Dementia in the ageing population: Understanding determinants and the natural disease course

Dementia is a devastating disease of the brain, affecting mainly older adults, for which currently no effective therapy exists. Understanding the origin of dementia is crucial for the prevention of dementia and for developing treatments. In the first part of this thesis, I focused on investigating the influence of body fat and glycation processes (advanced glycation end products). Both can be disturbed in people who are overweight or have diabetes. The glycation processes were associated with lower cognitive functions and appeared to play a role in the development of dementia. The role of body fat, on the other hand, was not straightforward and depended on age.

In the second part of the thesis, I focused on the natural disease course of dementia, as this information can be relevant for patients, relatives, physicians, and policymakers. To this end, I calculated the prognosis, expressed as remaining life expectancy, for people with dementia, as well as for people with mild cognitive impairment. Within the latter group, the risk of dementia is increased, although certainly not everyone develops dementia. The outlook appeared to be largely dependent on age, and further influenced by factors such as sex and educational level. Finally, I described and reflected on the dementia research field in a more general sense, particularly on the patients in these studies, through literature review. Noticeably, included patients were relatively young and often White, and may thus not always reflect older patients, or those in developing countries.