Thinking preventively about dementia: a review.

BACKGROUND

The dementias of late life now constitute a major public health challenge to our society.

OBJECTIVE

To examine the contributions of neuroscience, clinical treatment and health-care policy to the building of a national programme for preventive approaches to dementia.

METHOD: Critical review of the literature, making use of international databases (Medline, Embase, Psychlit) and British official publications.

RESULTS

Recent developments in a number of research fields afford prospects for advances in primary and secondary prevention. These include findings from case-control and cohort studies of associations with earlier head injury and vascular disease, possibilities of pharmacological protection for persons at high risk for Alzheimer's disease, and the use of more effective anti-dementia drugs in the mild to moderate stages of severity. Research aimed at tertiary prevention is lagging behind, but there are some indications that the worst features of late-stage decline could already be mitigated by improvements in community support services and nursing-home care.

CONCLUSIONS

Containment of the growing social and economic burdens of dementia calls for a national policy to ensure that new research findings can be translated into practice and applied to the benefit of all old people who stand in need. For this purpose the most appropriate conceptual framework is supplied by a preventive model, broadly similar to those already developed for some other forms of chronic degenerative disease.