Dementia before Death in Ageing Societies— The Promise of Prevention and the Reality

PLoS Medicine: Dementia before Death in Ageing Societies— The Promise of Prevention and the Reality: "Changing global population structures require societies to face major issues raised by increasing numbers of the very old. Western societies have experienced sufficient change to be able to anticipate patterns of health and ill health in their ageing populations. These changes are likely to be echoed in a shorter time frame over the next decades in the less wealthy regions of the world because of their more rapid experience of demographic shift. This continuing change in life expectancy has been attributed to improved health and lower morbidity in early life, and to effective primary, secondary, and tertiary prevention in later life. Reductions in incidence have been seen in vascular disease, including cerebrovascular disease [1,2].
Increased life expectancy and improvement in many areas of health have been demonstrated, but sharp increases of morbidity with age are still observed in all populations [3]. Dementia and severe cognitive impairment are amongst the disorders with greatest increase with age in both incidence and prevalence [4,5]. Preventive action at the population level ideally eradicates risk of disease, but in reality much prevention reduces disease at a given age rather than eradicating its occurrence. The overall contribution of primary and secondary prevention to the reduction in cardiovascular disease mortality has been estimated at around half of the effect, with improved care for established disease resulting in the remaining improvement [6]. There is a global effort aimed at improving health in our older populations, and much of this effort hinges on the hope that extension of life expectancy will not be accompanied by increases in morbidity but by compression of morbidity "