Dementia: how health nudging works

The claim that dementia can be prevented by lifestyle changes was convenient PR – but remains unproven

Just obey five rules and you’ll be less prone to dementia in old age, the media reported on Monday. Exercise, above all; cut out booze and fags; and diet healthily, down to a good body mass index. Obey, and you’ll cut your risk of dementia by two thirds, we were told.

In its varied forms, of which Alzheimer’s disease is the most prevalent, dementia is a real problem in society. However, when the government-funded Medical Research Council, the Alzheimer’s Society and the British Heart Foundation commission research to grab headlines, then their mythmaking and their paternal ‘nudges’ to our lifestyles are also a real problem.

These dementia dictats aren’t based on any new evidence. They’re old pieces of policy, garnished with meddlesome mayonnaise. Here’s what happened.

In a March 2012 report, Prime Minister’s Challenge on Dementia, UK prime minister David Cameron noted that, in England, 670,000 people suffer from dementia. Still, his report hoped that the UK would ‘be a world leader in dementia care and research’. By May 2013, the Department of Health and the Alzheimer’s Society published a progress report on dementia, observing: ‘We will use our presidency of the G8 to help shape an effective international response.’ Within months, a G8 ‘summit’ on dementia was announced for 11 December. Then, a long-running dementia study of 2,235 men from Caerphilly, Wales – men first tested when aged between 45 and 59 in 1979 – was magically given a new outing two days before the summit.

It was nice timing… from a PR point of view.

What did the Caerphilly Cohort Study (CCS) conclude? That ‘personal prevention measures’ could ‘have a large impact on the costs of healthcare services’. The study also concluded that because ‘decisions about behaviours lie with the individuals’, Britain urgently needs a ‘more effective partnership between health services and citizens’.

Such a partnership would indeed have to be effective. In 2009, the Welsh Health Survey found just 0.8 per cent of men and women aged over 16 following all of the recommended ‘five behaviours’. Five per cent ignored all five.

Exactly how Britain’s healthcare elite hopes to reform the lifestyles of the wayward Welsh – or anyone else – remains unclear. But then this whole project is about mind control and cultural obedience, not actually getting people to jog. And anyway, even without jogging much, life expectancies among Caerphilly 65-year-olds improved dramatically between 2000-02 and 2010-12: from 14.8 to 17.3 years among men, and from 17.9 to 19.6 among women.

The CCS relied for its dementia results on a sample of just 79 men. It could link exercise with reductions in dementia only weakly, and certainly didn’t prove causation. It found only 15 men consuming five or more portions of fruit and/or vegetables daily, so redefined ‘healthy diet’ to mean three or more portions per day. And just what kind of exercise people should take to fight dementia, it left unspecified.

On Monday, newspapers also reported that a diagnostic test for Alzheimer’s was ‘close to being developed’. But such news has been announced before – it just got more convenient in the week of the Dementia Summit.

Anyway, early diagnosis of dementia doesn’t guarantee a better prognosis. That depends on pharmaceutical firms coming up with preventions or cures for dementia. Owing to the sloth that now surrounds capitalist innovation, developments like these remain some years off.

In the meantime, it seems, we’ll just have to endure more finger-wagging dressed up as science.