Preventing dementia: early days

A great deal of the buzz at this year’s Alzheimer’s Association International Conference which just wrapped up in London, England, has been about preventing dementia, particularly Alzheimer’s disease, which is the most common form of dementia.

And that’s a good thing because given how meager the returns have been so far from treating dementia, it’s time the focus shifted more to emphasis on prevention.

That said, however, focusing more attention on prevention presupposes that we know a lot about preventing this increasingly common condition, and I’m afraid that on that issue, there is still some disagreement.

On the one hand, many experts believe that we do know a great deal about risk factors for dementia, and to that end, a Lancet Commission report presented at this conference listed 9 factors that contribute to 35 % of dementia cases.

The risk factors are by and large the factors we always mention – not smoking, preventing obesity, preventing diabetes, preventing high blood pressure, and living an inactive lifestyle (same old, same old) – but they also mention 3 factors that don’t get nearly as much attention: getting as much schooling as possible early in life, attending to hearing loss in midlife, and avoiding social isolation in senior years.

It’s important to stress, however, that there is that ubiquitous other hand (Lyndon Johnson once famously said that he’d love to meet an economist with only one hand, which is true as well for “experts” in all fields).

So on that other hand, lots of experts don’t think we can say for sure that most of those factors (the exceptions are, according to another report, exercise and high blood pressure, depression) play important roles in the onset of dementia: it makes sense that these factors do matter, but it’s still too hard to say how much they matter.

For example, it’s still hard to prove that treating hearing loss in midlife will lower the risk of dementia later one: it makes sense that it should but lots of things that make sense in theory don’t work out so well in practice (Homer Simpson: “In theory, communism works”).

The bottom line is if you live a healthy lifestyle, it’s likely that you will reduce – not eliminate – your risk for dementia from several different factors (even though we still don’t know how important each of those factors may be) but just as important, you will also reduce your risk for a whole lot of other problems you really don’t want to encounter.