Joan Presky is worried about dementia. Her mother lived with Alzheimer’s disease for 14 years, the last seven in a memory care, and her grandfather, her mother, also developed dementia.
“I am 100 percent convinced that this is in my future,” said Mrs Prasky, 70, a retired lawyer at Thornton, Colo.
Last year, he spent almost a whole day with a neuropsychologist, submitting an extensive evaluation. The results showed that her short-term memory was fine-which she found “shocking and comforting”-and that she was tested on average or on every cognitive category but one.
It is not reassured. “I saw what Alzheimer was,” she said of her mother’s long decline. “The memory of what passed is deep for me.”
The prospect of dementia, which includes Alzheimer’s disease and many other cognitive disorders, thus scares Americans that a recent study that is projecting sharp increases in cases over the next three decades has suffered huge attention to the public.
Researchers’ findings, published in January in medical nature, even appeared as a joke at the “Saturday Night Live” weekend.
“Dementia is a catastrophic situation and is largely related to older ages,” said Dr. Josef Coresh, director of The Optimal Aging Institute at Nyu Langone Health and the highest author of the study. “The bullet grows.”
Now the findings are challenged by other dementia researchers who say that while they are growing, they will be much smaller than Dr. Coresh and his co-authors predicted.
Using data from about 15,000 Americans over 55 years old, collected in four research clinics across the country from 1987 to 2020, Dr. Coresh predicted that the dementia of risk life much higher than previous studies had: 42 %, although most of this risk did not occur until the age of 85.
The highest number of life was likely to reflect the study of the study on a more different sample than previous researchers used, said Dr. Coresh and more dementia cases found through questionnaires, regular phone calls, medical records and certificates.
Researchers have applied their risk calculations to the US population and estimate that the number of people who develop dementia each year will double, about one million by 2060, from 514,000 in 2020.
Eric Stallard, an actress and co-director of the biodegradation of the Aging Research Unit at Duke University, read the study and believed that the team “seemed very capable of analyzing them” for individual risk.
But when it came to the point that the cases will be doubled, which assume that the frequency of dementia will remain steady in the next 40 years, “I don’t believe it,” Mr Stallard said.
“The idea that the number of people with dementia will double in the next 25, 30 or 35 years due to the aging of baby boomers is widespread. It is widespread – and is wrong,” he added.
He and two other Duke researchers recently published a comment on JAMA, pointing out that the age expert in the country had been steadily declined for 40 years.
“If your risks are lower than the dangers of your parents and this trend continues, you will not see the doubling or triplication of dementia that is predicted,” said Dr. Murali Doraiswamy, director of the DUKE neurogenic disorders program and a co-author of the article.
To be clear, experts agree that the number of people with dementia will rise in the coming decades, simply because the disorder increases so abruptly with age and the number of older adults in the United States will increase.
But Mr Stallard estimates that the increase will be more like 10 to 25 % by 2050. “It will still be a major challenge for the US health system,” he said.
The Duke Group was based on its own long -term study of people over 65 years old, with more than 21,000 respondents in 1984 and about 16,000 in 2004, as well as later data from the National Health and Pension Study and the national study of health and aging trends.
Their analysis found that between 85 to 89 years, for example, the percentage of dementia was about 23 % in the group born in 1905. To those born 10 years later, the number was reduced to about 18 %.
By the time the Americans born in 1935 arrived in the late 1980s, about 11 % had dementia. The projection for those born from 1945 to 1949 is now about 8 %.
For Dr. Coresh, whose primary interest was at an individual risk, the assumption that the previous reductions will continue in today’s pace “would be high, but it is a fairly optimistic, dramatic decrease,” he said in an email.
However, in another timeless study of older adults in England and China, published last year in the aging of nature, “we also found these fairly significant improvements to the latest born groups,” said lead author Dr. John Beard, Medical Epidemiologist at Mailman School of Public Health at Columbia University.
“One would expect that the increase in the absolute number of people with dementia in the US will be less than we were scared,” Dr. Beard said.
What led to a reduction in dementia, which was also observed in various European countries? Often reported explanations include increasing levels of training, reduced smoking and improved treatment for high blood pressure and high cholesterol.
The Lancet Committee on Dementia, Provision and Care has developed a list of 14 amendable risk factors, including greater use of hearing aids and reduced air pollution, which could lead to a greater reduction.
However, the reverse could also happen. If the number of dementia diagnoses increases earlier and more widespread tests or if the definition of dementia is expanded, the percentages will increase, Dr. Doraiswamy noted. Increasing life expectancy would have the same effect.
Obesity and diabetes, more common in recent decades, could lead to more dementia, but new drugs that reduce them could mitigate this trend-if people can take them.
“None of them are inevitable,” said Dr. Gill Livingston, a psychiatrist at College London University, who is leading the Lancet Committee. “It depends on what we do.”
Public Health Policy makes a significant difference, and noted, “the US is at a time when politics is changing huge.”
Rates of dementia may increase, for example, “if people have less access to health care, so they are less likely to cope with their blood pressure and high cholesterol,” Dr. Livingston said.
The decrease in Medicaid coverage could lead to this result. Therefore, a reinstatement of environmental policies, “if air pollution increases due to mineral fuels,” he added.
Already, dementia is affecting some American populations much more than others, the researchers said. Elderly women and blacks face greater risk, along with those with the APOE4 gene associated with Alzheimer’s disease.
Health inequalities could mean that “wealthy people will see lower rates of dementia” due to new diabetes and obesity drugs, Dr. Doraiswamy said. “People who cannot afford and whose conditions are not well managed will see rates go up.”
The debate on how many adults will develop dementia in the coming decades and how individuals, families, government and health care system should respond.
Thus, Mrs Presky’s fears.
For the time being, he enrolls in lifelong learning lessons, takes yoga walks and lessons despite orthopedic problems, listens to podcasts and reads a lot of history and fiction. She and her husband take the theater in New York and Phish concerts on the west coast and will soon head to London and Paris.
Still, its directive in advance contains many provisions on dementia. “I remain pessimistic,” she said, noting that her mother was diagnosed on 77. “I have seven years ago I met her fate.”
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