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Christina Lau, 23 Nov 2018

In patients with severe small vessel disease (SVD), intensive blood pressure (BP) lowering does not reduce cerebral perfusion or increase the risk of falls, according to results of the ASL substudy of the PRESERVE trial.

Early action key to ending dementia

Jackey Suen
29 Nov 2018
Prof Vincent Mok

Early detection, intervention and adoption of a healthy lifestyle are the key to ending dementia, according to Professor Vincent Mok of the Division of Neurology, Faculty of Medicine, Chinese University of Hong Kong.

“Preclinical dementia typically starts at around 50–60 years of age. The disease remains asymptomatic for 10–15 years until it progresses to the prodromal stage, when symptoms suggestive of mild cognitive impairment [MCI] start to appear,” said Mok during the 9th International Conference of International Society of Vascular Behavioural and Cognitive Disorders (VasCog 2018). “Patients with prodromal disease or MCI generally progress to develop dementia in a few years’ time.”

“The three ‘Es’ are the key to ending dementia: early adoption of a healthy lifestyle, early detection of at-risk individuals, and early intervention,” he emphasized.

“Early adoption of a healthy lifestyle can reduce the risk of developing dementia later in life by at least 30 percent,” said Mok. “Importantly, individuals have to adopt this lifestyle at 40–50 years of age before the preclinical phase of dementia begins. Early action is the key.”

“Early detection of individuals at risk of dementia, particularly those who have MCI, is of paramount importance as intervention for dementia has to be initiated at an early stage,” he continued.

“Nevertheless, distinguishing between MCI and cognitive decline associated with normal ageing may sometimes be difficult,” noted Mok. “The Hong Kong version of Montreal Cognitive Assessment [HK-MoCA] is a simple yet sensitive screening test for MCI. In addition, retinal imaging is an effective screening tool for Alzheimer’s disease [AD] and brain small vessel disease. Recently, we have developed and validated an automated analysis of retinal fundus images for the detection of brain small vessel disease.” [Ann Clin Transl Neurol 2018, doi: 10.1002/acn3.688]

Amyloid PET imaging and lumbar puncture are currently the confirmatory tests for MCI, but they are subjective, costly and inconvenient. “Our colleagues have developed an innovative artificial intelligence [AI] diagnostic system, which provides more objective interpretation of brain MRI images. There is also ongoing research on a novel MRI contrast agent for amyloid plaques,” added Mok.

“Once the diagnosis of MCI is confirmed, patients should start treatment as early as possible,” he said. “In the FINGER study, multidomain intervention consisting of diet, exercise, cognitive training and vascular risk monitoring was shown to improve cognitive function in at-risk elderly people. A local study also showed that structured lifestyle activity interventions improved cognitive function.” [Lancet 2015;385:2255-2263; PLoS One 2015;10:e0118173]

In addition, a medical nutrition drink was found to improve memory performance in patients with mild AD, with an effect on brain functional connectivity. [J Alzheimers Dis 2012;31:225-236]

“Several ongoing studies at our centre will investigate the effect of vasodilators, aerobic exercise, and experimental drugs on small vessel diseases,” Mok continued.

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Most Read Articles
Christina Lau, 23 Nov 2018

In patients with severe small vessel disease (SVD), intensive blood pressure (BP) lowering does not reduce cerebral perfusion or increase the risk of falls, according to results of the ASL substudy of the PRESERVE trial.