Dementia affects almost everyone: who doesn't know someone close to him or her who has (had) the disease? Prof. Arfan Ikram, born and raised in Rotterdam, epidemiologist and world-leading dementia researcher at Erasmus MC, delivered the 22nd Rotterdamlezing on Monday 11 May. He took the audience through more than 35 years of groundbreaking research, the role of lifestyle in dementia and his dream for the future of his field.
From Rotterdam-Ommoord to global insights
The core of Arfan Ikram's work is the ERGO study. This long-term population study in the Rotterdam district of Ommoord started in 1990 and is a leading study in the field of dementia worldwide. Almost 20,000 Rotterdammers aged 40 and older have already participated.
Before ERGO, scientists hardly knew how common dementia was in the Netherlands. The research changed that. The study yielded numerous insights: for example, the condition of the blood vessels turned out to be closely related to the disease. We now also know more about the role of genes, Ikram distinguishes between:
- Genetic mutations that lead to dementia, this accounts for 3 to 4% of all cases. Carriers often get dementia at a younger age.
- Susceptibility genes that cause the risk of dementia to increase or decrease. This plays a role in most cases.
More and more pieces of the puzzle that leads to dementia are becoming known.
Dementia no longer an inevitable consequence of old age
One of the most hopeful conclusions from decades of research: dementia is not an insurmountable consequence of aging. The relative risk of the disease has even decreased in recent years. Compared to ten years ago, dementia is now about 15 percent less common. However, this effect is compensated by the aging population and the absolute number of people with dementia will therefore increase.
"So we did something right, but what?" asked Arfan Ikram. "Our genes have not changed and no miracle drug has been invented. All that remains is that we have become better at prevention. All our prevention in the field of cardiovascular disease has also had an impact on the prevention of dementia. What is good for the heart is good for the brain. That is the only plausible explanation." Think of: no smoking, moderate to little alcohol consumption, healthy food and sufficient exercise.
"Our genes have not changed and no miracle drug has been invented. All that remains is that we have become better at prevention."
Not a panacea, but progress
Yet Ikram also tempered expectations. There will be no miracle cure for dementia, he explained. Dementia is a multifactorial disease, which means that there will probably never be one drug that solves everything. "Because most people with dementia have a combination of damage in the brain, a drug that targets one type of damage is not effective," he explains.
It is more realistic that several small steps will be taken in the coming years to tackle the various causes of the disease. The treatment of the future will therefore consist of a combination of lifestyle advice and medication.
According to him, the most profit can be made in that small group of patients with gene mutations. "I expect that medication that will target that particular gene will have a dramatic effect."
Individual as part of the whole
As with many other diseases, future research into prevention will have more focus on the individual as part of the whole. "We also have to include the living environment and psychosocial environment, because we are running up against the limit of what the individual can do himself." Think of external factors such as air pollution or sufficient greenery in the neighborhood. But there is more at play: "We are increasingly finding out that, for example, healthy eating is largely determined by policy."
The dream: research in Rotterdam-Zuid
Ikram concluded his lecture with a look at the future. To better understand dementia and develop tailor-made prevention, more diversity in the research population is needed. Arfan Ikram therefore wants to expand his research to Rotterdam-Zuid, in co-creation with the neighbourhoods there. Because if, for example, you want to investigate the link between diet and dementia in this new population, you also need to take into account diets and eating habits that may differ from those in the current population.
"How nice would it be if we could connect even better with the diversity that Rotterdam has to offer? If we can enrich all the knowledge we have for the entire population of Rotterdam? I would like to expand to Rotterdam-South. I live in Hillesluis myself, so that would be a good candidate. It would really enrich the existing research," says Ikram.
A gift to the city
The Rotterdamlezing is an annual gift from Erasmus University Rotterdam to the city, made possible by the Erasmus Trustfund. "One of the reasons we are organizing this lecture is to show what we are doing in terms of research in the city. Of course, many Rotterdammers know that there is a university, but not what we do," said Rector Magnificus Jantine Schuit in her opening speech. "It is very special and I am proud that we have been following people in this research here in Rotterdam for so long and can see how certain diseases develop." With the 22nd edition, the lecture once again proved its value: a platform for science that really matters, close to the people involved.
Arfan Ikram’s research explained in a short video
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Would you like to find out more about Prof. Arfan Ikram’s research into dementia? Listen to the first episode of the new podcast “Oh Ja Joh?!” (in Dutch).
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