Dr. Sandra Black is a Toronto neurologist who is site director for the Heart and Stroke Foundation Canadian Partnership for Stroke Recovery, director of the Brain Sciences Research Program at Sunnybrook Research Institute and executive director of the Toronto Dementia Research Alliance; Mary Lewis is vice-president, Research and Knowledge Exchange, of the Heart and Stroke Foundation.
Almost 2,000 years ago, the Roman poet Juvenal advised that one should pray for a "mens sana in corpora sano" – a healthy mind in a healthy body. The advice in this old saying is as relevant today as it was then, though our advances in knowledge mean we can do more about achieving that ideal state than just praying.
In fact, our knowledge advances are showing that Juvenal was far more correct than he could have dreamed. We now know that there is a link between keeping a healthy body and having a healthy mind.
This is particularly true for one of the greatest ravagers of a healthy mind, dementia. As people live longer and the population ages, dementia is becoming one of our great health challenges. This point was underscored recently with welcome federal government announcements of investments in dementia research and additional support for caregivers. Both announcements were in conjunction with Canada and France co-hosting an international scientific meeting in Ottawa, part of the "Global action against dementia" program initiated by the G7 at its summit on dementia in London last December.
The coming wave of dementia in Canada is very real; indeed, it is already upon us. Cognitive impairment including dementia affected 747,000 Canadians aged 65 in 2011, and without immediate action this will almost double to an estimated 1.4 million by 2031.
What sort of immediate action could we take to change this inevitability? The Ottawa meeting focused on fostering collaboration between academia and industry on research to find treatments and cures. This is an important effort, but a very challenging and uncertain one. We can't simply cross our fingers and hope a magic bullet will appear.
Another old saying offers a different approach – an ounce of prevention is worth a pound of cure. If we can't cure dementia, it is even more important to prevent it as much as possible. Fortunately, for this approach we have valuable evidence and proven methods to use that are readily available. We must make the best possible use of them.
The evidence is clear that there is an intrinsic link between failing cardiovascular health and dementia. Between one- quarter and one-half of patients with heart failure also have cognitive impairment. As well, "silent strokes" – small strokes that go unrecognized by the patient – are a major contributor to vascular dementia, the second most common form of dementia after Alzheimer's disease. Overall, in older adults, vascular disease is implicated in four out of five persons with cognitive impairment, and particularly in those with Alzheimer's disease.
The good news is that we have the knowledge and the tools to help people improve their cardiovascular health and therefore reduce their risk of dementia, along with other chronic diseases associated with poor cardiovascular health. Approximately one in three Canadians will develop heart disease, stroke or dementia. However, the development of these diseases can be reduced by programs that help individuals prevent or manage high blood pressure and adopt a healthier lifestyle, which includes being physically active, eating well, challenging one's brain, and staying social.
Public policy has a vital role in encouraging these behaviours, as it has had in other successful health initiatives in the past. Greater investments now in community-based interventions and education programs to promote these positive activities could enable a large number of Canadians to preserve brain health, delay the onset of dementia and be in overall better health for longer. This has the potential to greatly improve their quality of life and that of their caregivers.
It also promises important benefits for our health system and society as a whole. There is great potential for investments in such programs to reduce the economic burden of dementia, which by 2040 could amount to almost $300-billion in costs to the healthcare system. The results could be dramatic. Models show that if we could delay the onset of dementia by five years, we would reduce the number of people with dementia by as much as 44 per cent.
We wish every success to the research community that gathered last week in Ottawa, and caregivers always deserve our great support with their difficult tasks. Let's also make the right investments to improve the cardiovascular health of Canadians so those healthier bodies also lead to healthier minds.