Delaying dementia by even one year could avert care crisis

More than 1.7 million Canadians will have dementia by 2050, three times the number who had the disease in 2020, according to projections by the Alzheimer Society of Canada.

Without investments in prevention, home care, and long-term care over the next three decades, unpaid family and friends will end up shouldering nearly 1.4 billion hours of dementia care annually — the equivalent of more than 690 000 full-time jobs.

Some 350 000 informal caregivers already provide an average of 26 hours of dementia care a week, taking on the equivalent of 235 000 full-time positions.

“The figures in the report should sound alarm bells across the country,” says Kevin Noel, interim CEO of the Alzheimer Society of Canada. However, “There is still hope that solutions can be found to ease the burden of those living with dementia and those caring for them.

According to the organization’s projections, delaying the onset of dementia across the population could have an “enormous impact” on health systems and caregivers over the next three decades.

Delaying the average onset of dementia by even one year could result in nearly 500 000 fewer new cases by 2050. Meanwhile, a 10-year delay could avoid more than four million new cases over the next 30 years.

“With effective mitigation efforts on the parts of individuals, combined with increased support from all levels of government, it is possible to drastically reduce the number of Canadians who will develop dementia,” says Joshua Armstrong, a scientist with the Alzheimer Society of Canada.

While there is currently no cure for dementia, the organization’s report identifies a dozen modifiable risk factors as priority areas for prevention efforts.

In addition to the usual suspects implicated in poor health — smoking, excessive drinking, physical inactivity, hypertension, obesity, diabetes, depression, and air pollution — the report also lists social determinants like little social contact and lower levels of education alongside traumatic brain injury and hearing impairment as factors that can be addressed.

Together, these risk factors account for roughly 40% of dementias worldwide, according to a 2020 Lancet commission report.

Although age remains the biggest risk factor for dementia, studies show the chance of dementia increases with multiple or overlapping risk factors, suggesting there’s room for risk reduction even if you have factors you can’t modify.

One 2019 review showed that having three or more risk factors doubles the risk of developing dementia.

“If the goal is to minimize dementia risk for an individual, all risk factor exposures must be minimized across their lifetime,” the Alzheimer Society of Canada report notes.

The organization recommends people reduce their individual risk by remaining physically and mentally active, nurturing social connections, avoiding smoking, drinking, and head injuries, and seeking treatment for depression and hearing problems, as needed.

In one recent study of 2800 older adults published in BMJ Open, American researchers found that people with at least three depressive symptoms were diagnosed with dementia roughly five years earlier than those without depressive symptoms.

The researchers also found that older adults with higher levels of cognitive activities, such as reading books, were diagnosed with dementia more than three years later than those with lower cognitive activity levels.

However, according to a commentary published in The Lancet Healthy Longevity earlier this year, substantially delaying the onset of dementia across the population will require “scalable interventions that efficiently apply available resources to very large numbers of people.”

So far, dementia prevention efforts have reported mixed results, not least because these interventions have tended to focus exclusively on older people with the greatest risk of developing dementia — potentially missing many other people who later develop the disease.

According to the Alzheimer Society of Canada report, “whole-population approaches that influence the environments in which people live, work, and play have the greater potential to reduce overall dementia risk.”

The organization is calling on the federal government to cost and fund a strategy to prevent dementia, advance research into therapies and a cure, and improve the quality of life for people with dementia and their caregivers.

The report also urges provincial governments and health systems to increase spending on the dementia workforce, home care, social support, and long-term care, including “dementia-friendly” community spaces.

“The report should be seen as a wake-up call for Canadians,” says Saskia Sivananthan, Chief Research & KTE Officer at the Alzheimer Society of Canada. “Governments at all levels must commit to providing more resources to support programs, especially home care, to help people living with dementia in their own communities.”