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Round Up Email December 2022

This month's Round Up highlights changes in evidence relating to dementia - from the ground-breaking trial involving Lecanemab to evidence relating to use of aspirin and exercise and effects on risk of subsequent dementia.

Question 1
Increased homocysteine levels and risk of dementia - increased plasma homocysteine level is a strong, independent risk factor for the development of dementia and Alzheimer's disease. Even in the absence of vitamin deficiency, homocysteine levels can be reduced by administration of high-dose supplements of folic acid and vitamins B(6) and B(12). Does trial evidence support the use of high-dose vitamin B supplementation reducing dementia risk?: Increased homocysteine levels and risk of Alzheimer's disease and dementia
1) With respect to increased homocysteine levels and risk of dementia, which statement is false?
- there is evidence that high-dose vitamin B supplementation reduces the risk of development of dementia
- increased plasma homocysteine level is an independent risk factor for the development of dementia
- even in the absence of vitamin deficiency, homocysteine levels can be reduced by administration of high-dose supplements of folic acid and vitamins B(6) and B(12)
Question 2
Lecanemab in Alzheimer's disease – the facts about this new therapy are summarised on GPnotebook.: Lecanemab in Early Alzheimer's Disease
2) With respect to Lecanemab in Alzheimer's disease, which statement is false?
- study evidence showed that Lecanemab did not reduce markers of amyloid in early Alzheimer's disease but resulted in moderately less decline on measures of cognition and function than placebo at 18 months
- the accumulation of soluble and insoluble aggregated amyloid-beta (Abeta) may initiate or potentiate pathologic processes in Alzheimer's disease
- Lecanemab is a humanized IgG1 monoclonal antibody that binds with high affinity to amyloid beta soluble protofibrils
Question 3
Benefits of exercise in reducing risk of dementia – Exercise reduces risk of development of dementia by about 50%. How many steps per day are required to reduce dementia risk? Is there an optimum number?: Exercise and dementia risk
3) With respect to exercise and reduction of dementia risk, which statement is false?
- with respect to steps and dementia risk, peak 30-minute cadence (ie, an indicator of overall best natural effort in a free-living environment) was not associated with lower risks of dementia
- the optimal dose to reduce dementia risk was estimated at 9800 steps per day
- in reducing dementia risk, intensity of steps, more than the mere volume of steps, is a potent purveyor of the clinical benefits of stepping
Question 4
Type 2 diabetes and dementia risk – the onset of dementia in people with type 2 diabetes is earlier than in comparable populations without diabetes – is the onset 18 months earlier, two and half years earlier, or three and half years earlier?: Diabetes (DM) and dementia risk
4) With respect to type 2 diabetes and dementia risk, which statement is false
- onset of dementia in people with T2D is on average 1.5 years earlier than in comparable populations without diabetes
- diabetes has been identified as a key risk factor for dementia and MCI (mild cognitive impairment)
- the duration of diabetes has been linked to grey matter atrophy (1% decrease for every additional 10 years)
Question 5
Association of air pollution and risk of dementia – this subject is summarised on GPnotebook.: Cognitive decline , dementia and air pollution
5) With respect to the association of air pollution and risk of dementia, which statement is false
- evidence base is adequate to allow direct quantification using a meta-analysis of epidemiological studies linking air pollution with cognitive decline or dementia
- epidemiological evidence is suggestive of an association between exposure to ambient air pollutants and both the risk of developing dementia and acceleration of cognitive decline
- evidence suggests that a small proportion of very small particles that are inhaled can enter the brain, both from the blood and via the olfactory nerves leading from the nasal passages to the olfactory bulbs
Question 6
Aspirin use and dementia prevention - daily low-dose aspirin has been shown to cause an 11% proportional decrease in the risk of major vascular events (including a 19% reduction in ischaemic strokes) but a 43% proportional increase in the risk of serious bleeding. However, the use of aspirin has not been shown to reduce dementia risk. For more information then see GPnotebook.: Aspirin and dementia
6) With respect to aspirin use in type 2 diabetes and dementia risk, which statement is false
- analysis of the ASCEND trial in adults with diabetes and no history of CVD found no statistically significant benefit for daily aspirin on development of dementia
- analysis of the ASCEND trial in adults with diabetes and no history of CVD found statistically significant benefit for daily aspirin on development of cognitive impairment
- primary cardiovascular disease prevention, daily low-dose aspirin has been shown to cause an 11% proportional decrease in the risk of major vascular events (including a 19% reduction in ischaemic strokes)

Round Up Email December 2022

Question 1

Question 2

Question 3

Question 4

Question 5

Question 6