Couldn't the percentage of persons with full-fledged dementia be reducing because people with the earlier signs of mild cognitive impairment are getting medical help AND are developing their own strategies of nutraceuticals, physical activity, creative arts, good sleep, better nutrition, stress reduction, reduced exposure to toxins, meaningful work, and enjoyable life, and that this is slowing or reducing their move toward dementia? That is certainly the case for me and many others that I know with early MCI. Mary Kay Baum of forMemory, Inc.

Hello, an interesting observation. sure knocks some of the wind out of the hurricane of hot air blowing for doubling the funding for research in one specific type of dementia. It's a very complicated subject to come up with an a simple and sweeping conclusion.

But it sure is worth deeper investigation. the disability may not be revealing itself, but the underlieing process may still be going on, we are just getting better at covering it up for longer periods of time. Brains are aging at the same rate, and there are more and more older brains in the population. Seems counter intuitive that the conditions associated with aging brains should be decreasing at the same time the number of brains at risk is increasing.

Richard TaylorPerson living with the symptoms of dementiarichardtaylorphd.com

OMG! maybe its not a tsunami, its just a large tidal wave

And so now some are suggesting the let's find a cure for Alzheimer's, or at least keep people with dementia out of nursing homes for an additional year through the miracles of drugs movement and thus save lots and lots of tax payers' dollars and Medicare and Medicaid claims may not be as compelling as advertised. Ignore the psychosocial human side of this public health crisis and focus on economics, that is what we are told in many, many pleadings for more money to spend on research.Epidemiologists are beginning to suggest there is a decline in the numbers of folks living with cognitive disabilities. No one goes around door to door asking everyone (even those standing in a closet) who is exhibiting the symptoms of dementia to stand up and be counted, but through various surveys there is the smell of a trend that at least the symptoms of dementia may be observable in fewer people than we have been led to believe. I know for sure that all brains age. and I know for sure we now live in a time where there are lots of old brains walking around in every country in the world. what happened seventy years ago (WW II), and the tsunami of sexual contacts just after the war has now produced a world with lots and lots of living 50-60-70 year old human brains. If dementia is a natural consequence of an aging brain then shouldn't there be more and more brains walking around the world (actually they don't walk, they are carried around by the body at the top of which the live) exhibiting the symptoms of dementia?

It's possible many of us are better prepared to cover up the symptoms. More formal education, social and mental stimulation, better diets, lower blood pressure and cholesterol all seem to reduce the probability of someone acting like they have dementia. Since only our brains know for sure, and they are not confiding in anyone, we can only guess by our behaviors – what we say and do, if we know who the president of the united state is and how quickly we can tell someone his/her name, and other probing and revealing questions that must be answered on a computer and/or with a paper and pencil (or pen if it is black ink).

Some folks have a vested interest in counting as many folks as possible and some have a vested interest in counting as few folks as possible – both groups are counting the number of people who appear through whatever test is being used to be exhibiting the symptoms of dementia. there are even a group of folks who now claim to be able to count you in or out before you show any symptoms – they look at images of your brain, the color of the images, if the computer is making parts of the image flash, and other technological tricks. another group is basing their count on your genes. If you have this or that, or this or that combination you, may/might/will have this or that form of dementia – provided of course you do not die before you show the symptoms.

This is a messy process, this counting stuff. It means a lot to politicians, researchers, and Alzheimer's Associations – just how big the estimates are or are not. to someone living with the symptoms it means little to nothing, other than to confirm that all of us should not be really really sure about anyone who claims to be an expert about the number of people living with the symptoms of dementia. We should all also question for ourselves if what they are shouting at us is indeed a fact – a truth for all of us – or their opinion/hopes/wishes/guesses as to what is and is or is not a truth for all of us. Personally, I didn't need this latest bit of information to be suspicious of dementia experts, but perhaps you do/did. It would be great news of more and more of us were more and more able to disguise/cover up/repress and otherwise keep hidden our symptoms of dementia. It would be great news if less and less of us had the need to cover up the symptoms because there is no need to cover up something that isn't there in the first place. In either of these cases the stigmas, myths, and fears residing in the brains of most all folks over the age of about three years old are just as strong, just as prevalent. maybe we shouldn't be scared into doing something about dementia based on economic arguments (the costs may be inflated). maybe we should just do something(s) about dementia and the people living with its symptoms because it's the right thing(s) to do. and maybe the emphasis on the some things we do should first be on discovering cures for the day-to-day problems of living with the symptoms of dementia. from my heart and mind, there is no maybe about this. Richard

Mary Kay, thanks so much for your comment. the researchers addressed part of your question in their article. They wrote this about the increasing use of cholinesterase inhibitors to treat Alzheimer's:

Because these medications are used mainly only after diagnosis of dementia, and because their impact on cognitive function is modest, it is highly unlikely that they are an important explanation for the decreased prevalence of CI between 1993 and 2002 that we found in our study.

I don't think they addressed other types of medicines, or your comments about lifestyle changes.

Richard, thanks so much for your comments. You're right, of course, people with cognitive problems and their families don't really care how prevalence numbers and costs are calculated – they know their personal costs are high.

From a public policy point of view, I do think it's important for us to understand how various prevalence numbers and cost figures are developed. I would guess it's also important for pharmaceutical company planning.

Interesting, Richard, that you point out how some groups have a "vested interest" in either a growing or a decreasing rate of dementia. Can't blame those fighting for a cure for being alarmists, and can't blame those fighting for human dignity for minimizing the scope of the problem. So how are we to arrive at "truth"? I would like to know, for example, how the number 5.3 million is arrived at in the U.S.–for comparative purposes with other countries SO THAT we can get more of a feel for the underlying causes. If we overestimate our numbers and other countries underestimate their numbers, it may make us overlook some very important factors that we could use to get a handle on this disease. (On underestimates, I'm thinking specifically of East Asian countries given that it is anathema to say you have dementia in Asian Pacific cultures).