Dementia experts say 40 per cent of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life
Worldwide, around 50 million people live with dementia, and this number is projected to increase to 152 million by 2050, rising particularly in low-income and middle-income countries. Dementia affects individuals, their families, and the economy, with global costs estimated at about US$1 trillion annually.
Now, a new report by 28 world-leading dementia experts reveals that 40 per cent of dementia cases could be prevented or delayed by targeting 12 ‘risk factors’ throughout life – from obesity and diabetes to primary and secondary education for all children.
Aimed largely at global policymakers, the Dementia prevention, intervention, and care: 2020 report of the Lancet Commission, co-funded by UKRI’s Economic and Social Research Council (ESRC), updates an earlier report from 2017, which identified nine risk factors, and adds three new avoidable causes: excessive alcohol intake and head injury in mid-life, and exposure to air pollution in later life.
Presented on 30 July, at the Alzheimer’s Association International Conference 2020, the report’s authors show that modifying the 12 risk factors over the life-course could delay or prevent 40 per cent of dementia cases. The potential to prevent cases of dementia is high, with the biggest impact likely to be seen in low- and middle-income countries where two-thirds of cases occur, most notably in China, India and Latin America.
Lead author, Professor Gill Livingston, from UCL (University College London), says: “Our report shows that it is within the power of policymakers 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.
“Interventions are likely to have the biggest impact on those who are disproportionately affected by dementia risk factors, like those in low-income 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.”
Report co-author, Professor Adesola Ogunniyi, from the University of Ibadan in Nigeria, says: “National policies in lower- to middle-income countries addressing dementia risk factors like primary and secondary education for all and stopping smoking policies might have the potential for large reductions in dementia and should be prioritised. We also need more dementia research coming from these countries, so we can better understand the risks particular to these settings.”
The report calls for nations and individuals to be ambitious about preventing dementia and lays out a set of recommended policies and lifestyle changes. These are based around nine recommendations:
- Aim to maintain systolic blood pressure of 130 mm Hg or less in midlife from around age 40 years
- Encourage use of hearing aids for hearing loss 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 the authors stress 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
In the final section of the report, the authors advocate holistic individual care packages that address physical and mental health, social care, and support that can accommodate complex needs.
The authors note that people with dementia are particularly at risk from COVID-19, and that physical-distancing measures can be challenging for them. They also call for people with unknown COVID-19 status to not be admitted to care homes, which would help to protect existing residents, and also call for more research into how to protect dementia patients during the current pandemic and future public health emergencies.
This Commission was partnered by UCL, the Alzheimer’s Society UK, the Economic and Social Research Council and Alzheimer’s Research UK.
The Commission report is free to access, with free registration at TheLancet.com via the following URL: TheLancet.com/commissions/dementia2020
Professor Gill Livingston: firstname.lastname@example.org,
Professor Adesola Ogunniyi: email@example.com