WHO on Preventing Dementia

and a famous patient.

These posts examine modern psychiatry from a critical point of view. Unfortunately, mainstream psychiatrists usually react badly to any sort of critical analysis of their activities, labelling critics as “anti-psychiatry,” whatever that is. Regardless, criticism is an integral part of any scientific field and psychiatry is no different. As it emerges, there is a lot to be critical about.

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Another week, another lengthy report, this time from World Health on dementia [1]. Sure, there are plenty of people who would say this is neurology or geriatrics and not actually psychiatry but there’s a big overlap. This is not a report on how common it is, who should manage it or drugs and so on but the rather unusual topic of preventing dementia. That’s a bit unexpected because we tend to think of dementia as both unpredictable and inevitable: we have no idea who it will affect but once it’s started, there’s only one possible outcome. After careful consideration, they say that 45% of the burden of dementia can be prevented by dealing with contributing factors.

The first point to note about this report is that it is the product of many thousands of hours of consultations and research by hundreds of people from a hundred countries around the world. The chances of it being biased by a small group of fanatical people or by private companies or an individual country or doctrine are about zero. Moreover, they did most of it without American money since DJT withdrew the US from WHO because, he said, they were too much influenced by China, it was too expensive and they mishandled the pandemic. He didn’t mishandle the pandemic, of course.

Moving on, despite major research programs, classic dementias like Alzheimer’s Disease or Pick’s Disease (now called fronto-temporal dementia) remain mysteries, so that specific treatment of the disease process is not available. However, there are dozens of other factors that add to the risk and contribute to the progress of the disorder, many of which can be modified. This is important because with ageing populations in so many countries, health services could be overwhelmed by the rapidly rising numbers of impaired old people. The report gives lists of conditions and lifestyle choices that add to the individual’s risk of developing dementia. By implementing these, they suggest it should be possible to delay the onset of dementia and reduce its total incidence by 45%, which adds up to a very significant impact. The bad news is that preventative programs should start early and generally involve sweating while giving up all the fun things.

Research over many years in hundreds of places shows that it’s never too late for lifestyle interventions: eat, drink and be merry because tomorrow, you can sweat it off, but for best results, start young. A healthy, balanced diet is essential, meaning high fibre with low levels of processed food, red meat, saturated fats, salt, sugar. Instead, we need to move to one of the low-carb diets, of which there are many. One from Australia’s CSIRO is popular here, but diabetic groups are also strong on diet. These are not difficult diets to follow, it just involves shopping in a different aisle with weekly trips to the fish market. Regular steady exercise should be part of everybody’s life from puberty at the latest; if there isn’t time, make it because it’s far better to lose a few hours work and TV time now in order to keep out of the dementia wing later. Keep your brain active with reading, puzzles and any sort of intellectual challenge but balance it with a social life. Mixing with people is important but, to my surprise, this report says nothing about the very real value of mixing with animals. Most of the research has been done on pets and “companion animals” but also being involved in studying wild animals, even just the birds in your suburb, is valuable.

Major lifestyle choices include reducing alcohol to safe levels, avoiding tobacco and illegal drugs altogether, and keeping to a healthy weight. Obesity is a significant risk factor for dementia, along with each of its complications: hypertension, diabetes, high blood lipids, poor sleep, respiratory problems and so on. One factor that doesn’t get much attention is the cumulative effect of minor head injuries, now called traumatic brain injury (TBI). Boxing has long been recognised as a cause of early dementia (“punch drunk”) but there are lots of other lifestyles that do it. I don’t know of any research but riding motocross bikes, horse-riding at the rough end of the scale, anything that results in repeated blows to the head, needs to be considered. However, the biggest cause of TBI today is one that nobody wants to deal with: wars. Most of the US troops evacuated from the fighting in the Middle East have a diagnosis of TBI, caused by the concussion of the massive explosions of missiles. We presume the children of Gaza who are regularly exposed to the blasts of 2000lb bombs will also be affected, and their parents, of course. Air pollution is another very avoidable risk factor but governments will rarely do anything about it if it involves spending money to improve the lives of poor people.

Anybody in the health sector who deals with adults needs to be very aware of early dementia as it sneaks up and presents in some strange ways. If there was the slightest doubt in any patient, I got them to complete a brief cognitive test. I don’t mean the mini-mental state examination, that was too crude and didn’t pick up the subtle changes. If screening showed anything, they were referred to a psychologist for assessment before a scan, just because psychometry is more sensitive than scans.

All this is important and needs to be ingrained in people early in life but it doesn’t have to cost a lot. As an example, the Men’s Shed movement, which started in South Australia about 30years ago, is an outstanding success. It’s a charitable movement that provides a venue for retired men to keep their minds and hands busy working in groups of the same vintage. Mostly, they use donated facilities such as an empty shed on an industrial property, stocked with equipment companies no longer need or the members provide themselves. There are about 1,300 sheds serving 50,000 people in this country, and probably the same number in a dozen countries overseas. It provides occupation and socialisation: one of their mottoes is: “Women like to talk face to face but men like to talk shoulder to shoulder.” That’s true. They are locally-managed – some actually have women members – and largely self-sufficient. According to their website, they get about $24million in government subsidies a year. If it delays the onset of dementia in just 10% of their members for even a couple of years, that’s an enormous saving, not to mention making life easier for the sufferers and families.

Unfortunately, this sort of simple, community-based measure won’t get anything like the money that will be spent on research on drugs, but they are also easily captured by commercial interests. Australia privatised the health services sector on the basis that private enterprise is always more efficient than public, but costs have gone through the roof while standards have dropped. Mr Smith had been on disability pension for 20 yrs when he decided he would like a small dog. He mentioned this to his “service providers” who promptly arranged for him to see a psychologist to assess his “need for a companion animal.” This could only be done by a particular psychologist on Saturday morning about 20km across the city. He didn’t own a car so the social worker drove him to the appointment, waited and then drove him home. She didn’t meet the psychologist. Total cost for the morning: about $2000 but when he learned he would have to go to special training for the dog, he pulled out. I told him to go to the local RSPCA and tell them what he wanted, they would find him a suitable dog. However, because it wasn’t an “approved dog,” he wasn’t eligible for a food subsidy or vet fees. Approved dogs, if you’re interested, cost about $8000 each, which is easy money for dog trainers.

At 54, with numerous painful physical problems and mental trouble, Mr Jones was not in a good way. He had no living relatives and practically no social life, so he decided a dog would a good idea. When he heard what the training involved, he withdrew his application but was offered a course with horses. It didn’t involve riding or heavy lifting, so he agreed. For five days, he stayed at an expensive resort and spent the days with two staff and two other men, grooming, walking and feeding horses. That was it, about $4000 and he didn’t get to keep the horse.

And so to the world’s most famous dementia patient. Before you read on, look at this link to understand why this is important. I’ve been saying for at least six years that Trump is dementing but he started from such a low base that it misleads people (here’s a report from March 2024). Disinhibition and loss of social awareness and sensitivity and are among the first signs but these are quite subtle. Sometimes only the family realise that dad isn’t quite his normal self, or granny is getting a bit silly in her old age. The personality becomes, less refined, less aware of the consequences of actions, especially their own. In Trump’s case, he has only ever had the social awareness, sensitivity and inhibitions of an old bull in mating season. He has only had three ambitions in life: money, sex and revenge. The first two drives were designed to conceal his total lack of self-esteem while the last has come to the fore as he has gained power.

Another important early sign is that the person makes more and more mistakes. To start with, they recognise them and can correct them, then they recognise them but can’t correct them, then they don’t recognise them. Just recently, in an interview, Trump referred to the “Islamic republic of Japan.” He didn’t recognise it and just carried on carrying on. Rambling, turgid and over-inclusive speech, only tangentially related to the topic is a give-away, as in all his speeches. His talk always goes back to himself, which is a personality factor but much worse now. He recently talked for two hours in front of a military audience; by the end, they were laughing at him (short version, 75mins here). At the FIFA grand final, he had to be led away so they could take photos of the team (who mocked his silly little wooden “dance”). It’s all about ME, it’s always been all about ME but now it’s worse: “I think I’ll wipe out Iran’s civilisation tonight, or maybe not, we’ll see how I feel.”

As for the sex, he’s too old and too fat. A late night and a hard woman would kill him but, as everybody knows, testosterone is the gift that keeps on giving. Long after the hardware has given up the ghost (due to insensitivity of the pelvic nerves), a surge of testosterone still produces the little thrills that are so exciting, except the only way to get them is by dominating people. So that’s what he does. He orders the military to snatch a head of state which, by some bizarre subterfuge, they manage so Trump waddles around for weeks telling everybody how “We got ‘im, we showed ‘em who’s boss around here.” Every speech is a festering mass of threats, demands, whines and more threats because this produces a buzz. However, due to his accelerating lack of self-awareness (again, from an exceedingly low start), he doesn’t realise he’s making a fool of himself. All he knows is “Hey, threatening to bomb people feels good, I think I’ll do it again, and then I’ll threaten the people who say I shouldn’t threaten people.”

As for the money, the book Regime Change: Trump’s imperial presidency is more or less a catalogue of graft and corruption. There just is no end to it. He’s like grandpa who keeps going back for the icecream even though it’s bad for his diabetes, then lies about it. Any inhibitions on greed have long since dissolved but he is completely surrounded by the most appalling bunch of slime and grubs since the Borgia popes who are only there for what they can get. Finally, the revenge. For Trump, the greatest crime anybody can commit is to make him look like an ignorant, dim-witted and uneducated petty crook from Queens who doesn’t know which fork to use and would grope the waitress as she’s trying to serve. Which, of course, is what he is. His only goal in getting a second run at the job was to get even with everybody, in which he is aided and abetted by a very capable crew of seriously paranoid and seriously corrupt operators, as the book shows in repellant detail.

Now, of course, he’s in serious trouble. First day of reckoning is the brutal and absurd attacks on Iran urged on him by the equally dishonest but far smarter and more devious Benny Meliekowsky, aka Netanyahu, meaning “god has given” (presumable Ares, the Greek god of war, violence and chaos). This self-imposed disaster will keep generations of scholars busy as they untangle all the lies and deceit that have led the world to the edge of a dozen cliffs. Trump got himself into this mess but has no idea how to get out of it, he simply doesn’t have the brain power. In the past, as a personality factor, he would simply walk away from his many messes, blaming other people but this time, he can’t. He’s it, he’s the one in the big room with the gold gewgaws everywhere and the big desk, and sitting in the middle of the desk is a gold plate with a huge turd sandwich called “Surrender and pay reparations,” but he is simply incapable of admitting he is wrong, he would rather incinerate the world than do that. Second wall coming at high speed is the mid-term elections in November. If Trump loses the Senate, he’s going to prison for a very long time, and his ghastly children and all the parasites will be down the corridor from him.

We certainly live in troubled times. There have been demented kings in the past and quite a few dictators who were losing their grey matter but I don’t think there has ever been a elected head of state who was clearly losing his marbles before the election. Because people live longer these days, we’re approaching the point where elderly candidates for high office should be compelled to undergo proper psychometry and scans if necessary, with the results reviewed independently. Or all candidates, I don’t mind. Personality assessment would be valuable but, unlike formal cognitive testing (say WAIS-R or similar), which can’t be cheated, clever scoundrels can lie their way through personality profiles (faking good, as they call it). For example, former premier of NSW, Gladys Berejiklian, was widely thought to be very decent but it turned out she was corrupt. I’d say hers was the corruption of stupidity rather than cupidity but the end result is the same.

Dementia is real and coming to your street. Start now to head it off: cut out the booze and smokes, the coke and burgers, exercise regularly, lose weight, join some clubs, do the crosswords and sudoku, early to bed and early to rise, blah blah. Oh, and there is no evidence depression causes dementia [1, p68], which is not what psychiatrists tell tribunals when they want an order for involuntary ECT.

1. Risk Reduction of Cognitive Decline and Dementia. WHO guidelines, 2^nd edition. Geneva: World Health Organization; 2026. Licence: CC BY-NC-SA 3.0 IGO. At: https://www.who.int/publications/i/item/9789240123557

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My critical works are best approached in this order:

The case against mainstream psychiatry:

McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. Amazon (this also covers a range of modern philosophers, showing that their work cannot be extended to account for mental disorder).

Development and justification of the biocognitive model:

McLaren N (2021): Natural Dualism and Mental Disorder: The biocognitive model for psychiatry. London, Routledge. At Amazon.

Clinical application of the biocognitive model:

McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

Testing the biocognitive model in an unrelated field:

McLaren N (2023): Narcisso-Fascism: The psychopathology of right wing extremism. Ann Arbor, MI: Future Psychiatry Press. At Amazon.

The whole of this work is copyright but may be copied or retransmitted provided the author is acknowledged.