̽��ֱ�� of Cambridge - Fiona Matthews

New cases of dementia in the UK fall by 20% over two decades

cjb250 — Tue, 19 Apr 2016 15:00:50 +0000

Reports in both the media and from governments have suggested that the world is facing a dementia ‘tsunami’ of ever-increasing numbers, particularly as populations age. However, several recent studies have begun to suggest that the picture is far more complex. Although changing diagnostic methods and criteria are identifying more people as having dementia, societal measures which improve health such as education, early- and mid-life health promotion including smoking reduction and attention to diet and exercise may be driving a reduction in risk in some countries. Prevalence (the proportion of people with dementia) has been reported to have dropped in some European countries but it is incidence (the proportion of people developing dementia in a given time period) that provides by far the most robust evidence of fundamental change in populations.

As part of the Medical Research Council Cognitive Function and Ageing Study (CFAS), researchers at the ̽��ֱ�� of Cambridge, Newcastle ̽��ֱ��, Nottingham ̽��ֱ�� and the ̽��ֱ�� of East Anglia interviewed a baseline of 7,500 people in three regions of the UK (Cambridgeshire, Newcastle and Nottingham) between 1991 and 1994 with repeat interviews at two years to estimate incidence. Then 20 years later a new sample of over 7,500 people from the same localities aged 65 and over was interviewed with a two year repeat interview again. This is the first time that a direct comparison of incidence across time in multiple areas, using identical methodological approaches, has been conducted in the world.

̽��ֱ��researchers found that dementia incidence across the two decades has dropped by 20% and that this fall is driven by a reduction in incidence among men at all ages. These findings suggest that in the UK there are just under 210,000 new cases per year: 74,000 men and 135,000 women – this is compared to an anticipated 250,000 new cases based on previous levels. Incidence rates are higher in more deprived areas.

Even in the presence of an ageing population, this means that the number of people estimated to develop dementia in any year has remained relatively stable, providing evidence that dementia in whole populations can change. It is not clear why rates among men have declined faster than those among women, though it is possible that it is related to the drop in smoking and vascular health improving in men.

Professor Carol Brayne, Director of the Cambridge Institute of Public Health, ̽��ֱ�� of Cambridge, says: “Our findings suggest that brain health is improving significantly in the UK across generations, particularly among men, but that deprivation is still putting people at a disadvantage. ̽��ֱ��UK in earlier eras has seen major societal investments into improving population health and this appears to be helping protect older people from dementia. It is vital that policies take potential long term benefits into account.”

Professor Fiona Matthews from the Institute of Health and Society, Newcastle ̽��ֱ�� and the MRC Biostatistics Unit, Cambridge adds: “Public health measures aimed at reducing people’s risk of developing dementia are vital and potentially more cost effective in the long run than relying on early detection and treating dementia once it is present. Our findings support a public health approach for long term dementia prevention, although clearly this does not reduce the need for alternative approaches for at-risk groups and for those who develop dementia.”

̽��ֱ��researchers argue that while influential reports continue to promote future scenarios of huge increases of people with dementia across the globe, their study shows that global attention and investment in reducing the risk of dementia can help prevent such increases.

“While we’ve seen investment in Europe and many other countries, the lack of progress in access to education, malnutrition in childhood and persistent inequalities within and across other countries means that dementia will continue to have a major impact globally,” says Professor Brayne. “Our evidence shows that the so-called dementia ‘tsunami’ is not an inevitability: we can help turn the tide if we take action now.”

Dr Rob Buckle, director of science programmes at the Medical Research Council, which funded the study, added: “It is promising news that dementia rates, especially amongst men, have dropped by such a significant amount over the last twenty years, and testament to the benefits of an increased awareness of a brain-healthy lifestyle. However, the burden of dementia will continue to have significant societal impact given the growing proportion of elderly people within the UK population and it is therefore as important as ever that we continue to search for new ways of preventing and treating the disease. This study does, however, reinforce the importance of long-term, quality studies that create a wealth of data of invaluable resource for researchers.”

Reference
Matthews, FE et al. A two decade comparison of incidence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function Ageing Study I and II. Nature Communications; 19 April 2016; DOI 10.1038/ncomms11398

̽��ֱ��UK has seen a 20% fall in the incidence of dementia over the past two decades, according to new research from England, led by the ̽��ֱ�� of Cambridge, leading to an estimated 40,000 fewer cases of dementia than previously predicted. However, the study, published today in Nature Communications, suggests that the dramatic change has been observed mainly in men.

Our evidence shows that the so-called dementia ‘tsunami’ is not an inevitability: we can help turn the tide if we take action now

Carol Brayne

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Diagnosed autism is more common in an IT-rich region

gm349 — Mon, 20 Jun 2011 12:29:20 +0000

A new study from Cambridge ̽��ֱ�� has for the first time found that autism diagnoses are more common in an IT-rich region.

̽��ֱ��Medical Research Council (MRC) funded study, published today in the Journal of Autism and Developmental Disorders, has important implications for service provision in different regions and for the ‘hyper-systemizing’ theory of autism.

Professor Simon Baron-Cohen, Director of the Autism Research Centre (ARC) at the ̽��ֱ�� of Cambridge, led the study (which was conducted in the Netherlands) with Dr Rosa Hoekstra, a Dutch autism researcher based at ARC and ̽��ֱ��Open ̽��ֱ��.

̽��ֱ��researchers predicted that autism spectrum conditions (ASC) would be more common in populations enriched for ‘systemizing’, which is the drive to analyse how systems work, and to predict, control and build systems. These skills are required in disciplines such as engineering, physics, computing and mathematics.

̽��ֱ��team had previously discovered evidence for a familial association between a talent for systemizing and autism in that fathers and grandfathers of children with ASC are over-represented in the field of engineering. ̽��ֱ��team had also previously found that mathematicians more often have a sibling with ASC, and students in the natural and technological sciences, including mathematics, show a higher number of autistic traits.

̽��ֱ��researchers tested for differences in the prevalence of ASC in school-aged children in three geographical regions in the Netherlands: Eindhoven, Haarlem, and Utrecht-city. ̽��ֱ��region Eindhoven was selected because it is rich in information-technology (IT) having the Eindhoven ̽��ֱ�� of Technology there, as well as the High Tech Campus Eindhoven, where IT and technology companies such as Philips, ASML, IBM and ATOS Origin are based. ( ̽��ֱ��Philips factory has been in Eindhoven since 1891. Since then, the region has attracted businesses in IT and technology.)

̽��ֱ��growth of the High Tech Campus Eindhoven has led to Eindhoven becoming a major technology and industrial hub: 30% of jobs in Eindhoven are now in technology or ICT, in Haarlem and Utrecht this is respectively 16 and 17%.

̽��ֱ��two control regions were selected because they have similar size populations and a similar socioeconomic class. Schools in each region were asked to provide the number of children enrolled, the number having a clinical diagnosis of ASC and/or two control neurodevelopmental conditions (dyspraxia and ADHD). ̽��ֱ��participating schools in the three regions provided diagnostic information on a total of 62,505 children. ̽��ֱ��researchers found school-reported prevalence estimates of ASC in Eindhoven was 229 per 10,000, significantly higher than in Haarlem (84 per 10,000) and Utrecht (57 per 10,000), whilst the prevalence for the control conditions were similar in all regions.

Simon Baron-Cohen commented: “These results are in line with the idea that in regions where parents gravitate towards jobs that involve strong ‘systemizing’, such as the IT sector, there will be a higher rate of autism among their children, because the genes for autism may be expressed in first degree relatives as a talent in systemizing. ̽��ֱ��results also have implications for explaining how genes for autism may have persisted in the population gene pool, as some of these genes appear linked to adaptive, advantageous traits.”

Rosa Hoekstra added: “We need to conduct a follow-up study to validate the diagnoses and to test the alternative explanations for the elevated rate of autism in Eindhoven, including the possibility that children with autism may more often remain undetected in the two other regions. These results are important findings in the field of autism epidemiology, since they suggest regional variation in autism prevalence. In our follow-up study we plan to study the causes of this variation in more detail. This will help local authorities plan services appropriately for the number of children with autism.”

̽��ֱ��Cambridge research team also included Martine Roelfsema (a Dutch graduate student), Sally Wheelwright and Dr Carrie Allison (experts in autism screening), and Professor Carol Brayne and Dr Fiona Matthews (experts in public health research and biostatistics).

Research provides important insight into ‘systemizing’ theory of autism.

These results are in line with the idea that in regions where parents gravitate towards jobs that involve strong ‘systemizing’, such as the IT sector, there will be a higher rate of autism among their children, because the genes for autism may be expressed in first degree relatives as a talent in systemizing.

Professor Simon Baron-Cohen

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Improving cognitive ability through education and health may cut dementia risk

bjb42 — Fri, 27 Mar 2009 00:00:00 +0000

̽��ֱ��study by Cambridge ̽��ֱ�� researchers Dr David Llewellyn and Dr Fiona Matthews and the Medical Research Council Cognitive Function and Ageing Study shows a small but significant improvement in elderly people's mental abilities over the last two decades which researchers believe could be down to raising the age of compulsory education, reductions in the number of elderly people smoking and other health developments.

Published in the journal Aging, Neuropsychology and Cognition this month, the study could help to predict future numbers of elderly people who will develop dementia with greater accuracy.

̽��ֱ��researchers compared the results of a representative sample of more than 9,000 people over 65 whose mental faculties were tested in 1991 with those of over 5,000 people in 2002. ̽��ֱ��test, an animal naming test which is among the standard ones used for detecting early signs of dementia, was restricted to those whose first language was English and excluded non-white participants and those in nursing homes.

̽��ֱ��researchers also compared the results of 680 East Cambridgeshire residents aged between 60 and 69 who were tested in 1991 with an independent cohort of 600 people tested in 1996.

̽��ֱ��tests showed a small but potentially significant increase in the number of words a minute people used when asked to list words associated with animals. ̽��ֱ��results were similar across the general sample and the East Cambridgeshire sample.

In the 2002 study, the sample was slightly older and more prone to diseases such as hypertension and diabetes mellitus. In both samples, results were lower for older people, women and the less educated. ̽��ֱ��only group which showed no improvement between 1991 and 2002 were the least educated.

Poor cognitive function is associated with the onset of dementia, disability, institutionalisation and death. It has been predicted that around 3.1% of people aged over 60 worldwide will suffer from dementia with significant increases expected as the world's population ages. ̽��ֱ��results of this new study tally with those coming out of the US.

Writing in Aging, Neuropsychology and Cognition, Dr Llewellyn, a research associate in the Department of Public Health and Primary Care, and Dr Matthews, a statistician in the MRC Biostatistics Unit, say: "Our findings are important because detrimental influences on cognitive health appear to have been cancelled out by greater levels of education, fewer heart attacks, increased prescription of antihypertensive medications, decreased smoking and improvements in other unmeasured factors associated with cognition, such as early life nutrition. This is significant as these findings can be used to help refine future projections of cognitive function in aging industrialised populations."

Improvements in education and health could reduce the number of elderly people who suffer from dementia, according to the first study in England to compare elderly cognitive ability.

Our findings are important because detrimental influences on cognitive health appear to have been cancelled out by greater levels of education, fewer heart attacks, increased prescription of antihypertensive medications, decreased smoking and improvements in other unmeasured factors associated with cognition, such as early life nutrition.

Dr Llewellyn & Dr Matthews

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