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Analysis
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Health

There’s Good News on Dementia. But It Requires Big Changes to How We Live

The Lancet has mapped our best chance to prevent the memory wasting disease.

Crawford Kilian 5 Aug 2020 | TheTyee.ca

Tyee contributing editor Crawford Kilian blogs about dementia here.

A commission created by the esteemed Lancet medical journal predicts that the number of people in the world living with dementia will triple, from 50 million today to 152 million by 2050. If that holds true for Canada, our present 420,000 dementia cases will be well over a million in 30 years.

And so the grim curve keeps rising. Two years ago an article in the Lancet Neurology reported that the number of people worldwide living with dementia more than doubled between 1990 and 2016 — from 20.2 million to almost 44 million.

Already, the worldwide cost of dementia care, the Lancet commission says, is US$1 trillion a year.

But if dementia is its own pandemic relentlessly attacking humanity, there is emerging consensus on how to tackle it. The prescription is as radical as it is stark. It would require a revolution in both our lifestyles and our politics.

The good news about dementia is that much of its predictable harm is actually preventable right now, without the need to develop new drugs or vaccines. Indeed, prevention is the first goal of Canada’s own dementia plan.

But if we are to take prevention seriously, it does mean we need to transform our societies. Here’s why.

Earlier studies had confirmed nine major risk factors for dementia (see sidebar). They’re not guaranteed triggers, but your odds aren’t good if you have any of them. The new Lancet Commission adds scientific confirmation to three new factors: excessive alcohol consumption, head injury and air pollution. Reducing them at all stages of life would prevent or delay dementia in millions of people worldwide.

It wouldn’t be easy to follow that advice. Brewers and distillers and the hospitality industry are invested in expectations that people will keep drinking at current rates, or even more. If brain-jarring sports like hockey, football and soccer are implicated in dementia years later, would there ever be support for banning them? Yes, we have spent decades reducing air pollution, whether from tobacco smoke, cannabis, vaping or industry, but we still have a long way to go.

The good life of junk food and soda

Similar resistance can be expected to tackling the other risk factors, especially in the low- and middle-income countries where dementia is increasing rapidly. Increase education levels? Some people just aren’t quick learners, and schools cost taxpayers money. Fight hypertension, diabetes and obesity? People have a right to eat junk food and drink soda, especially while sitting on the couch for hours on end watching hockey or football and texting their friends.

Not only couch potatoes would hate the idea of “public health programs and individually tailored intervention.” COVID-19 has taught us how ineffective most public health messaging can be, and many already tune out those nagging public-service commercials. No one welcomes “interventions” in their personal lives by government employees.

One such intervention, however, could sharply reduce dementia all by itself: a seasonal flu or pneumonia vaccination. This summer’s Alzheimer’s Association International Conference included research findings that even a one-time seasonal flu shot was associated with a 17 per cent reduction in Alzheimer’s disease. Repeated vaccinations “cut Alzheimer’s incidence by a further 13 per cent.” Another study indicated that for people aged 65 to 75, a pneumonia vaccination could reduce Alzheimer’s risk by up to 40 per cent.

These findings are especially significant because dementia patients who are hospitalized because of an infection are 6.5 times more likely to die than persons without dementia. This may help to explain the catastrophic COVID-19 death toll in our long-term care facilities and nursing homes: over 80 per cent of COVID-19 deaths in Canada have been in such facilities.

Widespread vaccination of seniors for flu and pneumonia could therefore prevent many dementia cases and thereby prevent deaths from other infections as well — and perhaps encourage public acceptance of more dementia-prevention measures.

Equality is good for your health

Reducing one risk factor would require something close to a revolution. The Lancet Commission notes that “Many risk factors cluster around inequalities, which occur particularly in Black, Asian and minority ethnic groups, and in vulnerable populations.” Very few power elites, anywhere on the planet, would be prepared to cede power and wealth to such groups — even if it would create happier, healthier, more stable societies.

Still, a few democracies (and perhaps one or two enlightened despots) might see the wisdom in preventing not only dementia but perhaps the next pandemic as well. Their populations would be generally healthier and economically more productive. Seniors in such countries would make fewer demands on health-care systems, which would be focused more on preventing disease than on responding to it.

People in other countries may then legitimately ask their governments why they can’t have nice things like healthy grandparents doting on their healthy, educated grandchildren. What if we put more money into health and schools than into the military and riot police?

As we’ve seen in recent weeks, people are literally dying to go back to the carefree days of 2019, with no social distancing and the kids in school. What we don’t want to admit is that our 2019 lives and lifestyles set us up for this. COVID-19 has found every flaw in our society as well as in our health care, and it will keep sickening and killing us until we start behaving better.

Don’t count on the next pandemic being any easier.  [Tyee]

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