More training the key to dementia diagnosis boost

Tim Robertson

12/07/2022 4:17:18 PM

A new study has suggested bone density scans could be used to see if people have risk factors for dementia, but is it likely to prove useful for GPs?

GP talking to a patient.
GPs have been encouraged to talk to patients about all 12 modifiable risk factors for dementia.

A new long-term study, led by Edith Cowan University’s Nutrition and Health Innovation Institute and Centre for Precision Health, has shown a common bone density scan can reveal if people are at increased risk of developing dementia, based on calcified plaques in the abdominal aorta.
The researchers examined the abdominal aortic calcification (AAC) results in 968 women from the late 1990s, and then followed their health status for over 15 years. 
They found one in two older women had medium to high levels of AAC, and these women were twice as likely to be hospitalised or die from a late-life dementia independent of other cardiovascular or genetic factors.  
‘There’s an adage in dementia research that what’s good for your heart is good for your brain,’ Professor Simon Laws, Centre for Precision Health director said. 
‘This study reaffirms this link and further adds to our understanding of late-onset dementia risk and potential preventive strategies. 
‘What’s come to light is the importance of modifying risk factors such as diet and physical activity in preventing dementia: you need to intervene early and hopefully this study allows for the earliest possible change and the greatest impact.’
But while the study appears to confirm the link between vascular disease and dementia, Dr Marita Long, a Melbourne-based GP and educator at Dementia Training Australia, is unsure of how much value it will add to existing diagnostic efforts.
Instead, she says GPs should be focused on all 12 modifiable risk factors identified by a Lancet Commission 2020 report, which contribute to around 40% of worldwide dementias that ‘consequently could theoretically be prevented or delayed’.
‘As GPs, we are really good at preventive health,’ she told newsGP.
‘We know this because we are preventing strokes and heart attacks and cancers. Now we just have to turn our brains to our brains.’
The 12 modifiable risk factors are:

  • less education
  • hypertension
  • hearing impairment
  • smoking
  • obesity
  • depression
  • physical inactivity
  • diabetes
  • low social contact
  • excessive alcohol consumption
  • traumatic brain injury
  • air pollution.
Additionally, rather than only discussing dementia with older people, Dr Long believes GPs should discuss the risk factors with younger patients to educate them about what they can do to reduce their risk of developing dementia later in life.
‘The perfect time to target dementia prevention is in our 45–49-year-old health assessment,’ she said.
Dr Long would like to see a brain health check – using the Lancet Commission’s modifiable risk factors as a guide – included as part of the assessment.
She also describes GPs’ current dementia training as inadequate in preparing them for the timely diagnosis and ongoing management of dementia, calling for it to be improved.
‘We’ve done some study around GPs’ knowledge, attitudes and confidence towards caring for people with dementia and we found that only 6% of registrars have done any training or education in the area of dementia,’ she said, referring to a study she co-authored and recently presented at the Australian Dementia Research Forum 2022.
‘And only 20% of supervisors – so only one in five – have done any training.
‘Even recent medical graduates have done very little training in the area of dementia.’ 
Despite this, she insists that there are some good resources available.
Preventing Dementia is a free online course that anyone can do,’ Dr Long said.
‘It is run twice a year through the Wicking Dementia Research and Education Centre. It is fabulous and I recommend everyone do that, but especially health professionals.
‘They also run an “Understanding Dementia” open online course that covers the brain and pathology, then it goes through the disease.
‘It is a really lovely way of presenting the information – very easy to digest and incredibly useful.’
Dr Long also highlights some of the general practice specific resources available through Dementia Training Australia, where she works.
‘They have a website with a landing page for general practice, which has general practice management plans and online modules,’ she said.
‘We are doing a webinar [on Thursday, 14 July] with Professor Kaarin Ansty, who is an eminent researcher focused on dementia prevention.
‘She has developed some risk-reduction calculators, which are applicable for GPs. There are some guidelines and fantastic infographics on risk reductions for patients.’

UPDATED: This article was updated at 11.30 am on 13 July to clarify that Dr Marita Long works for Dementia Training Australia, not Dementia Australia. The summary has also been changed to reflect the fact that bone density scans can be used to show if people have risk factors for dementia, not as a marker for dementia.
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Dr Ian   13/07/2022 7:46:56 AM

General practice need to train more they are not working hard enough 60 hours a week if fit is the minimum . The other way is to allow more to do medicine by reducing the excessive intake requirements and expanding prescription rights in rural areas but with accelerated training for the traps example STD and bladder cancer exclusion for urinary tract symptoms .