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 Primary Care Doctors Must Become Part Of Dementia Prevention, Experts Argue



iStock_000024827335Large.jpgAnti-dementia interventions must become part of primary care in order to prevent a looming world epidemic, a pair of French doctors is arguing in a scholarly journal.

“The world of Alzheimer’s disease (AD) is moving to preclinical AD and to prevention,” University of Toulouse Gerontologist Bruno Vellas and primary care physician Stephane Oustric say. “We have to prepare now.”

The pair’s editorial was published in the latest issue of the Journal of the American Medical Directors Association.

As Vellas and Oustric see it, the day is fast approaching when dementia will be detected by biomarkers such as tau proteins in the brain, and anti-amyloid drugs, many of which are already in clinical trials, may treat them.

When that day comes, primary care doctors will be “in the best position to give the more adapted response” to early warnings of dementia or Alzheimer’s disease. Doctors will have to target two “large categories” of at-risk adults: older adults with subjective memory complaints who are otherwise perfectly healthy and the frail elderly.

The challenge is, people are not just living longer, but they’re living healthier, longer; meanwhile, longevity can bring with it chronic diseases and infirmities that can sometimes be confused with cognitive decline—all of which means that the early signals of dementia might be missed.

“Older adults are presently more educated, with better control of vascular and metabolic risk factors, and more elect to stay healthy,” Vellas and Oustric say. “On the other hand, due to the augmentation of life expectancy, more and more persons reach 85-plus years, and so some general health aspects, including comorbidities and frailty, must be taken into consideration.”

For the younger cohort, “a successful prevention approach could start by targeting those with [subjective memory complaints] and/or a family history of dementia and propose an individualized multi-domain intervention, including nutrition, physical exercise, cognitive stimulation, and risk-factor control,” Vellas and Oustric say.

For the frail elderly, doctors will look at some other general conditions that could explain cognitive decline, including vision and hearing impairment, depression, poly-medications, malnutrition, and co-morbidities.

Bill Myers is Provider’s senior editor. Email him at wmyers@providermagazine.com. Follow him on Twitter, @ProviderMyers.
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