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Alzheimer’s

Can We Prevent Alzheimer’s Disease and Related Dementias?

With help from a $29 million grant, a BU researcher is coleading a national project to determine whether addressing key lifestyle and risk factors could reduce dementia risk

Recent new drugs for treating Alzheimer’s disease have been heralded as breakthroughs—with the potential to slow the progression of dementia and give people a little more time with their memories. But they’re expensive. Really expensive. Leqembi, as an example, has a list price of $26,500 per patient, per year. And it reportedly only slows cognitive decline by about six months.

But what if there was a way to prevent dementia—without those high costs?

A major new project co-led by Boston University, the University of California, San Francisco, and Kaiser Permanente Division of Research will examine whether public health interventions that target alcohol use, social isolation, depression, and sensory impairments (like hearing loss) could also help reduce the risk of developing Alzheimer’s disease and related dementias. According to the World Health Organization, 55 million people around the world have dementia. The Triangulation of Innovative Methods to End Alzheimer’s Disease project was recently given a $28.8 million grant from the National Institute on Aging (NIA) to drive its work.

“There are multiple etiologies that contribute to dementia,” says Maria Glymour, a BU School of Public Health chair and professor of epidemiology, who will be the University’s lead on the project. “Your brain is just one organ. And all the bad things you do to it, those all come together to influence how you can use it; that also means there are lots of potential opportunities to keep it healthier.”

According to a Lancet commission report, 45 percent of dementia cases could potentially be prevented by addressing key lifestyle and risk factors, from substance use to loneliness to hypertension. And some of the solutions might be as simple as reducing alcohol use, promoting an active social life, or helping people lower their cholesterol in middle age.

Over the next five years, Glymour and the project team will analyze a wealth of health and clinical data and research to provide more robust evidence on how risk and lifestyle factors contribute to dementia. The overall goal of the project is to fill both a science gap and a public knowledge gap. With more evidence of what prevents dementia, Glymour says they can better inform policymakers and clinicians on prevention and treatment strategies, while also educating the public on changes they can make to reduce their dementia risk.

“The reason this [NIA] grant is so big is that we’re bringing together many, many data sources to be able to analyze them in a way that we can integrate the evidence from across all of them,” says Glymour. “If you want to provide guidance on what to intervene on, you need to really try to be right. It’s very important not to go out and say, ‘Hey, change your behavior,’ if you don’t actually have good evidence about what the health effects would be.”

She says there’s a lot of research out there on dementia, but that every study has its pros and cons: some may include lots of people, for example, but not follow them over a long period of time. The triangulation project’s goal is to analyze diverse sets of data to help fill in the gaps. Glymour gives the example of alcohol use, which has been tied to a higher risk of dementia.

“The main evidence the Lancet commission uses to guide their estimate of how beneficial alcohol changes could be [in reducing dementia risk] contrasts heavy users to moderate users, not moderate users to never users,” she says. “There’s pretty good consensus that heavy alcohol use is bad, but what does that mean for the many people who are moderate users?”

And, she adds, even the data on heavy users has some glaring gaps, particularly when it comes to diverse populations. The primary sources are a study of Swedish twins and another of British civil servants—not exactly a broad cross section of society. “Are we really going to take these studies and say we think they’re relevant for risk patterns in the United States across this really diverse country?” says Glymour.

That lack of inclusivity and diversity reflects a broader problem of dementia research that the triangulation project will aim to address: dementia doesn’t impact all Americans equally. African American and Latino people, women, and those from disadvantaged socioeconomic backgrounds are all at greater risk. Individual studies can struggle to illuminate the reasons why that is, but by pulling in a bigger trove of data, the triangulation project may help change that.

“We really want to use data sources that could address some of that and speak to everyone,” says Glymour, whose previous research has examined how social factors throughout life can impact health in older adulthood. “It seems unjust that so much existing evidence about Alzheimer’s disease is not necessarily relevant for some groups who are most affected by it.”

Because of the range of datasets the project will cover, the team will be calling on a wide variety of experts to help them interpret and analyze the data: epidemiologists, biostatisticians, neuropsychologists, economists, statistical geneticists. They’ll also be pulling in students, including from BU.

“Sometimes students don’t know what to do to make a difference in the world,” says Glymour. “And you can make a real difference by using the data to say why some whole groups of people are at elevated risk, and asking, ‘What can we do to fix that?’”

Glymour first became interested in the health of older adults after volunteering, then working, at a care home after college. The experience has shaped her career ever since—and motivates her leadership of the triangulation project.

“I did pretty basic work—helping people get dressed, making sure they ate. And then I started working with people who had cognitive impairment and dementia,” says Glymour. “It made a big impression on me. As I get older, I see how many are affected by some form of dementia—including in my own family—and it can be such a profound loss.

“There’s so much potential for us to learn about what matters for older people’s health. By using data really carefully, and taking advantage of improvements in computational power, we can bend that knowledge toward making a difference.”