New guidelines highlight avoidable nature of many dementia cases

Updated guidelines on risk reduction of cognitive decline and dementia have been released by the World Health Organization.

They reinforce the message that almost half of future dementia cases could be avoided by addressing common risk factors for chronic diseases and ensuring equity of access to preventative strategies through public health systems, education and healthy environments.

Nearly half a million Australians live with the disease, a number tipped to breach one million unless significant action is taken.

As well as addressing issues around access, the guidelines highlight that some risk factors overlap with non-communicable diseases such as diabetes, high cholesterol and high blood pressure. It also

Professor Kaarin Anstey, director of the UNSW Ageing Futures Institute and senior principal research scientist at Neuroscience Research Australia, was the only Australian researcher to be part of WHO’s guidance development.

“These guidelines are the culmination of a systematic and wide-ranging review of the evidence we now have about the efficacy of a range of interventions that can reduce dementia risk,” she said.

“These recommendations offer real-life actions that will reduce dementia risk and promote brain health.

“They’re both practical and evidence-based but require the buy in of governments and public health systems to be truly effective."

Professor Anstey said the guidelines reflect the understanding of dementia prevention across the life course, and the fact that brain health is something that needs to be considered as a lifelong commitment.

“We need to underline the message that many cases of dementia may be prevented, and these guidelines are a vital step forward in reinforcing that," she said.

Among the updated measures include the suggestion that cognitive training and stimulation may be offered to older adults with normal cognition or minor cognitive impairment as a preventive strategy, and that the pursuit of social activities should be encouraged.

Dementia Australia honorary medical advisor Dr Marita Long said the take home message for GPs was to encourage all patients to stay physically, cognitively and socially engaged.

“That's an important message which has evidence around it, the other things that we talk a lot about in general practice, which are also in there, are smoking cessation and reducing alcohol intake," Dr Long said.

“We're becoming more and more of the opinion that no alcohol is probably safest, but certainly not drinking more than the standard recommendations of alcohol."

Dr Marita Long said the new guidelines offered practical tips for GPs.

Dr Long added that the recommendations were also important for other areas such as cardiovascular disease and stroke prevention.

“Obesity, diabetes, high blood pressure, high lipids, it's stuff that we're doing all the time, but now we can actually put it in the context of protecting your cognition.”

The recommendations highlighted the importance of targeting more than one area of change.

Dr Long said while the guidelines would be useful to GPs, it was important that primary care did not have to carry the full burden of the increasing number of cases of dementia in Australia as a result of ageing population.

Menopause Hormone Therapy

Menopause hormone therapy was also addressed in the guidance. Historically there has been debate about whether MHT can help prevent cognitive decline.

The guideline states menopausal hormone therapy is primarily used for symptomatic relief of vasomotor symptoms and genitourinary syndrome of menopause, not for dementia prevention.

"Menopausal hormone therapy is not recommended for specifically reducing the risk of cognitive decline and/or dementia in postmenopausal women aged 65 years and older," it reads.

It adds there is insufficient evidence to advise for or against the use of menopausal hormone therapy in those under 65 years.

Dr Long said she was glad to see the guidelines included detail specific to women over the age of 65.

"In terms of menopause hormone therapy, we should not be giving that to women over the age of 65 for the sole purpose of dementia prevention,” Dr Long said.

“If a woman came to me who's over the age of 65 and said, look, mum had Alzheimer's disease, I really don't want to get it but I'd like to start hormone therapy, there is enough evidence there to say now that it wouldn't be a good idea."

Dementia Australia provides a risk assessment tool called CogDrisk to help GPs assess an individual’s dementia risk, but Dr Long said often GPs did not have sufficient time with patients.

“The difficulty in primary care is it's getting harder to have those long consults because of the cost for people," she said.

“It's getting harder for people to access primary care because it's getting more expensive. And if it's not getting more expensive, it's getting shorter, so the time patients are spending with their GP is shorter.

“The last thing we want is a new item number for a brain health check, once upon a time we thought that would have been a good idea, but it's just a matter of offering time.

"The difficulty is that the people who need this intervention the most are probably the people who are least able to access these long consults,” Dr Long said.

The guidelines were last updated in 2019. The new guidance can be accessed here.