Is there a role for self management in preventing dementia?

David Cameron’s challenge to the pharmaceutical industry a few weeks ago to accelerate the drive to find a cure for dementia can only be welcomed. The present medications available to patients with Alzheimer’s disease, the commonest form of dementia, can provide some symptomatic relief for this potentially devastating condition, but sadly do not seem to influence the underlying course of the disease.

The Prime Minister’s intervention will provide further impetus to find the holy grail of a disease altering medication for dementia. In the past, several approaches have been thought to have promise but these have so far proved to be false dawns. For example, the effects of using immunisation to attack the amyloid plaques that are thought to be a key pathological component of Alzheimer’s disease have been disappointing in those with established disease.

As a result of this, attention is now turning to the use of therapies much earlier in the disease process. However, in the midst of all the striving for a scientific solution to those who already have the condition, real progress has been made over the past decade in the prevention of dementia. A consensus statement, signed by over 100 international experts, concluded that half of the cases of dementia could be caused by potentially modifiable risk factors and that, by taking action on these known risk factors, up to 20% of dementia cases predicted to develop by 2025 could be prevented. 

So, what are these modifiable risk factors? In the main they could be regarded as the ‘usual suspects’, with poor diet, physical and cognitive inactivity, obesity, smoking, excess alcohol consumption and so on, all being linked to a higher risk of Alzheimer-type dementia. Indeed, there is already evidence that improved management of cardiovascular risk factors might have led to a reduction in the prevalence of this condition. However, the progress in identifying these risk factors leads to two further challenges.

Firstly, there is the lack of knowledge in the general public of these links. If you asked people about the dangers of obesity or smoking, many might say heart disease or cancer, but how many would say dementia? 

Secondly, and perhaps more intractably, there is the difficulty of translating this knowledge into action by those people at risk. We do know that simple self-management techniques have been successful in helping people with other medical conditions, such as diabetes, make important lifestyle changes, but as yet these have not been evaluated in patients with cognitive difficulties.

At Devon Partnership NHS Trust, we have been very grateful to receive support from the Health Foundation through their Shine programme to work on a project to use these self-management techniques in a group of patients with Mild Cognitive Impairment (MCI). These are patients who may represent an intermediate stage on the path to dementia and are thus at a high risk of developing the condition.

We know the risk factors for dementia, and from other studies such as the Health Foundation’s Co-creating Health programme, we know that self-management works. In spite of this, when I have mentioned these plans to my colleagues at meetings the response has, frankly, been mixed. Most have been supportive but some have made statements to me like 'At that age it’s too late to change' or 'They are too stuck in their ways'.

However, I’m old enough to remember similar sentiments about self-management in many other conditions and each time they have been proved to be wrong. Why should those who may be in the early stages of dementia be any different?

David is an Associate Specialist at Devon Partnership NHS Trust, uk.linkedin.com/pub/david-pearce/1a/6a8/511/

Further information and resources

For more information and resources on self management support, visit our person-centred care resource centre.