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Dementia: a silver lining but no room for complacency

The proportion of people with dementia seems to have declined. That’s good, but there could be a downside, says Alistair Burns, NHS England’s National Clinical Director for Dementia:

Forty years ago, people did not talk about dementia. Memory loss and growing incapacity were seen as inevitable consequences of ageing for which nothing could – or should – be done.

Today that is no longer the case. Increased awareness, reduced stigma and heightened interest from health services and politicians mean the profile of dementia has never been higher. In the UK, the National Dementia Strategy, Prime Minister David Cameron’s vocal campaign on the issue and the country’s hosting of last month’s G8 Dementia Summit, are testament to that.

One of the driving forces has been the large number of people affected, today and projected into the future. So what are we to make of recent research suggesting that fewer people than expected have Alzheimer’s and other forms of dementia.

This intriguing finding raises a number of important issues. First, it challenges the profound nihilism surrounding dementia. There is no cure, so what is the point of doing anything?

While it is true that there is no cure, the findings suggest that prevention is at least possible. This must surely explain any reduction in prevalence, so what might be behind it? Improved cardiovascular health, better diet and higher educational achievement are all plausible explanations. This opens up the possibility that people who are able to take control of their lives can reduce their individual risk of dementia.

The finding also suggests that the prevalence of dementia could be used as a barometer of general public health. We don’t yet know enough about the contribution of various factors – positive and negative – to the development of dementia to do so. But studying the effect of obesity, physical inactivity and diabetes on dementia could point us in that direction.

Lastly, though it is good news, we should be wary of hopeful headlines diverting attention away from the potentially devastating effect of a dementia diagnosis and the need for coordinated care from then until the end of life. Whatever the figures suggest about reduction in prevalence, the absolute number of people with dementia will continue to rise because of an overall increase in the number of older people.

So the need for more research, better diagnosis and improved support is as great as ever. But we can hope that when we look back in another 40 years, we will be able to say that the second decade of the 21st century was when dementia stopped being swept under the carpet.

This article is published in the current issue of New Scientist magazine.

Professor Alistair Burns

Professor Alistair Burns is Professor of Old Age Psychiatry and Vice Dean for the Faculty of Medical and Human Sciences at The University of Manchester. He is an Honorary Consultant Old Age Psychiatrist in the Manchester Mental Health and Social Care Trust (MMHSCT) and is the National Clinical Director for Dementia and Older Peoples’ Mental Health, NHS England.

He graduated in medicine from Glasgow University in 1980 and trained in psychiatry at the Maudsley Hospital and Institute of Psychiatry in London. He became the Foundation Chair of Old Age Psychiatry in The University of Manchester in 1992, where he has been Head of the Division of Psychiatry and a Vice Dean in the Faculty of Medical and Human Sciences, with responsibility for liaison within the NHS. He set up the Memory Clinic in MMHSCT and helped establish the old age liaison psychiatry service in UHSMT. He is a Past President of the International Psychogeriatric Association.

He is Editor of the International Journal of Geriatric Psychiatry and is on the Editorial Boards of the British Journal of Psychiatry and International Psychogeriatrics. His research and clinical interests are in mental health problems of older people, particularly dementia and Alzheimer’s disease. He has published over 300 papers and 25 books.