Paul Gavan (Sinn Fein) | Oireachtas source

It is good to see the Minister of State. She is always welcome. I will begin by acknowledging the good work she has done in this area.

According to the Alzheimer Society of Ireland, there are more than 64,000 people living with dementia in Ireland. The estimate is that 141,000 people will be living with dementia by 2050. These are stark figures. Research tells us that not all dementia can be prevented, and while not all the research and evidence is exactly clear on what dementia prevention works, many evidence reviews provide useful guidance and have identified important factors that, if addressed, could modify dementia risk by up to 40%. These include health behaviour factors, cardiovascular factors, psychosocial factors and developmental factors. Some of these are common health problems that we are familiar with, for example, hypertension, hearing impairment, obesity, depression and diabetes. There are also lifestyle and socio-economic factors such as lower levels of education in early life, social contact in later life, smoking and excessive alcohol consumption. In particular, lack of physical activity can, if addressed, improve brain health as well as helping with cardiovascular health, mental health and mobility in later years. We know that if we are to modify dementia risk, addressing these factors needs to start in middle-aged people, not among older people. Most of these risk factors are preventable and treatable with a healthy lifestyle and proper access to healthcare. The first point that springs to my mind is the relationship between some of these risk factors and poverty and access to health care.

I wish to speak about intellectual disability as a particular risk factor. Professor Mary McCarron, who spoke at the all-party Oireachtas group briefing yesterday, highlighted that, for people with intellectual disabilities, the risk of developing dementia was five times greater than for their peers in the general population. Many people with Down's syndrome have the hallmarks of Alzheimer's disease by 40 years of age and have an 88% risk of developing the clinical symptoms of dementia by age 65. As such, the promotion of brain health and the diagnosis of disease must begin at early ages.

Toxic proteins that cause Alzheimer's disease build and accumulate up to 15 to 25 years before clinical symptoms present, but cognitive reserve education, exercise, cognitive stimulation and social engagement at any age will help to slow or counteract these changes. It is possible to reduce the risk of dementia.

Actions to promote brain health in people with intellectual disabilities is needed now and at all ages. I acknowledge the Minister of State's work, particularly her support for the development of the national intellectual disability memory service for people with intellectual disabilities. Further memory support services are needed throughout Ireland and I hope she will provide more services and funding to address the particular risk of dementia for people with intellectual disabilities, who have an increased risk of developing dementia.

Awareness is important in dementia prevention. I acknowledge the work of the Understand Together campaign, the Alzheimer Society of Ireland and the all-party Oireachtas group on dementia. However, it is important that Government policy does not just talk about brain health and dementia prevention, but also actively seeks to improve our health system to support those prevention measures.

Severe brain injury is a risk factor for dementia. Recently, my Sinn Féin colleague, an Teachta Dála Cullinane, highlighted the lack of neurology nurses. By the HSE's own reckoning, we only have approximately 30% of the specialist neurology nurses that we need, which is making their job difficult. We need 100 more. University Hospital Limerick is the mid-west regional centre for neurology but it is short on neurology nurse specialists. Patients are unnecessarily waiting longer for diagnoses and treatment. Based on the catchment area, national and international guidelines recommend that there should be 11 neurology nurse specialists, but there are only three. Patients deserve better and I hope that we will hear a positive response in terms of how this issue is being addressed locally in Limerick and nationally.

There are many problems in our health service that will hinder the prevention of dementia. There is a large gap in the provision of mental health services across the country, shockingly long waiting lists for outpatient hospital appointments and GP shortages. None of this is helpful when we are talking about addressing risk factors for dementia or minding our brain health.

During the pandemic, day care centres for people with dementia were closed. This put considerable pressure on carers, with many telling us that they were at breaking point. Most of the centres have reopened, but I hope that more will be done to increase the number of day care centres and services in the community. They are important not only to people with dementia, but to their families and carers, who need this support. The work of carers was highlighted over the past couple of tough years and we need to do better for them.

Preventing dementia means promoting brain health and preventing common risk factors. It also means tackling the wider issues of poverty and the healthcare crisis. Awareness of the risk factors can be helpful in the first instance and I do not want to take away from the good work that has been done, but there is clearly much more to do.