According to research updating The Lancet Commission on Dementia Prevention, Intervention, and Care led by the University College London (UCL), 40% of dementia cases could have been delayed or prevented by modifying 12 risk factors from childhood to late life.
New risk factors
The study also adds head injury, harmful alcohol intake during midlife, and exposure to air pollution in later life to the list of preventable causes of dementia. These three new risk factors combined are associated with 6% of all dementia cases. Individually, it is estimated that head injuries in mid-life contribute to 3% of cases, excessive alcohol intake contributes to 1% of cases, and exposure to air pollution contributes to 2% of cases.
Greatest preventable risk factors
The remaining risk factors are associated with 34% of all dementia cases. The factors that are associated with the greatest proportion of dementia cases in the population are: less education in early life contributing to 7% of cases, hearing loss in mid-life contributing to 8%, and smoking in later life contributing to 5% of all dementia cases.
Calling for more proactive action to prevent dementia
The report was led by 28 leading dementia experts and builds on the 9 risk factors identified by the 2017 Lancet Commission, and calls for nations and individuals to be more proactive about taking steps to prevent dementia. It also lays out the groundwork to set up policies and lifestyle changes to help prevent the brain-wasting disease.
“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 make an impact at each stage of a person’s life,” says lead author Professor Gill Livingston (UCL Psychiatry and Camden & Islington NHS Foundation Trust). “Interventions are likely to have the biggest impact on those who are disproportionately affected by dementia risk factors, like those in low- and middle-income countries and vulnerable populations, including Black, Asian and minority ethnic communities.”
“As societies, we need to think beyond promoting good health to prevent dementia, and begin tackling inequalities to improve the circumstances in which people live their lives. We can reduce risks by creating active and healthy environments for communities, where physical activity is the norm, better diet is accessible for all, and exposure to excessive alcohol is minimised.” said Professor Livingston.
Numbers are expected to increase
Around the World some 50 million people are living with dementia, for which there is no cure. This number is expected to reach 152 million by 2050 and affect individuals, their families, and the economy, with global costs estimated to be upwards of $1 trillion annually.
The proportion of older people with dementia has decreased, which is probably due to improvements in nutrition, education, lifestyle changes, and healthcare which demonstrate that there is the possibility to reduce dementia with proactive preventative measures. To help reduce the risk of dementia the study authors call for 9 recommendations to be undertaken by individuals and policymakers:
- Maintain a systolic blood pressure of 130 mm Hg or less in midlife from around age 40 years.
- Encourage the use of hearing aids for those who need them, and reduce hearing loss by protecting ears from high noise levels.
- Reduce exposure to air pollution and second-hand tobacco smoke.
- Prevent head injury (particularly by targeting high-risk occupations and transport)
- Prevent alcohol misuse and limit drinking to less than 21 units per week.
- Stop smoking uptake and support individuals to stop smoking (which is beneficial at any age).
- Provide all children with primary and secondary education.
- Lead an active life into mid, and possibly later life.
- Reduce obesity and diabetes.
Increasing life expectancy contributing to global numbers
These actions are becoming especially relevant to low and middle-income countries where the rates of dementia are increasing rapidly with around two-thirds of the population living with dementia. This is due to their increasing life expectancy and higher frequency of risk factors such as lower education, higher rates of hypertension, obesity, hearing loss, and diabetes.
Numbers could be much lower
“Based on our modelling, we expect that even more cases of dementia could be prevented in low- and middle-income countries, compared to wealthier countries, due to the higher prevalence of the risk factors we have identified. We had previously estimated that nine factors contribute to 35% of dementia cases worldwide, but that figure rises to 40% in China, 41% in India and 56% in Latin America,” said co-author Dr Naaheed Mukadam (UCL Psychiatry and Camden & Islington NHS Foundation Trust).
“Supporting the physical health of people with dementia is important for their cognition, but also because they may struggle manage other illnesses, which can lead to preventable and potentially harmful hospitalisations,” said co-author Dr. Andrew Sommerlad (UCL Psychiatry and Camden & Islington NHS Foundation Trust).
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References/Sources/Materials provided by:
https://www.ucl.ac.uk/psychiatry
https://www.ucl.ac.uk/news/2020/jul/four-10-dementia-cases-could-be-prevented-or-delayed
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30367-6/fulltext
https://worldhealth.net/news/mediterranean-diet-could-help-reduce-risk-dementia/
https://worldhealth.net/news/digital-check-tool-could-help-reduce-risk-dementia
