The challenges, both personal and societal, associated with dementia have perhaps never been more clear than today, as detailed in recent reports. According to the Alzheimer’s Association, in 2017, dementia cost the nation roughly $259 billion, a figure that’s projected to jump to as high as $1.1 trillion by 2050. Alzheimer’s disease — the most common form of dementia — is the sixth leading cause of death in the U.S., responsible for more lives lost than breast cancer and prostate cancer combined.
Yet for all that is known about dementia, aspects of the condition itself remain shrouded in mystery and are frequently misunderstood, both by the public and many professionals. For example, nearly half of Americans — in a survey conducted jointly by WebMD and Shriver Media — don’t know that women are more likely to be diagnosed with Alzheimer’s than men. And while three-quarters of respondents know what the symptoms of Alzheimer’s are, only 11 percent have talked to their primary care physician about how to prevent them from occurring.
Peter Reed, Ph.D., director of the Sanford Center for Aging and professor of Community Health Sciences at the University of Nevada, Reno, has devoted much of his professional life to teaching and better understanding dementia, having published more than 50 reports and papers related to conditions associated with the aging process. He recently sat down to discuss in greater detail various aspects of dementia, including what it is, how it is treated, how public health practitioners can improve the well-being of those living with dementia and what students majoring in the Master of Public Health program can expect to learn in the course of their schooling.
What is dementia?
Perhaps because Alzheimer’s disease accounts for between 60 percent and 80 percent of dementia cases, according to the Alzheimer’s Association, dementia and Alzheimer’s are often used interchangeably. In reality, though, dementia is an umbrella term for describing several different symptoms, largely related to abnormal brain function. While they can be wide-ranging, symptoms typically include memory loss, inability to focus, and difficulty communicating (both listening and speaking), among several others. Reed noted that symptoms may also include personality changes — subtle at first but increasingly apparent over time.
“Essentially, [dementia] is a condition that affects people’s cognitive function,” Reed explained. “Cognition is the way in which the brain processes information and is critical to reasoning and communication. The term dementia itself is not the name of a disease, but rather it describes a collection of symptoms.”
There’s no single cause (or form) of dementia, but likely dozens. The most common cause is believed to be Alzheimer’s, but several other types of dementia are often associated with the aging process, including frontotemporal dementia, Lewy-Body dementia and Parkinson’s-related dementia.
How is dementia treated?
Studies about Alzheimer’s disease and its related symptoms are being conducted constantly, many with promising results. And while some of the treatments derived from these studies can reduce the severity of symptoms, there’s still no known cure or way to reverse the pathology in the brain, Reed stated.
“There is not an effective medication for controlling Alzheimer’s or preventing related cognitive decline,” Reed said. “There is a class of drugs called cholinesterase inhibitors, but the challenge with these drugs is the research shows they give you a cognitive bump for around 18 months on average, and then you fall back to a gradual decline with the symptoms.”
Reed went on to note that while the medication used for dementia can be effective in the short-term, they essentially put a Band-Aid on the issue by temporarily boosting cognitive function. What is needed are pharmaceuticals that attack the pathology of the disease, specifically the plaques and tangles that form in the brain. In the meantime, a blend of medication and regular social interaction can allay some of the condition’s symptoms and dramatically increase the quality of life for people living with dementia.
What are public health professionals doing to help?
Because dementia has affected so many lives — impacting in excess of 5 million Americans, according to the Alzheimer’s Association — public health practitioners are involved in understanding the condition, monitoring its impact on the population, supporting diagnosis and treatment, and developing and delivering community-based supports and services, Reed explained.
“If you think about the different disciplines of public health, epidemiologists, for example, may get engaged in research to better understand the risk factors and prevalence, generating data to inform program development and treatment, while health policy experts use data to develop policies and regulations to better support people living with dementia in our communities,” Reed said. “There really is a role for every type of public health professional in helping to reduce the impact of dementia.”
He further stated that the Master of Public Health program — offered by the University of Nevada, Reno — teaches prospective practitioners about how to interpret data so that it can be used to inform the public and be put to practical use, through community-based support programs and services. Ideally, these programs help improve the quality of life both for those affected by dementia as well as their caregivers, many of whom provide both financially and materially for loved ones living with the condition.
Both at the federal and state level, health policy is supporting these efforts by ensuring that those who specialize in treatment have the appropriate qualifications.
“For example, from state to state, there are varied requirements for how much dementia-specific training a person has to have to serve as a nursing assistant in a nursing home,” Reed said. “Are they being taught about dementia? That gets determined by state policy. Health officials develop and implement a wide range of policies to support people living with the disease.”
What is Dementia Friendly Nevada?
Nevada is at the forefront of dementia awareness, among the first states to implement campaigns that help make the Silver State more “dementia-friendly,” Reed hastened to mention. A new initiative— Dementia Friendly Nevada — is a grassroots effort that officially launched in 2016. The goal of the program, in addition to raising awareness, is supplying care partners and those living with dementia the knowledge and resources they need to create communities where people can live well, despite the changes that come along with the dementia process. Reed asks the question, “How can we ensure that people with cognitive changes can live in a community where they remain vibrant, respected citizens and can readily access every day services, similar to the way we support community members with physical limitations? That is the foundational question for dementia-friendly initiatives worldwide.”
Much of Reed’s work has revolved around putting in place support systems in both nursing homes and assisted living communities so those living with dementia can receive high quality care and maintain a high quality of life. Because the symptoms associated with dementia are progressive in nature, individuals living with dementia and family members often turn to these types of supportive environments
Another important consideration in addressing dementia is to promote early diagnosis. “Identifying dementia as early as possible enables people to help in the planning process for their own future,” Reed explained. “Secondly, it gives people the opportunity to get connected with all of the community-based supports and services. People must know they are experiencing cognitive changes in order to seek out needed support.”
Perhaps the biggest obstacle to early detection, Reed believes, is the stigma that people often ascribe to dementia. Earlier this year, Reed along with some of his colleagues, published a piece in the American Medical Association’s Journal of Ethics called “Transcending the Tragedy Discourse of Dementia: An Ethical Imperative for Promoting Selfhood, Meaningful Relationships and Well-Being.” In it, Reed argued that there needs to be a shift in perspective, so those with the condition are recognized first and foremost as people, and not products of their symptoms.
“Training is an important component to educating both professionals and the community at large that people living with dementia remain people who should be valued and respected,” Reed stressed. “What we need is widespread awareness raising. When they are advertising Alzheimer’s, how do they portray people who are living with it?”
Reed said that belaboring the tragedy narrative only furthers the negative stereotypes associated with dementia. To reverse course, more attention needs to be placed on how to enable individuals living with dementia to have more fulfilling lives by recommending effective approaches to wellness and support.
What can students expect to learn about dementia in the University of Nevada, Reno MPH program?
The MPH program aims to alter the negative narrative by helping students get a better appreciation of the aging process and how to increase the opportunities for aging well.
“Any discussion of healthy aging should include a discussion of physical, cognitive, social and emotional health, since those are core aspects that contribute to quality of life,” Reed said. “The core public health courses have content to help future professionals understand how to promote health across the lifespan, with recognition of how that relates to the natural aging process.”
Internships provide additional insight in understanding how dementia is treated and diagnosed, noted Reed. The Sanford Center for Aging has a number of opportunities Master of Public Health students take advantage of every year that are more hands-on.
The online Master of Public Health at the University of Nevada, Reno can help give students the tools they need to enter the healthcare profession with a firm grasp of key concepts and training. Find out more about our comprehensive curriculum and apply today.
Reed, Peter. Interview. Conducted Nov. 2017.