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

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 lifeEdu­ca­tion to a max­i­mum of age 15
  • Mid-lifeHyper­ten­sion; Obe­si­ty; Hear­ing loss
  • Lat­er lifeDepres­sion; 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

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As seen in The New York Times, The Wall Street Journal, BBC News, CNN, Reuters,  SharpBrains is an independent market research firm tracking how brain science can improve our health and our lives.

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