In his recent reply to our study “Preventable risk factors of dementia: Population Attributable Fractions in a population-based study”,1 Dr Daly has raised pivotal points to change the face of dementia prevention globally. He raised that “the dementia community should stress the need for action beyond lifestyles”, suggesting that structural factors should also be addressed and that the state should “provide access to stimulating activities”.2
We could not agree more. The reconceptualization proposed by Dr Daly shifts the paradigm from “deviant behaviours” to “lack of intervention”. This framework could be stated in such a way that lifestyle factors do not depend solely on the individuals’ free will, but also on the society in which one lives. Social determinants of dementia are consistently associated with dementia risks,3 and these determinants are unequally distributed among ethnicities. For example, individuals living in informal settlements/slums (called “favelas” in Brazil) live under lower sanitation conditions and income than other urban areas.4
Thus, state policymaking strategies are a cornerstone in this process. As researchers, we should raise a concern about the understatement of dementia in a continental-size country. As physicians, we should increase clinical suspicion of cognitive complaints and provide psychoeducation for families living with dementia. As Brazilians, we should be alarmed by the large number of individuals underdiagnosed with dementia and living in very impoverished conditions.5
Contributors
W.V.B. and R.M.C. designed and wrote the manuscript.
Declaration of interests
The authors declare they have no conflict of interest.
Acknowledgements
None.
References
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