Dementia the leading cause of death… if you discount its partners in crime

A 14 November 2016 headline stated dementia is now the 'leading cause of death in England and Wales' (The Guardian), overtaking ischaemic heart disease [see also our news report]. Dementia mortality rate has 'more than doubled' since 2010, and ischaemic heart disease 'declined sharply over the same period'.

As my team daily assesses people with comorbid ischaemic disease, this was a perplexing headline. Perhaps especially given that research suggests these often are not separate conditions. Around a fifth of dementia patients have been diagnosed with stroke, and overall cerebrovascular disease in approximately a third. In between half and a fifth of cases, cardiovascular disease actively killed dementia patients. One cross-sectional dementia sample studied by Brunnstrom and Englund (see tinyurl.com/z2ztafb) certified bronchopneumonia (38.4%) alongside ischaemic heart disease (23.1%) as the two leading causes of death. In Alzheimer's patients, circulatory and respiratory system diseases were recorded 23.2 per cent and 55.5 per cent of the time respectively; in vascular patients, 54.8 per cent and 33.1 per cent respectively.

The cited Office of National Statistics death statistics rely on coroners' certifications. Patients commonly die with dementia, but directly from it? Is coroners' practice masking public understanding of dementia's comorbid factors?

Perhaps the idea that reducing comorbid conditions also reduces dementia is difficult for public and professionals alike. From Alzheimer's Research UK spokesperson Hilary Evans, in the same Guardian article: '…dementia is not an inevitable part of ageing. It's caused by diseases that can be fought through research.' Evans is correct in saying dementia is not inevitable in ageing, but ironically isn't quoted more prominently about why not.

One reason is diseases that contribute to dementia onset are preventable. Vascular disease incidence increases with smoking; physical inactivity; poor diet; alcohol abuse. Whilst dementia research is certainly desirable, if the public perceives the only interventions are 'research fought' this may neglect lifestyle interventions reducing dementia risk. While it seems spurious to claim all dementias are caused by lifestyle, a 'dementia' vs. 'ischaemic heart disease' discourse seems undesirable to reinforce – especially as pharmaceutical treatments for dementia remain elusive.

Psychologists can help: through knowledge of intrinsic motivation, and what invokes behavioural change in patients; and evaluating and disseminating health statistics. We can also correct a potentially damaging message: that if patients 'only' have ischaemic/cardiovascular disease risk, dementia is 'off the menu' to think about.

Barry Orr
Principal Clinical Psychologist
Kent and Medway NHS and Social Care Partnership Trust