Date Published: March 7, 2017
Publisher: Public Library of Science
Author(s): Eric B. Larson, Kenneth M. Langa
Abstract: Eric Larson and Kenneth Langa discuss whether the risk of dementia is increasing or decreasing over time.
Partial Text: One likely explanation is changes in medical record coding practices during the time period of van Bussel and colleagues’ study, probably driven by increased recognition of dementia by patients, families, and health care providers. In the 1980s, what is now called an “epidemic of dementia” was a “silent epidemic” , because the condition was often unrecognized, especially in patients over 80 years of age. While detection is still a challenge for clinicians and families, diagnoses by practitioners have clearly increased over time. The authors of the PLOS Medicine study wisely note that they cannot distinguish between true stabilization of incidence rates or “a balance between increased detection and a true reduction.” They correctly emphasize that we should anticipate and prepare for a future increase in dementia occurrence in countries with aging populations.
Within these studies on the incidence and prevalence of dementia are hints at possible strategies to control the disease and its effects. Clearly, population aging plays the largest role in determining disease rates. We must plan for increasing numbers of predominantly older people with dementia in the decades to come, including addressing the growing need for long-term care in the context of a significant decline in the availability of family caregivers. Pressing clinical research issues include developing programs to foster activated, confident (typically family) caregivers, models for effective chronic care management, and avoiding unnecessary hospitalizations and visits to emergency rooms. New models for financing and delivering long-term care, either in community or in institutional settings, will be extremely important in the decades ahead. That said, substantial evidence supports several factors as protective against the risk of late-life dementia: advances in general education levels, especially in early life; socioeconomic well-being; and, most importantly for medical care, better control of cardiovascular risk factors, especially in midlife.