Dementia: epidemiology, intervention and concept of care

Dementia is going to be one of the major challenges of the next century for our societies due to the enormous burden on the health care systems. Dementia is the major cause of death and the most important risk factor for disability and entry into a nursing home in elderly people. Moreover, because of the progress in the treatment of Alzheimer's disease, in particular with the cholinesterase inhibitors, demented people will be more often and detected earlier by general practitioners and families. Thus, dementia will become progressively more a public problem than a private one. This tendency could be increased by the unemployment problem among young adults which obliges their parents to support them, neglecting then their own parents' problems. A possible way to win this challenge is prevention. Intervention on several risk factors of dementia in the elderly is possible. The Syst-Eur trial demonstrated recently that treatment of systolic high blood pressure could decrease the risk of dementia by 50%. Other vascular risk factors, depression, aluminium in drinking water, and active life are other good candidates for preventive intervention. Finally, secondary prevention by treatment among people with mild cognitive impairment will be another interesting way of delaying the onset of the disease and decrease it's prevalence.