Middle-aged People Have Up to 20-Year Window to Reduce PD Risk, Oxford Health Policy Report Says

Oxford Health Policy Forum

In calling for a public health campaign to promote a brain-healthy lifestyle, an Oxford Health Policy Forum report says people in middle age have a 10- to 20-year window of opportunity to potentially reduce the risk of developing neurodegenerative diseases such as Parkinson’s (PD), or to delay progression.

“The process of neurodegeneration begins many years before symptoms appear, and it may take years for an at-risk individual to progress through the presymptomatic and prodromal disease phases until a clinical diagnosis can be made,” the report’s executive summary said.

Called “Time Matters: A Call to Prioritize Brain Health,” the report condenses published evidence and the consensus findings of a group of international multidisciplinary experts. It’s meant to encourage individuals to prioritize their own brain health, and to challenge policymakers, scientists, medical professionals, and organizations that fund research and programs to collaborate in planning for healthcare structures.

Focusing on Parkinson’s as well as Alzheimer’s disease (AD), the report summarizes key risk factors for both disorders, and discusses how lifestyle changes can improve brain health. It also explores challenges to the introduction of population screening-type programs — successful in some areas of medicine, including cancer — in neurodegenerative diseases, noting the potential for false positive test results that can cause undue anxiety.

To prepare for future scientific advances, the publication calls for continuing the search for effective diagnostic tools, biomarkers, therapeutic targets and treatments. In addition, it promotes “big data” as a way to help identify links between brain diseases and causative factors, which could advance drug target identification. The report also concludes that wearable technology could be increasingly useful in tracking disease courses and in personalized healthcare.

Because lifestyle changes have been shown to improve both cardiovascular and brain health, the report recommends wide public-health dissemination of the message, “What’s good for your heart is generally good for your brain.” And since healthcare professionals and administrators will continue to play key roles in disease management, they should make sure that individuals are referred to specialists and get follow-up care referrals that includes multidisciplinary services, holistic care, prevention information, and treatment options, the publication said.

The 47-page report also includes a host of research recommendations, including understanding that people’s awareness of their risks for neurodegenerative disease may motivate them to change behaviors. Researchers should also learn how best to support those changes, it said.

“We cannot change our genetic make-up, but we can help reduce the risk of developing neurodegenerative diseases ourselves by taking exercise, keeping socially active, eating healthily, reducing alcohol intake, stopping smoking and keeping our brains active,” Alastair Noyce, co-chair of the report’s author group, and a professor at Queen Mary University of London, said in a press release.

As people live longer, neurodegenerative diseases such as Parkinson’s are becoming more common — and presenting a growing socioeconomic burden. But such diseases are not an inevitable consequence of normal aging, said Gavin Giovannoni, author group chair and also a professor at Queen Mary.

“Planning for the healthcare structures of the future has to start now if we’re to avoid a crisis,” he said.

The report’s 10 primary writers are from the U.K., the U.S., the Netherlands, Germany, Australia, Belgium, Switzerland, and Luxembourg. It was funded through educational grants from biotechnology company Biogen and multinational healthcare company F. Hoffmann-La Roche.

The Oxford Health Policy Forum works to develop and support initiatives aimed at improving global public health, particularly in areas of unmet medical needs.

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Lifetime Risk of Developing Parkinson’s Similar Between Women and Men, Study Reports

lifetime risk

One in two women and one in three men older than 45 will develop Parkinson’s disease, dementia or stroke during their lifetime, a new study suggests.

Preventive strategies to delay disease onset can reduce this risk by up to half.

The study with those findings, “Lifetime risk of common neurological diseases in the elderly population” was published in the Journal of Neurology, Neurosurgery & Psychiatry.

Parkinson’s disease, dementia and stroke are among the leading causes of mortality and disability in older individuals. In fact, the diseases often co-occur. Parkinson’s disease and stroke patients are at increased risk of dementia, and patients with dementia at increased risk of stroke.

Researchers from the University Medical Center Rotterdam, The Netherlands, assessed the lifetime risk for dementia, stroke and parkinsonism in middle-aged and elderly men and women between 1990 and 2016.

They followed 12,102 individuals (57.7% women) aged 45 or older who were free from these diseases at baseline (beginning), and enrolled in the Rotterdam Study, a prospective population-based group. Participants participated in full medical check-ups every four years.

After 26-years of follow-up, 1,489 individuals were diagnosed with dementia, 1,285 with stroke, and 263 with Parkinson’s disease. A total of 438 individuals were diagnosed with more than one disease.

The overall lifetime risk to develop any of these conditions for a 45-year-old was 48.2% in women and 36.3% in men.

This difference was due to a higher risk of dementia as the first manifesting disease in women rather than men (25.9% vs 13.7%, respectively), while the risk for stroke (19.0% vs 18.9%) and parkinsonism (3.3% vs 3.6%) was similar between the sexes.

Moreover, this risk increased with age – between the ages of 45 to 65 years this risk ranged from 2.6% for women and 3.2% for men. After that, and until the age of 95, up to 45.8% of women and 35.3% of men were at risk.

“At age 45, first manifestation of stroke posed the highest lifetime risk for men (18.9%). Dementia posed the largest risk for women (25.9%), which was significantly higher compared with that for men (13.7%),” researchers wrote.

The lifetime risk for Parkinson’s was similar between women (4.3%)  and men (4.9%).

Strategies that delay disease onset between one to three years could reduce the lifetime risk for developing any of these diseases by 20% in individuals 45 and older, and by more then 50% in the oldest members of that group.

“Even a delay in onset for a few years of only one disease could already result in substantial reductions for the combined lifetime risk of developing any of these diseases,” researchers wrote.

“These findings strengthen the call for prioritizing the focus on preventive interventions at population level which could substantially reduce the burden of common neurological diseases in the aging population,” they concluded.

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