The dementia paradox – a problem we are tackling but which is a growing concern
Dementia is the leading cause of death in England and Wales, according to figures released last month by the Office for National Statistics (ONS).
It has moved ahead of heart disease as the leading cause of death for the first time. Last year, 61,686 (11.6%) out of a total of 529,655 deaths registered were attributable to dementia.
The mortality rate for the condition has more than doubled since 2010.
It had been the second leading cause of death overall in the previous four years – although if all cancers are grouped together it is the leading cause of death, accounting for 27.9% of deaths last year, compared with 26.2% attributable to all circulatory diseases, such as heart attacks and strokes.
These figures relate specifically to England and Wales but they will also provide a good indication of trends in Northern Ireland – as will another set of figures, which shows that dementia rates are on the decline.
A University of Michigan study, published in medical journal JAMA, has found that the proportion of older people developing the condition is falling.
Data looking at over 21,000 people over the age of 65 showed prevalence rates fell from 11.6% in 2000 to 8.8% in 2012. This mirrors results from a study looking at dementia in western Europe, published in The Lancet last year.
Statistics without context are obfuscating rather than illuminating. What should we read into these two trends that, at first face, indicate a problem that is growing and shrinking at the same time?
Behind the numbers
An increase in dementia as a cause of death sounds like a negative thing but the major reasons behind this are, in fact, broadly positive.
The proportion of older people with dementia is falling and we have an ageing population – and this, in significant part, is due to better lifestyles and better handling of other medical conditions - while better recording of dementia will lead to a big increase in recording rates but in fact simply represents
Today’s older people tend to be healthier than previous generations and very few people are likely to die of dementia on its own.
Elizabeth McLaren, from the vital statistics outputs branch at ONS, said: “In 2015, dementia and Alzheimer’s disease became the leading cause of death in part because people are simply living longer but also because of improved detection and diagnosis.
“An updating of the international rules for determining the underlying cause of death is also a factor, with the increase in cases attributed to these conditions accompanied by falls in other causes.”
However, that doesn’t mean we should celebrate the ascension of dementia as a cause of death – it simply makes the fight against dementia a more relevant front in our continuing efforts to improve medicinal care (again, thanks in part to successes elsewhere).
Martina Kane, senior policy officer at Alzheimer’s Society, said the news that dementia is now the leading cause of deaths in England and Wales “is a stark reminder that dementia remains a growing concern across the country”.
She went on: “While the news represents improvements in diagnosis rates, general awareness and the accuracy of reporting, it also reflects that there are rising numbers of people with dementia.
“While there remains no cure for the condition, everyone who develops it will sadly still have the disease when they die. It is therefore essential that people have access to the right support and services to help them live well with dementia and that research into better care, treatments and eventually a cure remain high on the agenda.”
Of course, the data shows that there are already positives to build upon. Prof Kenneth Langa, who conducted the University of Michigan study, said: "Our results add to a growing body of evidence that this decline in dementia risk is a real phenomenon, and that the expected future growth in the burden of dementia may not be as extensive as once thought."
Hilary Evans, the chief executive of Alzheimer's Research UK, said the latest study was a cause for "optimism" but dementia remained the "greatest medical challenge".
He said: "While these findings present a positive picture, we must not forget that there are still huge numbers of people living with dementia.
"This useful study adds to emerging evidence suggesting that dementia prevalence may be either declining or stabilising in parts of Western Europe and the US, but there are still many unanswered questions. We need to understand what is driving this apparent change in dementia risk if we are to harness this knowledge to provide crucial public health advice."
Cautious optimism and moderated concern; the twin tones of commentary around the competing trends in dementia are two representations of the same viewpoint.
The one thing that will clarify and crystallise all these statistical trends will be an effective cure, or at least impediment to the condition. And, on this matter, there is hope.
The recently-retired former chair of the World Dementia Council said in February that a cure could be just five years away, while this article on attempts to develop a cure also sounds notes of optimism.
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