This is a cross-post with the Royal Society for Public Health.
Although we haven’t seen any new treatments for dementia in over 15 years, there has been considerable progress in research to understand the underlying diseases. Recent developments in the understanding of Alzheimer’s disease, including the development of molecular biomarkers of the disease, present an opportunity to detect and diagnose disease and the risk of disease earlier.
Data from recent clinical trials suggests that the best time to give a treatment is likely to be when you have changes in the brain associated with the disease, but you are not yet experiencing the symptoms of dementia. A growing evidence base suggests that one of the reasons we don’t currently have any treatments to slow or halt the progression of the diseases that cause dementia, is that probably that potential new treatments have been tested in clinical trials too late in the disease process. This means that we need to detect these diseases as early as possible, so that we stand the best chance of finding a new treatment that will work.
Alongside our growth in understanding of the diseases behind dementia a review published in The Lancet, Dementia prevention, intervention, and care, suggested that around a third of cases of dementia could be prevented if a number of environmental risk factors could be eliminated.
This relatively new evidence leads us to the conclusion at Alzheimer’s Research UK that:
- We must begin thinking of brain health / cognitive wellbeing in the same way we think of wellbeing for other disease areas like heart disease.
- We need to detect and diagnose dementia 10-15 years earlier than we do today.
Brain health as a public health issue
We need to think about dementia as part of a wider approach to our brain and mental health: something that we are thinking about and taking proactive steps to protect over our lifetime. If we thought of brain health like we think of heart health, we could promote the importance of protecting our brains and better understand how this vital organ contributes to overall health. This includes working to reduce people’s risk of dementia from midlife, when we know we are likely to have the greatest impact, and detecting changes that occur in the brain before symptoms of dementia begin. There are steps we can be taking in midlife that might help us reduce our risk. Risk factors for dementia include:
- physical inactivity
- social isolation
Recognising these risk factors also gets us thinking about brain health and taking positive steps to improve it, in the way we do for cardiovascular disease. However, there is a very low awareness among the public of the risk factors for dementia, with just 25% of people believing it is possible to reduce their risk of the condition, compared to 83% for heart disease. This lack of understanding must be addressed urgently.
In order to embed this awareness we must ensure practitioners involved in health, care, leisure and broader healthy lifestyle services are fully aware of the potential for reducing the risk of developing dementia. The 2015 NICE public health guidelines outlined the breadth of organisations who have a role to play including planners, housing providers and employers.
As a starting point, Alzheimer’s Research UK have worked with Public Health England to pilot the inclusion of dementia risk reduction awareness in the NHS Health Check for people aged 40-64, and this will now become a routine part of the Health Check across England. While this represents a step forward, public awareness programmes in all parts of the UK and through a variety of formal and informal channels are needed to inform and educate people, so they can better manage their risk factors.
Diagnosing far earlier than we do today
It’s thought that eliminating certain risk factors for dementia could reduce the prevalence of the condition by around one third, but like cancer, a disease like Alzheimer’s will occur for many people, even if they engage in healthy lifestyle choices throughout their life. If we are to slow down and eventually stop the diseases that cause dementia, we must begin to identify them 10 to 15 years earlier than we do today, before they have been able to cause significant damage to the brain.
To do this, we must pioneer new ways of diagnosing these diseases and build resources within the NHS to harness those methods once they are found. We must also ensure that medical professionals have crucial training to identify dementia today and support them as new diagnostic tools become available.
Alzheimer’s Research UK wants to see a revolution in the way dementia is diagnosed, as well as ensuring people get a timely diagnosis today. The development of new technologies and the huge breadth of data available, from information on gait and sleep patterns to clinical data from brain imaging, mean we could build ‘fingerprints’ that signify risk of future dementia and use these to identify people 10–15 years earlier than we do today.
Once again, this starts with the broader understanding of brain health. If you aware of action you can take in midlife to keep your brain healthy, then the prospect of further understanding your risk of dementia based on early changes in the brain in your late 50s or 60s becomes easier to grasp. This would allow people to plan accordingly and potentially take action to reduce their risk of dementia and build resilience.
Promoting brain health
By reframing dementia as part of brain health, somewhat akin to heart health, we can develop messaging that provides a fresh perspective of dementia as a physical condition. A pathway approach also starts to link midlife health with the potential for earlier detection in future, through risk profiling and developing approaches to manage and mitigate risk for those identified as having the highest likelihood of developing dementia.
This shift will allow us to innovate in research and adapt our services to improve patient care and support, which in turn will enable the incorporation of future developments in the field of dementia. We look forward to continuing this debate and working with RSPH to explore these issues in greater detail.