A recent Nature Medicine research report is sounding an alarm. The risk of developing dementia by the age of 95 is 42%. The finding that the risk of dementia increases with age is well described. What’s new and startling about this result is the number. It’s double prior estimates.
The investigator team, led by researchers at New York University and funded by the National Institutes of Health, reported even higher risk estimates for women, people who self-report Black racial identity, and carriers of a form of a gene associated with Alzheimer’s disease, one of the common causes of dementia.
Understandably, these results are causing people to ask, “What can I do to reduce my risk?” But numbers this large require a collective response in addition to individual efforts. As a nation, we need to ask, “What can we do?” The answers are policies and industries that promote healthy aging.
Chief among them: We need to discover drugs that work before a person has dementia. Diagnosis and treatment when test results foretell dementia in a person who is cognitively healthy could prevent the onset of disabling cognitive impairments. This is our approach for heart disease (think hypertension and high cholesterol).
The last few years have seen notable progress in this strategy to prevent one of the common causes of dementia: Alzheimer’s. Treatments approved for Alzheimer’s in the mild cognitive impairment and mild dementia stages are being tested in persons who are cognitively healthy. However, the treatments slow, not cure, Alzheimer’s. Moreover, at least four other common diseases cause dementia. The discovery of safe, simple, and affordable cures for all of them is an inspiring hope, not a sensible plan. To reduce the risk of dementia, we must dedicate resources of time, money, and political will to readily achievable strategies.
We need to promote healthy aging. An important result of the Nature study is from age 55 to 75, the risk of dementia is steady and low — about 4% — but after age 75 the risk curve sweeps upward. Living to 75 means accumulating decades of experiences that shape the health of an aging brain and body. Research has arrived at a consensus on at least 14 life events that increase the risk of dementia (scientists call them “risk factors”).
Some are events that occur early in our lives, notably education. People with either less than a high school education or a poor-quality education are at greater risk of dementia. Other factors are later-life events, such as hearing loss. In between are experiences of loneliness, social isolation, depression, poor sleep, tobacco use, obesity, head injury, vision loss, and undiagnosed or under-treated cardiovascular disease.
As diverse as these are, they share a common feature: Each is actionable. We can do something about each one, and we’ve made progress on several. Once controversial but now widely accepted bans on smoking in public places have reduced both consumption of cigarettes and exposure to secondhand smoke, thereby reducing the contribution of tobacco smoking to cardiovascular disease. The recognition of head injuries in sports has led to a reckoning on how to safely train and compete in sports such as football and soccer.
Surveying the list of risk factors shows the promise of redesigning and organizing where we live, blending regional with national strategies. The need for proper sleep supports the case for laws to prevent racing vehicles at night on our streets. To tackle obesity, diabetes, and cardiovascular disease, we’ve a host of strategies to try, such as promoting access to brain- and heart-healthy foods with incentives to build supermarkets in underserved communities, and to tax sales of hyper-sweetened beverages.
There are many causes of loneliness and social isolation. One of the biggest is hearing loss. Two-thirds of adults 71 years and older have it, but only one-third use hearing aids. One reason is Medicare doesn’t cover hearing aids. Congress could correct this.
Congress could also fund the national dissemination of the remarkable results of the National Endowment for the Arts’ Creativity and Aging study. This study showed participation in the arts improved older adults’ well-being: Loneliness and depression were reduced, connection and morale increased. Imagine a National Endowment for the Arts program that supports our nation’s vast network of libraries, schools, concert halls, museums, and theaters to support artists working with older adults in painting, pottery, dance, music, poetry, drama, and storytelling.
As people gather in these public spaces, not only are they shedding loneliness and isolation, they’re also engaging their aging brains in a distinctly human activity, creativity. They aren’t simply watching the artists at work. They’re learning how to create. They’re enhancing the precious thing dementia takes away: their minds.
The above are of course a selection of strategies and tactics, but they’re enough to define a persuasive message: If we do this now, it will help you and your loved ones later. This message could have tremendous political power to break the rhetoric of resistance to these ideas that typically blends concerns over threats to personal liberty — I’ll buy the food I want! — and limited resources — Why are my taxes paying for pottery classes?
By 2060, 1 in 2 Americans over 55 will have dementia. In a deeply divided, aging America, conversations about reducing our risk for dementia could unify us.
Jason Karlawish is a professor of medicine, medical ethics, health policy, and neurology at the University of Pennsylvania’s Perelman School of Medicine and co-director of the Penn Memory Center.