Q7 Dementia

Question 1

Dementia Definition

Answer 1

Dementia is an umbrella term for irreversible cognitive damage.
As we age cognitive damage is a natural process but in some cases can lead to more significant effects than others

Question 2

Dementia symptoms

Answer 2

Memory loss
Reduce movement and balance
Impaired judgement
Reduction in communication skills

Question 3

Alzhemimers

Answer 3

Most common type of dementia
Accounts for 50-60% of cases
Episodic memory loss and reduction in executive function

Question 4

Vascular dementia

Answer 4

While all Alzheimer’s cases are dementia cases not all dementia cases are Alzheimer’s.
The second most common type is vascular dementia.
Triggered by a stroke event causing irreversible damage. Progression of symptoms is step-wise with future stroke or mini stroke events

Question 5

Other types of dementia

Answer 5

Lewy body or front-temporal lobe dementia
Unique symptoms such as issue with alertness or change in personality.
Some individuals can have more than one dementia at once

Question 6

Pros of observational and dementia

Answer 6

Dementia is a longevity and complicated disease observational allows individuals to be followed throughout life in a cost effective manner
Gives context to research in a real world setting and so reflects day to day experiences individuals face
Observational studies are essential for finding a hypothesis to base RCTs off in the future

Question 7

Cons of observational and dementia

Answer 7

Face confounding factors and recall bias from participants.
Not possible to determine causation and mechanisms from observational

Question 8

Pros of RCTs and Dementia

Answer 8

Offer a causation and mechanism if confounding factors are accounted for.
More controlled environment and relies less on participant recall bias and so is more repeatable.

Question 9

Cons of RCTs and dementia

Answer 9

Participant selected often in groups of people that have already aged.
Mapt trial all participants over 70yrs

Question 10

Health and dietary patterns improve cognitive function introduction

Answer 10

Several different studies have looked at how nutrients may prevent dementia as it is on the most part incurable and medication techniques have been expensive and only work on in some of the dementia cases.
This has meant there is a push to reducing dementia cases overall through preventative mechanisms.

Question 11

FACIT Trial

Answer 11

One arm looked at how 800ug of folic acid may improve overall cognitive function.
Findings highlighted how the intervention performed significantly better on average than the control

Question 12

Pros of FACIT trial

Answer 12

Scientists were audited during cognitive tests. Showing care was taken for all participants to experience the cognitive test in same environment.

Question 13

Cons of FACIT trial

Answer 13

Cognitive function was not main aim of the trial
Tests selected not most appropriate and memory in a fatigued state was not tested.

Question 14

MAPT trial

Answer 14

Investigated how omega-3 supplements impacted individual cognitive performance
Consuming supplements of omega-3 had significantly less cognitive decline on COWAT score compared with controll

Question 15

Pros of MAPT trial

Answer 15

Designed to test cognitive functioning so testing was appropriate

Question 16

Cons of MAPT trial

Answer 16

Focused on participants over 70.
In many dementia cases by the age of 70 a patient has already developed the disease.
So trial showed benefits of omega-3 not useful for reducing dementia risk at a population level

Question 17

MED Diet

Answer 17

Shannon et al completed both observational and RCT trials on how med diet reduces risk of dementia

Question 18

EPIC Norfolk Observation trial

Answer 18

Found that greater compliance with med diet reduced risk of dementia.
Every 3 point increase of med diet score found 5 less years of cognitive decline

Question 19

Shannon Intervention study

Answer 19

Found same outcome and that physical activity also supported brain function later in life

Question 20

Cons to med diet

Answer 20

Clear benefits but it is a high cost diet and differs from what individuals may have as common dietary patterns
Food preference form during our early years so it might not be viable to implement later in life.

Question 21

Overall mechanisms for reducing cognitive decline

Answer 21

Protect neurone system
Protect blood brain barrier
Protect gut brain axis
Prevent DNA damage

Question 22

Folic acid mechanism

Answer 22

Reduces amount of homocysteine in brain
High levels of homocysteine are detrimental to cognitive function as it results in a build up of toxic beta-amylose and TAU which prevents DNA repair

In FACIT trial found individuals with low B12 levels or high homocysteine levels responded the best

Question 23

Omega-3 Mechanism

Answer 23

Vital role in formation of neuronal membrane
Pre-cursor for lipid metabolism and is anti-inflammatory
Inflammation often leads to many dementias such as Alzheimer.
Reduce inflammation protects overall neuronal tissue

Question 24

Med Diet overall mechanism

Answer 24

Contains many ingredients and nutrients that may be beneficial. Including omega-3

It is also high in fibre

Question 25

Fibre Mechanism

Answer 25

Improves gut health due to level of butyrate. Butyrate a nutrient for gut microbiome and so protects gut mucosal layer. Improve gut health it helps improve gut brain axis.

Question 26

Med diet and Nutritional Society Winter conference

Answer 26

The med diet has been shown to increase hippocampus and grey space in the brain which is suggested to be a cause for reducing dementia