In the first qualitative study of its kind in the UK, carried out by the University of Bradford, doctors were found to "never explicitly discuss dementia" even when patients present with risk factors. 

Dr Danielle Jones, Associate Professor in Dementia Studies, who led the study, (pictured below) said: "There is growing evidence that people can reduce their risk of dementia by making lifestyle changes. 

"The NHS has a focus on preventative care but while the GPs we interviewed regularly speak to patients about their risk of illnesses such as heart disease, stroke and diabetes, they do not talk about the changes patients can make to reduce their risk of dementia. However, they also felt they should be actively involved in dementia prevention."

The study, which will be published in the British Journal of General Practice next month (August), concluded that there needs to be a "whole systems shift towards brain health" in primary care. 

Eleven GPs with varying years of experience were interviewed for the study and all agreed that they did not routinely introduce dementia prevention conversations during appointments. 

Comments included:

• "We have to prioritise and often it’s the acute problems that have to come first."
• "We think a lot about hearts and kidneys and diabetes, but maybe don’t think about dementia prevention as much as we should."
• "We are regularly saying, ‘Oh your obesity is putting you at risk of breast cancer, ovarian cancer' … but we have not quite got into our pattern, saying you are at risk of having a heart attack, stroke and obesity, 'Oh and by the way, you are at risk of dementia.'"

Only two participants identified an exception when a patient had raised the matter themselves or because there was history of the condition in the patient’s family and it may be a contributory factor to current medical conditions. 

Dr Jones, Associate Professor at the Centre of Applied Dementia Studies at the University of Bradford, said: “The doctors we spoke to identified three key barriers to discussing dementia risk. They pointed to a lack of time in 10-minute appointment slots and a lack of knowledge about the modifiable dementia risk factors. They also felt unsure of how to communicate these risks with patients due to the fear and stigma of dementia.

"Current research shows people are more willing to engage with the term ‘brain health’ rather than ‘dementia risk’, as it is a more proactive term. The GPs in the study agreed using this terminology could facilitate better and more positive communication with patients."

Dementia is one of the fastest-growing causes of death and disability and the prevalence in the UK is rising, with one in 14 people over 65 living with dementia. There is growing consensus that reducing risks such as high blood pressure, obesity, alcohol, tobacco and physical inactivity, may prevent or delay dementia. 

'Bolster health messaging'

The NHS Prevention Programme, at the heart of its Long Term Plan, aims to support individuals in taking action to reduce risks to their health. Many of the same risks, such as obesity, high blood pressure, alcohol and tobacco, are already part of discussions with patients concerning weight management and risk of cardiovascular disease. 

Dr Jones added that participants in the study agreed that including dementia risks in the same conversations about cardiovascular disease could bolster the general health messaging. 

She said: “Some of the participants noted that risk communication in relation to other non-communicable diseases is becoming ineffective and they thought that adding dementia into the conversation might have a greater impact in influencing behaviour change."

Dr Jones's study has already had an impact. One of the GPs in the survey has reported changing their practice by introducing dementia risk when encouraging patients to take their blood pressure medication.

Participants in the study also called for a whole primary care team approach in conjunction with messaging from charities and a public health campaign. Most also discussed talking about dementia risk as part of reviews into patients’ long-term health conditions or medication reviews, as well as in NHS Health Checks. 

Improving brain health

Dr Jones said: "It's important to explore the roles which all primary care professionals - not just GPs - can play in dementia prevention.

"NHS Health Checks are carried out by allied health professionals and nurses for people aged 40 to 74 to check their overall health and whether they are at risk of health concerns, and the NHS already lists this as an opportunity to talk about dementia risks. 

"We would like to see such dementia prevention discussed as regularly as other health conditions, such as heart disease and diabetes, by the wider primary care team."

Dr Susan Mitchell, Head of Policy at Alzheimer’s Research UK, said: "Looking after our brains has never been more important. And while there are no sure-fire ways to prevent dementia, up to 40 per cent of all cases of dementia are linked to factors that we may be able to influence. That means there are steps we can all take to improve our brain health. But currently only a third of people in the UK realise this is possible, and that urgently needs to change.

"GPs play a vital role in helping people understand how to look after their brain health. But this new research shows these discussions are sadly not commonplace. GPs must be supported with the right resources to be able to champion evidence-based brain health advice in their communities. This is especially important for people who may be at greater risk of developing dementia, including minority ethnic groups."

Dr Jones intends to broaden her research to look at a wider range of communities and how health inequalities affect dementia risks and prevention communication.