Dementia, a condition that profoundly impacts individuals and societies, is on the rise globally, especially in low- and middle-income countries. This escalating trend underscores the urgent need for effective dementia prevention strategies. A recent study, published in the Journal of Prevention of Alzheimer’s Disease, embarks on a rapid review of dementia prevention literature, revealing a critical gap in the research landscape: the underrepresentation of population-level approaches compared to individual-level interventions.
The study’s examination of existing literature highlights a stark imbalance. While individual-level interventions, focusing on personal behaviour and lifestyle changes, dominate dementia prevention research, there is a conspicuous scarcity of studies exploring population-level strategies. These population-level interventions involve broader societal changes, such as public health policies and environmental modifications, aimed at reducing risk factors for the entire population.
Adding to this discourse, Sebastian Walsh, PhD a doctoral fellow from the University of Cambridge, remarks: “Evidence from several countries has suggested that the incidence of dementia has dropped over recent decades. This leads to two obvious, linked questions: why did it drop, and how can we make it drop further for the next generations that grow old? Most research, and as a result, most policy focus, has been focused on how we can encourage individuals to reduce their own risk. But it ignores the need to address the things in our environment and the societal structures that make these risk factors more likely to develop across the population. This paper was intended to quantify exactly how imbalanced the research work has been, with the intention of shining a light on the change needed in our research approach.”
The limited focus on population-level interventions raises concerns about the effectiveness and equity of current dementia prevention efforts. While individual-level strategies are crucial, they often place the burden of prevention on individuals, potentially overlooking socio-economic and environmental determinants of health. In contrast, population-level approaches can lead to more significant, inclusive, and sustainable outcomes by addressing these broader determinants and reducing health inequalities.
Walsh further explains the findings of his research: “We found 12 reviews that systematically summarised the dementia prevention evidence that’s out there. Of these, only around 3/600 studies had any meaningful focus on interventions that are society-wide. This means that we have not been meaningfully researching dementia prevention from a societal perspective, focusing almost exclusively on things that people can do for themselves.”
The study points out the challenges in researching and implementing population-level interventions. These approaches are academically complex to study and politically challenging to enact, contributing to their underrepresentation in research. This situation creates a cycle where the lack of evidence hinders the development of effective population-level dementia prevention policies.
Reflecting on future directions, Walsh states: “We are now looking to develop the evidence base for population-level interventions. This includes various types of research, including working with policymakers, doing statistical analysis, analysing policies, and further review work. We hope that we can produce evidence that is usable by policymakers to start working incrementally towards a more balanced approach.”
The study calls for a paradigm shift in dementia prevention research. It emphasises the need for a more balanced approach that equally values and investigates both individual and population-level strategies. Such an inclusive research approach is crucial for developing comprehensive and effective dementia prevention policies capable of making a substantial impact on the global burden of dementia.