May 22, 2013

Less Dementia in Sweden? What About Here?

With all the alarms about the coming Alzheimer’s epidemic – and its frightening impact upon our country’s already out-of-control healthcare costs – it’s a surprise to see a Swedish study that actually reports a DECLINE in dementia risk over the past 20 years.

The apparent reason? Improved cardiovascular health.

This particular study on aging and health began in 1987, and has tracked over 3,000 people aged 75 and up in a Stockholm neighborhood. Even though people with dementia have been living longer for several decades, the “prevalence” of dementia in men and women over 75 remained steady through the study periods (1987-89) and (2001-04).

Researchers conclude that the risk of developing dementia has fallen because treatment of cardiovascular disease has improved – a conclusion that isn’t especially surprising, since protein plaque accumulations have long been associated with Alzheimer’s and other dementias. If medicine can now better control vascular health, it follows that development of new cognitive impairment might be correspondingly reduced.

Do Stockholm Stats Have Meaning for Americans?
While the message may sound encouraging, it isn’t time to crack open the champagne. Said Aging Research Center Director Laura Fratiglioni:
The reduction of dementia risk is a positive phenomenon, but it is important to remember that the number of people will continue to rise along with the increase in life expectancy and the absolute numbers of people over age 75. This means that the societal burden of dementia and the need for medical and social services will continue to increase. Today there’s no way to cure people who have dementia. Instead we must continue to improve health care and prevention in this area.
There’s another caveat to this story, reported in a recent edition of one of my favorite bulletins, Science Daily. Improved cardiovascular health in one particular neighborhood in Stockholm, Sweden – with its high standard of living and universal healthcare – does not necessarily translate into similar positive trends elsewhere. In fact, the obesity epidemic in our country – with its inevitable increases in diabetes and heart disease – suggests we are experiencing no similar reduced dementia risk. If cardiovascular health is our guide, we might even expect the opposite.

The Heart Foundation website provides some sobering statistics, which suggest the Swedish study – while important and encouraging for Swedes – may not have much currency elsewhere. Among the bullet points:
  • Every 33 seconds someone in the United States dies from cardiovascular disease which is roughly the equivalent of a September 11th-like tragedy repeating itself every 24 hours, 365 days a year. 
  • Heart disease is the number one cause of death for both men and women in the United States, claiming approximately 1 million lives annually. 
  • By 2020, heart disease will be the leading cause of death throughout the world. 
  • An estimated 80 million Americans have one or more types of heart disease. 
  • In 2008, the total cost of cardiovascular disease (coronary heart disease, hypertensive disease, heart failure and stroke) in the U.S. was estimated at $448.5 billion. (This includes direct costs such as costs of doctors, hospital services, medications, etc., and indirect costs such as lost productivity.) In comparison, the estimated economic cost of cancer in 2007 was $219 billion. 
What should we make of the Swedish study in light of these American statistics? I’m inclined to put even more stock into the importance of diet and exercise.

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