Dementia 2020 Strategy for Canada Report

 is now available at https://alzheimer.ca/sites/default/files/documents/PHAC-A-dementia-strategy-for-Canada-2020-annual-report.pdf

The following are some excerpts from the report:

What is dementia?

Dementia is a term used to describe symptoms affecting brain function. It may be characterized by a decline in cognitive abilities such as memory; planning; judgement; basic math skills; and awareness of person, place and time. Dementia can also affect language, mood and behaviour, and the ability to maintain activities of daily living.

Dementia may be caused by neurodegenerative diseases (affecting nerve cells in the brain), vascular diseases (affecting blood vessels like arteries and veins) and injuries. Types of dementia include vascular, Lewy body, frontotemporal, Alzheimer’s disease and mixed. In rare instances, dementia may be linked to infectious diseases, including Creutzfeldt-Jakob disease, or caused by injuries.

 The report sets out data points to provide a snapshot of some aspects of the state of dementia in Canada. Tracking data points over time will help our efforts to assess how we are doing as a country in making progress on the national objectives and in moving closer to the aspirations set out in the national dementia strategy. To improve the data available about dementia in Canada, PHAC commissioned a national public opinion survey of about 4,200 Canadians in early 2020. This survey also provides insights into differences in knowledge and attitudes across regions and within different demographic groups. It found that 83% of respondents believe dementia is having a moderate to a significant impact in Canada today. About half of respondents worry about developing dementia themselves (49%) and almost two-thirds worry that someone close to them will develop dementia (64%).

COVID-19 has created new challenges for people living with dementia and caregivers and requires tailoring of responses to address those needs. Some of the early challenges identified for people living with dementia and caregivers include:

·    Physical distancing may disproportionately affect people living with dementia because they depend primarily on in-person support, are extremely sensitive to disruptions to their daily routines, and may have very low technological literacy to stay connected with friends and family.

·    Some people living with dementia may have difficulties remembering safeguard procedures such as regularly and thoroughly handwashing or understanding public health information and guidance, which could expose them to a higher risk of infection.

·    Given the recent occurrence of COVID-19, there has not been adequate opportunity to assess the impacts of COVID-19 on people living with dementia. However, 90 percent of those living with this condition have at least one other chronic condition and nearly 20 percent have five or more health conditions, which may increase their risk for severe symptoms and death.

·        COVID-19 is placing enormous additional pressure on family/friend caregivers who may already be feeling stretched and stressed. Key caregiver challenges include:

§  Lack of respite care and closures of day programs;

§  Concerns about loved ones living in long-term care facilities;

§  Restrictions on being able to see their loved ones who are living in facilities;

§  Moving their loved ones temporarily back home to reduce the risk of transmission; and,

§  Juggling children and work at home at the same time as continuing or increasing caregiver responsibilities.

Factors affecting the risk of dementia.

There is growing persuasive scientific evidence that healthy living throughout a lifetime may prevent or delay the onset of dementia. Along with having healthy environments to live in, there are individual health behaviours and other factors that can affect the chance of developing dementia. This list outlines several of the factors identified. Research is underway to further explore the links between the risk of developing dementia, individual actions, and environmental surroundings.

From unhealthy to healthy behaviours:

Physical inactivity                                                                 Be more active.

Harmful alcohol use                                                              Reduce or quit alcohol.

Smoking in later life (over age 65)                                        Reduce or quit smoking.

Sleep disturbances (e.g., obstructive sleep apnea)               Taking steps towards

sufficient and better-quality sleep.

Management of these health conditions:

·                    High blood pressure (hypertension)

·                    Stroke, heart disease and other vascular diseases (affecting blood vessels like arteries and veins)

·                    Cholesterol levels

·                    Diabetes

·                    Obesity

Other factors:

·                    Social isolation Social engagement and inclusion

·                    Lower levels of early life education More years of childhood education

Brain Health

 Six Ways to Promote Brain Health and Reduce Your Risk of Dementia from McMaster University

Physical Activity and Weight Management

Follow the Canadian Physical Activity Guidelines. Engage in 150 minutes of moderate to vigorous−intensity aerobic physical activity per week, in bouts of 10 minutes or more. Add muscle and bone−strengthening activities using your major muscle groups at least two days per week. Pick activities that you enjoy so you are more likely to stick with it. Eat a balanced diet to assist with weight management.

Diet and Nutrition

Adopt the Mediterranean Diet to optimize brain health. There is no evidence that vitamin and mineral supplementation will promote brain health.

Blood Vessel Health

Actively manage conditions such as high blood pressure, high cholesterol and diabetes to promote blood vessel health.

Smoking and Alcohol Use

Quit smoking and stay within Canada’s Low−Risk Alcohol Drinking Guidelines, which advise:

•        For women: no more than 10 drinks a week, with no more than 2 drinks on most days.

•        For men: no more than 15 drinks a week, with no more than 3 drinks a day most days.

•        Plan non-drinking days every week to avoid developing a habit.

•        For women aged 65+: no more than 1 drink per day, and no more than 5 per week.

•        For men aged 65+: no more than 1-2 drinks per day, and no more than 7 per week.

•        A standard drink is 142 ml (5 oz.) of wine, 341 ml (12 oz.) bottle or can of beer or 43 ml (1.5 oz.) of liquor.

Brain and Social Activity

Strive to maintain higher levels of brain activity in mid to late life. Being socially active is an important predictor of well-being in general and brain health throughout life. For optimum effect, incorporate activities that provide both cognitive and physical elements such as yoga or tai chi.

Health Conditions and Drug Side Effects

Watch for medications that have the potential for adverse effects on memory and cognitive function (e.g., benzodiazepines, ‘Z−drug’ sleeping pills and certain pain medications such as those that contain opioids.

Treat depression, get adequate sleep, manage conditions that lower your oxygen levels, like heart failure, COPD or sleep apnea. Get help with hearing loss.

Hearing loss and dementia

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission is an interesting report with all sorts of good advice. In the report, the authors talk about Hearing Impairment. Hearing loss had the highest population attributable fraction (PAFs) of dementia in our first report, using a meta-analysis of studies of people with normal baseline cognition and hearing loss. A cross-sectional study of 6,451 individuals designed to be representative of the US population, with a mean age of 59·4 years, found a decrease in cognition with every 10 dB reduction in hearing, which continued to below the clinical threshold so that subclinical levels of hearing impairment (below 25 dB) were significantly related to lower cognition.

Hearing aids

A 25-year prospective study of 3,777 people aged 65 years or older found increased dementia incidence in those with self-reported hearing problems except in those using hearing aids. Similarly, a cross-sectional study found hearing loss was only associated with worse cognition in those not using hearing aids. A US nationally representative survey of 2,040 people older than 50 years, tested every two years for 18 years, found immediate and delayed recall deteriorated less after initiation of hearing aid use, adjusting for other risk factors. Hearing aid use was the largest factor protecting from decline adjusting for protective and harmful factors. The long follow-up times in these prospective studies suggest hearing aid use is protective, rather than the possibility that those developing dementia are less likely to use hearing aids. Hearing loss might result in cognitive decline through reduced cognitive stimulation. 

So bottom line, if you need a hearing aid, get one or you may have a good chance of getting dementia as you age.

Ideas to help prevent Dementia Physical Activity

As I indicated yesterday, dementia is a serious problem and there are many risk factors for dementia, some are under our control and some are not. However, the existence of potentially modifiable risk factors means that prevention of dementia is possible through a public health approach, including the implementation of key interventions that delay or slow cognitive decline or dementia.

Risk factors for dementia, that are out of our control include age, gender, race/ethnicity and family history.  It is important to note that while age is the strongest known risk factor for cognitive decline, dementia is not a natural or inevitable consequence of ageing.

During the last two decades, several studies have shown a relationship between the development of cognitive impairment and dementia with educational attainment, and lifestyle-related risk factors. These lifestyle risk factors are those we can control. These lifestyles choices are associated with an increased risk of developing dementia, physical inactivity, tobacco use, unhealthy diets and harmful use of alcohol.

In addition to the lifestyle choices certain medical conditions are associated with an increased risk of developing dementia, including hypertension, diabetes, hypercholesterolemia, obesity and depression.

Other areas that may cause an increase risk of dementia includes social isolation and cognitive inactivity. Over time I will look at all of the factors involved that we can control.

Seniors need according to the research about 150 minutes a week of physical activity or about 30 minutes a day, to stay healthy. Studies have linked a physically active lifestyle to good brain health. In large observational studies with follow-up periods extending decades, physically active people seem less likely to develop cognitive decline, all-cause dementia, vascular dementia and Alzheimer's disease when compared with inactive people. Especially, the highest levels of physical exercise seem to be most protective. Physical activity seems to have beneficial effects on brain structures, which may underlie this association.

Being physically active has a positive effect on other modifiable cardiovascular risk factors, such as hypertension, insulin resistance and high cholesterol levels. As well some other positive effects of exercise are enhancing the immune system function, anti-inflammatory properties.

Physical activity for adults 65 years and above, include recreational or leisure-time physical activity, transportation (e.g. walking or cycling), occupational (if the person is still engaged in work), household chores, play, games, sports or planned exercise, in the context of daily, family, and community activities. In order to improve muscular fitness, bone and functional health, and reduce the risk of depression and cognitive decline, the following guidelines are recommended by the World Health Organization (always check with your doctor before beginning or changing your exercise regime):

If you are aged 65 years and above you should do at least 150 minutes of moderate-intensity aerobic physical activity throughout the week.

If you can not find 150 minutes a week then you could also do at least 75 minutes of vigorous-intensity aerobic physical activity throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity. Aerobic activity should be performed in bouts of at least 10 minutes’ duration.

For additional health benefits, you might consider increasing your moderate-intensity aerobic physical activity to 300 minutes per week, or engage in 150 minutes of vigorous-intensity aerobic physical activity per week, or an equivalent combination of moderate- and vigorous-intensity activity.

If you have poor mobility you should consider physical activity to enhance balance and prevent falls on 3 or more days per week.

Muscle-strengthening activities should be done involving major muscle groups, on 2 or more days per week.

If you cannot do the recommended amounts of physical activity due to health conditions, you should be as physically active as your abilities and conditions allow.

Overall the benefits of implementing the above recommendations, and of being physically active, outweigh the harms. At the recommended level of 150 minutes per week of moderate-intensity activity, musculoskeletal injury rates appear to be uncommon.

If you are thinking about changing your exercise regime, check with your doctor, but it would be appropriate to start slowly and use gradual progress to move to the higher levels of physical activity.

Dementia is a rapidly growing public health problem

Dementia is a rapidly growing public health problem affecting around 50 million people around the world. There are nearly 10 million new cases every year and this figure is set to triple by 2050.

Dementia is a major cause of disability and dependency among older people and can devastate the lives of affected individuals, their careers and their families. Additionally, the disease inflicts a heavy economic burden on societies as a whole, with the costs of caring for people with dementia estimated to rise to US$ 2 trillion annually by 2030.

While there is no curative treatment for dementia, the proactive management of modifiable risk factors can delay or slow the onset or progression of the disease. In May 2017, the Seventieth World Health Assembly endorsed a Global Action Plan on the Public Health Response to Dementia 2017–2025. Dementia risk reduction is one of the seven action areas in the global action plan. The following is taken from this plan

Dementia is a rapidly growing global public health problem. Worldwide, around 50 million people have dementia, with approximately 60% living in low- and middle-income countries (LMIC). Every year, there are nearly 10 million new cases. The total number of people with dementia is projected to reach 82 million in 2030 and 152 million in 2050. Dementia leads to increased costs for governments, communities, families and individuals, and to the loss in productivity for economies. In 2015, the total global societal cost of dementia was estimated to be US$ 818 billion, equivalent to 1.1% of global gross domestic product (GDP).

Crucially, while age is the strongest known risk factor for cognitive decline, dementia is not a natural or inevitable consequence of ageing. Several recent studies have shown a relationship between the development of cognitive impairment and dementia with lifestyle-related risk factors, such as physical inactivity, tobacco use, unhealthy diets and harmful use of alcohol.

Certain medical conditions are associated with an increased risk of developing dementia, including hypertension, diabetes, hypercholesterolemia, obesity and depression. Other potentially modifiable risk factors include social isolation and cognitive inactivity. The existence of potentially modifiable risk factors means that prevention of dementia is possible through a public health approach, including the implementation of key interventions that delay or slow cognitive decline or dementia. 

Dementia prevention

It’s no surprise that adopting a healthier lifestyle is key in reducing dementia risk. When the World Health Organization (WHO) released a report earlier this year, entitled Risk Reduction of Cognitive Decline and Dementia, it found that what was good for the body was good for the brain. To help prevent or delay Dementia WHO came up  with its guidelines:

Stop smoking — even after age 60, smoking cessation has been shown to help lower risk

Manage conditions including hearing loss, hypertension, high cholesterol, diabetes and depression

Avoid drinking in excess and middle-age weight gain.

And for the most bang for your buck, eat healthily and exercise regularly.

Diet

Researchers have long hailed the Mediterranean diet as one of the healthiest and, according to the WHO, it’s the best one for reducing the risk of dementia. It’s defined as being high in fruits, vegetables, legumes and grains; including healthy fats such as nuts and olive oil; and low in dairy and meat.

In fact, a study by Toronto’s Baycrest Rotman Research Institute showed that older adults who limited meat to once a day and ate red meat less than once a week reduced Alzheimer’s risk by 36 per cent.

At home, use less ground beef in tacos but add a handful of chopped walnuts. Or try lentils, lower in fat than even turkey, as the protein in soups and stews.

Exercise

The WHO also advises that people aged 65 and older get at least 150 minutes a week of moderate aerobic activity — increasing it to 300 minutes further boosts cognitive benefits. Walking briskly, swimming and cycling all fit the bill — and have been shown to extend lifespan — as do household chores such as sweeping floors and mowing the lawn.

Warning signs of Dementia

As I have said in earlier posts, my friend has been diagnosed with Vascular Dementia and is starting to show a decline in his ability to function. Dementia is a term that describes a variety of symptoms affecting a person's cognitive functioning, including their ability to think, remember, and reason. Dementia occurs when nerve cells in a person's brain stop working. Although it typically happens in older people, it is not an inevitable part of ageing. The brain's natural deterioration happens to everyone as they grow older, but it occurs more quickly in people with dementia. Dementia tends to get worse over time, and there are a few key early warning signs.

There are 10 typical early signs of dementia. Here are the first five. For a person to receive a diagnosis, they would usually experience two or more of these symptoms, and the symptoms would be severe enough to interfere with their daily life.

These early signs of dementia are:

1. Memory loss

A person developing dementia may have trouble remembering dates or events. Memory loss is a common symptom of dementia. A person with dementia may find it difficult to recall information they have recently learned, such as dates or events, or new information. They may find they rely on friends and family or other memory aids for keeping track of things.

Our workshop on Memory Loss is very popular, and I think it is because many of us relate memory loss to dementia. It is important to remember that while most people occasionally forget things more frequently as they age, they can usually recall them later if their memory loss is age-related and not due to dementia.

2. Difficulty planning or solving problems

A person with dementia may find it difficult to follow a plan, such as a recipe when cooking, or directions when driving. Problem-solving may also get more challenging, such as when adding up numbers to paying bills.

3. Difficulty doing familiar tasks

A person with dementia may find it difficult to complete tasks they regularly do, such as changing settings on a television, operating a computer, making a cup of tea, or getting to a familiar location. This difficulty with familiar tasks could happen at home or work.

4. Being confused about time or place

Dementia can make it hard to judge the passing of time. People may also forget where they are at any time. They may find it hard to understand events in the future or the past and may struggle with dates.

5. Challenges understanding visual information

Visual information can be challenging for a person with dementia. It can be hard to read, to judge distances, or work out the differences between colours. Someone who usually drives or cycles may start to find these activities challenging.

A change in Walking patterns

An interesting study posted in the New York Times shows a link between walking gait and early signs of dementia. The full story is here, the following is an excerpt from the story

A large study at the Mayo Clinic involved basic walking, not dual-tasking, but found a similar relationship, said Dr. Rodolfo Savica, a neurologist at the clinic. Most of the 1,341 participants did not have dementia. They were evaluated twice, 15 months apart, with tests of cognitive ability and walking.

Dr. Savica and his colleagues found that on average a person who walked one meter per second slower on their second test scored half a point lower on cognitive tests.

Slower walking was mostly strongly linked to declines in “executive function,” the ability to plan and organize activities. A study led by Dr. M. Arfan Ikram, a neuroepidemiologist at Erasmus MC University Medical Center in Rotterdam, tried to connect particular changes in gait with specific cognitive impairments.

More than 1,200 people with no signs of dementia were asked to walk normally, to walk and turn around halfway through, and to “tandem walk,” in which the heel of one foot is placed directly in front of the toe of the previous foot. The subjects also were given cognitive tests.

People with poor tandem walking scored low on tests involving fine motor skills. People with lower cadences, who took fewer steps per minute, did worse on tests of thinking speed. And people whose walks were slower and more variable showed poor executive function.

Aside from suggesting that walking may provide early clues that dementia is on its way, the studies may reinforce the possibility that physical activity could help stave off dementia. If slower and more erratic walking signifies neurological damage, could exercises to improve fitness and coordination not only help people walk, but also by help them think?

“Those are the ultimate questions,” Dr. Ikram said. “Right now, we are really at the first step.”

Who did you say you were?

I read this and thought I would pass it on along with a link to the blog, where it was originally posted.  I found this to be very powerful

It happened … one day last weekend…. I was driving down our street with Bill, my husband who has dementia, and he said, “that’s our place there on the right.”
Rather dryly I responded ,“yes I know. I’ve been there many times.”
“You have?” he asked.
At that point I turned to look at him directly to see if he was kidding me. He wasn’t. His face was straight and serious.

“Do you know who I am,” I asked. “No,” he said. “Who are you?”
I can’t describe how I felt at that moment. Panic-stricken I guess. Friends had been asking me if Bill still recognized me and I had been shrugging it off with a quick “of course.” I wonder if I’ve been in denial about his dementia for the past two years.


As we pulled into the driveway I decided to resort to one of my two regular defence mechanisms: humour and faking it. I chose faking it.

We came in and unloaded a couple of groceries. Because it was a wet and chilly day, I put on the fireplace and we sat down in the living room to work on our jigsaw puzzle.

After a few minutes of silence Bill said, “You’re a very nice person.”

I nodded a sort of thank-you. Then he picked up the TV clicker and tried to dial out with it (he often gets it mixed up with the phone).

“Who are you trying to call?”“Pauline. It’s not like her to not call on her way home.”



Now I was really in a panic.

I finally said, “I am Pauline, your wife. We’ve been married for 22 years.”

The look that came back at me was absolutely incredulous.

“You are? We have? Why didn’t I know?”

So I went back to silence and found a few more jigsaw puzzle pieces that fit. Hell, I needed something to fit!

After dinner, Bill started it again, saying he really loved his wife and if it weren’t for her, he would be quite interested in me because I’m so nice. But he wanted me to know that we could never have anything together because he’s happily married.


Realizing it was almost bedtime, a wave of fear washed over me. If he doesn’t think I’m his wife, and he’s so faithful to her (I did smile to myself at that thought), then where are we going to sleep? Would he try to push me out of bed?

I stayed as normal as possible, got into my pajamas and threw my clothes into the laundry basket, as usual.

Bill said, “Pauline does all our laundry. She’ll wonder about those clothes in there.”

“Oh, I’m sure she’ll be fine with it,” I said.


The actual showdown came when I got into bed. He stood in the middle of the room and asked what I was doing. I said I was going to sleep, to which he replied, “but you can’t sleep there. That’s my wife’s place.”

Taking a big gamble I said, “I know you don’t understand this, because you have a disease in your brain and you can’t help it, but I am your wife. I am Pauline. If you don’t want to sleep with me, you can go to sleep in the spare room. I don’t plan to give up my bed.”

“Oh,” Bill said and came to bed quietly (Phew!)

The next day nothing more was said on the subject. I didn’t know who I was that day and I was afraid to ask.

Today I’m back to being Pauline.

For how long I wonder?

Published: March 24, 2012 10:00 AM by Pauline Buck Pauline Buck is a local blogger and columnist at http://www.homeontheranch.info/ which is a blog as described by th author as A running dialogue - some humour, some poignant, about moving from the city to the farm; life with a husband who has dementia, and being a happy retired baby boomer. Love my OAP and CPP)

Education 'helps brain compensate for dementia changes'

An interesting article on  dementia by By Caroline Parkinson, Health reporter, BBC News, posted July 26th

People who stay in education for longer appear to be better able to compensate for the effects of dementia on the brain, a study suggests.

A UK and Finnish team found those with more education were as likely to show the signs of dementia in their brains at death as those with less.

But they were less likely to have displayed symptoms during their lifetime, the study in Brain said.

Experts said scientists now had to find out why the effect occurred.

Over the past decade, studies on dementia have consistently shown that the more time you spend in education, the lower the risk of dementia.

But studies have been unable to show whether or not education - which is linked to higher socio-economic status and healthier lifestyles - protects the brain against dementia.

Compensation
The researchers in this study examined the brains of 872 people who had been part of three large ageing studies.

Before their deaths they had also completed questionnaires about their education.

The researchers found that more education makes people better able to cope with changes in the brain associated with dementia.

"Education in early life appears to enable some people to cope with a lot of changes in their brain before showing dementia symptoms" r Hannah Keage

Post-mortems showed the pathology - signs of disease - in the brains of people with and without long educations were at similar levels.

But the researchers found those with more education are better able to compensate for the effects of the condition.

It also showed that, for each year spent in education, there was an 11% decreased risk of developing dementia.

Dr Hannah Keage of the University of Cambridge, who co-authored the study, said: "Previous research has shown that there is not a one-to-one relationship between being diagnosed with dementia during life and changes seen in the brain at death.

"One person may show lots of pathology in their brain while another shows very little, yet both may have had dementia.

"Our study shows education in early life appears to enable some people to cope with a lot of changes in their brain before showing dementia symptoms."

'Dementia resistant'

The researchers used data from the Eclipse collaboration, which combines the three European population-based longitudinal studies of ageing from the UK and Finland which have assessed people for up to 20 years.

Professor Carol Brayne, who led the study, said: "Education is known to be good for population health and equity.

"This study provides strong support for investment in early life factors which should have an impact on society and the whole lifespan.

"This is hugely relevant to policy decisions about the importance of resource allocation between health and education."

Ruth Sutherland, chief executive of the Alzheimer's Society, said: "This is the largest study ever to confirm that hitting the books could help you fight the symptoms of dementia in later life. What we don't know is why a longer education is so good for you.

"It could be that the types of people who study longer have large brains which adapt better to changes associated with dementia.

"Another reason could be that educated people find ways of managing or hiding their symptoms."

She added: "We now need more research to find out why an education can make the brain more 'dementia resistant'. Until then the message appears to be stay in school."

Rebecca Wood, chief executive of the Alzheimer's Research Trust, added: "During dementia, proteins build up in the brain and nerve cells become damaged. This research suggests that education is not able to stop the damage but enables the brain to cope better and alleviate its impact. "

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