So you think you don't need to worry about dementia until you are old.
Wrong!
Two in five adults living beyond 55 will develop dementia.
It's the disease we fear most.
The good news is that almost half of the risk of dementia can be modified.
We can all take action to reduce our chances of developing dementia.
How?
It sounds too obvious. A good education in childhood and challenging our brains throughout life lays the basis for a rich neural network; it builds our cognitive reserve.
Exercise regularly, preferably aerobic and strength training. Eat a healthy Mediterranean-style diet. Be socially connected.
Check your blood pressure regularly and treat if high. Ditto for cholesterol or lipids.
If possible, avoid or treat depression midlife obesity and diabetes. Don't smoke. Don't drink alcohol to excess.
Protect your noggin; avoid head injury.
For those who develop hearing loss, wear a hearing aid - earlier is better. Avoid living in an area with air pollution.
The contribution of all these risk factors ranges from 1 per cent to 7 per cent each but together they add up to 45 per cent.
The evidence comes from cohort studies which compare the habits and exposure to risk factors of populations of people who did and didn't develop dementia.
Many of these risk factors can operate in tandem such as physical inactivity, obesity, high cholesterol and diabetes. People with less education are likely to be less affluent and be unable to afford a healthy diet or have time to exercise.
While researchers can adjust statistically for these confounding factors, there may be other factors not accounted for.
A more rigorous approach is to conduct a randomised controlled trial in which risk factors are targeted proactively.
There is evidence from many prevention studies internationally demonstrating that coaching people in how to reduce their dementia risk can improve cognition and possibly delay the onset of dementia.
For every year we can delay dementia's onset, we reduce its incidence by 10 per cent.
As dementia is mostly a disease of late life, ideally, we would like to delay the onset till after we die!
Our Centre for Healthy Brain Ageing at the University of NSW in Sydney conducted the Maintain Your Brain trial.
More than 6000 community-dwelling dementia-free adults aged 55 to 77 were randomly allocated to receive coaching or provision of information to avert four risk factors.
Over three years, both groups improved their cognition with the coaching group improving almost three times as much as the information group.
This is equivalent to delaying the onset by at least a year.
We also found sustained improvements in physical activity, healthy diet and mood.
Australians have embraced heart disease prevention. The result is that deaths from heart disease have dropped dramatically in the last 50 years. However, we are now in the century of neuro-degenerative diseases.
What's more, the reduction in health costs over three years, such as hospital admissions, emergency department presentations, doctor visits and prescription costs reductions completely offset the cost of the trial.
If we scaled this up to 600,000 or 6 million Australians, the savings would be in the billions.
We have the tools.
We have the evidence.
We have the economic analysis.
It's time for a Brain Health Australia campaign.
Australia has been world leaders in reducing smoking, limiting HIV spread, eradicating cervical cancer with HPV immunisation and preventing skin cancer.
We now need the "Slip Slop Slap" of brain health.
Investment in Brain Health Australia would pay for itself many times over.
As well as improving cognition we could show benefits in preventing or reducing high blood pressure, heart disease, diabetes, obesity, osteoporosis, falls and depression.
Australians have embraced heart disease prevention. GPs have been excellent at managing vascular risk factors. We have reduced smoking. Many of us, but unfortunately not all, check our blood pressure regularly. We check our cholesterol and blood glucose and treat as needed.
The result is that deaths from heart disease have dropped dramatically in the last 50 years.
However, we are now in the century of neuro-degenerative diseases.
The responsibility for achieving this lies with us personally, with health professionals and with society.
Our proposal is that we work with the community, GPs and health professionals and government to launch a two-tier program.
The first tier would be a general information campaign to convince people to think about their brains and act. Ideally, this would be a whole of life approach.
Realistically, we could start with targeting adults aged 45 and over.
The second tier would be an online coaching program where people would choose the risk factors they wish to reduce and for each receive online coaching for 10 weeks supplemented by booster sessions and education programs for GPs.
Developments in computing, technology, smartphones and AI make this feasible at a national level. Australia could become the world leader.
We would see benefits in general health as well as reduced numbers of new cases of dementia over 10 years.
The time to act is now!
