Joan Draft worries dementia. Her mother lived with Alzheimer’s disease for 14 years, the last seven in a residence for memory care and her maternal grandfather also developed dementia.
“I am 100 % convinced that this is in my future,” said Mrs. Dethop, 70 years old, retired lawyer in Thornton, Collo.
Last year, he spent almost a whole day with a neuropsychologist, subjected to a vast evaluation. The results indicated that his short-term memory was fine-che found “shocking and comforting” -and who tested the average or higher in each cognitive category except one.
It is not reassured. “I saw Alzheimer’s as was,” said his mother’s long decline. “The memory of what he has passed is deep for me.”
The prospect of dementia, which includes Alzheimer’s disease and a series of other cognitive disorders, so frightens the Americans that a recent study that projected steep increases in cases in the next three decades has attracted enormous public attention.
The results of the researchers, published in January in Nature Medicine, even present themselves as a joke in the weekend update segment of “Saturday Night Live”.
“Dementia is a devastating condition and is very linked to the oldest ages,” said dr. Josef Coresh, director of the Optimal Aging Institute at the Nyu Langone Health and the senior author of the study. “The globe is aging.”
Now the results are challenged by other dementia researchers who say that while the increases are coming, they will be much smaller than Dr. Cobra and its expected co -authors.
Using the data of about 15,000 Americans over the age of 55, collected in four research clinics throughout the country from 1987 to 2020, the Dr. Cobreh team has projected a much higher risk of dementia than the previous studies had: 42 %, although most of this risk did not emerge until after 85 years.
The highest number of life probably reflected the study dependence on a more diversified sample than previous researchers, said dr. Coresh and more cases of dementia identified through in -depth questionnaires, regular phone calls, medical records and death certificates.
The researchers applied their risk calculations to the United States population and estimated that the number of people who would develop dementia every year would be doubled, at about one million by 2060, from 514,000 in 2020.
Eric Stallard, an actor and co-director of the biodemography of the elderly research unit at Duke University, read the study and thought that the team “seemed very competent in their analysis” of individual risk.
But when it was the projection that the cases would double, which assumed that the incidence of dementia would remain stable in the next 40 years, “I don’t believe it,” said Stallard.
“The idea that the number of people with dementia will double in the next 25, 30 or 35 years due to the aging of the baby boomers is widespread, is pervasive – and it is wrong,” he added.
He and two other Duke researchers recently published a comment in Jama stressing that the specific prevalence for the age of dementia in this country had constantly decreased for 40 years.
“If your risks are lower than your parents’ risks and this tendency continues, you will not see the doubling or triple of dementia that has been projected,” said dr. Murali Doraiswamy, director of the program of neurocognitive disorders in Duke and co -author of Jama’s article.
To be clear, experts agree that the number of people with dementia will climb in the coming decades, simply because the disorder thus increases steeply with the age and number of older adults in the United States will increase.
But Mr. Stallard estimates that the increase will be more similar to 10 to 25 percent by 2050. “It will still be a significant challenge for the health system in the United States,” he said.
The Duke group rely on their long -term study on people over the age of 65, with over 21,000 interviewees in 1984 and about 16,000 in 2004, in addition to the subsequent data of the national study for health and retirement and the national study for health and aging.
Their analysis discovered that between 85 and 89 years, for example, the proportion with dementia was about 23 percent in the cohort born in 1905. In the born 10 years later, the figure had fallen to about 18 percent.
When the Americans born in 1935 reached the end of the 80s, about 11 % had dementia; The projection for people born from 1945 to 1949 is now about 8 percent.
For Dr. Cores, whose primary interest was at individual risk, the hypothesis that the past drop would continue at about the current rate “would be great, but it is a rather optimistic and dramatic reduction,” he said in one and -mail.
Yet in another longitudinal study on the elderly in England and China, published in Nature Aging last year, “we also found these rather marked improvements in cohorts born more recently,” said the main author, dr. John Beard, a medical epidemiologist at the Columbia University’s Mailman School of Public Health.
“You would expect that the increase in the absolute number of people with dementia in the United States will be less than we feared,” said dr. Beard.
What led to the decrease in dementia, also observed in different European countries? The explanations often mentioned include the increase in education levels, the reduction of smoking and the improvement of treatment for hypertension and high cholesterol.
The Lancet Commission for dementia, intervention and care have developed a list of 14 modifiable risk factors, including greater use of hearing aids and a reduction in air pollution, which could still lead to greater drop.
Yet the opposite could also happen. If the previous and most common tests increase the number of dementia diagnoses or if the definition of dementia widens, rates will increase, observed Dr. Doraiswamy. The increase in life expectancy would have the same effect.
Obesity and diabetes, more common in recent decades, could lead to more dementia, but new drugs that reduce them could be taped this trend, if people can get them.
“None of this is inevitable,” said Dr. Gill Livingston, a psychiatrist of University College London who leads the Lancet commission. “It depends on what we do.”
The public health policy makes a big difference, he observed and, “the United States are at a time when politics is changing enormously”.
Dementia rates could increase, for example, “if people have less access to health care, so they are less likely to treat their blood pressure and their high cholesterol treatment,” said dr. Livingston.
The coverage of cut medicoid could lead to that result. So could a rollback of environmental policies, “if air pollution increases due to fossil fuels,” he added.
Yes, dementia afflicts some American populations much more than others, the researchers underline. Elderly women and blacks face a greater risk, together with those who bring the Apoe4 gene associated with Alzheimer’s disease.
Health disparities could mean that “wealthy people will see lower rates of dementia” because of the new drugs for diabetes and obesity, said dr. Doraiswamy. “People who cannot afford it and whose conditions are not well managed will see the rates go up.”
The debate on how many elderly people will develop dementia in the next decades and how individuals, families, government and the health system should respond, will probably continue.
So it will be the fears of Mrs. Draft.
For now, he enrolls in permanent learning lessons, makes walks and yoga lessons despite the orthopedic problems, listen to podcasts and reads a lot of history and fiction. She and her husband take the theater in New York and Phish concerts on the west coast and will soon go to London and Paris.
However, his advanced directive contains many provisions on dementia. “I remain pessimistic,” he said, observing that his mother was diagnosed at 77 years old. “I have another seven years before meeting his destiny.”