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One Third of Dementia May Be Preventable With Lifestyle Change
More than one third of global dementia cases may be preventable by addressing nine lifestyle factors that affect an individual’s risk, according to the findings of a new comprehensive report from The Lancet Commission on Dementia Prevention, Intervention, and Care.
The report, presented today at the Alzheimer’s Association International Conference (AAIC) 2017 and simultaneously published in The Lancet, was compiled by 24 international experts in the field of dementia who reviewed the available literature in the field and conducted a new meta-analysis that included some risk factors not considered in previous similar analyses.
They found that nine lifestyle factors are responsible for 35% of dementia burden. These factors include not completing secondary education in early life; hypertension; obesity and hearing loss in midlife; and smoking, depression, physical inactivity, social isolation, and diabetes in later life.
Alzheimer’s Association International Conference (AAIC) 2017. Abstracts 19550, 19551, 19552, and 19553. Presented July 20, 2017.
Lancet. Published online July 20, 2017. Abstract
10 Key Messages in the Report
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1. The number of people with dementia is increasing globally, although incidence in some countries has decreased.
2. Be ambitious about prevention. Recommendations include active treatment of hypertension; increasing childhood education, exercise, social engagement; reducing smoking and better management of hearing loss, depression, diabetes, and obesity.
3. Treat cognitive symptoms. To maximize cognition, people with Alzheimer’s disease or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia. Cholinesterase inhibitors are not effective in mild cognitive impairment.
4. Individualize dementia care. Good dementia care should be tailored to unique individual and cultural needs, preferences, and priorities and should incorporate support for family carers.
5. Care for family carers. Family carers are at high risk for depression. Effective interventions to reduce the risk for depression and treat the symptoms should be made available.
6. Plan for the future. People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis.
7. Protect people with dementia. These patients require protection from self-neglect, vulnerability (including to exploitation), managing money, driving, or using weapons. Risk assessment and management at all stages of the disease are essential but should be balanced against the person’s right to autonomy.
8. Manage neuropsychiatric symptoms, such as agitation, low mood, or psychosis. Treatment should usually be psychological, social, and environmental, with pharmacologic management reserved for individuals with more severe symptoms.
9. Consider end of life. One third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether patients have dementia — they might be unable to make decisions about their care and treatment or express their needs and wishes.
10. Technological interventions have the potential to improve care delivery but should not replace social contact.
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