727 © The Author(s) 2020. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. Letters to the Editor Why discuss dementia risk reduction with middle-aged patients in general practice? Kali Godbee* , Department of General Practice, The University of Melbourne, Melbourne, VIC, Australia. *Correspondence to Kali Godbee, Department of General Practice, The University of Melbourne, 780 Elizabeth Street, Parkville, Melbourne, VIC 3010, Australia; E-mail: kali.godbee@unimelb.edu.au Dementia is a complex condition mainly affecting older people (1). Fewer than half of cases are thought to be attributable to modifable risk factors (2, 3), and the quality of evidence for de- mentia risk reduction is moderate at best (4). There is stigma, fear and lack of understanding among the patient population (5). The question for general practitioners and general practice nurses (GPNs) is, why mention dementia at all? Why not simply manage risk of cardiovascular disease and diabetes, and (given the overlapping risk factors) hope that reduces risk of dementia as well (4)? Here are fve reasons for general practitioners and GPNs to explicitly discuss dementia risk reduction with their middle-aged patients at elevated risk of developing dementia as they get older. 1. Professional standards and responsibilities The Regulation of General Practice Programme Board in England (6) and the Royal Australian College of General Practice in Australia (7) require general practices to provide health promo- tion and preventive services that are based on patient need and best available evidence. Patient need for dementia risk reduction is manifest: dementia risk factors are prevalent in middle-aged patients in England (8) and Australia (9, 10), yet patient under- standing of dementia risk reduction is poor (11, 12). In terms of best available evidence, new (4, 13) and existing (14, 15) guidelines indicate that physical activity, tobacco cessation and safe alcohol consumption should be recommended to middle-aged patients to reduce dementia risk. A Mediterranean-like diet and management of weight, hypertension, diabetes and dyslipidaemia may also be recommended (4, 13–15). Discussing dementia risk reduction is a crucial component of adhering to professional standards of general practice. Beyond professional standards, general practitioners and GPNs have a professional responsibility to ensure patients are fully in- formed about all aspects of their health care (16, 17) and are supported to understand the consequences of care and treatment op- tions (18). Patients have a right to know that their risk of dementia is increased if, for example, they continue smoking or discontinue prescribed statins. 2. Patients want to know about dementia risk reduction from a trusted source Nearly 80% of people surveyed in general practitioner waiting rooms in England and Australia wanted to learn more about re- ducing dementia (19), and the dementia awareness component of the National Health Service (NHS) health checks was welcomed by patients in England (20). Furthermore, we know that dementia is ‘over-expressed’ in the media, with many messages overstating the evidence (21). General practitioners and GPNs who discuss dementia risk reduction can clarify points of confusion for their middle-aged patients and appropriately tailor advice and support. 3. Discussing dementia risk reduction could strengthen working alliances Relational aspects of primary care are important. The working al- liance between patient and clinician comprises the bond between the two parties, collaborative goal setting and agreement on the required tasks to reach the goals (22). Discussing dementia risk reduction can reinforce to the patient that their clinical care team genuinely cares about them and their long-term health goals and provide an opportunity to revisit goals and agreed tasks. General practitioners and GPNs might be concerned about causing distress or unnecessary worry (20), but there is limited evidence to suggest this. In one evaluation in England, only 9% of 164 participants who recalled the dementia awareness component of the NHS Health Check felt uncomfortable when dementia risk reduction was mentioned (20). Done skilfully and sensitively, a discussion about dementia risk reduction may actually strengthen working alliances with patients. 4. Discussing dementia risk reduction could motivate patients to change their behaviour Dementia is one of the most feared health conditions (5, 12). It is the leading cause of death in England (23) and the second leading cause of death in Australia (24). Whereas repetitive messages about Family Practice, 2020, 727–729 doi:10.1093/fampra/cmaa032 Advance Access publication 7 April 2020 Downloaded from https://academic.oup.com/fampra/article/37/5/727/5816758 by guest on 13 April 2022