I love checklists. I really love checklists that can predict things. The academic world calls them risk scores. I believe in risk scores. After all, I wrote my master’s thesis on them.
However, I am a bit skeptical of a risk score that can predict dementia. Don’t get me wrong. I think we need this. As researchers (and caregivers) well know, despite the incredible devotion of effort, money and time “to studying the causes of dementia and the means to prevent it, no effective treatment exists yet”.
So the next best thing would be to at least predict, accurately, who is most at risk of developing this disease, and then we could throw many more resources at those people.
This is the newest article from JAMA that caught my attention this week. A population-based study, (my favorite kind! ‘cause the sample sizes are big and are often more accurate) identifying preclinical (before there are symptoms) risk factors of dementia.
First off, the most significant risk factor was, wait for it, age. Okay, no surprise there.
The other factors were also expected: fewer years of education, having cerebrovascular disease or diabetes. Interestingly, daytime sleepiness was also a significant risk factor.
Gender plays a role as well. To sum up their findings, “For example, a man with a history of diabetes (1 point) would have a lower dementia risk than a woman with a history of diabetes (2 points) if they had the same background. A 70-year-old (10 points) man with underweight (3 points), low educational level (1 point), and a history of diabetes (1 point) and cerebrovascular disease (5 points) has a total risk score of 20 points, and the corresponding risk of dementia is 9% at 5 years [post scoring], 31% at 9 years, and 54% at 13 years.”
The real question, however, is what do we do with all this?
Just like today that we have mammography and colonoscopies, I think that the medical system has a definite obligation to identify individuals at risk prior to showing symptoms. And a checklist is much less invasive than inserting a camera into an open body cavity.
But the obligation cannot stop there. If someone is identified at significant risk for developing dementia in another decade, then that is the time to start working with the individual and the family. Discussing financial arrangements, considering durable power of attorney, implementing supported decision making, for example, are all actions that we know can relieve the burden on both caregiver and patient as well as avoid future crises.
There needs to be an active push toward integrating medical and welfare support services as the population ages and more and more individuals are living longer, without immediate family members to care for them.
Dementia is not going away and we need to be smarter at managing its effects in the future.
