David Payne: Can higher education help protect against dementia?

David Payne2In 2001 Tony Blair’s bid for a second term as UK prime minister included a pledge to make “education, education, education” top priority for the Labour party, with a follow up target to get 50% of  students entering higher education. Critics of Labour dismissed the figure as arbitrary and meaningless. But might the policy help protect some people from developing dementia? Two weeks ago a Cambridge University study published in The Lancet Neurology found that the proportion of elderly people with the condition in the UK has fallen, contrary to predictions that cases would soar.

According to The BBC report, it means there are around 670,000 over-65s with the condition rather than the 810,000 figure regularly cited.

The study analysed twinned dementia studies that were conducted in the same way, but decades apart, based on data from the Netherlands, UK, Spain, and Sweden.

It concludes that reductions “could be the outcomes from earlier population-level investments such as improved education and living conditions, and better prevention and treatment of vascular and chronic conditions. This evidence suggests that attention to optimum health early in life might benefit cognitive health late in life.”

Lead author Carol Brayne, Professor of Public Health Medicine at Cambridge, told The BBC when the study was published: “Dementia is still common in the older age group. It still doubles every five years after 65. What we’re hoping from this research is that it will provide more evidence for focusing research beyond drug discovery.”

The paper’s abstract makes a similar point, noting: “Policy planning and future research should be balanced across primary (policies reducing risk and increasing cognitive reserve), secondary (early detection and screening), and tertiary (once dementia is present) prevention. Each has their place, but upstream primary prevention has the largest effect on reduction of later dementia occurrence and disability.”

The study’s findings were discussed last week at an Edinburgh Book juneandrews_mainFestival discussion led by June Andrews (pictured),  director of Stirling University’s Dementia Services Development Centre and author of Dementia: The One-Stop Guide

She said of the study: “Either we started from the wrong number, and we were overestimating all the time, or, and I find this much more interesting and exciting, it’s possible that the kind of advice in this book is being followed by people, and so there is an easing off of the number of people affected.

“We do know that if you have more brain development then you have more resistance to dementia.

“The idea in Scotland, where we have got almost half of the young people going to university now, you might say what’s the good of a degree in social networking but the person has been made to sit exams at a certain level so we might find 60 or 70 years from now that that might help with a reduction in dementia.”

Andrews reminded the event that growing old remains the main risk factor for dementia, so dementia rates seem to have risen in line with ageing populations.

She mentioned meeting a woman in the US whose five siblings all had dementia, but the two who had gone to university developed the condition a decade later than those who had not.

One audience member, a retired GP, took issue with the “alarmist” name of the book festival event, Tackling the terror of dementia. Andrews agreed, but pointed out that her book’s title was in fact a practical guide to help families affected by the condition.

Earlier she reminded the audience that dementia took many forms, but charities and support groups tended to style themselves Alzheimer’s organisations, because the term “dementia” and “demented” had insulting and negative connotations in many countries.

David Payne is digital editor, The BMJ.