Health apps for the healthy and the risk of dementia

There’s an interesting discussion in the British Medical Journal on the pros and cons of the use of Health Apps by healthy people. While there is a risk that some of the more “medical” apps may cause unnecessary anxiety, and we need much more research than there currently is on the impact of health apps, I cannot agree more with Iltifat Hussain, who makes a powerful case for them.

As the numbers of people with dementia will grow as a result of our success in living longer (if all continues as is now, there will be over 2 million of people with dementia by 2050 in the United Kingdom, compared to around 850,000 today), as a society we need to make sure that we meet the resulting care needs better and that we do so in an affordable way. I am working, with other colleagues, on finding the best possible evidence to help us achieve this.

Of all the ways in which we can try to make the care of people with dementia affordable, the best one is, undoubtedly, to make sure that as few people as possible are affected by dementia in the first place. While we do not yet know how to prevent or cure Alzheimer’s Disease or some of other causes of dementia, we do know quite a bit about what we can do to minimise the risk of developing it. The 2014 World Dementia Report published by Alzheimer’s Disease International concludes that the strongest evidence is that the risk of dementia increases with low education in early life, hypertension in mid life and smoking and diabetes across the lifecourse.

In line with those findings, a recent paper by Sam Norton and colleagues estimates that about a third of cases of Alzheimer’s disease worldwide could be attributed to the following risk factors*:

  • low education
  • physical inactivity
  • obesity
  • hypertension
  • diabetes
  • smoking
  • depression

(*the reseachers have taken into account the interdependence between these risk factors).

And we even have an example of interventions that actually work in practice: a recent Finnish study that has found that an intervention involving nutritional advice, exercise, cognitive stimulation and monitoring of metabolic and vascular health did have a significant effect on the levels of cognition of a cohort of people aged between 60 and 77 who were at risk of dementia.

We need to understand more about the link between physical activity, particularly in midlife, and dementia and other chronic conditions, but the evidence suggests that, what all of us already know, that being physically active is good for us, also holds for the long term and will give us a much better chance to age well.

The take home message from research has been neatly summarised in the picture below (borrowed from a presentation by Marc Wortmann of Alzheimer’s Disease International:

ADI

I am a user of a smartphone health app, a pedometer (one of the less sophisticated ones, which is free).  While my app may not be as accurate as some of the more expensive ones, it does give me a fairly good idea of how physically active I am each day. I have realised, for example, that the 10,000 daily steps the app suggests as a goal do not happen if I go about my normal routine (desk based job, etc. resulting in around 2,000 steps!). I am increasingly making changes to my day to make sure I get at least a bit closer to the goal (walking instead of using the tube, taking up the stairs instead of the lift, running more regularly…).

I do feel very pleased whenever I reach the goal, and even more if I beat it by a long way. Incidentally, I also found out that dancing works very well at boosting the steps, may be I should go out more…

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