Forty percent of dementia cases could be prevented or delayed by attacking 12 risk factors throughout life

Modifying 12 risk factors during the life cycle could delay or prevent 40% of dementia cases, according to an update from The lancet Commission for the prevention, intervention and care of dementia, to be presented at the Alzheimer Association Association International Conference (AAIC 2020).

Combined, the three new risk factors are associated with 6% of all dementia cases, with an estimated 3% of cases attributable to mid-life head injury, 1% of cases at Excessive alcohol consumption (over 21 units per week) in mid-life, and 2% from exposure to air pollution in adulthood.

The remaining risk factors are associated with 34% of all dementia cases. Factors associated with the highest proportion of dementia cases in the population are less education in early life, hearing loss in mid-life, and smoking in adulthood (7%, 8%, and 5%, respectively).

Led by 28 global experts on dementia, the report is based on the 9 risk factors identified in the 2017 Lancet Commission, and provides an updated analysis of the best evidence on dementia prevention. The new report calls for nations and individuals to be ambitious about dementia prevention and sets out a set of policies and lifestyle changes to help prevent dementia.

Worldwide, around 50 million people live with dementia, and this number is projected to increase to 152 million by 2050, increasing particularly in low- and middle-income countries (LMICs) where around two-thirds of people live. with dementia. Dementia affects people, their families, and the economy, with global costs estimated at approximately $ 1 trillion annually.

However, in certain countries, the proportion of older people with dementia has decreased, likely due to improvements in education, nutrition, health care, and lifestyle changes, demonstrating the possibility of reducing dementia through measures preventive.

“Our report shows that it is within the power of policy makers and individuals to prevent and delay a significant proportion of dementia, with opportunities to impact every stage of a person’s life,” says lead author, The Professor Gill Livingston, University College London, UK. “Interventions are likely to have the greatest impact on those who are disproportionately affected by dementia risk factors, such as those in low- and middle-income countries and vulnerable populations, including black, Asian and minority ethnic communities” .

Professor Livingston continues: “As societies, we must think beyond promoting good health to prevent dementia and begin to address inequalities to improve the circumstances in which people live their lives. We can reduce risks by creating active and healthy environments for communities, where activity is the norm, a better diet is accessible to all and exposure to excess alcohol is minimized. “

To address the risk of dementia, the authors call for 9 ambitious recommendations to be made by policymakers and individuals:

• Try to maintain systolic blood pressure of 130 mm Hg or less in middle age from age 40.
• Encourage the use of hearing aids for hearing loss and reduce hearing loss by protecting your ears from high noise levels.
• Reduce exposure to air pollution and second-hand tobacco smoke.
• Prevent head injuries (particularly when targeting high-risk occupations and transportation)
• Avoid alcohol abuse and limit alcohol consumption to less than 21 units per week.
• Quit smoking and support people to quit smoking (which, according to the authors, is beneficial at any age).
• Provide all children with primary and secondary education.
• Live an active life in the middle and possibly later.
• Reduces obesity and diabetes.

These actions are especially important in LMICs where dementia rates are increasing faster than in high-income countries. This is the result of increased life expectancy and an increased frequency of certain dementia risk factors, such as lower education rates; high rates of hypertension, obesity and hearing loss, and rapidly growing diabetes rates.

Based on their previous model that includes 9 risk factors, the authors estimated that many more cases of dementia could be prevented in LMICs, compared to the world. Although globally it is estimated that the 9 risk factors contribute to 35% of all dementia cases, in China they could represent 40% of the cases, 41% in India and 56% in Latin America.

The authors caution that the estimates could be even higher, as they used conservative estimates for the prevalence of these risk factors in these populations, and because they do not account for the three new risk factors. The authors also note that almost all evidence for dementia comes from studies in high-income countries, so risks may differ for LMICs and interventions may require modifications to better support different cultures and settings.

The authors note that modeling for their prevention estimates globally and in LMICs assumes that there is a causal relationship between risk factors and dementia, but were careful to include only risk factors with strong evidence of a causal link.

Co-author of the report, Professor Adesola Ogunniyi, University of Ibadan, Nigeria, says: “In low- and middle-income countries, the higher prevalence of dementia risk factors means that an even higher proportion of dementia is potentially preventable than in the “highest income countries.” In this context, national policies that address dementia risk factors, such as primary and secondary education for all and smoking cessation, may have the potential for large reductions in dementia and should be prioritized. We also need more research on dementia from and middle-income countries, so that we can better understand the particular risks of these settings. “

In the final section of the report, the authors advocate evidence-based, individualized, holistic care that addresses physical and mental health, social care, and support that can meet complex needs. Keeping people with dementia physically healthy is important to their cognition, but they often have other illnesses that may have difficulty managing on their own, resulting in potentially harmful preventable hospitalizations.

They note that people with dementia are particularly at risk of contracting COVID-19 (due to age and having pre-existing conditions, such as hypertension), and that physical distance measures can be challenging for dementia patients, who may have difficulties in complying with the guidelines or distressing for not being able to have contact with caregivers and family members. The authors request that people with an unknown status of COVID-19 not be admitted to nursing homes to protect existing residents, periodic testing of staff, and symptomatic and symptomatic residents when exposed, do not transfer staff or residents between homes, and more research on how to protect dementia patients during the current pandemic and future public health emergencies.