The good news about Alzheimer’s


October 28, 2016 – By age 95, people have a 50% chance of having Alzheimer’s disease. That’s the bad news. But Albert Hofman, new chair of the Department of Epidemiology at Harvard T.H. Chan School of Public Health and an expert in vascular and neurologic diseases, thinks that that sobering Alzheimer’s statistic will improve in the years to come.

It’s predicted that the number of people worldwide living with dementia—about 46 million—will triple by 2050. But you’re hopeful that things will get better in the future. Why?

We’ve learned that Alzheimer’s is a very prevalent disease. We’ve also learned that vascular factors are important causes of dementia and Alzheimer’s. And the good news is that these vascular factors can be influenced. You can do something about your risk for vascular diseases, by treating high blood pressure or high cholesterol, or by not smoking. We have seen a gradual decline in the incidence of dementia over the past decade, and I think it is because of those kinds of preventative interventions. It’s true that there will be more people having dementia as they become older, because numbers of older people in the world are increasing—but the incidence of dementia is not. We think, overall, that the picture for Alzheimer’s is improving.

Here at Harvard Chan School, we are working on linking nine different research cohorts in the world that have focused on Alzheimer’s. This will provide us with valuable information over time for about 80,000 people, including roughly 15,000 with Alzheimer’s.

What do you see as priorities for future Alzheimer’s research?

We have found in the past decade over 30 genes involved in Alzheimer’s. But we don’t know the genomic pathways involved in leading to disease. More research in this area needs to be done, particularly in relation to the vascular factors that we know play a role in Alzheimer’s. The Department of Epidemiology at Harvard Chan School is particularly strong in the development and application of new epidemiologic methods and should be able to help shed new light on the factors that lead to Alzheimer’s.

I am also hoping to get involved in Harvard Chan’s work on aging in general. In countries around the world, the number and proportion of older people is growing, and the effects of this will be very big. Nearly all chronic diseases, such as heart attacks and strokes, increase with age, as do locomotor diseases like arthritis and osteoporosis. It all sounds a bit pessimistic, but the uplifting fact is that also in recent decades we have been able to substantially increase life expectancy—not just additional years, but healthy years. Many of these chronic diseases are now occurring later in life, and we want this trend to continue.

What do you see as the strengths of the Department of Epidemiology, and what are your future goals for the department?

I am very honored to be the chair of what I consider the most important Department of Epidemiology in the world. In addition to its role in the development of new epidemiologic methods, the department has played a key part in finding the causes of breast cancer and how to treat it; in developing pharmaco-epidemiologic methods that help pinpoint the side effects of drugs; and in uncovering the health effects of passive smoking. The Department has also played a major role in evaluating data from the Nurses’ Health Study to produce crucial research on cardiovascular disease, cancer, and nutrition.

I am impressed not only with the enormous dedication of people working here in scientific research, but also with those at the School working to create the very best educational programs in public health. For instance, the new on-campus/online MPH in epidemiology program, which I think has a great future, is a very important way of translating and linking the enormous talent of the Harvard Chan School to the world, because it makes participating in our programs easier for people who would otherwise not be able to be here as full-time students.

Looking ahead, one of my priorities will be to help strengthen and develop the PhD in Population Health Sciences; epidemiology is woven throughout the program, and is also one of the fields of study.

I also hope to help build a research group in clinical epidemiology, in concert with the great hospitals in the area—Mass General, Brigham & Women’s, Beth Israel, and Children’s Hospital—to help advance our efforts at the intersection of clinical medicine and public health.

Karen Feldscher