Dementia in the US: Public Health, Causes, and Solutions

This essay addresses dementia as a major public health concern, particularly in the United States. It begins by defining dementia and highlighting its global impact, with a specific focus on Alzheimer's disease as the most prevalent type. The essay delves into the causes of dementia, including neuropathology, structural and chemical changes in the brain, and modifiable and non-modifiable risk factors such as age, genetics, lifestyle, and health conditions. The solution proposed is a public health campaign that promotes lifestyle modifications, including physical activity, healthy weight maintenance, and smoking cessation. The campaign involves engaging stakeholders, adapting key messages, mobilizing the community, and utilizing various media channels to influence the target population. The essay concludes by emphasizing the importance of this campaign in reducing the incidence of dementia, facilitating early diagnosis, and alleviating the disease's burden on healthcare systems.

Running head: ESSAY 1
Case study analysis
Name of the Student
Name of the University
Author Note

ESSAY 2
Introduction
In recent times, public health surveillance has resulted in the recognition and
prioritization of a range of health problems that are prevalent in the world such as, diabetes
mellitus, HIV/AIDS, zoonotic diseases, waterborne diseases, antibiotic resistance, substance
abuse, and cardiovascular complications. The major objective of public health is to enhance
the quality of life of all people through proper prevention and treatment strategies, and is
generally accomplished through continuous monitoring of the health indicators and
promotion of healthy behavior (Brownson, Baker, Deshpande & Gillespie, 2017). This
assignment will elucidate on dementia that has been identified as a matter of major concern in
the United States.
Background
Dementia is an umbrella term that refers to brain disorders that bring about a decline
in the capability to remember and think, thereby gradually affecting the daily lives of the
patients. Researchers have recognized dementia as a global health priority owing to the fact
that the disease impedes neurotransmission in the brain, and no definite effective treatment
has been devised for curing this disease, though it is not a component of ageing (Livingston
et al., 2017). According to the World Health Organization (2019) around 50 million people
are affected with dementia, with an estimated 10 million new instances each year.
Alzheimer’s disease is the most prevalent type of dementia, affecting around 60-70% of the
total population.
The prevalence of this disease in the US can be accredited to the fact that
approximately 5.7 million affected individuals have been identified in the nation, with an
estimate that the total people affected with Alzheimer’s disease will increase to around 13.8
million by 2050 (ASHA, 2019). Moreover, Alzheimer’s disease has also been identified to be

ESSAY 3
the fifth most prevalent reason for death of Americans ages more than 65 years, and African
Americans have the maximum prevalence of 13.8% (CDC, 2019). According to Preidt (2018)
the approximate cost of caring for US citizens suffering from dementia and Alzheimer’s
disease was $277 billion in 2018, of which around $60 billion was out-of-pocket expenditure.
Cause
Most dementias can be associated to neuropathology that originates from the diffuse
degeneration in the neural pathways and the cortical or subcortical structures in the brain.
Structural changes occurring in older adults commonly include neuritic plaques and
neurofibrillary tangles that result in disruption of connection between neurons, thereby
affecting learning and memory (Esparza, Gangolli, Cairns & Brody, 2018). Additionally,
there also occurs chemical changes such as, deficits in the cholinergic neurotransmission in
the subcortical regions of the brain. There are certain modifiable risk factors, which when
eliminated help in potential prevention of dementia cases. Less educational attainment during
early life is one such factor. During middle age, the onset and progression of hypertension
and obesity have also been found responsible for dementia since they bring about progressive
organ damage (Yahya, Shamim & Anand, 2019).
According to Singh-Manoux et al. (2018) obesity decreases blood supply to the brain,
in addition to increasing fat cells, thereby damaging the white matter and causing decline in
intellectual and cognitive behavior. Other factors that increase the likelihood of older adults
to suffer from dementia are namely, depression, smoking, social isolation, physical inactivity,
and diabetes mellitus (metabolic alterations affecting amyloid clearance). In addition, some
non-modifiable risk factors are age and heredity. The risk increases in the presence of first-
order relatives suffering from dementia, besides the inheritance of apolipoprotein E (ApoE)
gene (Shih, Paul, Haan, Yu & Ritz, 2018).

ESSAY 4
Solution
Taking into consideration the modifiable risk factors, the first suggested solution is
modification of lifestyle and individual behavior, which in turn will prove promising for
dementia prevention. According to research evidences, engagement in physical activity
during the early and middle stages of life has been correlated with a decreased risk of
dementia and concomitant cognitive decline (Lamb et al., 2018). This can be associated to the
fact that physical activity stimulates the ability of the brain to maintain the old neural
connections, while promoting new ones. Lifestyle modification plan will also include
maintenance of a healthy weight and cessation of smoking. Generally people affected with
dementia report greater-than-average body mass index (BMI), around two decades before
dementia onset. This calls for the need of maintaining BMI since high BMI increases
dementia risk, long before the first appearance of symptoms (Kivimäki et al., 2018).
Smoking cessation forms an essential component of the solution since it increases risk
of suffering from vascular complications, such as, small bleeds in brain and strokes, both of
which increase the likelihood of dementia. The toxins present in cigarette smoke also cause
inflammation and increase the oxidative stress, thus making people more vulnerable to the
condition (Nystrom et al., 2018). The solution will be implemented in the form of a public
health campaign across all territories. The first step will involve identification of the key
stakeholders, partners and target audience (patients and healthcare professionals). After
adaptation of key messages for this campaign, the community will be mobilized and asked to
participate in panel discussions, exhibits and poster competitions. Leaflets and brochures
shall be prepared in the local language (English) and distributed across healthcare services,
community centers, households, marketplaces, and aged care homes. The media such as,
television, social media and radio will also play an important role in influencing the target
population on the solution. It is expected that if the strategies discussed in the solution are

ESSAY 5
implemented well, there will be a substantial decrease in the number of new dementia cases
and associated healthcare costs.
One such plan already in existence is the New Alzheimer’s Campaign that encourages
family members to talk about cognitive problems and memory issues faced by older adults, to
facilitate early detection of the condition (Alzheimer’s Association, 2019). Effectiveness of
this campaign can be associated to the fact that it aims to bridge the existing gap in
communication by fostering discussions about dementia, which in turn is beneficial for
critical care planning, enhanced disease management, and future care strategies.
Conclusion
To conclude, there is a growing body of evidence that identifies dementia as a public
health issue, with particularly high prevalence in the United States. The gradual decline in
memory and cognition amid the patients make it difficult for them to conduct daily activities,
thereby affecting their health and quality of life as well. Hence, one major solution that can
address this issue is a campaign that will promote healthy behavior and lifestyle choices. Not
only will this decrease the risk of developing dementia, but also facilitate early diagnosis,
thus decreasing the burden of the disease.

ESSAY 6
References
Alzheimer’s Association. (2019). New Alzheimer’s Campaign Encourages Families to
Discuss Cognitive Problems Sooner, Enabling Early Diagnosis.
https://www.alz.org/news/2019/new-alzheimer-s-campaign-encourages-families-to-di
American Speech-Language-Hearing Association. (2019). Dementia- Incidence and
Prevalence. https://www.asha.org/PRPSpecificTopic.aspx?
folderid=8589935289&section=Incidence_and_Prevalence
Brownson, R. C., Baker, E. A., Deshpande, A. D., & Gillespie, K. N. (2017). Evidence-based
public health. Oxford university press. https://books.google.co.in/books?
hl=en&lr=&id=tCnADgAAQBAJ&oi=fnd&pg=PP1&dq=public+health+issues&ots=
X6ybkSlU4b&sig=13swP19WbZYV8OMxrl8Wd3bWbvo#v=onepage&q=public
%20health%20issues&f=false
Centres for Disease Control and Prevention. (2019). CDC study first to forecast Alzheimer’s
estimates by race/ethnicity. https://www.cdc.gov/media/releases/2018/p0920-
alzheimers-burden-double-2060.html
Esparza, T. J., Gangolli, M., Cairns, N. J., & Brody, D. L. (2018). Soluble amyloid-beta
buffering by plaques in Alzheimer disease dementia versus high-pathology
controls. PloS one, 13(7). https://doi.org/10.1016/j.bbr.2018.03.030
Kivimäki, M., Luukkonen, R., Batty, G. D., Ferrie, J. E., Pentti, J., Nyberg, S. T., ... &
Knutsson, A. (2018). Body mass index and risk of dementia: analysis of individual-
level data from 1.3 million individuals. Alzheimer's & Dementia, 14(5), 601-609.
https://doi.org/10.1016/j.jalz.2017.09.016

ESSAY 7
Lamb, S. E., Sheehan, B., Atherton, N., Nichols, V., Collins, H., Mistry, D., ... & Lall, R.
(2018). Dementia And Physical Activity (DAPA) trial of moderate to high intensity
exercise training for people with dementia: randomised controlled trial. bmj, 361,
k1675. https://doi.org/10.1136/bmj.k1675
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... &
Cooper, C. (2017). Dementia prevention, intervention, and care. The
Lancet, 390(10113), 2673-2734. https://doi.org/10.1016/S0140-6736(17)31363-6
Nystrom, N. C., Cook, J., Norton, D. L., Zuelsdorff, M., Wyman, M. F., Benton, S. F., ... &
Gleason, C. E. (2018). TOBACCO EXPOSURE AND CESSATION IS
ASSOCIATED WITH INCIDENT DEMENTIA AND NURSING HOME
PLACEMENT. Alzheimer's & Dementia: The Journal of the Alzheimer's
Association, 14(7), P1347-P1348. https://doi.org/10.1016/j.jalz.2018.06.1948
Preidt, R. (2018). Alzheimer's costs Americans $277 billion a year -- and rising.
https://www.cbsnews.com/news/alzheimers-costs-americans-277-billion-a-year-
report/
Shih, I. F., Paul, K., Haan, M., Yu, Y., & Ritz, B. (2018). Physical activity modifies the
influence of apolipoprotein E ε4 allele and type 2 diabetes on dementia and cognitive
impairment among older Mexican Americans. Alzheimer's & Dementia, 14(1), 1-9.
https://doi.org/10.1016/j.jalz.2017.05.005
Singh-Manoux, A., Dugravot, A., Shipley, M., Brunner, E. J., Elbaz, A., Sabia, S., &
Kivimaki, M. (2018). Obesity trajectories and risk of dementia: 28 years of follow-up
in the Whitehall II Study. Alzheimer's & Dementia, 14(2), 178-186.
https://doi.org/10.1016/j.jalz.2017.06.2637

ESSAY 8
World Health Organisation. (2019). Dementia- Key facts.
https://www.who.int/news-room/fact-sheets/detail/dementia
Yahya, A., Shamim, R., & Anand, K. S. (2019). Hypertension and Diabetes as a risk factor
for dementia: a cross sectional study. International Journal of Research in Medical
Sciences, 7(9), 3337.
https://www.researchgate.net/publication/335567705_Hypertension_and_Diabetes_as
_a_risk_factor_for_dementia_a_cross_sectional_study?enrichId=rgreq-
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