Report: 35% of worldwide dementia cases could be prevented by modifying these 9 modifiable risk factors

by

The Lancet Com­mis­sion: One Third of Demen­tia May Be Pre­ventable (Lancet report release):

“Today’s find­ings are extreme­ly hope­ful,” said Maria Car­ril­lo, PhD, chief sci­ence offi­cer at the Alzheimer’s Asso­ci­a­tion. “At an indi­vid­ual lev­el, many peo­ple have the poten­tial to reduce their risk of cog­ni­tive decline, and per­haps demen­tia, through sim­ple, health­ful behav­ior changes. At a pub­lic health lev­el, inter­ven­tions based on this evi­dence could be extreme­ly pow­er­ful in man­ag­ing the glob­al human and eco­nom­ic costs of Alzheimer’s dis­ease and oth­er dementias.”

…The Lancet Com­mis­sion brings togeth­er 24 inter­na­tion­al experts to con­sol­i­date the huge strides that have been made in our knowl­edge and under­stand­ing of demen­tia risk fac­tors, treat­ment and care, and the emerg­ing knowl­edge as to what we should do to pre­vent and man­age demen­tia. The Com­mis­sion con­duct­ed a new review and meta-analy­sis; based on which they extend­ed cur­rent mod­els of risk by includ­ing hear­ing loss and social iso­la­tion. Incor­po­rat­ing poten­tial­ly mod­i­fi­able risk fac­tors from across the life-span, they pro­posed a nov­el life-course mod­el of risk, high­light­ing the oppor­tu­ni­ty for prevention.

Among their key rec­om­men­da­tions are:

  • Be ambi­tious about pre­ven­tion. Inter­ven­tions for estab­lished risk fac­tors may have the poten­tial to delay or pre­vent one third of dementias.
  • Treat cog­ni­tive symp­toms. To max­i­mize cog­ni­tion, peo­ple with Alzheimer’s demen­tia or demen­tia with Lewy bod­ies should be offered cholinesterase inhibitors at all stages, or meman­tine for severe dementia.
  • Indi­vid­u­al­ize demen­tia care. Good demen­tia care spans med­ical, social and sup­port­ive care; and should be tai­lored to unique indi­vid­ual and cul­tur­al needs, pref­er­ences, and priorities.
  • Care for fam­i­ly car­ers. Fam­i­ly car­ers are at high risk of depres­sion. Effec­tive inter­ven­tions reduce the risk and treat the symp­toms, and should be made available.
  • Plan for the future. Peo­ple with demen­tia and their fam­i­lies val­ue dis­cus­sions about the future and impor­tant upcom­ing decisions.
  • Man­age neu­ropsy­chi­atric symp­toms. Man­age­ment of the neu­ropsy­chi­atric symp­toms of demen­tia — includ­ing agi­ta­tion, low mood or psy­chosis — is usu­al­ly psy­cho­log­i­cal, social, and envi­ron­men­tal, with drug treat­ment reserved for more severe symptoms.
  • Con­sid­er end of life. A third of old­er peo­ple die with demen­tia, so it is essen­tial that pro­fes­sion­als work­ing in end-of-life care con­sid­er whether a patient has demen­tia as they may be unable to make deci­sions about their care or express their needs and wishes.

The Lancet Com­mis­sion launched a nov­el life-span-based mod­el of demen­tia risk, show­ing inter­ven­tions that may max­i­mize cog­ni­tion, decrease dis­tress­ing asso­ci­at­ed symp­toms, reduce crises, and improve qual­i­ty of life. The team esti­mate the con­tri­bu­tion of each of the risk fac­tors to the over­all inci­dence of demen­tia, at the pop­u­la­tion lev­el. The com­bined evi­dence to date shows that rough­ly 35 per­cent of all cas­es of demen­tia are attrib­ut­able to nine poten­tial­ly mod­i­fi­able risk fac­tors. Many of the risk fac­tors occur at par­tic­u­lar life stages but some, such as smok­ing and hyper­ten­sion, are like­ly to make a dif­fer­ence at all life stages.

The nine mod­i­fi­able risk fac­tors include:

  • Ear­ly life — Edu­ca­tion to a max­i­mum of age 15
  • Mid-life — Hyper­ten­sion; Obe­si­ty; Hear­ing loss
  • Lat­er life — Depres­sion; Dia­betes; Phys­i­cal inac­tiv­i­ty; Smok­ing; Low social contact

Accord­ing to the Com­mis­sion’s report, world­wide demen­tia preva­lence could be reduced by more than 1 mil­lion cas­es with a 10 per­cent reduc­tion in the preva­lence of sev­en prin­ci­pal health and lifestyle fac­tors. An inter­ven­tion that delayed demen­tia by a year might decrease the num­ber of peo­ple liv­ing with demen­tia glob­al­ly by 9 mil­lion in 2050.

The Study

Demen­tia pre­ven­tion, inter­ven­tion, and care (The Lancet)

  • Exec­u­tive Sum­ma­ry: Demen­tia is the great­est glob­al chal­lenge for health and social care in the 21st cen­tu­ry: around 50 mil­lion peo­ple world­wide have demen­tia and this num­ber is pre­dict­ed to triple by 2050. The Lancet Com­mis­sion on demen­tia aims to review the best avail­able evi­dence and pro­duce rec­om­men­da­tions on how to best man­age, or even pre­vent, the demen­tia epi­dem­ic. Demen­tia is not an inevitable con­se­quence of age­ing and the Com­mis­sion iden­ti­fies nine poten­tial­ly mod­i­fi­able health and lifestyle fac­tors from dif­fer­ent phas­es of life that, if elim­i­nat­ed, might pre­vent demen­tia. Although ther­a­pies are cur­rent­ly not avail­able to mod­i­fy the under­ly­ing dis­ease process, the Com­mis­sion out­lines phar­ma­co­log­i­cal and social inter­ven­tions that are able to help man­age the man­i­fes­ta­tions of dementia.

The Study in Context