We invited experts from the field of public health and dementia to discuss the growing interest in dementia risk reduction and the implications of a new paper launched at the event entitled 'Preventing dementia: a provocation. How can we do more to prevent dementia, save lives and reduce avoidable costs?' Building on the momentum of the Blackfriars Consensus from Public Health England and the UK Health Forum on “promoting brain health and reducing risks for dementia in the population”, we are keen to stimulate debate and discussion about how we could tackle dementia risk factors at scale and the potential economic, health and societal benefits of dementia risk reduction. The provocation to be launched on the day posits that we can have a significant impact on reducing the number of people who will develop dementia. The paper identifies a number of risk factors for dementia that are amenable to intervention and have modelled the impact of matching the best-practice interventions on reducing the six main risk factors from global case studies. It is estimated that over the 27-year period from 2013-2040 this could prevent nearly 3 million people developing dementia in the UK. This would reduce the costs to the state in the UK by £42.9 billion (calculated from 2013 and 2040, minus any associated costs of intervention). We see this paper as a provocation and a starting point for more detailed and rigorous research in this field, and are keen to hear views on further research gaps in this area and other research and policy analysis being carried out. Speakers included Rebecca Wood (Alzheimer's Research UK), Sally-Marie Bamford (ILC-UK), Phil Hope (Improving Care), Keiran Brett (Improving Care), Shirley Cramer (The Royal Society for Public Health), Dr Charles Alessi (Public Health England), Johan Vos (Alzheimer's Disease International).

1. Where next for the dementia and
prevention agenda?
Monday 14th July 2014
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

2. Welcome
Rebecca Wood
Chief Executive
Alzheimer’s Research UK
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

3. Sally-Marie Bamford, Director of Research and
Strategy, ILC-UK
Kieran Brett, Director, Improving Care
Phil Hope, Director, Improving Care
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

4. Preventing Dementia:
How can we do more to prevent
dementia, save lives and reduce
costs?
A Provocation by
Improving Care and the ILC-UK
Funded by Pfizer
4

5. ILC-UK Planning Tomorrow, Today
• Westminster based think tank
• Evidence based research organisation
• Focussed on policy
• Independent and non partisan
• Experts in ageing, demography and longevity
• Produced a range of reports on dementia
• Part of the ILC Global Alliance with 14 soon to
be 17 centres across the world
• Formally affiliated to University College
London

6. The Climate and Context
Steps in the right direction:
• The World Health Organization (WHO) and Alzheimer’s
Disease International show smokers have a 45% higher risk of
developing dementia than non-smokers.
• Blackfriars Consensus Statement from Public Health England
and the UK Health Forum receives high level support from all
four nations in the UK.
• Global Actions and Initiatives: Australia’s Dementia
Prevention Strategy
6

7. Making the political case
for dementia prevention
Ageing population and funding constraints mean we
need to innovate to get better outcomes at lower cost
Dementia is a very high political priority but
preventing dementia has not been the focus
Need to convince No.10 and HMT of the case for
investment in prevention
Interventions, health benefits and savings claimed for
preventing dementia have to be rigorous
7

8. The Authors
Improving Care
– Kieran Brett, Co-Director, Trustee at DEMOS, former
Special Adviser to the Prime Minister and Secretary of
State of Health
– Phil Hope, Co-Director, Adjunct Professor Imperial College,
former Secretary of State for Care Services,
– Steve Beales, Policy Fellow in Health Infomatics, Imperial
College
International Longevity Centre
– Sally-Marie Bamford, Director of Research and Strategy
8

9. The presentation
Section 1: The human and financial costs of dementia
Section 2: Risk factors for dementia
Section 3: Interventions that reduce risk factors for dementia
Section 4: The human and financial benefits of applying
interventions to reduce the risk factors for dementia
Section 5: Next steps:
• Comments on the analysis
• Strengthening the case:
– identifying best practice interventions for the risk factors
– Identifying additional risk factors for dementia
• How to to take this argument forward
9

10. Numbers of people with dementia – ‘Policy Off’
10

11. Number of years of life lost to dementia – ‘Policy Off’
11

12. The annual cost to the state
of dementia in 2013 was £10.54bn
12

13. Cumulative cost to the state and to
individuals of dementia 2013 -2040
Year Cost to State Costs to
Individual
Total Costs
2013 £10.54bn £4.03bn £14.57bn
2040 £18.31bn £7.15bn £25.46
2013-2040 £392bn £151bn £543bn
13

14. Relative risk of developing dementia
• Relative risk indicates how much of an
increased chance of developing dementia a
person might have for a particular condition
• For example the relative risk for a person with
diabetes is 1.39 – that is, the chance of
developing dementia is 1.39 times greater for
those with diabetes than when compared to
someone with out diabetes, all other things
being equal
14

15. The top six relative risk factors for
dementia
15

16. Reducing risk factors
• Reducing the number of people with a given risk factor
should lead to a reduction in the number of people
developing dementia.
• To work out the proportion of people developing
dementia due to a risk factor we use the relative risk
factor and the prevalence of the risk factor within the
target population. For example:
– Relative risk (RR) of diabetes for dementia is: 1.39
Current prevalence (PRF) of diabetes in the UK is for men
65+: 15-16% and for women 65+:12-13%
• We then apply the Levin formula to identify the
projected proportion of people developing dementia
due to a risk factor
16

17. The Levin Formula
From this calculation, we can say:
Projected proportion of people developing dementia due to diabetes is ~5.3%
17

18. Projections of the impact of reducing a risk factor on
life years saved and costs reduced
The expected impact on dementia of a 10% reduction in diabetes
prevalence
Life years are calculated by looking at the difference in life
expectancy between people with and without dementia
18

19. Potential savings to the state of reducing diabetes in
the population by 10%
19

20. Effective interventions for
reducing risk factors
• For each risk factor we have identified what
appears to be the most effective intervention for
reducing its prevalence among the population
• And we have identified the impact this given
reduction would have on the numbers of people
developing dementia
• For example we have found an intervention that
has been shown to reduce type 2 diabetes by
58%
20

21. Impact on dementia of intervention to
reduce diabetes
21

22. Savings from reducing diabetes as a risk
factor for dementia
22

23. Summary of impact of interventions for each risk factor
23

24. Summary of savings for each risk factor
Note of caution: these savings do not take account of the cost of the
interventions
24

25. Cumulative savings to the state - £42.9bn
25

26. Total savings 2013-2040
Where savings accrue Amount 2013-2040
The state £42.9bn
Individual self-funders £16.4bn
Informal care £28.95bn
Total £88.25bn
26

27. Rebecca Wood
Chief Executive
Alzheimer’s Research UK
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

28. A blueprint to
defeat dementia

29. Blackfriars Consensus on promoting brain
health: Reducing the risks of dementia in
the population
Dementia is a common syndrome closely associated with ageing, with
some known underlying causes and others which are less well
understood. Recent evidence suggests that risk in the population might be
reduced so that fewer people at particular ages develop dementia. The
scientific evidence is evolving rapidly and sufficient to justify considered
action and further research on dementia risk reduction, both by reducing
the modifiable risk factors and improving the recognised protective factors.
HEADLINE CONSENSUS MESSAGE

30. G8 Dementia Summit, December 2013
The G8 countries announced:
• Identify a cure or a disease-modifying therapy for dementia by 2025 and to
increase collectively and significantly the amount of funding for dementia
research to reach that goal.
• Appoint a global Dementia Innovation Envoy
UK Global action against dementia legacy event, June
2014
The UK-led event focused on the execution timeline and plan towards a Global
Dementia Innovation Fund to:
• stimulate greater social impact investment and innovation in dementia
research
• improve the prevention and treatment of dementia
• improve quality of life for people with dementia and their carers

31. DEFEAT DEMENTIA: £100M, 5 YEARS

33. Prevention / risk reduction
• We will introduce a new Prevention Fund by challenging the scientific
community to answer the biggest questions in prevention, seed-funding the
best ideas.
• We will seek to understand why there has not been greater investment in
prevention research
• We will work in partnership to raise awareness of the ways in which you can
reduce the risk of developing dementia, particularly Alzheimer’s disease and
vascular dementia
• Pursue recommendations in Blackfriars Consensus
• Ensure the messaging does not lead to further stigma of the condition

34. Dr Charles Alessi
Lead Dementia
Public Health England
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

35. Dementia risk reduction: update
on developing PHE work
programme
Charles Alessi

36. Why is dementia a public health
priority?

37. 37
Why is dementia a public health priority?
• 21 million of the UK population have a
close friend or family member with
dementia.
• Two thirds of people with dementia are
women, and a higher number of carers
are female
• As well as the huge personal cost,
dementia currently costs the UK
economy £19 billion a year, more than
cancer and heart disease combined.
• The social and economic costs will keep
rising as the number of people with
dementia increases.

38. DEMENTIA
Ref: Global Burden of Disease Study
• Dementia is the leading cause of mortality.
• It’s the 3rd biggest cause of over 70s
disabilities, after lower back pain and falls.
• 25% of hospital beds are occupied by people
with dementia.
• Low diagnosis rate (48%) and levels of
support
• There are significant health inequalities
issues, with challenging cultural norms, both
around the condition and with carers.
Why is dementia a public health priority?

39. Can we reduce the risk of
dementia?

40. Action on dementia risk reduction is vital
• In the absence of a cure, risk reduction is the only way we can reduce the
numbers of people getting dementia, postpone the onset and/or mitigate the
impact of dementia.
• Worldwide, risk reduction is increasingly becoming a key focus of those
involved in dementia care. The Global Dementia Legacy Event in Japan,
later this year, will focus on risk reduction, and it is included in the World
Dementia Council statement of purpose.
• Dennis Gillings, the World Dementia Envoy said (on 19th June 2014)
“I am particularly keen for there to be a greater focus on prevention – in terms of
minimising risk factors such as obesity, smoking, physical inactivity, diabetes and high
blood pressure. There is growing evidence that these risk factors may be bringing
forward the onset of dementia.”
• Risk reduction and slowing the development of symptoms is more cost
effective, and far better for individual wellbeing.
40

41. 41
Action on dementia risk reduction is evidence based
• PHE and the UK Health Forum have
published the Blackfriars Consensus
statement, signed by 60 leading figures
and organisations from across the
dementia and public health community.
• It stated that “the scientific evidence is
sufficient to justify action on dementia
prevention and risk reduction”.
• Evidence suggests that effective public
health policies to tackle the major chronic
disease risk factors of smoking, physical
inactivity, alcohol and poor diet across the
population will help reduce the risk of
dementia in later life.

42. • Autopsy evidence suggests that Cerebrovascular disease contributes to
neurodegenerative disease cases.
42
Action on dementia risk reduction is evidence based
Toledo JB, Arnold SE, et al. Brain 2013;135:2697-2706
Prevalence of Vascular
Pathology (%)
Vascular findings
reaching or not a
threshold sufficient
enough to contribute to
clinical status

43. What can PHE contribute?

44. BigAmbitions
• PHE wants to maximise our impact
through focusing on a small number of
Big Ambitions for the public’s health for
the next three, five and 10 years.
• Dementia is one of PHE’s “Big
Ambitions”, and we are in the process
of developing and testing proposals.
• We are exploring whether we might
have an ambition around significantly
reducing the numbers of people who
get dementia, potentially linked to
retirement age, with actions focused on
40 – 60 age group.
• There will be more detail in PHE’s
Health And Wellbeing Framework.
44

45. PHE is planning action to promote dementia risk reduction
We want to work with system partners to change the game on dementia risk
reduction. We are already planning action in five key areas:
• System leadership: raise awareness and promote and coordinate work
• Public awareness: develop world-class health marketing to raise
awareness and enable action
• Professional understanding: incorporate messages in training and
curricula
• Health improvement programmes: integrate dementia risk reduction, and
building on the inclusion of dementia in the NHS Healthchecks
programme from April 2013..
• Risk tool: develop a ground- breaking “rate of brain ageing tool” with UCL
Partners, to support self-assessment, early diagnosis and preventative
action.
45

46. PHE Dementia work programme
Issues Action
Risk
Reduction
Lifestyle action can reduce risk –
poorly understood locally.
• Clarify and articulate evidence
• Test public-facing messages
• Align with overall risk reduction work e.g. NHS Health
Checks
• Developing a “brain ageing” risk tool
Living well People with dementia and carers
often marginalised and poorly
supported
• Dementia Friends Campaign
• Dementia friendly communities – support local action
• Dementia friendly employers – drive best practice in HR
• Align crosscutting issues eg carers, end of life, isolation
Equity Significant cultural determinants.
Little analysis of issues and best
practice.
• New national collaboration: best practice, analysis, and
research
K&I Fragmented data and intelligence • Dementia intelligence network
46

47. Shirley Cramer
CEO
Royal Society for Public Health
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

48. Johan Vos
Deputy Director
Alzheimer’s Disease International
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION

50. About Alzheimer’s
Disease International (ADI)
• Established 1984
• The umbrella
organisation of
Alzheimer associations
around the world
• 84 member
associations
Aims to help establish and strengthen Alzheimer
associations throughout the world, and to raise global
awareness about Alzheimer's disease and all other
causes of dementia

51. World Alzheimer’s Month
• September is
World Alzheimer’s
Month
• 21 September is
World Alzheimer’s
Day
• International
campaign to raise
awareness
globally
• 2014 theme:
Dementia: Can we
reduce the risk?
www.alz.co.uk/world-alzheimers-month

52. 5 ways to help reduce risk
www.alz.co.uk/world-alzheimers-month

53. 5 ways to help reduce risk
www.alz.co.uk/world-alzheimers-month

54. World Alzheimer Report
Sept 2014
www.alz.co.uk/research/world-report
• Modifiable Risk and
Protective Factors
• Global Observatory for
Aging and Dementia
Care, Kings College
• Comprehensive
systematic review with
some new meta
analysis
• International Launch 17
Sept 2014 in London
• Supported by Bupa

55. • New WHO ADI factsheet
launched July 2014
• Reveals smoking can
increase dementia risk
by 45%
• 14% of dementia cases
around the world
potentially attributed to
tobacco
• Urges governments to
implement tobacco
control measures and
cessation services
Smoking and dementia
www.who.int/tobacco

56. NCD Alliance
www.ncdalliance.org/
• ADI joins NCD Alliance
in May 2014
• Dementia shares
common risk factors to
NCD’s
• Strongest civil society
voice at the UN and
WHO
The NCD Alliance was founded
by four international NGO
federations representing four
main NCDs – cardiovascular
disease, diabetes, cancer, and
chronic respiratory disease.
The NCD Alliance unites a
network of over 2,000 civil
society organizations in more
than 170 countries. The mission
of the NCD Alliance is to combat
the NCD epidemic by putting
health at the centre of all
policies.

57. Estimated increase in dementia worldwide

58. Follow ADI on Twitter
https://twitter.com/alzdisint
Like us on Facebook
https://www.facebook.com/alzheimersdi
seaseinternational
Visit our website
http://www.alz.co.uk/
Thank you!

59. Panel Debate and Q&A
• Do we now have a sufficient evidence base on dementia risk
reduction to justify action in this field?
• How can we incorporate dementia risk reduction into general
health policies and what may be the implications of raising
awareness of dementia prevention for the general public?
• With such high level endorsement (including last week Rt
Hon Jeremy Hunt MP, Secretary of State for Health, England,
Norman Lamb MP, Minister of State for Care and Support)
signing up to the Blackfriars Consensus, where do we go
next and how can we work together to push this agenda
further?

60. Where next for the dementia and
prevention agenda?
Monday 14th July 2014
This event is kindly supported by Alzheimer’s Research UK and Improving Care
#DEMENTIAandPREVENTION