It is never too early and never too late in the life course for dementia prevention, says Staywell's Chair of Trustees, Dr Debbie Stinson, Consultant Psychiatrist at South West London and St George's Mental Health NHS Trust.

Dementia is an umbrella term for a number of progressive disorders which affect brain functioning – thinking processes such as planning and organising, word-finding in conversation, reasoning and judgement etc, but also memory – leading to effects on behaviour and personality.

Dementia is not inevitable with ageing; at age 65 about 1 in 14 (7%) people have dementia and at age 80 it is 1 in 6 (17%). At present, there is no cure for dementia but there are drugs which can have modest benefit in slowing the progression of Alzheimer type dementia, the commonest form. However, increasingly there is a focus on active models of care which cover physical, psychological and social factors – aiming to maintain skills, reduce excess disability – helping people cope. Interventions such as good signage, useful prompts, calendars, electronic aids and robotics, and cognitive stimulation therapy (CST) aid resilience, independence and may give a sense of coherence.

The Lancet Commission (2017 and 2020) has identified 12 modifiable risk factors which account for 40% of dementias worldwide. In theory, tackling these would reduce or delay dementia. These factors are high blood pressure, hearing impairment, smoking, excessive alcohol intake, obesity, diabetes, traumatic brain injury and air pollution – but also less education, depression, physical inactivity and low social contact. The report points out that ‘it is never too early and never too late in the life course’ for dementia prevention. In later life, these factors influence ‘brain reserve’ which can delay the onset of dementia – the general recommendation is to keep active cognitively, physically and socially in midlife and later life. Although there is little evidence that any one activity is better than others.


The ‘biopsychosocial model’ of dementia (Spector and Orrell, 2010) is a practical tool which those caring for people with dementia may use to develop personalised interventions to help them. Spector and Orrell suggest that a person has ‘fixed’ factors such as level of education, past employment, personality – but also ‘tractable’ factors which can be influenced – mental stimulation, environment, mood.

CST is a psychosocial evidence-based group intervention for people with dementia and is recommended in NICE guidelines (2006; 2018). It targets social and cognitive function and has been shown to improve quality of life.

In other than complex cases or young age onset, the diagnosis of dementia is usually made based on the story of how a person has changed in behaviour, memory and personality over an extended period of time, having ruled out other causes. A medical diagnosis of dementia may be confirmed by increased levels of one of two proteins in the cerebrospinal fluid (CSF), which surrounds the brain and spinal cord, and changes on brain scans. Increased levels of amyloid β or tau protein indicate an increased risk of progression to Alzheimer’s dementia. However, testing CSF involves a lumbar puncture which is unpleasant and is not without risk. Also, not all people with abnormal levels actually go on to develop dementia. The current hope is to develop a simpler (i.e. blood) test which would aid medical diagnosis. Although in the oldest older people, dementia of mixed cause is actually the commonest. Also, at present there is no evidence to support making a diagnosis before a person has symptoms.


Linked with the hope of having a simple blood test is the aim to identify an effective ‘disease-modifying’ treatment – e.g. a drug which would reverse or halt the underlying disease process. Most research is on treatments for Alzheimer’s dementia and Parkinson’s disease, but a breakthrough could have relevance for other types of dementia too. There is much optimism, but nothing imminent.

People with dementia have more physical health problems than other older people of the same age. This was highlighted during the first wave of the Covid-19 pandemic, when people with dementia had a higher rate of death. The problem is aggravated by people with dementia being less active, forgetting to take prescribed medication, forgetting to eat or drink sufficiently – all potentially reversible.

Another area of concern is carer stress, which is particularly high for family carers who have to cope with so-called ‘neuropsychiatric symptoms’ of dementia, which are not uncommon as the illness progresses and include depression, agitation, apathy, sleep disturbance, hallucinations and delusional beliefs. Medication often has limited benefit, and there is increasing evidence that psychosocial interventions – e.g. trying to understand the context of behaviour, providing reassurance or distractions, reducing boredom or loneliness, modifying environments etc may help.

Supporting family carers by providing education and emotional support – and practical support such as respite care – has been shown to reduce depression and anxiety.

In conclusion, to quote the Lancet Commission, ‘with good quality care, people can live well with dementia and families can feel supported’. In terms of achieving this aim, there are implications for policy at national level and action at individual level, and also for the delivery of physical and mental health care and social care in an integrated way.

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