This concluding section gives recommendations to leverage and develop evidence-based and effective measures in the field of dementia prevention in the Nordics.
The fact that there are common lifestyle factors connected to prevention and risk reduction of many diseases calls for a holistic approach to dementia prevention. Considering the available research, the Nordic countries need a long-term strategy for dementia prevention clearly integrated into the work on preventing other non-communicable diseases.
Some areas of improvement in implementing measures were identified in the mapping, including the lack of awareness in the population, both overall and in more vulnerable groups. In addition, implementation of practice should focus on making healthy lifestyle choices available for everyone, promoting brain health and supporting cognitive functionality during the whole lifespan.
Organisational aspects are central in supporting the implementation of dementia-preventive measures. Taken together, there is a need for a comprehensive approach in the municipalities, good plans locally that act together with legal support structures. We need a broad prevention strategy in all local sectors, while also strengthening the provision of prevention among high-risk groups. Examples given in the report are high-risk municipalities or dementia prevention in subgroups, such as for persons with intellectual disabilities, minority groups, those with lower income levels, or people with low health literacy. The unequal distribution of social determinants of health conditions in which people are born, grow up, live, work, and age are also important factors in the regulation and legalisation efforts at a population level.
A formalised Nordic–Baltic expert network can contribute to continued knowledge sharing between the Nordic and Baltic countries on dementia prevention. A common focus on development in this novel area can leverage dementia prevention in the Nordics and Baltics in the coming years.
Recommendations for dementia prevention in the Nordics
Interaction between the prevention of dementia and the prevention of non-communicable diseases
Multiple concurrent risk factors may have a bearing on preventive measures. Common risk factors for heart and brain diseases and all NCDs are the driving force behind preventive measures in Nordic health services nationally. These measures are based on the policy and strategies described in the results section. There appears to be a general approach that links to these broader recommendations. All Nordic countries have policy documents for NCDs, and all of them take a broad approach to dementia prevention. Continued health policies in areas such as education, tobacco, and alcohol in the Nordic region are crucial to promoting healthy lifestyles among citizens.
Although all Nordic countries have strategic dementia plans, dementia prevention is tackled to varying degrees. Primary prevention is less common in the strategies than secondary and tertiary prevention. So far, none of the Nordic countries has used knowledge/evidence for dementia risk reduction as the basis for a systematic prevention strategy. National guidelines for following up on diseases that pose a risk of developing dementia, such as diabetes and cardiovascular disease, are important secondary preventative measures. In the future, the focus should be on synergies with established policy and on thinking at the population level also in dementia prevention.
Prevention of dementia among people with intellectual disabilities is not specifically mentioned in any Nordic government plans or strategies. Instead, the issue appears to come up under public health and the prevention of NCDs. There must be a greater focus on this group if they are to receive the same care as everyone else, and a greater awareness of lifestyle changes that might have a preventive effect for this group. This includes healthy lifestyle counselling to combat obesity and providing a good education, physical activity, healthy food, and social inclusion. Introducing descriptions of functional consequences in various plans and strategies for the prevention of dementia may also be a way of ensuring the inclusion of all groups and appropriate adaptations.
How can the Nordic countries support each other?
Robust co-operation networks already exist between the Nordic countries. One of the Nordic representatives pointed out the importance of maintaining the existing networks in Nordic co-operation. The future of Nordic co-operation to reduce inequalities in health is outlined in a Nordic report.
“In the Nordics, public health has developed positively for many years … A major challenge for Nordic welfare is all the chronic diseases that concern lifestyle.”
Bo Könberg (2014)
This is also the case in the prevention of dementia, where efforts are required to leverage the potential for reducing the risk of chronic diseases in old age, such as dementia. We need cross-country research in the Nordic countries, such as research on dementia prevention and Down syndrome. The Nordic countries need to design indicators to compare the development of dementia, such as its prevalence and incidence across the Nordic region. The field of dementia prevention is actively sharing experiences and knowledge to promote rapid development. The Nordic countries, with their comparable populations, are closely aligned in this effort.
During the project on dementia prevention in the Nordics, Nordic and Baltic experts shared topical knowledge and examples of current preventive measures and to compile working material for this report. The meetings have provided new insights, valuable contacts, and established an informal Nordic network in this new area of public health and dementia policy. A suggestion from the network is to continue the collaboration also after the report has been published to leverage the momentum that this Nordic project has brought about. Continued co-operation of the Nordic–Baltic network for a limited time could further promote dementia prevention in the Nordic and Baltics countries in the coming years.