The Japanese maintain a healthy lifestyle when it comes to nutrition – and the country does a lot for education. Photo: dpa
–
By Michael Abschlag
Heidelberg. Christian Wolf is Senior Physician at the Clinic for General Psychiatry and Head of the Cognitive Neuropsychiatry Section at Heidelberg University Hospital.
Mr. Wolf, the WHO assumes that the number of dementia cases worldwide will triple in the next few decades. How do you rate that?
The assessment is not surprising. If one speaks of a worldwide tripling, one has to take a closer look. But the fact that the number is generally increasing is not new. The most important factors are also mentioned in the most recent WHO publication: population growth and age. The average age is steadily increasing, and with it the risk of dementia. However, the WHO report makes a kind of adjustment to various known risk factors. On the other hand, it also specifies points of contact for individual, social and political measures. If you can change something about the risk factors, you can also reduce the number of dementia cases or take timely measures to continue to provide patients with optimal care in the future.
What are the risk factors?
This includes a lot that affects your personal lifestyle. The most recent report by the WHO explicitly includes three physical factors in the global prediction of dementia diseases, namely obesity, diabetes and smoking. So it’s about physical factors related to cardiovascular disease and the longer-term effects of these diseases on the brain. But that is only one aspect. The report also includes the influence of education: Improving the educational landscape can certainly prevent dementia. However, he says nothing about lifelong learning. He pretends that the level of education is constant after the age of 25, which of course is not true in reality. There are also other factors that have been identified by the WHO in recent years, such as alcohol, depression, social isolation, accidents and physical inactivity. All of these risk factors are fundamentally modifiable.
Does that mean that the risk not only increases as society ages, but also as a result of personal risk?
That’s the way it is. The most important predictors of the study were: the population is increasing, people are getting older. But at the same time there are many risk factors that can be changed – on the one hand through personal behavior and on the other through social measures. These include educational opportunities, better access to psychiatric care, promotion of physical activity and the like.
Would that be a job for the healthcare system?
The healthcare system and also the individual. This has to go hand in hand, and the authors of this study also say so indirectly.
A particularly large increase in cases is expected in some countries, such as Qatar and Saudi Arabia. Do you have an explanation for this?
This is mainly due to aging and population growth. Certain regions, such as Northern Sahara, will see the greatest population growth, and that is driving development. Conversely, we have the lowest growth in Asian countries, especially Japan. One explanation is that Japan has invested heavily in education in recent decades and lifestyle has always played a major role.
And how is it in Germany?
In Germany, a lower increase is expected than the Western European average. In Western Europe, the forecast is 74 percent, in Germany around 65 percent. That would be an increase from the current 1.7 million cases in 2019 to 2.8 million cases in 2050. However, it must be said that dementia was recorded in the report regardless of its cause. It is therefore not possible to say how many cases can be traced back to Alzheimer’s disease or cardiovascular disease. The report also says nothing about how severe they are. An important aspect that is unfortunately somewhat overlooked is the understanding of the causes. More efforts should be made in this area, including to develop better treatment strategies. This is a very important point that deserves more attention. Otherwise the impression is created that the numbers would inevitably increase, and that would be fatalistic. This is exactly what the report should not achieve, but, on the contrary, motivate change.
Will it ever be possible to cure dementia? With a drug?
Yes, absolutely. But, as I said, dementia is a generic term for very diverse causes. One will only be able to approach the best treatment if one carefully examines the causes and can then also develop cause-related therapies. I definitely believe that there will be a lot more to do by 2050.
Christian Wolf. Photo: zg–
