New Scoop on Dementia: The Problem of Doom-and-Gloom Metaphors

Michael Gordon MD, MSc, FRCPC is a geriatrician working at Baycrest Health Science System. He is medical program director of the palliative care program, co-head of the clinical ethics program and a professor of Medicine at the University of Toronto. He is the author of Late Stage Dementia, Promoting Compassion, Comfort and Care; Moments that Matter: Cases in Ethical Eldercare and Brooklyn Beginnings: A Geriatrician's Odyssey . For more information see

“Dementia Care Cost Is Projected to Double by 2040”—The headline was very dramatic and from the trusted New York Times (April 3, 2013). Similar articles have appeared in Canada’s main newspapers as well. The implications were potentially enormous, but then again as all of us who deal with the medical literature and work under the new theology of “evidence-based medicine” we are waiting to either hear about the other shoe dropping or to find out from someone who looks at the data again that there were some fallacies in process or some other reason why we should take the findings with a proverbial grain of salt.

In the traditional one-hand–other-hand controversy, if indeed the findings are robust, consistent and borne out on careful scrutiny and perhaps confirmed in other western jurisdictions or by other methodologies, the impact and implications for our aging population is indeed potentially profound.

During the past few years there have been doom and gloom predictions about the negative impact that the increasingly aged population which would “naturally” including vast numbers of those living with dementia has flooded the media. This so much the case that when it comes to creating public policy, one often hears various ministers or government representatives of portfolios such as health and finance prepare the population for drastic changes in funding because of the erroneously and hysterically classified as a “tsunami of dementia”. This latter term is not a neutral demographic term, it is one to strike fear and dread into the minds and hearts of citizens, health care and social service providers and those responsible for healthcare and fiscal policy. Even the venerated American Association for Retired Persons (AARP) has adopted the dreaded term tsunami to highlight concerns in a recent website posting by Amy Goyer (March 12, 2013). This follows published studies projecting the massive costs to the health care system that dementia will create—a dire prediction for the delivery of health care systems.

In the April 3, 2013, New York Times article by Pam Belluck, “Dementia Care Cost Is Projected to Double by 2040, Belluck writes, “The research, led by an economist at the RAND Corporation, financed by the federal government, and published Wednesday in The New England Journal of Medicine, provides the most reliable basis yet for measuring the scale of the problem.

Until now, the most-cited estimates of the condition’s cost and incidence came from the advocacy group Alzheimer’s Association. Although some figures from the new research are lower than the association’s projections, they are nonetheless staggering and carry new gravity because they come from an academic research effort. Behind the numbers is a sense that the country, facing the aging of the baby boom generation, is unprepared for the coming surge in the cost and cases of dementia.”

The British press has had its hand in such fear-mongering as noted in a report in the Independent; Britain unprepared for a "tsunami"of dementia patients. The writer Sarah Morrison reported on September 16, 2012, “More than one million people are expected to be living with the disease in 10 years, but there are not enough care homes……Unless a radical overhaul is taken, they say that y hundreds of thousands of patients will face a future defined only by neglect. In the New York Times article about the projected costs of health care related to Dementia written by Belluck, The imagery of the tsunami was echoed by Dr. Ronald C. Petersen, who is chairman of the advisory panel to the federal government’s recently created National Alzheimer’s Plan and was not involved in the RAND study, “It’s going to swamp the system."

So it was with a sigh of great relief that a respected newspaper rather than carrying another dire prediction of doom at the hands of our already negatively viewed seniors carried the following headline on July 16, 2013, “Dementia Rate Is Found to Drop Sharply, as Forecast” written by Gina Kolata. The essential message from the article was, “A new study has found that dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend that researchers say is probably occurring across developed countries and that could have major social and economic implications for families and societies.”

As evidence that this finding is not likely an isolated finding or one due to an aberration in the research model Kolata goes on to report, “Another recent study, conducted in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who had reached their 90s a decade earlier. Nearly one-quarter of those assessed in 2010 scored at the highest level, a rate twice that of those tested in 1998. The percentage of subjects severely impaired fell to 17% from 22%” Both studies were published in the Lancet.

As might be expected there were those who were elated by the findings and others who are very dubious. These two studies do not necessarily change the equation of increased aging and an increase in dementia prevalence- but they do raise the possibility that we might be doing something “right” in the way many have changed their lifestyle--especially their vascular risk factors which evidence suggests is closely linked to the development of the common causes of dementia including Alzheimer’s and vascular dementia or as is usually the case the mixed variety.

So while the researchers are looking for pharmaceutical or dietary “magic bullets” and the pharmaceutical industry is supporting their efforts and trying to raise the specter of the importance of early diagnosis, everyone can take the known steps to promote their own brain health by eliminating smoking, exercising, decreasing blood pressure levels and lipid levels, and eating as healthy a diet as reasonably possible for each individual. And wait while this saga unfolds!