14Jul2014 - Dementia and Prevention

Where next for the dementia and prevention agenda?

Monday 14th July 2014

This event is kindly supported by Alzheimer’s Research UK and Improving Care

#DEMENTIAandPREVENTION

Welcome

Rebecca Wood

Chief ExecutiveAlzheimer’s Research UK



Sally-Marie Bamford, Director of Research and Strategy, ILC-UK

Kieran Brett, Director, Improving Care

Phil Hope, Director, Improving Care



Preventing Dementia: How can we do more to prevent dementia, save lives and reduce

costs?A Provocation by

Improving Care and the ILC-UKFunded by Pfizer

4

ILC-UK Planning Tomorrow, Today• Westminster based think tank• Evidence based research organisation• Focussed on policy• Independent and non partisan• Experts in ageing, demography and longevity• Produced a range of reports on dementia• Part of the ILC Global Alliance with 14 soon to

be 17 centres across the world• Formally affiliated to University College

London

The Climate and ContextSteps in the right direction:• The World Health Organization (WHO) and Alzheimer’s

Disease International show smokers have a 45% higher risk of developing dementia than non-smokers.

• Blackfriars Consensus Statement from Public Health England and the UK Health Forum receives high level support from all four nations in the UK.

• Global Actions and Initiatives: Australia’s Dementia Prevention Strategy

6

Making the political case for dementia prevention

Interventions, health benefits and savings claimed for preventing dementia have to be rigorous

7

The AuthorsImproving Care

– Kieran Brett, Co-Director, Trustee at DEMOS, former Special Adviser to the Prime Minister and Secretary of State of Health

– Phil Hope, Co-Director, Adjunct Professor Imperial College, former Secretary of State for Care Services,

– Steve Beales, Policy Fellow in Health Infomatics, Imperial College

International Longevity Centre– Sally-Marie Bamford, Director of Research and Strategy

8

The presentationSection 1: The human and financial costs of dementiaSection 2: Risk factors for dementia Section 3: Interventions that reduce risk factors for dementiaSection 4: The human and financial benefits of applying interventions to reduce the risk factors for dementiaSection 5: Next steps:

• Comments on the analysis• Strengthening the case:

– identifying best practice interventions for the risk factors – Identifying additional risk factors for dementia

• How to to take this argument forward

9

Numbers of people with dementia – ‘Policy Off’

10

Number of years of life lost to dementia – ‘Policy Off’

11

The annual cost to the state of dementia in 2013 was £10.54bn

12

Cumulative cost to the state and to individuals of dementia 2013 -2040

Year Cost to State Costs to Individual

Total Costs

2013 £10.54bn £4.03bn £14.57bn

2040 £18.31bn £7.15bn £25.46

2013-2040 £392bn £151bn £543bn

13

Relative risk of developing dementia

• Relative risk indicates how much of an increased chance of developing dementia a person might have for a particular condition

• For example the relative risk for a person with diabetes is 1.39 – that is, the chance of developing dementia is 1.39 times greater for those with diabetes than when compared to someone with out diabetes, all other things being equal

14

The top six relative risk factors for dementia

15

Reducing risk factors• Reducing the number of people with a given risk factor should

lead to a reduction in the number of people developing dementia.

• To work out the proportion of people developing dementia due to a risk factor we use the relative risk factor and the prevalence of the risk factor within the target population. For example:– Relative risk (RR) of diabetes for dementia is: 1.39 Current prevalence

(PRF) of diabetes in the UK is for men 65+: 15-16% and for women 65+:12-13%

• We then apply the Levin formula to identify the projected proportion of people developing dementia due to a risk factor

16

The Levin Formula

From this calculation, we can say:Projected proportion of people developing dementia due to diabetes is ~5.3%

17

Projections of the impact of reducing a risk factor on life years saved and costs reduced

The expected impact on dementia of a 10% reduction in diabetes prevalence

Life years are calculated by looking at the difference in life expectancy between people with and without dementia

18

Potential savings to the state of reducing diabetes in the population by 10%

19

Effective interventions for reducing risk factors

• For each risk factor we have identified what appears to be the most effective intervention for reducing its prevalence among the population

• And we have identified the impact this given reduction would have on the numbers of people developing dementia

• For example we have found an intervention that has been shown to reduce type 2 diabetes by 58%

20

Impact on dementia of intervention to reduce diabetes

21

Savings from reducing diabetes as a risk factor for dementia

22

Summary of impact of interventions for each risk factor

23

Summary of savings for each risk factor

Note of caution: these savings do not take account of the cost of the interventions

24

Cumulative savings to the state - £42.9bn

25

Total savings 2013-2040

Where savings accrue Amount 2013-2040

The state £42.9bn

Individual self-funders £16.4bn

Informal care £28.95bn

Total £88.25bn

26

Rebecca Wood

Chief ExecutiveAlzheimer’s Research UK



A blueprint to defeat dementia

Blackfriars Consensus on promoting brain health: Reducing the risks of dementia in

the population

Dementia is a common syndrome closely associated with ageing, with some known underlying causes and others which are less well understood. Recent evidence suggests that risk in the population might be reduced so that fewer people at particular ages develop dementia. The scientific evidence is evolving rapidly and sufficient to justify considered action and further research on dementia risk reduction, both by reducing the modifiable risk factors and improving the recognised protective factors.

HEADLINE CONSENSUS MESSAGE

G8 Dementia Summit, December 2013The G8 countries announced:• Identify a cure or a disease-modifying therapy for dementia by 2025 and to

increase collectively and significantly the amount of funding for dementia research to reach that goal.

• Appoint a global Dementia Innovation Envoy

UK Global action against dementia legacy event, June 2014

The UK-led event focused on the execution timeline and plan towards a Global Dementia Innovation Fund to: • stimulate greater social impact investment and innovation in dementia

research • improve the prevention and treatment of dementia • improve quality of life for people with dementia and their carers

DEFEAT DEMENTIA: £100M, 5 YEARS

Prevention / risk reduction

• We will introduce a new Prevention Fund by challenging the scientific community to answer the biggest questions in prevention, seed-funding the best ideas.

• We will seek to understand why there has not been greater investment in prevention research

• We will work in partnership to raise awareness of the ways in which you can reduce the risk of developing dementia, particularly Alzheimer’s disease and vascular dementia

• Pursue recommendations in Blackfriars Consensus

• Ensure the messaging does not lead to further stigma of the condition

Dr Charles Alessi

Lead DementiaPublic Health England



Dementia risk reduction: update on developing PHE work programme

Charles Alessi

Why is dementia a public health priority?

37


• 21 million of the UK population have a close friend or family member with dementia.

• Two thirds of people with dementia are women, and a higher number of carers are female

• As well as the huge personal cost, dementia currently costs the UK economy £19 billion a year, more than cancer and heart disease combined.

• The social and economic costs will keep rising as the number of people with dementia increases.

Over 7

0s disab

ility

DEMENTIA

Ref: Global Burden of Disease Study

• Dementia is the leading cause of mortality.

• It’s the 3rd biggest cause of over 70s disabilities, after lower back pain and falls.

• 25% of hospital beds are occupied by people with dementia.

• Low diagnosis rate (48%) and levels of support

• There are significant health inequalities issues, with challenging cultural norms, both around the condition and with carers.


Can we reduce the risk of dementia?

Action on dementia risk reduction is vital• In the absence of a cure, risk reduction is the only way we can reduce the

numbers of people getting dementia, postpone the onset and/or mitigate the impact of dementia.

• Worldwide, risk reduction is increasingly becoming a key focus of those involved in dementia care. The Global Dementia Legacy Event in Japan, later this year, will focus on risk reduction, and it is included in the World Dementia Council statement of purpose.

• Dennis Gillings, the World Dementia Envoy said (on 19th June 2014)“I am particularly keen for there to be a greater focus on prevention – in terms of minimising risk factors such as obesity, smoking, physical inactivity, diabetes and high blood pressure. There is growing evidence that these risk factors may be bringing forward the onset of dementia.”

• Risk reduction and slowing the development of symptoms is more cost effective, and far better for individual wellbeing.

40

41

Action on dementia risk reduction is evidence based

• PHE and the UK Health Forum have published the Blackfriars Consensus statement, signed by 60 leading figures and organisations from across the dementia and public health community.

• It stated that “the scientific evidence is sufficient to justify action on dementia prevention and risk reduction”.

• Evidence suggests that effective public health policies to tackle the major chronic disease risk factors of smoking, physical inactivity, alcohol and poor diet across the population will help reduce the risk of dementia in later life.

• Autopsy evidence suggests that Cerebrovascular disease contributes to neurodegenerative disease cases.

42

Action on dementia risk reduction is evidence based

Toledo JB, Arnold SE, et al. Brain 2013;135:2697-2706

Prevalence of Vascular Pathology (%)

Vascular findings reaching or not a

threshold sufficient enough to contribute to

clinical status

What can PHE contribute?

Big Ambitions• PHE wants to maximise our impact

through focusing on a small number of Big Ambitions for the public’s health for the next three, five and 10 years.

• Dementia is one of PHE’s “Big Ambitions”, and we are in the process of developing and testing proposals.

• We are exploring whether we might have an ambition around significantly reducing the numbers of people who get dementia, potentially linked to retirement age, with actions focused on 40 – 60 age group.

• There will be more detail in PHE’s Health And Wellbeing Framework.

44

PHE is planning action to promote dementia risk reductionWe want to work with system partners to change the game on dementia risk reduction. We are already planning action in five key areas:

• System leadership: raise awareness and promote and coordinate work

• Public awareness: develop world-class health marketing to raise awareness and enable action

• Professional understanding: incorporate messages in training and curricula

• Health improvement programmes: integrate dementia risk reduction, and building on the inclusion of dementia in the NHS Healthchecks programme from April 2013..

• Risk tool: develop a ground- breaking “rate of brain ageing tool” with UCL Partners, to support self-assessment, early diagnosis and preventative action.

45

PHE Dementia work programmeIssues Action

Risk Reduction

Lifestyle action can reduce risk – poorly understood locally.

• Clarify and articulate evidence• Test public-facing messages• Align with overall risk reduction work e.g. NHS Health

Checks• Developing a “brain ageing” risk tool

Living well People with dementia and carers often marginalised and poorly supported

• Dementia Friends Campaign• Dementia friendly communities – support local action• Dementia friendly employers – drive best practice in HR• Align crosscutting issues eg carers, end of life, isolation

Equity Significant cultural determinants.Little analysis of issues and best practice.

• New national collaboration: best practice, analysis, and research

K&I Fragmented data and intelligence • Dementia intelligence network

46

Shirley Cramer

CEORoyal Society for Public Health



Johan Vos

Deputy DirectorAlzheimer’s Disease International



About Alzheimer’s Disease International (ADI)

• Established 1984• The umbrella

organisation of Alzheimer associations around the world

• 84 member associations

Aims to help establish and strengthen Alzheimer associations throughout the world, and to raise global awareness about Alzheimer's disease and all other causes of dementia

World Alzheimer’s Month• September is

World Alzheimer’s Month

• 21 September is World Alzheimer’s Day

• International campaign to raise awareness globally

• 2014 theme: Dementia: Can we reduce the risk?

www.alz.co.uk/world-alzheimers-month

5 ways to help reduce risk


5 ways to help reduce risk


World Alzheimer Report Sept 2014

www.alz.co.uk/research/world-report

• Modifiable Risk and Protective Factors

• Global Observatory for Aging and Dementia Care, Kings College

• Comprehensive systematic review with some new meta analysis

• International Launch 17 Sept 2014 in London

• Supported by Bupa

• New WHO ADI factsheet launched July 2014

• Reveals smoking can increase dementia risk by 45%

• 14% of dementia cases around the world potentially attributed to tobacco

• Urges governments to implement tobacco control measures and cessation services

Smoking and dementia

www.who.int/tobacco

NCD Alliance

www.ncdalliance.org/

• ADI joins NCD Alliance in May 2014

• Dementia shares common risk factors to NCD’s

• Strongest civil society voice at the UN and WHO

The NCD Alliance was founded by four international NGO federations representing four main NCDs – cardiovascular disease, diabetes, cancer, and chronic respiratory disease.

The NCD Alliance unites a network of over 2,000 civil society organizations in more than 170 countries. The mission of the NCD Alliance is to combat the NCD epidemic by putting health at the centre of all policies.

Estimated increase in dementia worldwide

Follow ADI on Twitter

https://twitter.com/alzdisint

Like us on Facebook

https://www.facebook.com/alzheimersdiseaseinternational

Visit our website

http://www.alz.co.uk/

Thank you!

https://twitter.com/alzdisint





Panel Debate and Q&A• Do we now have a sufficient evidence base on dementia risk

reduction to justify action in this field? • How can we incorporate dementia risk reduction into general

health policies and what may be the implications of raising awareness of dementia prevention for the general public?

• With such high level endorsement (including last week Rt

Hon Jeremy Hunt MP, Secretary of State for Health, England, Norman Lamb MP, Minister of State for Care and Support) signing up to the Blackfriars Consensus, where do we go next and how can we work together to push this agenda further?

Where next for the dementia and prevention agenda?

Monday 14th July 2014



Presentations & Public Speaking

14Jul2014 - Dementia and Prevention