Epidemiology has played a crucial role over the decades in understanding Alzheimer’s disease and other common causes of dementia, like vascular disease and Lewy body disease. Yet, there are still more questions than answers about the causes, appropriate treatment and preventive measures for dementia-related diseases.
[Photo: Dr. Walter Kukull]
According to a group of international researchers, including Dr. Walter Kukull from the University of Washington School of Public Health, an interdisciplinary population-focused approach to this public health issue is needed to push scientific discovery forward. Dr. Mary Ganguli from the University of Pittsburgh leads the group.
In a special report published in the January issue of the Alzheimer’s Disease and Associated Disorders, the researchers propose reframing the current study of dementia epidemiology toward a more inclusive and understandable term: “population neuroscience.” This broader term would better reflect the multidisciplinary collaboration needed to effectively address these diseases and expand toward precision medicine and population health.
“We’ve come to a point where we really have to turn our eyes out toward the general population, so we can figure out how to address this issue and know we aren’t just dealing with very odd cases in clinical settings,” said Dr. Kukull, a professor in the department of epidemiology at the UW School of Public Health.
The World Health Organization estimates 50 million people are affected by dementia worldwide, and nearly 10 million new cases are diagnosed each year. Progress in the field of dementia epidemiology is critical.
As some breakthroughs continue to challenge our knowledge of dementia and related illnesses, researchers have also uncovered limitations to how we currently study the disease. For example, Alzheimer’s disease pathology likely begins 10 to 25 years prior to any dementia symptoms, thus the data collected in clinical settings on persons who already have dementia symptoms can oftentimes lead to comparisons with persons who harbor the disease but are asymptomatic. This could cause researchers to miss important risk factors. Further, limiting studies to clinical settings or solicited volunteers may fail to reflect how Alzheimer’s disease and other brain diseases commonly co-occur in the population, as well as how they may act synergistically, antagonistically or independently to cause dementia in the population as a whole.
Population neuroscience would use several cross-disciplinary approaches to paint a fuller picture of dementia while taking into account the disease biology, personal and environmental factors, and social determinants of health at the community level. For example, establishing large longitudinal population-based cohort studies beginning with unaffected persons could potentially take advantage of new technologies to identify disease processes well before any cognitive symptoms appear and increase our understanding of how the underlying diseases may be able to be treated, ultimately preventing dementia symptoms.
Other approaches include exploring the links between disease patterns and the environment, looking at specific generational risk factors, and observing the effectiveness of interventions among different races and ethnicities.
Article co-authors include Drs. Emiliano Albanese (University of Geneva), Sudha Seshadri (Boston University), David A. Bennett (Rush University Medical Center), Constantine Lyketsos (Johns Hopkins University), Walter Kukull (University of Washington), Ingmar Skoog (Gothenburg University), and Hugh Hendrie (Indiana University Center for Aging Research).