Global planning and local action: complementary strategies to tackle dementia

From the corridors of the WHO in Geneva to the shopping malls of Singapore, efforts are being made to deal with the rising tide of dementia.

With a new case occurring every three seconds, the number of people with dementia is set to triple between now and 2050, when there will be more than 150 million cases worldwide. Sometimes the statistics are daunting; perhaps almost paralyzing in their scale. But then there are finer-grain data that suggest that there is opportunity for intervention. 

In Singapore, the prevalence of dementia is 1.8% in Chinatown but 5% in the middle-class suburbs. A likely explanation is the greater prevalence among the suburban population of diabetes and social isolation. Both are pointers towards prevention, Kua Ee Heok (National University Hospital, Singapore) told the Mexico City meeting. 

Fine-grain data suggest opportunity for intervention

Aging Well Everyday (AWE)  

A result of such insights is the ten-year long Jurong Aging Study,1which meets its two thousand participants not in a clinical setting but in a shopping mall. Local elderly people are encouraged to come to the mall and talk about health education and hypertension, but they are also engaged in a program of Tai Chi, reminiscence music therapy, art therapy, and mindfulness – all of which can achieve helpful reductions in subsyndromal anxiety and depression. 

Mindfulness in particular seems to have helpful effects in slowing cognitive decline. Achieving even the modest aim of postponing the onset of dementia by a few years would profoundly reduce disease burden. 

While small, “care for the community by the community” initiatives of the kind described above are one approach to dementia, there is no doubt of the need for action on a larger scale. The majority of new dementia cases will be in low and middle income countries (LMICs) – hence the need for a global approach of the kind outlined by Tarun Dua (WHO, Geneva, Switzerland) 

A “care for the community by the community” model is proving productive in Singapore

The global perspective

The WHO is aiming for a combination of preventive strategies on the one hand, and care and support on the other -- such that both dementia sufferers and their carers can live well and fulfil their potential in dignity, respect and equality. With this in mind, the WHO has produced a guide to developing a national dementia plan. The approach is based on the interlocking principles of human rights, equity, empowerment, the availability of universal health and social care, and collaboration between agencies. 

One aim is a society that is dementia-friendly and inclusive. The other, of course, is prevention. And the underlying philosophy here is that what is good for the heart is good for the brain.    

The greatest burden in coming years will be in low and middle income countries. Hence the need for a global approach

An IDEAL scale

Any approach to dealing with dementia needs tools to measure the severity of the problem and the needs of patients. As reported by Antonio Lobo (University of Zaragoza, Spain), the International Dementia Alliance (IDEAL) has developed a new scale for the clinical staging of dementia and assessment of care needs. 

Those familiar with its use say that this multidimensional scale -- designed to be sensitive enough to detect small differences in activities of daily living, cognition, physical health, social support and carer distress -- can be completed in five minutes. And that is all the time that many busy health workers have. 

  1.  Da-Xing Wu et al. Lancet Psychiatry 2014;1:9-11
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