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It is estimated that someone in the world develops dementia every 3.2 seconds. In Utah, 34,000 people aged 65 and older were living with Alzheimer's or dementia in 2020, and the number is expected to grow to 42,000 in 2025. While a cure continues to elude doctors and scientists, the push is on to identify new strategies and treatments that might work to prevent or delay the onset of the disease.
"If we can delay the onset by even a couple of years, the number of people who will develop dementia goes down by the millions," said Mark Supiano, MD. "If you just delay the onset long enough and push that diagnosis out far enough, people are going to die of other conditions before they develop Alzheimer's disease. So that is why the preventive approach is so critical."
Supiano is a geriatrician in University of Utah Health's Geriatrics Clinic and director of the University of Utah Center on Aging. His assessment of the importance of measures designed to reduce the risk of developing dementia is based on decades of research and care for a population of aging patients.
Over the years, Supiano has served as an investigator in a series of studies designed to determine if drug and behavioral modifications in the treatment of common health conditions might lower the risk of developing dementia. Among these is his involvement in the Systolic Blood Pressure Intervention Trial, or SPRINT Study.
"SPRINT demonstrated that treating to lower blood pressures was associated with a reduction in mild cognitive impairment," Supiano said. "So, it was really the first evidence that lower blood pressure was not only good for the heart but good for the brain." These results sparked Supiano's interest in further exploring the connection between vascular health and brain health.
This year, Supiano and research colleagues from around the country are conducting a nationwide long-term study called PREVENTABLE (Pragmatic Evaluation of Events and Benefits of Lipid-lowering in Older Adults). The study was launched in 2020 and continues to recruit up to 20,000 participants aged 75 and older who are healthy and not currently taking a statin to lower high cholesterol, treat heart disease, and/or diabetes.
Some evidence shows that statins might be useful in lowering the risk for dementia and/or slowing its progression. But more data is needed to compare those on the drug with those who are not taking it. The PREVENTABLE study was funded with the goal of clearing up these critical uncertainties.
"After five years, the study's primary outcome is whether statin use will result in an improvement in survival free of either dementia or disability," Supiano said. There is an opportunity to recruit more Utahns into the study. "Recruitment started during COVID-19, and just under 7,000 participants are currently enrolled." Supiano emphasized, "It's already the largest study of people 75 and older ever. So, there's just an incredible amount of information that is going to emanate from this study."
PREVENTABLE is a pragmatic study that makes participation by older adults easier since it uses new methods to connect researchers with participants where they live and on their schedules. Study participants' health records are reviewed electronically and through phone calls and home visits. The drugs involved, whether they are statins or placebos, are mailed directly to the participant's home. Supiano asked those who might be interested in joining the study to visit the PREVENTABLE website at https://www.preventabletrial.org/home.cfm. In addition, there is a central recruitment screening phone number at 833-385-3899.
Supiano also discussed the potential link between sedentary behavior and dementia, long an open question that he and other geriatricians are eager to answer. A recent study published in the Journal of the American Medical Association (JAMA) suggests that people who sit for long hours at work and home are at higher risk of developing dementia than those who engage in movement throughout their day. But, Supiano believes that study was seriously limited by its reliance on hospital and death records for the diagnosis of dementia.
When it comes to getting solid answers about sedentary behavior's impact on the development of dementia, Supiano now turns his attention to a research project added onto the PREVENTABLE study. It is headed by Srinivasan Beddhu, MD, the Clinical Research Medical Director in the Department of Internal Medicine at University of Utah Health.
"The participants in the study led by Dr. Beddhu get a research accelerometer in the mail that they wear for a week," Supiano said. "It's strapped around your thigh, and it gives a three-dimensional reading so at any one time you can see if the person is moving, lying down, standing, or sitting. It allows for a much more refined assessment of sedentary time." He is also involved in the study leading the cognitive adjudication committee whose members use annual telephone interviews to determine participants' cognitive performance and identify those who are developing cognitive impairment or dementia.
This summer, the U.S. Food and Drug Administration approved the use of Leqembi, an amyloid beta-directed antibody, designed to reduce amyloid plaques that form in the brain of a person diagnosed with early Alzheimer's or dementia. Supiano hopes the benefits of these types of treatments will continue to show promise, but he does worry about high costs and side effects.
Searching for a cure while seeking strategies to prevent and postpone the onset of dementia are goals Supiano and his colleagues strive for every day in their research and clinical practice.
The so-called King of Horror, author Stephen King, recently talked about what scares him the most in life at age 76. He said, "Alzheimer's disease. I'm afraid every time that I must search for a word. My mind is my tool. It is what I use to enjoy life. The idea of losing my mind or the connection to my family terrifies me."
Supiano realizes King is not the only one worried about going into cognitive decline as they age. It is on the minds of millions of Americans, and Supiano's research efforts will continue to address these fears and share the good news about effective strategies to prevent age-related cognitive decline.
