Academic journal article Canadian Journal of Public Health

The Canadian Dementia Challenge: Ensuring Optimal Care and Services for Those at Risk or with Dementia throughout the Country

Academic journal article Canadian Journal of Public Health

The Canadian Dementia Challenge: Ensuring Optimal Care and Services for Those at Risk or with Dementia throughout the Country

Article excerpt

Canada is currently in the midst of an unprecedented demographic shift in its aging population, with more Canadians than ever living longer, and with an aging average age that continues to rise. Our societal and personal hope for old age is that it is healthy and vital. One of the biggest threats to quality of life in aging is the loss of cognitive ability and functional autonomy associated with dementia caused by neurodegenerative brain diseases.

Today's estimates are that there are 750 000 Canadians living with dementia, 72% of them women.1 While there has been a recently recognized decline in dementia prevalence among people over 65 years of age over the past few decades, because of the increase in the average age of the population, and demographic shift to those over age 65, the total number of people with dementia is expected to continue to rise significantly.2 Canadian population estimates are that by 2038, across all ages, there will be an increase of 2.3 times, to a total of 1.1 million persons affected by dementia.3 An additional 17% of the population can be expected to have cognitive impairment, not dementia (CIND) with their cognition falling outside of the normal range, but not sufficiently impaired to meet diagnostic criteria for dementia.4 Global numbers mirror Canada's; worldwide, there are nearly 47 million people living with dementia today, a number expected to almost double by 2030 and more than triple by 2050.5 A major driver of this growth will come from low- and middle-income countries as their citizens' longevity increases.6 The economic cost of dementia in Canada in 2011 was estimated at $33 billion;by 2040, that is expected to rise exponentially to $293 billion.1 The effects of dementia and cognitive impairment will be far reaching within our communities, affecting systems of care, the built environment, transportation, and the workplace.

Alzheimer's disease (AD) accounts for 60%-80% of the neurodegenerative diseases commonly included under the umbrella term "dementia".1 For AD and other forms of neurodegenerative dementia, there are currently no definitive pharmacological solutions, and failures are mounting with more than 200 drug development failures in the last 30 years.7 Recent experimental therapeutic efforts targeting the amyloidopathy of AD have had disappointing results,8,9 with many pharmaceutical companies leaving this field of research, given the costs of development failure. At the same time, approximately 28% of the risk for AD lies in preventable and treatable risks such as diabetes mellitus, midlife hypertension and obesity, physical inactivity, depression, smoking, and low educational attainment.10,11 Some of the downward trend in prevalence of dementia may be attributable to a combination of medical, lifestyle, demographic and social factors, as well as treatment of vascular risk factors.

In the area of prevention, there has been a growing interest and evidence base focussed on the modification of treatable risk factors to delay the onset of dementia and to lessen cognitive decline. The recently reported FINGER study investigated intensive multidomain interventions, including dietary counselling, exercise training, cognitive training, and vascular risk factor control over 24 months, in individuals aged 60-77 years at higher risk of dementia, with significant benefits achieved in cognition and wellbeing.12 This study and others have set the stage for larger multinational studies, pragmatic prevention programs, and integrative efforts with other chronic disease management platforms in Canada.

In September 2015, the Canadian Academy of Health Sciences (CAHS) convened a Forum on the topic of dementia in Canada, bringing together social scientists, biomedical researchers, health care practitioners and technology experts to discuss the breadth of critical challenges of dementia in Canada, with a focus on potential solutions. The researchers who presented and participated in panel discussions, focussed on the implications for the growth in the number of Canadians living with dementia over the next 15 years, emphasizing that this growth will reshape our social, economic, medical and political landscapes. …

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