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Dementia rate has fallen by a quarter in 20 years

But prevalence has risen by a quarter in care settings in England

Louise Prime

Tuesday, 16 July 2013

The prevalence of dementia in England has fallen by almost a quarter over the past two decades, research has shown. At the same time, it has become much more prevalent in care homes – but most people with dementia still live in the community, say the authors of the study, published online today in The Lancet. Its editor in chief, Dr Richard Horton, insists that the findings should not lead to complacency, and that in fact dementia care and research still need better funding.

Researchers for the Cognitive Function and Ageing Studies, funded by the Medical Research Council, had assessed the health and cognitive function of 7635 people aged 65 or more living in six regions of the UK including Cambridgeshire, Newcastle, and Nottingham in 1989-94 (CFAS I). They asked participants about lifestyle, health, socioeconomic factors, medication, social care, and other factors, and then invited about a fifth of them for diagnostic assessment using the geriatric mental state (GMS) examination. For CFAS II, in 2008-11, researchers randomly selected another 7796 older people in these three areas for similar diagnostic assessment.

The study authors used CFAS I age- and sex-specific estimates of prevalence in people aged 65 and older, standardised to the 2011 population, to calculate that 8·3% of this population would have been expected to have dementia in 2011. But the prevalence actually found in CFAS II was just 6.5% – almost a quarter (24.1%) lower than expected.

In all settings, women remained consistently much more likely than men to have dementia (7.7% vs. 4.9% overall in 2011, compared with 9.4% vs. 7.4% in CFAS I).

Despite the general fall in prevalence of dementia over the two decades of the study, its prevalence in care homes rose by nearly a quarter (23.4%) in this time – affecting more than two-thirds (69.6%) of care home residents in CFAS II.

The authors suggest that improvements in education, and prevention and treatment strategies in recent decades, have contributed to the “substantial” reduction in dementia prevalence that their research reveals.

They conclude: “Whether or not the gains that we have identified for the present older population will be borne out in later generations will probably depend on whether further improvements in primary prevention and effective health-care for disorders that increase the risk of dementia can be achieved, including addressing inequalities.”

The Lancet’s editor in chief Dr Richard Horton said: “A reduction in prevalence of dementia in the older population is an important and welcome finding. But it is not a signal for the government to deprioritise investment in dementia care and research.

“Dementia remains a substantial challenge for those affected, their families, the NHS, and the Treasury. We need to understand better why the prevalence of dementia has fallen, and what that means for prevention and treatment services. Sadly, dementia care and research are too often neglected and underfunded in the UK.”

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