Dementia is a condition that is widely misunderstood by many people.1 Admittedly, my knowledge of dementia was limited until my late wife, Susan, received the diagnosis of Alzheimer’s disease. That’s when it became all too real.
When I’ve spoken to other people who’ve been affected by dementia, the word “inevitable” often crops up. Yet to describe dementia as an inevitable part of ageing would be inaccurate. Although there are no sure fire ways to prevent the diseases that cause dementia—as risk is influenced by factors such as age and genetics—there’s compelling evidence that we can all take steps to protect our brain health.
The Lancet Commission on Dementia has reported 12 modifiable health and lifestyle factors that have the potential to prevent or delay the condition if acted upon.2 The commission proposed that, if these factors were effectively targeted worldwide, dementia cases could drop by 40%.
But are doctors fully grasping this opportunity? Research into this area is limited, but what evidence we have suggests not. Surveys of healthcare professionals have found that they have a low awareness of dementia risk factors.3 And a recent—albeit small—qualitative study suggested that UK GPs don’t widely discuss dementia risk with their patients, even when their circumstances or lifestyles put them at increased risk.4 This includes having conditions like hypertension, which affects 16 million adults in the UK, many of whom successfully self-manage it.5
Susan had hypertension a decade before she developed Alzheimer’s. Of course, back then, the link between the two hadn’t been properly established.2 But I like to think that, had we known, we would’ve had more questions for our GP, explored numerous avenues to help prevent or delay the onset of Susan’s Alzheimer’s, and we would’ve had the opportunity to speak with family and friends about dementia risk.
It’s devastating to think that people developing hypertension today, with this link now clearly established, are still missing out on prevention opportunities. And it’s not just a loss on an individual level—it’s predicted that 1.6 million people in the UK will have dementia by 2050 with a projected cost of £47bn.67 We urgently need to change that trajectory, and although potential new Alzheimer’s treatments are starting to emerge from clinical trials, we mustn’t overlook the importance of prevention.
Missed opportunities
Realistically, we all know that discussions about prevention can be time consuming—and time is a luxury that is often in short supply for GPs. But surely there’s a way to make the necessary information more accessible and to ensure that this is signposted to patients during healthcare consultations.
For one thing, many of the risk factors for dementia, like smoking and obesity, are shared with other non-communicable diseases. Risk reduction programmes already in place, such as stop smoking services, put GPs in a good position to highlight these shared risk factors to patients. Knowing that they are also at risk of dementia might encourage patients to make changes or to access these services so that they can also reduce their risk of developing dementia.
It would also seem sensible to adapt the NHS Health Check to motivate people to reduce their risk of dementia. In 2016, a successful pilot project explored adding dementia risk to the NHS Health Check for 40-64 year-olds. After the health check, 46% of participants said that they were much more likely to adopt a healthy lifestyle to reduce their dementia risk compared with 25% in the control group; 80% of people said that the advice would have some effect on their behaviour.8
But we also need to tackle stigma among clinicians and the wider public. Poor understanding and fear of dementia create a barrier to having open discussions about dementia risk, and that needs to be overcome. I worry that too many people leave appointments without being informed that they’re at higher risk of developing dementia and being told about the actions they can take to reduce that risk, because GPs fear that their patients “wouldn’t want to know.”
Discussing dementia is challenging and can be emotive. Still, these conversations are vital, and training is key to equipping GPs with the skills and confidence to navigate the topic, allowing them to steer conversations in a way that sensitively conveys all the essential information. It’s what we’ve come to expect with conversations about conditions like cancer. Failing to do the same for dementia is to effectively deny us the opportunity to discuss prevention, and in my view that is unacceptable.
To tackle stigma about dementia effectively, it’s crucial to rebrand the narrative. A subtle shift from “dementia risk” to “brain health” could work wonders. Only a third of UK adults feel confident that dementia risk can be reduced, but more than two thirds believe in their ability to protect their brain health.1 GPs should harness this insight for conversations about brain health and dementia.
These solutions are not new or groundbreaking, but they are imperative. The UK public needs to understand that our brains are organs that we can help protect in the same way as our hearts. This understanding must, in part, be promoted by the clinical community. I know this will help change the outlook for dementia and its effects on individuals, families, and society.
Footnotes
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Competing interests: I am a member of Alzheimer’s Research UK’s Policy Insight and Experience Panel.
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Provenance and peer review: Not commissioned; not peer reviewed.