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Expanding healthy life expectancy: Insights on ageing
Reported by Aubin Ramon, CSaP Policy Intern (Sept-Dec 2024)
As life expectancy grows, age-related conditions such as neurodegenerative diseases, cancer and immune system disorders become more prevalent. Consequently, a growing number of individuals experience ill health in their later stages of life, which compromises the dignity of elders and increases the strain on the economy and healthcare systems. Delaying the onset of dementia by five years could reduce its prevalence by 50%, saving £14 billion in care costs. In this meeting, we discussed effective ways to improve healthy life expectancy through the perspectives of neurology, epidemiology, genomics and AI.
CSaP's Dowling Policy Fellowship met last month to listen to a series of talks designed to stimulate discussion around ageing and health.
Professor Kay-Tee Khaw (Emeritus Professor of Clinical Gerontology, University of Cambridge) presented an epidemiological understanding of ageing through behavioural studies conducted on large populations. She shared her conclusions on the behaviour factors impacting healthy ageing in the EPIC-Norfolk study she led on 30,000 men and women over the past 30 years. In that study, Professor Khaw broke down lifestyle changes impacting health to four prevailing behaviours explaining mortality: non-smoking, physically active, moderate alcohol intake, and fruit and vegetable intake of at least five servings a day. She concluded by stating that the greatest impact we can make is through early intervention in childhood, fostering the development of healthy habits that can last a lifetime.
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Professor Zoe Kourtzi (Department of Psychology, University of Cambridge) gave a talk on a new AI tool to predict the progression of Alzheimer’s disease, responsible for 60-80% of dementia cases. Professor Kourtzi developed an AI model able to predict from MRI scans and cognitive tests whether and how fast an individual with cognitive problems will progress to developing Alzheimer’s disease. Professor Kourtzi’s model outperformed current standard of care by correctly predicting the trajectory and speed of Alzheimer’s disease’s progression on a 6-year longitudinal clinical study. She concluded on the importance of such a prognostic tool to enhance the reliability of clinical trials and for the early identification of individuals who may benefit from new treatments, while flagging those who require close monitoring due to a rapid disease progression.
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Dr Alex Cagan (Assistant Professor, Departments of Genetics, Pathology and Veterinary Medicine, University of Cambridge) carried on with genomic insights into longevity across the animal kingdom to explore the genetic factors contributing to a longer healthspan. As we age, we linearly accumulate DNA mutations in our cells, leading to an increased prevalence of age-associated diseases. Dr Cagan developed a technique at the Sanger Institute to determine the variation of mutation rates across different cell types. He extended his genomic cartography to multiple species to investigate the fundamental mechanisms of ageing longevity to enable new approaches to prevent age-induced diseases. Dr Cagan's research notably revealed that larger animals exhibit lower mutational rates, limiting their cancer prevalence despite having more cells – a phenomenon known as Peto's paradox. Based on those findings, Dr Cagan and the scientific community are now looking at a molecular understanding of underlying cellular longevity to enable new approaches to prevent age-induced diseases.
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In response, participants were keen to know which habits they should focus on (and which to avoid) in order to maximise healthy ageing; as an example, discussion highlighted the increased health risks faced by night-shift workers, who often experience sleep deprivation and might rely on caffeine to compensate for their irregular sleep patterns.
Turning to a population perspective, discussion covered topics such as the NHS screening programme, the low number of breast cancers in Japan, potentially linked to higher soy consumption, and the negative impact of ultra-processed foods on microbiome diversity. The conversation also touched on population-wide health measures, noting that in Hong Kong, people tend to be more active due to widespread use of public transport, ample green spaces, and the city's reputation as a safe place to walk.
A discussion followed Dr Cagan’s presentation on the complex relationship between genetic mutations and environmental exposure in cancer development. Dr Cagan noted that some mutations only lead to tumour growth when exposed to specific molecular promoters that the environment can trigger. Mutations are essential in evolution; however, little is known about the mutational landscape in normal tissues, which still undergo mutations. In some cases, cancer can develop in cells that lack specific mutations typically associated with tumour formation, highlighting the complexity of cancer evolution and the need for further research in this area.
The final roundtable discussion explored data availability as well as the steps required to facilitate the transfer of new technologies into clinics. Professor Kourtzi and colleagues’ new tool could be widely adopted, requiring only a cognitive test and a 5-minute MRI scan. Such scans can be performed using low-tesla machines like the new 0.5T mobile scanners. This tool has the potential to be integrated into routine primary care checks at the GPs for an early detection of dementia-related diseases, ultimately expanding healthy life expectancy.
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Cutting edge research on ageing from the perspectives of neurology, epidemiology, genomics and AI helps us as individuals as well as policy makers responsible for the health of populations to better understand effective ways to improve healthy life expectancy, improving quality of life as well as reducing the considerable cost of age-related illness on society. Overall, we learned that the roots of healthy ageing lie in what we do in childhood, laying the foundations, as individuals and societies for better ageing populations.