There are no proven ways to stave off Alzheimer’s, but a new report raises the prospect that avoiding nine key risks starting in childhood just might delay or even prevent about a third of dementia cases around the world.

How? It has to do with lifestyle factors that may make the brain more vulnerable to problems with memory and thinking as we get older. They’re such risks as not getting enough education early in life, high blood pressure and obesity in middle age, and being sedentary and socially isolated in the senior years.

Thursday’s report in the British journal Lancet is provocative – its authors acknowledge their estimate is theoretical, based on statistical modeling. A recent U.S. report was much more cautious, saying there are encouraging hints that a few lifestyle changes can bolster brain health but little if any proof.

Still, it’s never too early to try, said Lancet lead author Gill Livingston, a psychiatry professor at University College London.

“Although dementia is diagnosed in later life, the brain changes usually begin to develop years before,” she noted.

Early next year, a $20 million U.S. study will begin rigorously testing if some simple day-to-day activities truly help older adults stay sharp. In the meantime, Alzheimer’s specialists say there’s little down side to certain common-sense recommendations.

“Increased health of the body supports increased health of the brain,” said cognitive neuroscientist Laura Baker of Wake Forest School of Medicine in North Carolina, who will lead the upcoming U.S. study.

Consider physical activity, crucial for heart health. “If in fact it should also improve the prospects for cognitive function and dementia, all the better,” said Dr. Richard Hodes, director of the U.S. National Institute on Aging and an avid exerciser.

Here’s the latest from this week’s Alzheimer’s Association International Conference on possible ways to guard your brain:

Key risks

A Lancet-appointed panel created a model of dementia risks throughout life that estimates about 35 percent of all cases of dementia are attributable to nine risk factors – risks that people potentially could change.

Their resulting recommendations: Ensure good childhood education; avoid high blood pressure, obesity and smoking; manage diabetes, depression and age-related hearing loss; be physically active; stay socially engaged in old age.

The theory: These factors together play a role in whether your brain is resilient enough to withstand years of silent damage that eventually leads to Alzheimer’s.

Does changing these or other lifestyle factors really help?

Last month, the U.S. National Academies of Sciences, Engineering and Medicine reported there’s little rigorous proof. That report found some evidence that controlling blood pressure, exercise and some forms of brain training – keeping intellectually stimulated – might work and couldn’t hurt.

Why? What’s good for the heart is generally good for the brain. In fact, high blood pressure that can trigger heart attacks and strokes also increase risk for what’s called “vascular dementia.”

And exercising your gray matter may bulk up the brain, whether it’s from childhood education or learning a new language as an adult. The more you learn, the more connections your brain forms, what scientists call cognitive reserve. Some U.S. studies have suggested that generations better educated than their grandparents have somewhat less risk of dementia.

Other factors have less scientific support. Studies show people with hearing loss are more likely to experience memory problems, and have speculated that it’s because hearing loss leads to depression and social isolation – or even makes the brain work harder to deal with garbled sound, at the expense of other thinking skills. But so far there aren’t studies proving hearing aids reverse that risk.

In fact, the strongest evidence that lifestyle changes help comes from Finland, where a large, randomized study found older adults at high risk of dementia scored better on brain tests after two years of exercise, diet, cognitive stimulation and social activities.

Hunting proof

Would those strategies help Americans, who tend to be sicker, fatter and more sedentary than Scandinavians? The Alzheimer’s Association is funding a study to find out, with enrollment of 2,500 cognitively healthy but high-risk older adults to begin next year.

Want to try on your own? They’ll test:

-Walking – supervised, so no cheating. Wake Forest’s Baker puts seniors on treadmills at the local YMCA to avoid bumpy sidewalks. She starts exercise-newbies at 10 minutes a day for two days a week and works up to longer walks on more days.

-A diet that includes more leafy greens, vegetables, whole grains, fish and poultry than the typical American menu.

-Certain brain games and what Baker called an “intellectual stimulation barrage,” outings and other steps that keep people social, not sitting home on a computer, while they exercise their brains.

-Improving control of medical conditions like high blood pressure and diabetes that are toxic to the brain.

 
…

For the first time in the global AIDS epidemic that has spanned four decades and killed 35 million people, more than half of all those infected with HIV are on drugs to treat the virus, the United Nations said in a report released Thursday.

AIDS deaths are also now close to half of what they were in 2005, according to the U.N. AIDS agency, although those figures are based on estimates and not actual counts from countries.

Experts applauded the progress, but questioned if the billions spent in the past two decades should have brought more impressive results. The U.N. report was released in Paris where an AIDS meeting begins this weekend.

“When you think about the money that’s been spent on AIDS, it could have been better,” said Sophie Harman, a senior lecturer in global health politics at Queen Mary University in London. 

She said more resources might have gone to strengthening health systems in poor countries.

“The real test will come in five to 10 years once the funding goes down,” Harman said, warning that countries might not be able to sustain the U.N.-funded AIDS programs on their own.

The Trump administration has proposed a 31 percent cut in contributions to the U.N. starting in October.

According to the report, about 19.5 million people with HIV were taking AIDS drugs in 2016, compared to 17.1 million the previous year.

UNAIDS also said there were about 36.7 million people with HIV in 2016, up slightly from 36.1 million the year before.

In the report’s introduction, Michel Sidibe, UNAIDS’ executive director, said more and more countries are starting treatment as early as possible, in line with scientific findings that the approach keeps people healthy and helps prevent new infections. Studies show that people whose virus is under control are far less likely to pass it on to an uninfected sex partner.

“Our quest to end AIDS has only just begun,” he wrote.

The report notes that about three-quarters of pregnant women with HIV, the virus that causes AIDS, now have access to medicines to prevent them from passing it to their babies. It also said five hard-hit African countries now provide lifelong AIDS drugs to 95 percent of pregnant and breast-feeding women with the virus.

“For more than 35 years, the world has grappled with an AIDS epidemic that has claimed an estimated 35 million lives,” the report said. “Today, the United Nations General Assembly has a shared vision to consign AIDS to the history books.” The death toll from AIDS has dropped dramatically in recent years as the wide availability of affordable, life-saving drugs has made the illness a manageable disease.

But Harman said that “Ending AIDS” — the report’s title — was unrealistic.

“I can see why they do it, because it’s bold and no one would ever disagree with the idea of ending AIDS, but I think we should be pragmatic,” she said. “I don’t think we will ever eliminate AIDS so it’s possible this will give people the wrong idea.”
…

In summer, life becomes intolerable for rickshaw puller Mohammad Khan.

“I keep running into the shade to save myself from the sun,” he said as he waited for midafternoon customers in a busy New Delhi market.

Like millions of others, Khan is experiencing on the ground what a recent study has highlighted: Heat waves in India have become deadlier and further global warming could take a “relatively drastic” human toll in the coming years.

Amir Aghakouchak, an associate professor at the University of California, Irvine who co-authored the study, said they found that even small variations in temperature are causing the change.

“While mean temperatures from 1960 to 2009 increased by around 0.5 C degrees, both heat waves and mortality have increased substantially,” he said.

​Grim warning

The India-specific study is the latest grim warning of how new deadly summer highs are affecting India, where millions cope with perennial shortages of water and power.

Spring became summer when temperatures crossed 40 degrees Celsius in March in several parts of the country this year. Last year was declared the warmest year on record since 1901, and in May 2016, the northern town of Phalodi shattered the national heat record when the mercury touched 51 degrees Celsius. In 2015, the world’s fifth deadliest heat wave seared large swathes of India, claiming about 2,500 victims.

The director of the Indian Institute of Public Health in Gandhinagar, Dileep Mavalankar, said, “heat waves are the single most important reason of disaster-related deaths in India in the last few years although only the tip of the iceberg is getting reported.”

Focus on poor people

As record-breaking heat becomes a fact of life, the focus is turned on millions of poor people who are impacted the most by more intense summers, particularly in urban areas.

According to Aghakouchak, “adverse effects are pummeling the world’s most vulnerable populations.”

They are wage workers, such as construction laborers, rickshaw pullers, hawkers and vendors who toil outdoors in the day and live in sweltering slums. And in sprawling cities like New Delhi and Mumbai, where the population tops 20 million, the only shelter people on the street often find is in metro stations or under road bridges.

The deputy director at New Delhi’s Center for Science and Environment, Chandra Bhushan, said what is called an “urban heat island” effect is taking a huge toll on the health, productivity and livelihoods of poor people in cities.

“It’s a concrete jungle where heat gets trapped and many studies indicate that the temperature in city centers is 5 degrees, even 7 degrees higher than the ambient temperature,” he said.

Shorter work days

A report by the U.N. Environment Program last year said workers such as farmers or construction laborers will have to shorten their work days within four decades, simply because it will be too hot outdoors. That could result in significant economic loss for poor people in countries such as India.

Researchers in New Delhi say that is already happening. Studies have demonstrated that street hawkers and others lose three to four hours of work a day because even acclimatized populations are unable to cope with the spiking temperatures.

On a hot summer morning, 17-year-old Anil Kumar, is downcast. He usually hangs around Delhi’s popular landmark India Gate, hoping to make some money taking photos of visitors, but the crowds are much thinner than usual.

“I have come since the morning, but have not got a single customer. It is so sunny, people don’t come,” he said.

​Heat Action Plan

As studies highlight that the high temperatures are here to stay, there have been growing calls for the government to draw up contingency plans to cope with heat events in the same manner as natural disasters like earthquakes and cyclones.

A handful of cities are now launching a Heat Action Plan begun five years ago in the western Ahmedabad city that has helped bring down heat-related deaths.

Mavalankar said it involves public awareness campaigns, setting up cooling spaces in public buildings, training doctors and alerting supervisors on how to protect laborers.

But the efforts are sporadic and more programs need to be implemented nationwide, experts say.

“You don’t allow people to work in the afternoon, you have availability of water and shelter, you have emergency medical response and office timings are changed,” Bhushan said. “In long term in urban areas, there is a lot of talk of having more greenery in the city to reduce the impact of heat island effect.”

A small start has been made. Last year, the Indian meteorological department began putting out temperature advisories from April to June for 100 Indian cities to encourage people to stay indoors on very hot days. However that is unlikely to help rickshaw puller Khan or photographer Kumar, who have no option but to earn their livelihood under a blazing sun.
…

Thirty-five European children have died from measles in the past 12 months in what the World Health Organization calls an “unacceptable” tragedy. The deaths could have been prevented by a vaccine. A measles outbreak in Minnesota sent nearly two dozen people to the hospital. Still, some parents in developed countries continue to believe false reports that the measles vaccine causes autism. VOA’s Carol Pearson reports.
…

Thirty-five European children have died from measles in the past 12 months in what the World Health Organization calls an “unacceptable” tragedy. The deaths could have been prevented by a vaccine. A measles outbreak in Minnesota sent nearly two dozen people to the hospital. Still, some parents in developed countries continue to believe false reports that the measles vaccine causes autism. And now a number of parents are refusing to get their children vaccinated for other diseases as well.

A vaccine ended small pox. Another vaccine is close to ending polio. Vaccines prevent the flu, hepatitis, liver cancer, cervical, oral and penile cancers and a dozen or so other diseases. They have saved countless lives and prevented enormous suffering. Scientists are now working on vaccines for AIDS, malaria and tuberculosis.

Dr. Flavia Bustreo is an outspoken advocate for immunizations at the World Health Organization.

“Immunization and vaccines are the most powerful public health tools that we have,” said Bustreo.

One of the most effective vaccines available, to prevent measles, mumps and rubella, is meeting resistance from many parents because of a debunked study that linked the vaccine to autism. Yet some parents oppose all vaccines. Gabriella Cashman is hoping to start a family soon, and says she is not going to give any vaccines to her children.

“We don’t want anybody to force anything on our children. As parents, it’s our decision whether or not we want to vaccinate,” she said.

In the U.S., the issue goes beyond autism. It’s become a parents’ rights issue. Dr. Peter Hotez is an immunologist who develops vaccines for tropical diseases at Baylor College of Medicine in Houston.

“In the state of Texas, we now have 50,000 kids whose parents are opting them out of getting vaccinated,” he said.

Dr. Hope Scott says all pediatricians strongly favor vaccines. The topic is very personal to her, because she lost a daughter to pneumococcal meningitis five years before a vaccine became available.

“I’d give a million dollars and my right arm to have the opportunity to vaccinate my child and save her life. … And I didn’t have that opportunity. And I have a hard time understanding why people choose to not protect their children,” she said.

Doctors and other health professionals are sometimes at a loss when it comes to convincing parents that vaccines will keep their children healthy. As director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci oversees programs to immunize and care for people around the globe who suffer from infectious diseases. His institute funds the research and development of vaccines for AIDS, malaria, tuberculosis and other infectious diseases.

“I think the approach toward people who are anti-vaccinating is to respect their opinion and don’t denigrate them and don’t criticize them, but try to explain to them on the basis of solid evidence why the risk benefit of vaccines clearly, clearly — very, very heavily — leans toward vaccinating your children,” he said.

In a column written for The Seattle Times newspaper, autism expert Annette Este said health professionals need to “urgently find a way out of our impasse and rediscover the connections between” those who oppose immunizations and the medical community.

The American Medical Association has adopted a policy to continue efforts to promote public understanding and confidence in the safety of vaccines. Some European countries are now making vaccines against measles and other diseases mandatory. Meanwhile, the measles outbreak in Minnesota is not over. A 19-year-old whose parents opposed vaccinations is Minnesota’s 79th case.
…