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October 14, 2019

America's biggest public health crisis, according to 4 former US surgeons general

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    The number of dementia cases in the United States is "exploding," making it the country's largest public health crisis—and the nation has yet to come up with a plan to tackle the condition, former U.S. surgeons general Richard Carmona, Joycelyn Elders, Antonia Novello, and David Satcher write for the Orlando Sentinel.

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    Dementia: The growing public health crisis

    The former surgeons general write that, over a "span of more than 20 years," they tackled a diverse range of public health crises, including SARS, Ebola, and the opioid epidemic.

    Now, dementia is proving to be one of the worst health crises the United States has faced, the former surgeons general write. Dementia, or the loss of cognitive ability due to a neurodegenerative disease, is "unprecedented" in scale, and "its numbers … are growing rapidly," they write.

    For instance, the former surgeons general note that the number of people over age 65 living with dementia doubles every five years. Given that 50% of baby boomers will be over age 65 in five years, the United States likely will have 14 million people living with dementia by 2050.

    But "[d]espite these staggering numbers, dementia remains little understood … and garners neither the urgency nor the resources it deserves," the former surgeons general write.

    That's true even though research has found that dementia is not inevitable. For example, the former officials cite a recent study by the Lancet Commission that found "'around 35% of dementia is attributable to a combination of … nine risk factors,'" including diabetes, education to a maximum age of 11 to 12 years, late-life depression, midlife obesity, and social isolation.

    In addition, they note that studies performed by NIH have found "a diet high in natural plant-based foods and limited in saturated fats," as well as lower blood pressure, are associated with reduced cognitive decline. Another study published this year by the American Academy of Neurology found that physical and cognitive activity were associated with a reduced risk of dementia, they write.

    "What the latest science is therefore telling us is that brain health should be as much on people's minds as heart health, breast cancer, and the war on smoking have been for decades," the former surgeons general write, "[b]ecause the science is revealing that dementia … can be mitigated, delayed, or possibly even prevented by proactive detection, assessment, and diagnosis across the lifespan."

    Establishing a cognitive culture

    The former surgeons general write that the United States has "an obligation" to "mobilize every corner of the legislative, public policy, and health communities" around dementia as a public health crisis.

    For instance, they contend that the country should establish a "culture of brain health" among health care providers that encourages conversations about cognitive decline and the ways that it could be delayed.

    According to the former officials, a paper recently published by the Brain Health Partnership and USAgainstAlzheimer's "provides a good example" of how providers can create a culture of cognitive health. "Most importantly," the former surgeons general write, the paper encourages incorporating cognitive assessments as part of routine, annual check-ups, which "would go a long way in the service of establishing a cognitive baseline for millions of patients at all ages."

    "Fundamentally, individuals are simply wanting to know the right questions to ask their health care provider. And the providers … feel a strong desire not only to be better equipped but better incentivized to engage in standard brain health check-ups," the former surgeons general write. They conclude, "Promoting the need for an annual cognitive assessment and brain health check-up is an important place to start" (Carmona et al., Orlando Sentinel, 10/10).

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