Young Onset Dementia

A Guide to Recognition, Diagnosis, and Supporting Individuals with Dementia and Their Families

Hilda Hayo, Alison Ward, Jacqueline Parkes

• Publisher: Jessica Kingsley Publishers
• Year: 2018
• ISBN:
  9781784503833
• Topic: Ciencias sociales
• Subtopic: Trabajo social

Providing key information and insight into the experiences of people living with a diagnosis of young onset dementia, this book will increase the knowledge and skills of health and social care professionals in the early recognition, diagnosis and support of young people with dementia and their families.

The book explores the experiences of people living with a diagnosis of young onset dementia through detailed case studies, and gives learning points to implement in practice for the better provision of appropriate support and care. It explains the need for adapting services which are often designed for older people, and how the complicated diagnostic process can lead to misdiagnosis among younger people. Key issues are considered, including at-risk groups, work and dealing with potential loss of employment, changes in personal and family relationships, readjusting life expectations and plans, and social isolation.

CHAPTER 1

Promotion of Health and Prevention of Ill Health in Reducing Incidence of Dementia

Rationale

Recent studies provide a positive message about the way individual changes in behaviour and lifestyle could reduce the incidence or delay the onset of some dementias in later life, particularly Alzheimer’s disease and vascular dementia. In 2014, key UK health and dementia representatives met to discuss the need for greater information and strategic policy around recognition of the risks for dementia or cognitive decline, especially those which are modifiable and may lead to reduced incidence of dementia or delay the onset of dementia. The Blackfriars Consensus (Lincoln et al. 2014) recognised the main modifiable risk factors as: smoking, poor diet, physical inactivity, alcohol consumption, and brain injury, with additional associations to hypertension, cardiovascular disease, obesity and diabetes. Furthermore, it was acknowledged there is a need for improved health promotion to encourage health throughout a person’s life, their workplace and through increased social engagement.

The importance of promoting health factors which could reduce the incidence of dementia in the population is associated with the rising cost of dementia; current figures estimate that dementia costs more than heart disease, stroke or cancer, at £26.3 billion a year in the UK (Public Health England 2016). Long term, an investment in health promotion could not only save the health and social sectors money, but may also result in people living a healthier and more fulfilling life into old age.

Learning objectives

The learning objectives for this chapter are to:

• Identify the modifiable and non-modifiable risks factors associated with dementia.

• Consider ways to promote a healthier lifestyle.

• Identify the value of early interventions.

• Identify ways in which the person living with a dementia and their carer/families can benefit from improved health and lifestyle choices.

Introduction

Much research has gone into finding a cure for dementia, however, currently no cure has been found. What has become a more recent focus for research and policy is understanding the risk and preventative factors of dementia and whether it is possible to delay or reduce the incidence of dementia. There are a number of risk factors associated with dementia, some which are not changeable, or non-modifiable, such as a person’s genetics, gender, ethnicity or age, but there are others which people can take steps to modify, such as lifestyle behaviours (Alzheimer’s Society 2016a; Public Health England 2016; Richie et al. 2010). Prince and colleagues (2014) advocate that ‘what is good for the heart is good for the brain’, therefore exercise, diet and wellbeing are crucial factors not only for a healthy lifestyle, but also for reduced risk of developing dementia. What is also evident is that a person can change their behaviours at any time and this could still have a positive impact on a person’s health and risks, as Prince and colleagues state, ‘it’s never too late to make these changes’ (p.5). However, the Alzheimer’s Society (2016a) suggests that a number of the main risk factors occur in midlife, when changes in the brain, which can result in dementia, occur, and that making changes to lifestyle behaviours between the ages of 40–64 can have a positive effect.

While the main focus of this chapter is on the preventative measures which can be promoted to maintain a healthy lifestyle, this chapter will also consider the way a person diagnosed with dementia and their carer/family may also benefit from being healthy, fit and active.

Modifiable risk factors of dementia

The main modifiable risk factors associated with dementia are: low education attainment early in life, high blood pressure in midlife, and those who smoke or have diabetes throughout their lives (Mitchell et al. 2016). Furthermore, taking part in physical activity, reduced obesity and reduced alcohol consumption are also associated with reduced risk of developing dementia (Lincoln et al. 2014; Public Health England 2016), as represented in Table 1.1. Other health risk factors also include existing medical conditions, for example Parkinson’s disease, stroke and head injury. Not only are health risks important to identify, but a person’s mental health, social engagement and interests may also have an important part to play, particularly to a person’s overall health and wellbeing.

Table 1.1 Protective and risk factors for dementia
Protective factors	Risk factors
Reduced alcohol consumption	Alcohol consumption
Weight loss	Obesity; High blood pressure in midlife; Diabetes
Physical exercise/activity	Physical inactivity
Stop smoking	Smoking
Social activity; Hobbies/work	Depression
Cognitive activity	Educational attainment; cognitive inactivity

The life course approach considers the whole life course, whereby early development and experiences can develop resilience to later life illnesses. In the case of dementia, education, social and physical activities, and a healthy diet may impact on a person’s risks of developing dementia in later life. Barnett, Hachinski and Blackwell (2013) suggest that even pre- and neonatal development can have a possible impact on the development of conditions later in life, such as on cardiovascular disease. However, early life experiences do not define our future health and midlife and later-life experiences will also have an impact (Prince et al. 2014), hence the importance of making positive changes at any age.

Why is there a focus on risk and preventative factors? Recent evidence suggests there may be a way for people to reduce their risks of developing dementia. A study by Norton et al. (2014) reported that a third of cases of Alzheimer’s disease could be associated with modifiable risk factors, while Barnett et al. (2013) suggested that half of the risks associated with Alzheimer’s disease are modifiable lifestyle risks. Furthermore, the National Institute for Health and Care Excellence (NICE 2015) suggests that vascular disease could be preventable through changes in modifiable risk factors. However, NICE recognises that other types of dementia are less well known and as such it is not yet known what risk factors are associated with these, particularly frontotemporal dementia or Lewy bodies. While changes to modifiable risk factors may have a positive impact on a person’s health, it is not necessarily the case that dementia will be prevented, Prince et al. (2014) stress that while there may not be a way of preventing dementia, working to reduce the risks will be a positive way forward.

Much of the research conducted on health risks is with those aged over 65 years, so why might this be important for younger people? It is important to stress that it is never too early to promote a healthy lifestyle message and that ill health in midlife can be a key risk factor for development of dementia. What seems to be increasingly evident is that the changes which occur as a result of dementia may do so 10 or 20 years before a diagnosis, and so making changes earlier in life is important (Barnett et al. 2013; Gandy et al. 2017; Wang et al. 2017). By raising awareness and addressing these issues, it may be possible to reduce a person’s risk and possibly reduce the incidence or delay the onset of dementia. Furthermore, for those who may be at a higher risk of developing dementia through non-modifiable risks, such as genetics, gender or ethnicity, maintaining a healthy lifestyle is even more important in potentially delaying any onset.

Work by Barnett et al. (2013) shows a clear representation of the ways in which a person can support their health and wellbeing in relation to dementia. This includes decisions made by parents when children are growing up, for example by not smoking. Our early life experiences can impact on our resilience and health, and some researchers are advocating for a ‘life span’ approach to the prevention of dementia: ‘Prevention of dementia should start early in life, “at conception”, and continue through the life span’ (Scazufca et al. 2008, p.879). In this way people are more likely to adopt healthy habits and lifestyles that can mitigate the risks of not only dementia, but also other long-term illnesses such as diabetes or cardiovascular disease.

Diet and obesity

Obesity is considered as a potential risk factor for dementia; certainly it is linked to diabetes and heart disease – both risk factors for dementia. Being overweight can increase a person’s blood pressure, which has been linked to a higher risk of dementia (NHS 2014). Baumgart et al. (2015) provide a summary of the evidence which sees a strong association between midlife obesity and an elevated risk of dementia. Similarly, hypertension in midlife has been identified as an associated risk factor for dementia (Corrada et al. 2017). Furthermore, those in midlife who have a large waist circumference and hips run a higher risk of dementia, with the fat in these areas having an impact on blood vessels and brain health (Srikanth 2017). This is supported by Albanese et al’s (2017) meta-analysis, looking at body mass index (BMI) of people in midlife, who found strong associations between a BMI over 30 and increased risks of developing dementia.

Eating a good diet can be an important preventative measure. The Mediterranean diet, based on vegetables, fruit and fish, is thought to be a preventative factor for Alzheimer’s disease and cognitive decline (Scarmeas et al. 2006; Lourida et al. 2013), although the findings on this are not conclusive (Anstey 2017). This has been supported by longitudinal research which found eating fruit and vegetables (at least two portions a day) can be a factor in reducing the occurrence of dementia (Richie et al. 2010). Hogervorst (2017) also suggests that the benefits of nutrition for dementia prevention are most beneficial in midlife and before any symptoms of dementia are present, while Ritchie et al. (2010) advocate that the consumption of fruit and vegetables is one of the main ways to reduce the incidence of dementia, although they are less clear on how and why this might be.

Alzheimer’s Research UK (2015a) advocate that people follow the ‘eatwell plate’ whereby a balanced diet is consumed which is low in salts, saturated fats and sugars. E...

Table of contents

• Cover
• Title Page
• Contents
• Foreword by Wendy Mitchell
• Introduction
• 1. Promotion of Health and Prevention of Ill Health in Reducing Incidence of Dementia
• 2. Groups at Increased Risk of Young Onset Dementia
• 3. Why Early Recognition and Diagnosis Matter
• 4. Post Diagnostic Support and Intervention
• 5. The Impact of Young Onset Dementia on Family Relationships
• 6. Lonely in a Social World: Maintaining Social Connections in Young Onset Dementia
• 7. Meaningful Occupation and Activities
• Conclusions
• Resources
• Subject Index
• Author Index
• Join our mailing list
• Acknowledgements
• Copyright
• Of Related Interest