The global impact of dementia is expected to grow as many countries, including Canada, are experiencing aging populations. With the rate of dementia much higher after the age of 80, sharing information about reducing its risk is increasingly important.
As researchers continue to seek promising treatments for dementia, research on prevention is providing valuable direction on risk reduction. Rates of new dementia cases are decreasing in some countries and the understanding of factors linked with reduced risk is growing. This evidence suggests that focusing on certain modifiable risk factors can contribute to delaying or preventing dementia.
As noted in the Lancet Commission’s 2020 recommendations and the WHO guidelines for risk reduction, along with other research studies, it is clear that promoting a healthy life course approach plays a role in reducing new cases of dementia and delaying symptoms. We have learned that there are tangible actions people can take to reduce the risk of developing dementia. While every country has a different context that needs to be considered, acting on these evidence-based findings to support healthy aging is not only important, but necessary.
With the identification of modifiable dementia risk factors, Canada has prioritized awareness raising on prevention in our implementation of the national dementia strategy. As of 2016-17, more than 432,000 Canadians aged 65 years and older were living with diagnosed dementia.1 While it is expected that the number of Canadians diagnosed with dementia will continue to increase given our aging population, it is encouraging that the incidence of dementia has decreased over the past 8 years; from 1,576 newly diagnosed cases per 100,000 Canadians in 2008-2009, to 1,440 new cases in 2016-2017.2 Public opinion research in 2020 found that approximately 9 in 10 Canadians are aware of at least one risk factor linked to developing dementia, although knowledge is less widespread about some risk factors such as smoking, hypertension and diabetes.3 I am hopeful that through our collective efforts to encourage and expand the adoption of healthy behaviours, we will continue to see a decline in new cases of dementia in Canada and around the world.
Over the past year, Covid-19 has had an impact on the ability to maintain healthy behaviours. For example, due to the closure of many activity spaces and other public health protection measures, dementia risk factors such as physical inactivity and social isolation have been more difficult to address. As a result, over 40% of Canadians who reported being inactive prior to the public health measures taking effect, reported being even less active after they were imposed, and just over 20% of active respondents reported becoming less active.4 Rates of social isolation have also increased, while some Canadians reported increasing their use of alcohol (14%).5
The growing understanding of factors linked to the risk of developing dementia is the reason preventing dementia is one of the three national objectives of A Dementia Strategy for Canada: Together We Aspire. The strategy outlines the need to advance our understanding and build the evidence base about which actions are most effective in reducing risk, and to broaden awareness about actions Canadians can take.
Supporting health equity is a top priority for Canada and efforts are made to systematically integrate sex and gender considerations into all research, policies, programs and services, including the national dementia strategy. Canada’s national dementia strategy places an emphasis on groups who have been identified to be at a higher risk of dementia, as well as those who face barriers to equitable care.
These groups, which include but are not limited to Indigenous peoples, individuals with existing health conditions, older adults, women, ethnic and cultural minority communities, and LGBTQ2 individuals, are prioritized in our work to develop dementia risk reduction interventions.
Canada is investing in building awareness by supporting initiatives focused on dementia prevention, reducing stigma, encouraging dementia-inclusive communities, supporting community-based projects to optimize the wellbeing of people living with dementia and family/friend caregivers, and increasing knowledge of dementia and its risk and protective factors. Awareness raising activities include developing, testing, disseminating and scaling up initiatives, knowledge, and tools. A knowledge hub is also disseminating program findings, lessons learned, and best practices to dementia policy and program stakeholders across Canada.
Research is one of the many ways Canada is contributing to the global effort to prevent dementia. At the centre of research investments is the Canadian Consortium on Neurodegeneration in Aging (CCNA), a pan-Canadian research network that brings together over 350 Canadian researchers and clinicians to accelerate progress in research on age-related neurodegenerative diseases that affect cognition in aging, including dementia. The CCNA’s research is focused around three main themes, one of which is risk reduction and prevention. The flagship program of this theme is the CanThumbsUp initiative that is linked to the international FINGERS initiative, established to support and convene global multidomain dementia prevention trials, share experiences and data, and harmonize methods. Recommendations from the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia were also recently published to share this group’s latest guidelines on dementia risk reduction.
In Canada’s annual reports to Parliament on dementia, examples of the work undertaken every day by many organizations and dedicated individuals across the country that support our national dementia strategy are highlighted. Prevention related data points are also included.
Initiatives related to dementia prevention move us closer to one of our national strategy’s aspirations, to work towards preventing dementia through risk reduction. As our understanding of dementia prevention grows, it is increasingly important to create effective ways of sharing this knowledge in a way that persuades and enables Canadians to take action. Increasing individual awareness of risk reduction actions and promoting the development of supportive social and built environments are some of the ways we can help support changes in behaviour.
The World Dementia Council has furthered the global conversation on dementia and its recent workshop on dementia prevention was a welcome discussion, reaffirming the importance of advancing our collective knowledge about risk reduction. We are seeing a declining incidence of dementia in some countries, a trend that provides hope for the future. To make this more widespread and accelerated in other countries, dementia prevention should be a priority.
Our vision for Canada is one that we wish for the world; a nation and world in which all people living with dementia and caregivers are valued and supported, quality of life is optimized, and dementia is prevented, well understood and effectively treated.
__________
Dr Theresa Tam is the Chief Public Health Officer of Canada