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• W1861036592 abstract "The changing global demographic characteristics of dementia have led to worldwide predictions of unaff ordable treatment and care costs over the coming decades. Recognition of the economic consequences has encouraged many countries to develop national dementia plans, as well as international actions such as the G8 Dementia Summit in London, UK, in 2013 and the WHO Ministerial Conference on Global Action Against Dementia in Geneva, Switzerland, in 2015. Dementia is defi ned as severe cognitive impairment that interferes with activities of daily living. There is a tendency to confl ate dementia with Alzheimer’s disease, which is not surprising because Alzheimer’s disease is the commonest form of dementia in older people (older than 65 years), progressive, and without interventions to slow that progression. Nevertheless, many diseases can be associated with severe cognitive impairment or dementia and, importantly, many more are associated with less severe cognitive impairment, some of which can progress if undiagnosed. The term mild cognitive impairment was developed to describe cognitive deterioration that does not fulfi l the severity criterion of dementia, although mild cognitive impairment has tended to be used when older people present with a memory problem that might represent early Alzheimer’s disease. We would argue, however, that to focus only on late-life dementia misses the societal opportunity to foster cognitive health and to preserve cognitive capital. If one considers all causes of cognitive impairment across the lifespan—including the absence of activities to develop full cognitive potential, such as education—then a deeper and broader debate is opened up. It is important, however, to appreciate that cognition here is not confi ned simply to memory, but to the entire range of cognitive function including language, perception, creativity, and social activity. In reframing and extending the debate in this way, it might be helpful to borrow a concept from another major global challenge of modern times: global warming. Can we develop a so-called cognitive footprint that, as with a carbon footprint, can be either negative (impair cognition) or positive (enhance cognition)? A cognitive footprint could then be used to assess and model potential cognitive eff ects of medical and public health interventions through to social and wider public policies. It could be identifi ed across many public policy areas, including health, social care, education, criminal justice, transport, sport, employment, and doubtless others. The importance of this footprint stems from links between cognitive skills and educational attainment, employment status, earnings, performance in instrumental activities of daily living, and (at national level) to income distribution and economic growth. Thus a range of activities will have an eff ect on cognition throughout the life course that could be associated with footprints as illustrated below. Adverse eff ects during pregnancy of smoking, alcohol, and many drug exposures (eg, sodium valproate) are widely recognised. More diffi cult to establish are eff ects of stress arising from adverse environments of the mother, although emerging evidence suggests that chronic exposure to stress hormones can have a lifelong detrimental eff ect on off spring. Maternal perinatal mental illness can aff ect a child’s cognitive development. The increasing focus on epigenetic eff ects also suggests that ancestral environment can aff ect the health of off spring, and although studies have focused on cardiovascular and metabolic disease, both secondary and primary eff ects on cognition might be anticipated. Links between education and cognition are bidirectional: educational attainment is partly determined by prior cognitive ability, but receipt of education (both quality and duration) also aff ects subsequent cognitive development, even after adjustment for earlier cognition, sex, and parental socioeconomic position. Those eff ects have a long reach: raising of the school-leaving age in England and Wales in 1947 has been associated with improved cognitive performance in old age. Educational investment can thus reduce a negative subsequent cognitive footprint. Many infectious diseases result in permanent cognitive defi cits and many are associated with poor cognitive function. The cognitive footprint will be greater with childhood diseases because of the potential lifelong eff ect. Neurocysticercosis is endemic in Latin America and southeast Asia, and is associated with poor sanitation. It is listed as a neglected tropical disease by WHO, which in July, 2014, ranked Taenia solium top of the list of leading food-borne parasites “with greatest global impact”. Neurocysticercosis is a leading cause of epilepsy worldwide, which in itself can have secondary eff ects on cognition. Active neurocysticercosis is associated with cognitive impairment; thus childhood exposure to T solium can have a major negative cognitive footprint over an individual’s lifetime and partly negate educational investments in developing countries. Exercise has well known short-term and long-term positive benefi ts on cognition as well as other protective eff ects on health. But a lot of attention is now also being focused by some sports governing bodies on head injuries and their consequences. Many sports (particularly contact sports such as boxing, football, and rugby) carry risks of long-term cognitive damage. A major US review of youth sports reported higher rates of concussion and Lancet 2015; 386: 1008–10" @default.
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• W1861036592 title "Can we model a cognitive footprint of interventions and policies to help to meet the global challenge of dementia?" @default.
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• W1861036592 doi "https://doi.org/10.1016/s0140-6736(15)60248-3" @default.
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