So researchers say in the latest Briefing from the Department of Public Health at the University of Otago, Wellington.

They say the risk of developing dementia is 60 per cent higher for people living in New Zealand's most deprived areas compared to those in the least deprived.

Right now, our dementia rates are soaring, the Briefing says.

Dr ‘Etuini Ma'u and co-authors from the Department of Psychological Medicine at the University of Auckland saw that Maori and Pacific people are particularly at risk.

They are over-represented in the more disadvantaged areas of NZ society, Ma'u says.

Forty percent live in areas of high deprivation.

"These findings indicate that the higher risk and rates of dementia in Maori and Pacific peoples are not due to ethnicity per se but their over-representation in areas of high social disadvantage and poverty."

What to do

Prevention through broader population-level approaches, like policies addressing inequity, could significantly reduce the number of people with dementia, Ma'u says.

He says it's already known that the number of people living with dementia in NZ is expected to double in the next 20 years.

It will triple in the same period for Maori and Pacific peoples.

The recent Lancet Commission Report pointed to 14 risk factors for the disease Aa'u says. From this, we know good policy can change that trajectory.

Even by reducing 12 of the 14 risk factors by just 10 per cent could mean 3,000 fewer people get dementia.

"Most risk factors build up across a lifetime" he explains.

"It is their incremental and cumulative damage to the brain that eventually leads to dementia.

"This shows the importance of promoting brain health in early life and midlife, even when the immediate dementia risk is deemed to be low."

While individual behaviour changes are important, social policy should also play a role the Briefing authors say.

They would like to see effective policies and interventions to address the health inequities associated with poverty and social disadvantage.

Targeted legislative and public health measures to reduce the availability and marketing of alcohol, tobacco and unhealthy food would help.

"So would urban planning that promotes exercise and social connection" Ma'u says.

Source

• Sun Live

Dementia victims, certain to be targets, can be got to "consent" without any fixed or firm idea what they are doing.

With the ageing of the world's population dementia has become the new leprosy.

As Marcus Roberts notes in a recent post on Demography is Destiny, the latest report by Alzheimer's Disease International has projected a steady increase in the number of suffers of dementia worldwide in the coming decades.

World Alzheimer Report 2015 finds that there are currently 900 million people in the world aged 60 years and over. This number will greatly increase by 2050 due to rising life expectancy and there will be a concomitant rise both in the number of people living with dementia and in the cost of caring for such people.

Maybe, maybe not.

All across the Western world, legislatures are increasingly cool with the idea of medically directed death kits.

Many proposed initial users will be people with dementias (whether or not they "consent," in any meaningful sense.)

Legislators have sniffed the wind. People with dementias are looked on as beings apart, as lepers once were.

But dementias are not different in principle from other disabilities.

Dementia: The brain is an organ; when challenged, it tries to heal, like any other organ. And it often succeeds, up to a point, just by rewiring (neuroplasticity).

So dementias go forward and backward, depending.

They are more of a problem in some areas of life than others.

In that respect, dementias do not differ much from, say, mobility issues.

It is true that mobility declines with age. But it is also true that seniors who arrive in rehab in wheelchairs routinely progress to walkers and canes.

Mental awareness is like that too. Just for example: I was in the dining room in an old age home a couple of months ago. Some residents were complaining that it was too dark for that time of year.

Well, no surprise there, five light bulbs were burnt out.

I said, I am going to grab one of those deaders, go get five like it, and just screw them all in. (How big a committee do we need for this? How many meetings?)

Then an old fellow diagnosed with dementia—who usually could not speak clearly—rasped from the back of the room, "Maybe you should leave that to the landlord."

I realized he was right.

If I did it myself, I'd be personally responsible for any consequences, no matter how unforeseen.

Following his implied suggestion, I spoke to the front desk, and they got Maintenance to do the job.

Continue reading for a couple of takeaways for a compassionate understanding.

Yet people with dementia can still find meaning in life, she says.

MacKinlay is professor of theology at Charles Sturt University in Canberra and an Anglican priest.

She has been presenting workshops in New Zealand, "Spiritual Reminiscence in Dementia", on ageing and spirituality, particularly spiritual reminiscence for people with dementia.

Some of the work Prof MacKinlay does looks at unpacking what people think is ‘spirituality'. "It's not religion, although religion may be a way of working out one's spirituality," she says.

"A lot of Australians and New Zealanders don't have a religious faith. Yet they still search for meaning."

MacKinlay's work in this field started when one of her friends, Christine Bryden, was diagnosed with early onset alzheimer's at age 46.

"She asked me if I would journey with her because I was both a geriatric nurse and an Anglican priest. She thought that she needed both."

"She challenged me in many ways over the coming years and I found that it was possible to talk with her quite naturally."

Bryden has since published several books including "Who will I be when I die."

MacKinlay was brought to New Zealand by the Selwyn Foundation for Ageing and Spirituality.

She is the author of a number of books

Her book, "Finding Meaning in the Experience of Dementia: the Place of Spiritual Reminiscence Work ," won an Australasian Journal of Aging book prize last year.

Source

• Taranaki Daily News
• Scoop
• Image: Shutterstock

The pattern of over-diagnosis is the same for many diseases: we screen healthy people and those with minimal symptoms; we use sophisticated technologies that detect early or minor abnormalities that may not progress; and we treat people with these abnormalities on the assumption that this will prevent significant illness and death.

The downside of all this medical intervention is that we're exposing healthy people to the potential harms of diagnosis, investigation and treatment without any certainty about long-term benefits. Indeed, there's a growing unease that this trend is being driven by the financial benefits of creating a larger market for drugs rather than genuine health gains.

I work in geriatric medicine and over the last few years, I have seen how the changing definitions of dementia and Alzheimer's disease has insidiously been leading to over-diagnoses.

Screening the healthy

Let's start with the schema of over-diagnosis: are we screening healthy people and those with minimal symptoms? Yes. In the past, we diagnosed older people complaining of minor memory impairment with "benign senescent forgetfulness", and told them that it didn't require any further action. It was, after all, benign.

But this terminology progressed to "mild cognitive impairment (MCI)" and now (more ominously), to pre-dementia and pre-clinical Alzheimer's disease. We are also being encouraged to screen older people for any memory impairment because this has now been defined as a pre-disease or early disease.

The screening tools are usually simple questionnaires, such as the mini-mental state examination (MMSE). There's variability in how well the assessments are performed, and forgetting the date or stumbling on a repetition task can lead to a diagnosis of mild cognitive impairment. But how many of these people actually progress to dementia?

Most studies show that only one in ten cases of mild cognitive impairment progress to dementia each year, and many improve. One study that followed outcomes for ten years concluded - "The majority of subjects with MCI do not progress to dementia at the long term." Read more

Sources

• The Conversation
• Image: TopNews.in

Preconditions don't always lead to actual conditions, but that doesn't stop millions of Americans from seeking treatment of some kind anyway. In fact, over 100,000 people die every year due to complications associated with treating preconditions, according to Ivan Oransky, the executive editor of Reuters Health, who spoke yesterday at TEDMED, a three-day conference in Washington, D.C. on technology and medicine.

As with many of the challenges facing the country's healthcare system, the profit motive has a large role to play in exacerbating the prediagnosis epidemic. Making treatments available for preconditions does more than enable more frequent diagnoses of said illnesses, Oransky believes. It actually creates greater demand in a weird kind of feedback loop, because people want to believe that every medical ailment has a ready medical solution.

"You can actually, perversely, tell people to come" and be diagnosed with preconditions, Oransky told TEDMED attendees. "You can convince them that they have to come."

"I have another name for these preconditions," Oransky added. "I call them preposterous."

In many cases, he said, over-medicalization may be counterproductive. Instead of developing better lifestyle habits, patients go to doctors seeking drugs, which are provided by pharmaceutical companies aiming to sell as many pills as possible. Meanwhile, precondition advocacy groups whose survival depends on successful fundraising have an interest in perpetuating the idea that preconditions are themselves diseases that must be treated medically.

It's hard to know whether better living can eliminate all preconditions. But the culture of precondition diagnosis may be doing more harm than good.

"I have really bad news for all of you," Oransky said. "You all have a universally fatal condition. It's called pre-death. Every single one of you has it, because you have the risk factor for it, which is being alive."

Sources

• Brian Fung in The Atlantic
• Image: NewScientist