Due to the rapid aging of the population in Italy, “the number of people with dementia is expected to almost triple by 2050, from 1.2 million in 2019 to over 3 million, with estimated direct costs of up to more than 60 billion euros. The increase in life expectancy will also lead to an increase in people with dementia in low-income and poverty-stricken countries”. The Sin, the Italian Society of Neurology, took stock of the situation on the occasion of World Alzheimer’s Day, celebrated on September 21, and the G7 meeting on dementia scheduled in Ancona on October 8.
“In recent years, several studies have highlighted how the development of dementia and especially Alzheimer’s disease is not inevitable. In fact, intervening on modifiable risk factors, starting in childhood and continuing throughout life, could prevent or delay by many years almost half of the cases of dementia – continues Sin – Even if in Italy people live longer and at the same age get sick less than 30 years ago, the number of people affected by dementia is destined to increase by virtue of the aging of the population. Nonetheless, the potential to prevent and better manage dementia is high if we intervene to counteract the risk factors, even in people with a high genetic risk of dementia”.
Based on recent evidence, “two new risk factors have been identified: elevated low-density lipoprotein (LDL) or ‘bad’ cholesterol in middle age and untreated vision loss in old age – the neurologists recall – These new risk factors add to the risk factors previously identified by the ‘Lancet Commission’ in 2020 (low levels of education, hearing problems, hypertension, smoking, obesity, depression, physical inactivity, insulin resistance and diabetes, excessive alcohol consumption, head trauma, air pollution and social isolation), which are linked to 40% of all dementia cases. In addition to these, however, food contamination and adulteration, alterations in the gut and oral microbiota, sleep disturbances, HSV infections and probably immune aging or immunosenescence must also be taken into account”.
Sin calls on governments and society to ‘commit to addressing the risks of dementia across the lifespan’
Sin calls on governments and society “to commit to addressing the risks of dementia throughout life, maintaining that a promotional action in favor of primary and secondary prevention represents the real weapon to win the challenge with dementia, while at the same time increasing social and health support for patients and their families”.
“Much more can and must be done to reduce the risk of Alzheimer’s,” says Alessandro Padovani, president of Sin. “We have convincing evidence that longer exposure to different risk factors has a greater effect and that the risks are more prevalent in vulnerable people. This is why it is essential to incentivize preventive efforts towards those who need them most, including those living in low- and middle-income areas and in socio-economically disadvantaged groups. It is a task that concerns everyone and must aim to reduce risk inequalities by making healthy lifestyles as accessible as possible for everyone.”
The recommendations of the Sin
To reduce the risk of dementia throughout life, the Sin outlines several recommendations including: providing good quality school education by encouraging higher education; promoting lifelong learning throughout life by supporting third-age universities and voluntary association activities; promoting the use of helmets and head protection when using scooters and bicycles, in risky workplaces and in contact sports activities; reducing exposure to environmental and food pollution through rigorous policies for a clean and healthy environment; expanding measures to reduce cigarette smoking, such as price controls, raising the minimum age for purchasing and banning smoking in public places, including outdoors; reducing alcohol consumption and expanding measures to reduce excessive consumption of spirits in meeting places
And again: promoting a fight against isolation and loneliness at all ages by promoting the creation of community environments and supportive housing to combat social hardship; promoting an active campaign to prevent vision and hearing disorders in the logic of the ‘One Health’ approach, promoting ophthalmological and audiological screenings at age 65; promoting dental health by making dental screenings accessible to all through the involvement of the Orders of Physicians and Dentists; monitoring triglyceride and cholesterol levels together with blood sugar and LDL cholesterol, starting from age 35 by promoting a campaign to prevent eating disorders; monitoring blood pressure levels periodically starting from age 35 by reducing the use of salt in food; preventing and treating sleep disorders through sleep hygiene education; identifying mood disorders early also through the involvement of the Order of Psychologists by promoting timely care by Psychiatry in treatment centers; promote an active information campaign in schools and workplaces in favor of healthy eating and constant physical activity even in advanced ages
According to Sin, “these actions are particularly important in light of new evidence showing that reducing dementia risks not only increases healthy life years, but also reduces the time that people who develop dementia spend in poor health, supporting the need for early diagnosis and secondary prevention interventions.”
‘Aiming to improve the quality of life’
“A healthy lifestyle – continues Padovani – that includes regular physical exercise, not smoking, regular sleep, providing cognitive and mental stimulation even outside of formal education and that avoids excessive use of alcohol and promotes a balanced diet rich in vegetables and fruit, is not only able to reduce the risk of dementia, but can also delay its onset as well as slow its progression. This has enormous implications on the quality of life for individuals and benefits in terms of cost savings for companies”. According to neurologists, Italy “could in this way obtain savings on current costs of around 10 billion euros in 20 years to be allocated to the implementation of support activities for patients and their families”.
In a study published in The Lancet Healthy Longevity, Naaheed Mukadam (UCL Psychiatry) and co-authors modelled the economic impact of implementing some of these recommendations, using England as an example. The study’s “findings suggest that using population-level interventions of known effectiveness to address dementia risk factors could have a profound effect on dementia prevalence and inequalities, as well as significant cost savings,” Sin said.
Precisely to raise awareness among the population about Alzheimer’s disease, starting from Saturday 21 September, video clips will be published on the official social channels of the Italian Society of Neurology in response to some of the questions received from users.
Sin’s requests to the Government
Sins also calls for “greater support for people with dementia and their families. In many regions and areas of our country, effective interventions that are known to benefit people with dementia are not yet available or are not a priority. Likewise, the needs of many caregivers are not adequately considered and met. It would be important to provide ‘coping’ interventions for family members who provide care and who are at risk of depression and anxiety, ensuring in addition to financial benefits and support, also emotional support, planning for the future and information on medical and social-health resources. All the more reason, it is more necessary than ever to promote concerted actions to support lonely and isolated people as well as all frail people, given the evidence that they are at greater risk of developing Alzheimer’s disease”.
“To fully implement the actions described above, it is necessary to create a better organization of dementia services at the level of health districts – says Camillo Marra, president of Sindem (an autonomous association adhering to Sin for dementia) – with the aim of networking all the skills present at the territorial level, fully implementing the dictates of Ministerial Decree 77. The creation of local Pdtas will facilitate access for patients in the earliest stages of the disease and allow those policies of risk stratification and population screening that are preparatory t
o the implementation of prevention programs and early care of patients and caregivers”.
For research, Sin calls for “greater integration between the various national and regional institutions in order to access European funding to encourage basic, translational and epidemiological research in our country, already among the first in the world in terms of studies on Alzheimer’s and Dementia. Much still needs to be done to understand the different mechanisms that promote brain diseases and to date we do not have a miracle therapy capable of preventing the development of Alzheimer’s disease or blocking the disease. There is several pieces of evidence to support the fact that it can be slowed down with drugs that are not yet authorized in Europe, especially if diagnosed early, but we must do more to ensure effective and safe treatments and above all to support the creation of regional networks that allow for pathology registries”.
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