Of all the things Australians fear, cancer is number one and dementia is number two. For me the order is reversed. I’ve had cancer (radiation, chemotherapy, lumpectomy). I’ve seen people die of cancer. It’s not easy or pretty. But I’ve also seen people die slowly of dementia – whether Alzheimer’s disease or vascular dementia, it doesn’t matter. Dementia holds a particular horror because it robs people of their intellect, their personality, their memory, their speech, their essential self. Cancer sufferers, on the other hand, remain recognisably themselves through the experience, maybe grow a bit wiser or a bit crankier.
So I took my extreme phobia about dementia to one of Australia’s experts, Professor Perminder Sachdev, in the hope of good news, and developing a better attitude. I’m aware it’s politically incorrect to say things like, “If I had a diagnosis of Alzheimer’s I’d kill myself.” I admire those people trying to reduce the stigma around dementia who ‘come out’ as sufferers like the marvellous John Whelan in the Sydney Morning Herald recently. I admire Ita Buttrose, president of Alzheimer’s Australia, whose tireless work has brought more awareness of the disease. But I’m not sure I agree with her view that the public’s fear of dementia may be due to lack of understanding. Many of us have seen dementia up close and understand it all too well.
So Professor Sachdev, a neuropsychiatrist, seemed the right man to set me straight. He’s at the Centre for Healthy Brain Ageing (CHeBA) at the University of NSW. He’s also leading a campaign to get enough signatures on a petition to have dementia placed on the G20 conference agenda. The G20 meeting in Brisbane in November of the world’s top leaders will set out a few key issues for focused effort in the coming years. Because the number of dementia sufferers is growing rapidly, not just in developed countries but in low and medium income countries, such as China, India and Brazil, it’s important to get a commitment from world leaders to start planning now.
Given the barrage of “new findings” on dementia that daily assault me through emails and social media, I asked Professor Sachdev to provide some clarity. Where do we really stand? Do you want the good news or the bad news first? Let’s start with the good-ish news.
It appears the risk of getting dementia in our later years is declining. Put another way, we’re somewhat less likely to be affected than people born a few decades ago who also reached old age. Only two or three quality studies as yet point in this direction so don’t get over-excited. Still it’s cheering. For example, a recent UK study compared dementia prevalence in people aged 65 and over in 1991 and 2011. Based on the 1991 rate, it was expected that 8.1 per cent of people would have the disease in 2011. But the prevalence in 2011 turned out to be only 6.5 per cent, meaning 24 per cent fewer people were affected by dementia than had been anticipated. “We need more evidence,” said Professor Sachdev, “but the risk of having dementia at a particular age may be going down.”
Here’s some good news. Even though Alzheimer’s disease does have a strong genetic basis, it’s possible, Professor Sachdev said, to modify some of the risk factors linked to dementia generally. The reason dementia prevalence may be on the decline is because we’re smarter than previous generations. A Danish study showed 90 year-olds born in 1915 had better brain functioning than 90 year-olds born in 1905. And this was attributed to the 1915 generation having enjoyed a more stimulating environment and better education in their early years. As well, use of medication to control high blood pressure, and smoking cessation, have contributed to declining stroke rates, and thus to better brain health in older age.
Governments, in other words, can play a bigger role in dementia prevention through vigorous public health policies. Access to pre-school education for all may prove the starting point for cutting dementia rates, a disease that can take 30 years to develop. And almost any measure that improves coronary and vascular health will improve brain health. Professor Sachdev wants the government to be more pro-active in taxing junk food and alcohol, and in actively encouraging people to regularly check their blood pressure and cholesterol, and most importantly, to exercise an hour a day. Yes, I’m afraid he said an hour a day.
And what about brain training? The news is good-ish, not definitive. If you play bridge a lot you’ll get better at bridge but whether it prevents dementia is unknown. “No-one has shown any particular cognitive activity is better than anything else,” Professor Sachdev said. But on the other hand, a study that compared people who watched television documentaries with a group who performed more active cognitive tasks showed the active group improved their brain performance more than did the TV-watching group. “So I advocate a mixture of challenging activities that takes you out of your comfort zone,” Professor Sachdev said.
And the bad news? There’s no cure on the horizon, no magic pill. Indeed “the drug development cupboard is bare”, he said. We shouldn’t give up on research into a cure but the focus on prevention, public health strategies and better care for sufferers and their families must be high priorities. I’m not sure I feel comforted but when it comes to phobias it always helps to have the facts. Please sign the G20 petition here.
What experience and feelings do you have about dementia? Please Comment.
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