Dementia as a Public Health Issue

As the United States’ aging population grows, the number of people living with dementia is also rising – at a dramatic rate. New research has found that the risk of developing dementia is significantly higher than previously believed and the number of people diagnosed with dementia annually is expected to double to about 1 million a year by 2060. The number of new cases among Black Americans is expected to triple, exacerbating what is already a significant public health concern. There is currently no cure for Alzheimer’s disease—the most common form of dementia—but medications are available that alter disease progression and help reduce symptoms. According to a recent report in The Lancet, around 45% of dementia cases are potentially preventable by modifying personal behavior to reduce various risks.

As Principal Investigator for the Yale School of Public Health’s Social Gerontology and Health Lab, Dr. Joan K. Monin, PhD, specializes in dementia research with a focus on caregiving and the emotional processes that affect health in older adult relationships. Dr. Monin, an associate professor in the Department of Social and Behavioral Sciences, recently discussed the significance of the new dementia prevalence study and steps individuals can take to reduce their risk of dementia as they age.

Joan Monin (JM): Dementia is a general term that describes symptoms that affect cognitive abilities, memory, thinking, behavior, and affect. It is an umbrella term that is not specific to any one disease. You probably have heard of Alzheimer’s disease, because that is the most common type of dementia. Alzheimer’s disease is characterized by an accumulation of substances in the brain called amyloid and tau, and symptoms most often include memory problems, thinking difficulties, language problems, changes in hearing and seeing, and mood changes. Other common types of dementia are vascular dementia, Lewy body dementia, and frontotemporal dementia. These types of dementia have different biological indicators, and the people who experience them have different symptoms than Alzheimer’s disease.

JM: A report in The Lancet in 2024 shows that 45% of people’s risk for dementia is modifiable. There are actions that public health programs and individuals can take to reduce the risk of dementia. In early life, government needs to ensure that every child has access to high quality education. Scientists have found that low education in early life accounts for 5% of the risk for developing dementia. In midlife, the following risk factors have been associated with dementia: hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity, and excessive alcohol use. In older adulthood, social isolation becomes more important, with air pollution and vision loss entering the equation for higher risk. Taken together, at any age, people need to prioritize getting their hearing checked, eating healthy, managing any chronic conditions they have, not being sedentary, refraining from smoking, and not drinking excessively. Globally, we should provide more opportunities for social engagement for all age groups and decrease pollution.

JM: If a person is living with dementia, it is important they know that they will always continue to have meaning and purpose in their life despite any functional and cognitive limitations that develop over time. They can still contribute their voices to their community, family, and friends in a meaningful way. They can still enjoy life. They might just need support from their community and their support network to do so, like any other disability. Even at the very end of the disease, their personhood remains.

Some behaviors people can engage in to maintain quality of life while living with dementia are: (1) continuing to do things that make them happy, (2) staying socially engaged, (3) eating healthy foods, (4) engaging in physical exercise, (5) stimulating one’s mind (e.g. try something easy that the person may have never tried before when they are feeling up to it); (6) openly sharing their experience with dementia so they can be supported by the wider community and help change the stereotypes about what a person living with dementia looks like; (7) getting enough sleep and avoiding naps during the day; (8) getting their chronic conditions treated. There are many more options and possibilities, too!

Family and friends can help by paying attention to signs that the person living with dementia may be engaging in activities that may be harmful (e.g. driving, using the stove or fireplace). If one notices that the person living with dementia cannot engage in shared activities that once brought them friendship and joy, the friend or family member can get creative in finding new ways to share time together. Taking a walk in nature and commenting on the wonders of the environment might be one possibility, simply sitting and singing or listening to music together is another. Another action a family or friend can take is to care for the caregivers. Find out about one or two things that are causing a primary caregiver stress and ask if you can take over that task(s). For example, if the primary caregiver is getting burned out trying to connect with agencies or health care systems every day, ask if you can make some calls to find out about their eligibility for respite services in their city or town.