Approximately 30% of dementia is preventable by addressing risk factors such as diabetes, hypertension, obesity, physical inactivity, depression and smoking by making lifestyle changes. Establishing and maintaining a healthy lifestyle is important to help lower the risk of dementia, particularly vascular dementia. Encouraging people (particularly in their forties and fifties) to reduce their risk of dementia will support them in living longer, healthier lives. Taking actions, which promote prevention or early detection, include leading a healthy lifestyle and effectively controlling or treating diabetes, high blood pressure and high cholesterol.
There are a number of lifestyle factors that can increase the risk of dementia:
- A sedentary lifestyle (exercise in older people is associated with a slower rate of decline in memory and some thinking skills that occur with ageing)
- Excessive alcohol consumption (10% of the dementias are related to alcohol)
- Eating a poor diet high in saturated fat, sugar and salt and obesity in midlife
- Smoking is the biggest risk factor for dementia and can double an individual’s risk
- Excess weight
Keeping the brain active and challenged throughout life may help reduce dementia risk.
Improving social connectedness and being socially active can also help to reduce dementia
 Capitalising on modifiable risk factors for Alzheimer’s disease. Biessels, Geert Jan. The Lancet Neurology , Volume 13 , Issue 8 , 752 – 753
Table 1: Risk factors for dementia
The risk of dementia, disability and frailty will sometimes be determined by factors that can’t be changed, such as inherited conditions or injury. But changing specific risk factors and behaviours such as smoking, lack of physical activity, alcohol consumption, poor diet and being overweight can reduce the risk of dementia, disability and frailty for many people. Guidance on prevention of dementia in mid-life was produced by NICE (NICE Clinical Guidance (CG 42) Dementia: supporting people with dementia and their carers in health and social care2015) and highlights the following recommendations:
Encouraging healthy behaviours
- Develop and support population-level initiatives to reduce the risk of dementia, disability and frailty by making it easier for people to:
- stop smoking
- be more physically active
- reduce their alcohol consumption
- adopt a healthy diet
- achieve and/or maintain a healthy weight.
- Use the local regulatory options and legal powers available to encourage increased adoption of healthy behaviours, and risk reduction.
- Make physical activity, adopting a healthy diet and achieving and maintaining a healthy weight as accessible, affordable and acceptable as possible.
Integrating dementia risk reduction prevention policies
- Include dementia in strategy documents aimed at preventing other non‑communicable chronic conditions
- Make it clear that some common unhealthy behaviours can increase the risk of dementia and that addressing those behaviours will reduce the likelihood of developing dementia and other non‑communicable chronic conditions.
Raising awareness of risk of dementia, disability and frailty and producing information on reducing the risks.
- Commission local campaigns aimed at the public and health and social care professionals to show how the risk of dementia, disability and frailty can be reduced and to promote the concept of keeping mentally and physically healthy.
Preventing tobacco use
- Make smoking tobacco less accessible, affordable and acceptable.
- Extend smoke‑free policies into a wider range of public places, for example, public parks, open‑air markets and sports grounds.
- Promote, and support people to establish and maintain, smoke‑free homes and cars.
- Local authorities and clinical commissioning groups should continue to commission smoking cessation services and promote quitting as the best way to reduce the risks from tobacco
Improving the environment to promote physical activity
Reducing alcohol‑related risk
- Making alcohol less accessible, affordable and acceptable.
- Ensuring plans include screening and brief interventions for people at risk of an alcohol‑related problem (hazardous drinkers) and those whose health is being damaged by alcohol (harmful drinkers)
Supporting people to eat healthily
- Reducing availability and promotion of foods that can contribute to an unhealthy diet.
- Service organisation and delivery
Delivering services to promote behaviour change
- Work together to deliver services that address the needs of people with multiple risk factors as well as for those with single risk factors.
- Help people identify and address their personal barriers that prevent them from making changes to improve their health.
- Develop the NHS Health Check programme to promote opportunities in mid‑life to reduce the behavioural risk factors for dementia, disability and frailty
Providing accessible services
- Work with local communities to understand the range of services that they need to reduce the risks of dementia, disability and frailty.
Providing advice on reducing the risks of dementia, disability and frailty at every appropriate opportunity
- Use routine appointments and contacts to identify people at risk of dementia, disability and frailty
- Whenever the opportunity arises give people advice on how to reduce the risk factors for dementia, disability and frailty or refer them to specialist services when necessary
- Commission or provide training and continuing professional development programmes for local authority staff, all health and social care professionals, relevant third‑sector staff and community volunteers to help to reduce the risk factors for dementia, disability and frailty in later life. Training should include how to identify people at most risk and how to advise and support people to change behaviour
Identification, Treatment and Support
Dementia is associated with complex needs and, especially in the later stages, high levels of dependency and morbidity. NICE Clinical Guidance (CG42) makes recommendations for the identification, treatment and care of people with dementia and the support of carers. These form part of the recommendations.
Early identification of dementia
- Primary healthcare staff should consider referring people who show signs of mild cognitive impairment (MCI) for assessment by memory assessment services to aid early identification of dementia, because more than 50% of people with MCI later develop dementia.
- Memory assessment services that identify people with MCI (including those without memory impairment, which may be absent in the earlier stages of non‑Alzheimer’s dementias) should offer follow‑up to monitor cognitive decline and other signs of possible dementia in order to plan care at an early stage.
Diagnosis and assessment of dementia
- Clinical cognitive assessment in those with suspected dementia should include examination of attention and concentration, orientation, short and long‑term memory, praxis, language and executive function.
- As part of this assessment, formal cognitive testing should be undertaken using a standardised instrument. At the time of diagnosis of dementia, and at regular intervals subsequently, assessment should be made for medical comorbidities and key psychiatric features associated with dementia, including depression and psychosis, to ensure optimal management of coexisting conditions.
- A diagnosis of subtype of dementia should be made by healthcare professionals with expertise in differential diagnosis using international standardised criteria
Addressing needs that arise from the diagnosis of dementia
Following a diagnosis of dementia, health and social care professionals should, unless the person with dementia clearly indicates to the contrary, provide them and their family with written information about:
- the signs and symptoms of dementia
- the course and prognosis of the condition
- local care and support services
- support groups
- sources of financial and legal advice, and advocacy
- medico‑legal issues, including driving
- local information sources, including libraries and voluntary organisations.
Promoting and maintaining independence of people with dementia
The NICE guidelines on dementia (NICE, 2006) make recommendations for the treatment and care of people with dementia. Medication may be prescribed for some dementias to prevent symptoms from getting worse and psychological treatments may help patients to cope with some of the symptoms. These include:
- Acetylcholinesterase (ACE) inhibitors to improve mild to moderate Alzheimer’s disease
- Memantine hydrochloride to improve severe Alzheimer’s disease
- Antipsychotic medication to treat distressing behavior, although should be used with caution due to the uncertainty of the adverse effects of overuse of antipsychotics in dementia
- Antidepressants may be prescribed for people with dementia who also have depression or anxiety
The NICE guidelines also recognize the importance of promoting and maintaining the independence of people with dementia. Care plans should be drawn up which maximize independent activity, enhance function, and minimize the need for support.
Living with Dementia
Dementia friendly communities are recognised as important in improving the everyday lives of people with dementia and raising awareness of the condition, and the term has become widely used in UK policy. The Alzheimer’s society has outlined areas of focus that include accessing community services, support such as befriending services to enable community engagement; adjusted housing, transport and travel arrangements and respectful and responsive businesses and services. Much of this will require working with the voluntary and community sector and small businesses to implement. There is opportunity for housing and urban planning as well as design of residential and inpatient units to incorporate facets of a dementia friendly environment.
The Use of Assistive technologies can promote independence and enable people to manage potential risks around the home, reduce the need for early entry into care homes and hospital, and reduce stress on carers. These technologies can include: memory aids such as voice recorded reminder messages; Clocks and calendars; Medication aids; Locator devices and; telecare
Support for Carers of people with Dementia
NICE recommend that the needs of carers should be assessed regularly to identify any psychological distress or psychosocial impact. Care plans should include a range of tailored interventions, which may consist of a mixture of psychoeducation, peer-support groups, support and information, training courses, and involvement of other family members in family meetings. Another key service for carers is respite care. Respite care can take various different forms: in house day care, day centre, overnight or longer holiday breaks in a host-family or institution
 NICE Clinical Guidance (CG 42) Dementia: supporting people with dementia and their carers in health and social care