The NHS should update dementia care planning in light of new prevalence analysis suggesting rates are actually stabilising rather than increasing, a group of leading experts have said.
Analysing a large amount of data from four Western European countries including the UK, University of Cambridge researchers found prevalence estimates made in the 1980s and 1990s were much exaggerated, linking the decline in prevalence to healthier lifestyles.
Writing today in the Lancet Neurology Journal, the experts said that in light of their up-to-date analysis, policy makers focusing on dementia should put more emphasis on prevention through public health messages than on diagnosis and potential cures.
The findings suggest that prevalence (the percentage of the population with dementia) and incidence (the number of new dementia cases over a given time) of dementia in specific age groups are falling across time and generations. The group of experts looked at five major epidemiological studies from four high-income Western European countries to reach their conclusion.
Findings from four of the five studies analysed showed non-significant changes in overall dementia occurrence over the past 20 to 30 years. The UK study showed a significant reduction (about 22%) in overall prevalence in people aged 65 years in 2011 than the predicted estimates in 1990, resulting in stabilisation of estimated numbers of people with dementia.
Carol Brayne, professor of public health medicine at the Cambridge Institute of Public Health (CIPH) at the University of Cambridge, said the research on which NHS primary care targets are based was actually started in the 1980s.
She said: ‘These old studies support the idea of a continuing “dementia epidemic”, but are now out of date because of changes in life expectancy, living conditions, and improvements in health care and lifestyle.’
Professor Bray said that behind the positive development were likely improvements in ‘protective factors’ for dementia, including education and living conditions and a reduction in general risk factors such as vascular diseases over recent decades.
She added: ‘Our up-to-date evidence suggests a relatively optimistic picture of possible future trends in dementia occurrence and strengthens the need to shift more of our societal and research focus to primary prevention across the lifecourse, with a rebalancing from what could be seen as the current overemphasis on diagnostics and drug interventions for dementia.
‘Policies which address determinants of health in earlier life stages and enhance cognitive reserve for populations may have the greatest long term impact on reduction of dementia risk at given ages in later life as well as on population health more generally.’
The news comes as the Coalition Government’s drive to increase rates of dementia diagnosis in recent years – including dementia DES and one-off £55 per diagnosis GP scheme last year – have resulted in a record 25% hike in cases.
But estimated GP practice dementia rates increased by 5% overnight in April this year after NHS managers accepted their previous projections for the prevalence of the disease were out of date.
