa. While these nations are seeing positive increases in life expectancy, this brings with it the issue of increased prevalence of dementia. Current projections show that there will be 132 million people with dementia worldwide by 2050, 70% of whom will live in low- and -middle income countries.

“Population growth and the increase in life expectancy means that there’s been an increase in the number of people in South Africa from 3.5 million to over 5 million in the past 20 years,” Fox pointed out.

“The shape of the South African population [with a large portion between the age of 20 and 40] means that it’s not just the people in their 50s and 60s that we need to be concerned about. The life expectancy of people in their 30s and 40s means that those people will go on to be the ones with a high risk of dementia.”

The era of dementia prevention

Although these statistics may paint a grim picture for low- and middle-income countries, Fox pointed out that there is plenty of hope. “We have entered the era of prevention of dementia,” he said.

He said that there are multiple avenues for addressing dementia. Primary prevention would focus on defending against the onset of dementia pathology and could include population-wide interventions such as vaccines or those aimed at specific risk groups.

Secondary prevention, on the other hand, is aimed at early detection and treatment to prevent the onset of the effects of dementia. Here, individuals can be screened for early signs of the syndrome using brain imaging, analysis of cerebrospinal fluid markers, blood-based biomarkers as well as Alzheimer’s disease markers.

This proactive approach helps to ensure that the pathology is detected before dementia symptoms arise and creates enough time to alter the trajectory of the syndrome through effective treatment.

“Anyone looking to lower their risk of developing dementia should aim to eat a well-balanced diet, get regular exercise, avoid excessive alcohol consumption and smoking, and keep their minds active.”

While dementia detection and treatment have both progressed in leaps and bounds over the past 20 years, there are still major gaps in the research around the drivers of dementia in African patients.

Harrison highlighted that this is a challenge that UCT researchers are working to overcome. Through various projects, researchers hope to improve the diagnosis of the syndrome, especially in the context of low-income countries and environments where HIV prevalence is high.

Although the causes of dementia are multiple and vary with age and geography, there are a variety of predictors that can be used to accurately establish whether an individual is likely to develop the syndrome. These include gender, family history and genetics, HIV and other infections, repeated head trauma, vitamin and hormone deficiencies, and alcohol abuse.

As such, anyone looking to lower their risk of developing dementia should aim to eat a well-balanced diet, get regular exercise, avoid excessive alcohol consumption and smoking, and keep their minds active.