Warning: Dementia ahead

There is a significant need in all Western societies to cope with the steadily increasing number of elderly people with dementia. This illness has a dramatic impact on the lives of those afflicted and on family members who care for them. It necessitates greater efforts on the part of the health and welfare systems, on communities and on taxpayers.

In October this year, Israel adopted a “National Strategic Plan to Address Alzheimer’s and Other Types of Dementia.” The recommendations offer a holistic perspective and emphasise collaboration among all relevant agencies: government ministries, the public healthcare system and other organisations in both the voluntary and private sectors. There is also a growing crisis in Diaspora Jewish communities with more people (especially women) living into their nineties and beyond. In the UK, for example, almost fifty per cent of individuals over 85 are suffering from some form of dementia.

The Israeli Strategic Plan aspires to cope with key issues that make it difficult for the current health system to provide an appropriate response to the unique needs of dementia patients:

1. The need to raise public awareness of the illness and dispel related stigmas.
2. The prevailing sense that ‘nothing can be done’ among the public and the need to make them aware of the ways in which patients and their families can be helped.
3. The need for diagnosis at the earliest possible stage, so as to prepare for the illness and provide the patients with appropriate care through to the end of life.
4. The need to develop a range of services for dementia patients and ensure support for their families.
5. The need to develop and expand training for professionals working with dementia patients, not only to ensure quality care, but also to prevent burnout.
6. The need for additional research to support policy planning and service development.

The National Strategic Plan lays down the basic principles for the development of the most appropriate services and interventions for dementia patients. The Israel Ministry of Health has already set up an implementation committee and is working intensively to implement the plan. In the UK the government has recently announced the doubling of the budget for dementia research.

Now the good news. The first systematic review of related research has confirmed that a Mediterranean diet, as consumed by most Israelis and many other Jews, with a high intake of olive oil, fish, fruit and vegetables has a positive impact on cognitive function. Over recent years many pieces of research have identified a link between adherence to a Mediterranean diet and a lower risk of age-related disease such as dementia. Now this systematic review of such research confirms the link.

Academics analysed twelve eligible pieces of research, eleven observational studies and one randomised control trial. In nine out of the twelve studies, a higher adherence to a Mediterranean diet was associated with better cognitive function, lower rates of cognitive decline and a reduced risk of Alzheimer’s disease. However, results for mild cognitive impairment were inconsistent.

In addition, another study suggests that mothers who breastfeed run a lower risk of developing Alzheimer’s with longer periods of breastfeeding further reducing the risk. The report suggests that the link may be to do with certain biological effects of breastfeeding. For example, breastfeeding restores insulin tolerance which is significantly reduced during pregnancy, and Alzheimer’s is characterised by insulin resistance in the brain. The researchers observed a highly significant and consistent correlation between breastfeeding and Alzheimer’s risk. The findings may point towards new directions for fighting the global Alzheimer’s epidemic, especially in developing countries where cheap, preventative measures are desperately needed.

Yale School of Medicine researchers have discovered a protein that is the missing link in the complicated chain of events that lead to Alzheimer’s disease. Researchers have also found that blocking the protein with an existing drug can restore memory in mice with brain damage that mimics the disease. Scientists have already provided a partial molecular map of how Alzheimer’s disease destroys brain cells.

In 1980 there began a large, long-term study in which the health habits of 2,500 men in Caerphilly, South Wales were monitored in order to work out what five forms of healthy behaviour were integral to a disease-free life. They discovered that taking regular exercise, not smoking, a low body weight, healthy diet and low alcohol consumption were the main factors. The most recent finding was that exercise in particular significantly reduced the risk of developing dementia. Men who had consistently followed four or five of these healthy forms of behaviour experienced a 60 per cent decline in dementia, as well as 70 per cent fewer instances of Type 2 diabetes, heart disease and stroke, compared with people who followed none.