A newly released study demonstrates that approximately one third of Alzheimer’s cases worldwide are attributable to seven modifiable risk factors: depression, physical inactivity, diabetes, midlife hypertension, midlife obesity, smoking, and low educational attainment. The largest proportion of cases was attributed to physical inactivity, which affects more than half of all Americans. Depression, which affects approximately 14.8 million Americans, accounted for approximately one in ten cases of Alzheimer’s disease globally.
These findings highlight the urgent need for more investment in prevention – and specifically in a holistic approach to health promotion, which includes mental health. We need to act years before the disease develops rather than react to the burden once it manifests itself. Without a timely intervention, the worldwide prevalence of Alzheimer’s is expected to more than triple by 2050.
There is clear evidence for the powerful impact of health promotion and disease prevention. We know how to prevent and reduce obesity, hypertension, diabetes, and depression; help people quit smoking; improve physical activity; and raise educational attainment. We even know how these factors are interrelated, explaining why physical activity can reduce depressive symptoms and the risk of future depression and how health promotion interventions will also act synergistically throughout the lifespan.
Unfortunately, we have historically fallen short on implementing this knowledge, which has among other things resulted in mental health services that are difficult to access/afford and fraught with stigma. Thankfully, the Affordable Care Act and current government-led studies are aiming to close these gaps. However, by the time working-age Americans enter the Medicare pool, it will be too late to prevent many of these conditions and we will have to bear the cost of disease management. As Dr. David Katz brilliantly points out in his Parable of the Tiny Parachute, the timing of the intervention is critical to its success.
We therefore call upon the public and private sectors to adopt a life-course approach for evidence-based prevention measures and seize opportunities to use newly emerging evidence to reshape current programs and guide future endeavors. Lifestyle interventions for the working-age population will ensure successful promotion of active living, healthy eating, and mental well-being now – at work, in homes, and in communities, ultimately resulting in superior health in advanced age and preventing a significant number of Alzheimer’s cases.