MANY Australians dismiss dementia as a natural part of ageing and don’t realise they can do things to prevent it or slow its progress.

Dr Kaele Stokes, Executive Director of Advocacy and Research at Dementia Australia, told InSight+ that many of the people who call the Dementia Australia hotline are looking for ways to either prevent dementia or slow its decline. Knowing there are things they can do gives them a sense of hope.

“There is a sense of being powerless for people with a diagnosis of dementia that there’s nothing they can do,” she said.

“But the more research we do, the more we realise there are significant changes people can make through all stages of life to reduce their risk. And to support them to live as independently as possible when they get a diagnosis,” Dr Stokes said.

According to the authors of an MJA Perspective 40–48% of dementia risk is modifiable. Risk factors include “physical inactivity (17.9%), mid-life obesity (17.0%), low educational attainment in early life (14.7%), mid-life hypertension (13.7%), depression (8.0%), smoking (4.3%), and diabetes mellitus (2.4%)”.

Half a million Australians are currently living with dementia, with this number set to rise to over a million by 2056, according to the authors. Dementia is now considered the greatest cause of disability in Australians aged over 65 years and the second leading cause of death – the leading cause of death in women.

According to Professor Ruth Hubbard, a geriatrician and Masonic Chair of Geriatric Medicine at the University of Queensland, now is an opportune time to focus on dementia prevention.

“Ageing well is something we should embrace as a society. [We need] to emphasise the importance of strategies that would help us age well as a population. There may be a climate to receive that sort of information now,” she told InSight+.

Dr Terence Chong, psychiatrist and Senior Research Fellow at the University of Melbourne, and colleagues proposed a multilayered action plan in the MJA article, with eight recommendations about preventing dementia over the next 40 years.

Recommendation 1 is the drafting of Australian guidelines for dementia prevention.

“Guidelines are important, and from there we can use that to promote the importance of prevention at a community level and health level,” said Dr Chong.

A dedicated public health campaign, which would explain the ways dementia can be prevented, was also suggested.

Public health campaigns have had success in Australia in the past. However, according to Dr Stokes, those campaigns need significant funding and a long time frame to see any benefit.

“Public health campaigns take a long time to shift practice. If you think of the public campaigns around seat belts or quitting smoking, they’ve taken a long and sustained period of consistent awareness-raising to change practice,” she said.

The MJA article notes that any campaign will need to reach a broad and diverse audience – “this is particularly important for Aboriginal and Torres Strait Islander people, for whom dementia prevalence is three to five times higher than the general population”.

However, public health messaging can only do so much. Tailoring these messages to each individual will be the way to see behaviour change, Chong and colleagues wrote, putting the focus firmly on primary care physicians.

They highlighted that many of the risk factors for dementia, such as physical inactivity and midlife obesity, are risk factors in many chronic conditions including diabetes, hypertension and heart disease.

“A key step is the coordination and pooling of resources between peak advocacy bodies such as Dementia Australia, Diabetes Australia, and the Heart Foundation, with clear messaging focusing on single risk factors that have multiple benefits.”

Dr Chong and colleagues wrote that GPs need to have enough resources and equipment to help them spearhead dementia prevention throughout life. They suggested a focus on dementia prevention including additional Medicare Benefits Schedule item numbers and changing existing items, such as the 45–49-year-old health check for individuals at risk of chronic conditions.

Dr Chong also told InSight+ that, thanks to their long association with their patients, GPs can understand what’s meaningful to each patient in order to effect change. Sometimes, it may be more relevant to talk to patients about the risk factors rather than the disease it’s preventing.

“Physical inactivity will put them at risk of lots of things including heart disease, osteoarthritis, diabetes etc,” he said.

“It doesn’t matter if they’re doing (physical activity) for preventing dementia or cancer or because they saw their mum have to get a hip replacement because of osteoarthritis. There’s also a lot of evidence of physical activity being important for mental health. There are lots of important reasons to be addressing that risk factor.”

Even older patients who have recently been diagnosed with dementia often don’t realise they can still do things to help reduce the decline of their disease.

“[Exercise] often make patients feel empowered that there’s something they can do about it,” Professor Hubbard said.

“It’s a lot more powerful than a medication. The patients who come to see me … don’t realise exercising can have a lot more of an impact on their general health and cognition.”

Although there has been more funding for dementia prevention research, there still needs to be urgent funding into critical evidence-to-practice gaps, according to Dr Stokes.

“The research translation tends to be very slow and inconsistent in the way it’s applied. It makes a difference to have evidence-based interventions and strategies that tie into the latest research.”


Poll

The Federal Government's initial response to the Aged Care Royal Commission final report does not go far enough
  • Strongly agree (75%, 148 Votes)
  • Agree (10%, 20 Votes)
  • Neutral (7%, 14 Votes)
  • Strongly disagree (6%, 11 Votes)
  • Disagree (3%, 5 Votes)

Total Voters: 198

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6 thoughts on “Almost half of dementia risk is modifiable, GPs told

  1. Jon Phipps says:

    Something practical to lower tau and amyloid levels might also help.

  2. Anonymous says:

    I TOTALLY agree with anon when he/she says we have been unable to change those factors before: think OA of the knee where we see increasing obesity and sloth but we can’t get patients to address these and they want TKR’s instead! (I am an Orthopaedic surgeon constantly berated for doing TKR’s when the patients “should be offered alternatives to surgery” according to academics!)

  3. Dru Haywood says:

    I admit I have not read the original research that backs up this article. I am fairly certain however that the effect of these modifiable risk factors on dementia risk is age-adjusted. That is to say at any given age dementia risk is increased with by these risk factors.
    But I think we all know that the number one is oak factor for dementia is advancing age. And there is only one way to prevent old age. Let’s see some research into the lifetime risk of dementia – we might find that all those things that increase risk of dementia at a given age increase the lifetime risk. It’s obvious frankly – stay healthy and your more likely to live longer. And get dementia. Be more honest about what exactly we are trying to prevent

  4. Anonymous says:

    According to the authors of an MJA Perspective 40–48% of dementia risk is modifiable. Risk factors include “physical inactivity (17.9%), mid-life obesity (17.0%), low educational attainment in early life (14.7%), mid-life hypertension (13.7%), depression (8.0%), smoking (4.3%), and diabetes mellitus (2.4%)”.

    Call me cynical – but we aren’t having much success to date with these issues in helping to modify other diseases so why do we think dementia will be different!!

  5. Anonymous says:

    Seems a bit out of date. The latest statement from the Lancet has 12 modifiable risk factors https://www.alzheimers.org.uk/news/2020-07-30/lancet-40-dementia-cases-could-be-prevented-or-delayed-targeting-12-risk-factors
    The one of concern is alcohol use given the high rates of alcohol use in middle aged women atm.

  6. Anonymous says:

    Yes, we do need to focus on the modifiable risks for dementia. I was surprised that hearing loss was not more prominently mentioned. Hearing loss is now internationally profiled as a significant contributor to dementia as well as social isolation and other mental health concerns.

    The other factor that could be considered is the progressive deterioration in cognitive function can be monitored over time. There are a variety of cognitive function tests, like the MoCA or ACE-III or even the SMMSE with Clock Drawing that can be trended over time. Understanding if there is a decline would emphasise the importance of addressing the reversible issues.

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