In 2013, more than one hundred scientists from 36 countries called upon governments of highly industrialized nations to make prevention of dementia one of their major health aims. Nearly a decade later none of nations in the G8 at that time has done this, despite the increasing cadence of strong evidence that protective measures and risk reduction steps are effective in delaying onset of dementia and in some cases, preventing it.
The Economist stated it unequivocally: dementia is a global emergency and governments should act now. Millions of families deserve better information and swift action.
Setting a national goal to reduce the number of people that develop Alzheimer’s and other dementias and putting an accountable plan in place to reach that goal should be a top priority for the incoming United States President and the 117th Congress.
Failing to take action is tantamount to budget imprudence and health racism.
Medicaid (read: state budgets) pay a significant portion of the nation’s long-term care bill, second only to individual out-of-pocket spending. Even a five-year delay in dementia onset by 2025 would reduce total health care payments 33 percent and out-of-pocket payments born by families by 44 percent in 2050.
Furthermore, without action, Latinos and Black Americans in the United States will see the largest increases in Alzheimer’s disease and related dementias (ADRD) between 2015 and 2060. Already, communities of color bear a disproportionate share of risk.
In 2020 alone, three important studies augmented the growing evidence that prevention may be possible. The Lancet Commission on Intervention, Prevention and Care reported up to 40 percent of dementia cases could be delayed or prevented by modifying 12 risk factors—less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, low social contact, excessive alcohol consumption, traumatic brain injury, and air pollution. Another large-scale systematic review of more than 395 studies identified a total of 21 evidence-based suggestions that can be used in life-course practices to prevent Alzheimer’s, and an NIH supported study concluded that combining more healthy lifestyle behaviors was associated with a 60% lower risk for Alzheimer’s disease.
These and hundreds of other studies over the past decade demonstrate there are steps individuals and communities and public health systems can take now, steps that are good for overall health and have positive impacts on not just dementia, but other co-occurring conditions including diabetes, hypertension and obesity. Moreover, addressing known risk factors necessitates ameliorating health disparities. Under resourced communities at highest risk for dementia are further disadvantaged from the solutions due to deep inequities in education, dietary and physical activity interventions and access to health services.
Yes, more evidence is needed, especially focused on people of color. And we should fund more research on the health, environmental, and lifestyle factors that may contribute to Alzheimer’s and other dementias as well as the practical applications that work to address them. At the same time, it is also true that enough solid ground exists to merit an attention to prevention and evidence-backed clinical interventions today.
Yes, progress is being made on pharmacological interventions, with the possibility of new treatments on the horizon. And it is also true that no treatment will be a magic pill.
Ending Alzheimer’s and other dementias for all will mean both prevention and cure.
More than 120 organizations and experts, including the American Heart Association, the YMCA of the USA, AARP, UnidosUS, the National Kidney Foundation, HADASSAH and the Milken Institute, have now joined in a new call for a national dementia prevention goal that aims to reduce prevalence by 2030. A Federal Advisory Council on Alzheimer's Research, Care, and Services recently recommended that its work should include developing a national goal to reduce burden of risk factors to prevent or delay onset of AD/ADRD. This is welcome news, and the effort should be elevated and supported.
Without a plan, more than 82 million people worldwide are expected to develop dementia by that time.
No one can afford to wait another decade for government leaders to act.
Kelly O’Brien is executive director of the Brain Health Partnership at UsAgainstAlzheimer’s. For more information on the Brain Health Partnership click here.