Health system falling behind on dementia, researcher tells SACPA
Of the thousands of deadly diseases and health conditions known to inflict the human race, none may be more significant than dementia, says the director of the Canadian Centre for Behavioural Neuroscience.
Rob Sutherland, who is also chairman of the department of neuroscience at the University of Lethbridge, spoke Thursday at a session of the Southern Alberta Council on Public Affairs, and said dementia is the most important health problem facing Canada, the U.S. and Europe.
“The reason why it is such an important problem, is the fact it is directly related to aging,” Sutherland said. “The older the population becomes, the more the prevalence of dementia, specifically Alzheimer’s disease.”
Sutherland pointed out the number of dementia cases are expected to double over the next 20 years, and the healthcare costs will triple. Yet authorities don’t seem to be doing anything about it.
“I don’t notice any provincial governments around here that are getting ready for that. They’re simply not.”
Sutherland said even now, dementias are more costly than heart disease and cancer combined. And in the U.K., which has had a dementia strategy for years, dementia is the leading cause of death, ahead of cardiovascular disease and cancer.
“And I think that’s true in Alberta, and in the south zone, as well. We’re just very far behind in record-keeping.”
Sutherland said brain aging is on a spectrum; some people age well and are “sharp as a tack” at 105, while some may show signs of dementia in their 40s.
“Dementia refers to a cognitive impairment that’s so severe that it interferes with daily life, so the person really can’t live independently.”
Seventy-five per cent of dementia is Alzheimer’s, which is the most common age-related dementia.
Symptoms include memory problems, anxiety, depression, mood changes, personality changes, difficulty planning or making decisions, poor comprehension, and even difficulty eating, drinking and dressing. Eventually most people lose the ability to perceive complex things and are unable to recognize faces or familiar places.
Dementia is “very” poorly diagnosed in Alberta Health Care’s south zone, Sutherland said, and it is often the family doctor, if a person has one, who makes the diagnosis. Geriatricians, who are specialists in the care of the elderly, also diagnose dementia, but by then it’s too late to do much about it.
“Normally, people don’t arrive at a geriatrician’s office until they’re already moderately demented, no longer able to live independently. And that’s too late for many interventions.”
Reducing the overall risk of getting Alzheimer’s disease by 15 per cent depends on risk factors present in old age; smoking, clinical depression, physical or cognitive inactivity, untreated hypertension, improperly controlled diabetes, and traumatic brain injury.
“The total amount of modifiable risk is about 35 per cent, so the majority of the risk is actually earlier than old age, so it’s too late to have a big, big impact, but you can have an effect on 15 per cent.”
Reducing the risk during midlife is about 12 per cent, and risk factors include obesity, inactivity, sleep problems and traumatic brain injury.
Early life only accounts for about eight per cent of the risk factor, Sutherland said, and the most significant risk factor is low education.
“The less formal education you have, the higher is your risk for Alzheimer’s disease. Then completing high school, completing post-secondary education, getting an advanced degree; all of these things reduce the overall risk.”
There are treatments for dementia that have various effects. Cholinesterase inhibitors, while not having anything to do with Alzhemiers pathology, are general cognitive enhancers, and NMDA blockers tend to reduce the amount of neural damage. Sutherland recommended a combination of them in the early stages of dementia through to the moderate dementia.
“It should increase the quality of life for most people.”
Just not in southern Alberta. “You’ll be happy to know that Alberta Health Services south zone has the lowest rate of prescribing these two kinds of treatments. Physicians don’t do it. People are not getting the medications we know produce some benefits.”
Sutherland pointed out many dementia cases can be prevented.
“From what we know right now, we could prevent a third of the cases of Alzheimer’s. I don’t know why any enlightened health service wouldn’t want to get out there and viciously pursue these preventative steps that are pretty straightforward and easy.”
Sutherland also noted Alberta is the only province that does not invest in the Alzheimer’s Society, which is the main contact point for people to get help.