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Universa Medicina                                                                                                             January-April 2018 - Vol.37 - No.1

Richard Tjan

Editor

The proportion of older persons worldwide
is steadily increasing and by 2050 around 2 billion
people will be 60 years of age and older.(1,2) As a
consequence, in that year there will be 135 million
people with dementia, particularly in low- and
middle-income countries where 60% of the more
than 47 million cases (2015 estimate) are living
now.(2) Therefore it is not surprising that on 29
May 2017 the Seventieth World Health Assembly
accepted the global action plan on the public health
response to dementia 2017-2025. The aim of this
plan is “to improve the lives of people with
dementia, their families and the people who care
for them, while decreasing the impact of dementia
on communities and countries.”(3)

In this connection, last December the
WHO also initiated the Global Dementia
Observatory, an internet-focused monitoring
service for dementia data, such as government
policy, treatment and care infrastructure, and
disease burden.(4) This initiative is part of the
WHO plan to improve the health of the elderly,
as discussed in the World Report on Ageing and
Health 2015,(5) where healthy aging is defined
as “the process of developing and maintaining
the functional ability that enables well-being in
older age”. In this report, the following principle
of attaining and maintaining elderly health is
discussed, i.e. person centered and small-scale
care, which emphasizes flexibility or doing away
with the single rigid method of standardized
care.(5) This approach is particularly needed in
the care of persons with dementia, since there
is currently no effective medical treatment
available for this disorder.(6) Previously, the First
WHO Ministerial Conference on Global Action
Against Dementia held in October 2015 outlined
the principles and approaches to guide global
efforts and the plan for a global dementia
observatory,(5) the latter being realized in
December 2017, as mentioned above.

The most important types of dementia are
Alzheimer’s disease and vascular dementia. The
first accounts for around 80% of cases, while
the latter results from cardiovascular conditions,
including hypertension, obesity, hyperlipidemia,
diabetes, and also from smoking.(6) Evidently the
type of dementia that is preventable is vascular
dementia, comprising around 20% of cases, by
improved control of the risk factors. However,
this is a long-term goal, since dementia requires
one or more decades to become manifest (from
around the age of 35-40 years up to old age at
around 60 years and over). Currently, prevention
may be applied to older persons with normal
cognitive function and to those with minimal
cognitive impairment. For existing cases of
dementia, the focus will be on personalized
care.(2)

For the general practitioner not directly
connected with the care of older persons with
dementia, the focus should be on giving practical
advice both to the younger generation for the
prevention of cognitive decline and to the older
generation for retarding the onset of mild
cognitive impairment and dementia. This should
include reassurance that three-fifths of older
persons do not develop dementia and that one-
fifth of dementia cases can be prevented by not
smoking (or for smokers, by cessation of
smoking), by weight control and control of blood
pressure and blood glucose (for those with
diabetes). Last but not least, there should be an
e mp ha sis  o n a  he al thy di et , s uc h a s th e
Mediterranean die t, and r egular physical
activity.(6)

REFERENCES

1. United Nations Department of Economic and
Social Affairs. World population ageing 2017 -
highlights. New York: United Nations; 2017.



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Univ Med 2018;37:1-2. DOI: http://dx.doi.org/10.18051/UnivMed.2018.v37.1-2

2. World Health Organization. The epidemiology
and impact of dementia: current state and future
trends. Geneva: World Health Organization;
2015.

3. World Health Organization. Seventieth World
Health Assembly update; new realase. Geneva:
World Health Organization;2017.

4. Editorial. Dementia burden coming into focus.
Lancet 2017;390:2606.

5. World Health Organization. World report on
ageing and health. Geneva: World Health
Organization; 2015.

6. Ray S, Davidson S. Dementia and cognitive
decline: a review of the evidence. Age UK
Research; 2014.

Universa Medicina                                                                                                             January-April 2018 - Vol.37 - No.1