1. Brain health must be prioritised across the life course to reduce risk and promote healthy ageing.
Brain health is shaped across the lifespan by a combination of biological, medical, psychological, and social factors. Many contributors to dementia risk are modifiable, even in later life, meaning prevention and risk reduction should be integral to public health policy and clinical practice.1 A population-level commitment to brain health has the potential to reduce dementia incidence, support healthier ageing, and improve wellbeing across society, while ensuring people with dementia are not marginalised or blamed for their condition.2
A brain health approach must incorporate primary, secondary and tertiary prevention. This includes addressing risk factors such as cardiovascular disease, hypertension, diabetes, smoking, hearing loss, physical inactivity, social isolation, and poor mental health; identifying and treating risk factors early, especially in midlife, when intervention may have the greatest impact on cognitive outcomes; and slowing progression and maintaining function in people with cognitive impairment and dementia through rehabilitation, lifestyle interventions, and proactive clinical management.3
Prioritising brain health requires:
-
Public health messaging that is clear, evidence-based, and free from fatalism or individual blame.
-
Integration of brain health into routine clinical care, including long-term conditions management and healthy ageing pathways.
-
Investment in early intervention and community support to reduce avoidable decline, frailty, and crisis presentations.
-
Policies that tackle wider determinants such as education, socioeconomic inequality, and environmental exposures, which influence brain health decades before symptom onset.
2. Dementia is a complex neurological condition, not a normal part of ageing.
Dementia encompasses a range of progressive neurological conditions that affect cognition, behaviour, function, and physical health. It is not an inevitable consequence of ageing and should never be dismissed as “just old age”.4 A shift in language and attitudes is essential to improving both care quality and public understanding of dementia.
Recognising dementia as a complex neurological condition:
-
Emphasises the need for specialist clinical expertise, including clinicians from across the multiprofessional team with expertise in geriatric medicine, psychiatry, and neurology.
-
Supports earlier identification of reversible or modifiable contributors such as delirium, polypharmacy, sensory impairment, and comorbid illness.
-
Challenges stigma and ageist assumptions that lead to diagnostic delay, therapeutic nihilism, and dehumanising care.
-
Reinforces the importance of seeing the person beyond the diagnosis, with individual goals, strengths, and preferences.
3. Dementia care is a shared responsibility across health and social care.
High-quality dementia care cannot be delivered by any single profession or service. It requires shared ownership, leadership, and accountability across health and social care systems.5,6 Without shared responsibility, people with dementia are at high risk of fragmented care, repeated assessments, and avoidable deterioration.
Effective shared responsibility means:
-
Strong collaboration between primary care, specialist services, community teams, acute hospitals, social care, and the voluntary sector.
-
Clear roles for all healthcare professionals including geriatricians, GPs, nurses and AHPs in managing multimorbidity, frailty, and functional decline alongside dementia.
-
Integrated working that avoids artificial divides between mental and physical health.
-
Local leadership that prioritises dementia within system-wide planning, including workforce development and service design.
4. Timely and accurate diagnosis must lead to action.
Diagnosis should be timely, accurate, and meaningful, enabling people with dementia and their carers to understand what is happening and what support is available.7 Diagnosis should mark the start of a coordinated care journey, not the end of clinical involvement.
A high-quality diagnostic pathway:
-
Facilitates accurate diagnosis of the type of dementia wherever possible and offers targeted information about symptoms and progression.
-
Enables diagnosis to be made in the most appropriate setting for the individual patient, be that their own home, an outpatient clinic, or while an inpatient.
-
Recognises that delirium is a significant risk factor for dementia8 and facilitate assessment and review accordingly.
-
Provides clear communication, tailored to the individual and their family.
-
Avoids both late diagnosis (which limits planning and treatment) and tokenistic diagnosis that offers no follow-up support.
-
Connects people promptly to specialist advice, treatments where appropriate, and non-pharmacological interventions.
-
Enables future planning around health, care, finances, and legal matters.
5. Dementia demands through-life care which is centred around the person and the people who matter to them.
Dementia is a long-term, progressive condition that requires ongoing review and proactive support, rather than episodic or crisis-driven care. Person-centred care recognises that needs evolve over time9 and that continuity of support is critical to preventing crises and unnecessary hospital admissions.
Support should include:
-
Post-diagnostic support and education for people with dementia and carers.10
-
Involvement of family carers in decision-making and psychosocial support with adjusting and coping with changes.11,12
-
Regular, planned reviews to address changes in cognition, function, behaviour, physical health, and social needs.
-
Access to social care, rehabilitation, and community support to maintain independence and quality of life.
-
Proactive care planning, including advance care planning, introduced sensitively and early, and ensuring end-of-life care needs are met.13
6. Support must be available for people with cognitive concerns, with or without a formal diagnosis.
Many people experience changes in memory, cognition, or behaviour without immediately receiving a diagnosis of dementia. The Alzheimer’s Society estimate that between a third and half of people living with dementia do not have a formal diagnosis.14 Uncertainty, stigma, and service barriers can leave people without guidance or reassurance, despite significant need. Access to high-quality dementia care should not depend on postcode, age, ethnicity, socioeconomic status, or service configuration.15 Providing support before and beyond diagnosis reduces anxiety, improves confidence, and encourages help-seeking, while ensuring that no one is left “in limbo” without appropriate guidance.
Effective support for those with or without a diagnosis means:
-
Clear, accessible information about cognitive concerns and when to seek clinical assessment.
-
Compassionate communication.
-
Clinically informed signposting to community, social, and voluntary sector resources.
-
Recognition that people may remain undiagnosed for long periods, or may never meet diagnostic criteria.
-
Reducing unwarranted variation in access to diagnosis, specialist review, and post-diagnostic support.
-
Improving access for underserved groups, including people from minority ethnic communities and those living in deprived areas.
-
Designing services that are flexible, inclusive, and responsive to diverse needs across the life course.
7. Equitable opportunities for research and clinical trial participation must be expanded.
Research is essential to improving prevention, diagnosis, treatment, and care for people with dementia, yet opportunities to participate remain limited, unevenly distributed, and poorly integrated with routine services.16 Greater participation accelerates innovation and ensures that advances are relevant, equitable, and beneficial to the diverse population of older people affected by dementia.17
Expanding participation requires:
-
Embedding research access within diagnostic and post-diagnostic pathways.
-
Proactive outreach to older adults, under-represented communities and care home residents.
-
Clear communication about research options, benefits and risks at all stages of the dementia pathway.
-
Workforce capacity to identify and support suitable participants.
-
Ethical inclusion of people with cognitive impairment who may lack capacity, ensuring safeguards while avoiding exclusion.
8. Dementia care must meet the needs of older people, including those with complex needs.
Most people with dementia are older adults living with multimorbidity, frailty, sensory impairment, and functional change, yet service models are frequently inappropriate for this group.18,19
Age-attuned services involve:
-
Specialist expertise in multimorbidity, polypharmacy, delirium, falls, and functional decline.
-
Comprehensive assessment that integrates cognitive, physical, psychological, and social domains.
-
Dementia-friendly environments across hospitals, community services, and care homes.
-
Rehabilitation, reablement, and proactive management rather than crisis-driven care.
-
Collaboration between geriatric medicine, psychiatry, neurology, and primary care.
-
Support for carers and families as core partners in care.
