Nearly half of dementia cases could be prevented or delayed by tackling 14 modifiable risk factors starting in childhood, as highlighted in the third Lancet Commission on dementia prevention, intervention, and care. The report, presented at the Alzheimer’s Association International Conference, emphasizes that addressing these risk factors could significantly impact the global dementia landscape.
NEW RISK FACTORS ADDED TO DEMENTIA PREVENTION
The latest report introduces two new risk factors—high cholesterol and vision loss—which contribute to 9% of all dementia cases. High low-density lipoprotein (LDL) cholesterol in midlife accounts for an estimated 7% of cases, while untreated vision loss in later life contributes 2%.
These new factors are in addition to 12 previously identified risk factors by the Lancet Commission in 2020, which include:
- Lower levels of education
- Hearing impairment
- High blood pressure
- Smoking
- Obesity
- Depression
- Physical inactivity
- Diabetes
- Excessive alcohol consumption
- Traumatic brain injury (TBI)
- Air pollution
- Social isolation
IMPACT OF ADDRESSING RISK FACTORS
The Commission estimates that hearing impairment and high LDL cholesterol are each associated with 7% of dementia cases globally. Early life education and social isolation in later life are linked to 5% of cases each. The report calls for governments and individuals to adopt ambitious strategies to tackle these risks throughout life.
RECOMMENDATIONS FOR DEMENTIA RISK REDUCTION
The report outlines 13 recommendations for reducing dementia risk, including:
- Providing quality education for all children and promoting cognitive activity in midlife.
- Making hearing aids accessible for those with hearing loss and reducing harmful noise exposure.
- Detecting and treating high LDL cholesterol from around age 40.
- Ensuring accessible screening and treatment for vision impairment.
- Treating depression effectively.
- Encouraging helmet use in contact sports and on bikes.
- Promoting supportive community environments to increase social contact.
- Implementing strict clean air policies to reduce exposure to air pollution.
- Expanding measures to reduce smoking, such as price control and smoking bans.
- Reducing sugar and salt content in food sold in stores and restaurants.
GLOBAL CHALLENGE AND POTENTIAL BENEFITS
With the aging global population, the number of people living with dementia is expected to almost triple by 2050, rising from 57 million in 2019 to 153 million. Dementia-related health and social costs are estimated at over $1 trillion annually. Despite this, high-income countries like the USA and UK have seen a decline in dementia prevalence among older adults, partly due to improved healthcare and lifestyle changes.
ADDRESSING INEQUITIES IN DEMENTIA PREVENTION
The report emphasizes the need for inclusive dementia prevention strategies that address diversity, equity, and inclusion. Many national dementia plans lack specific recommendations for underserved cultures and ethnicities disproportionately affected by dementia risks.
ECONOMIC IMPACT OF PREVENTATIVE MEASURES
A separate study in The Lancet Healthy Longevity journal models the economic impact of implementing dementia prevention recommendations in England. The findings suggest that addressing risk factors such as excess alcohol use, brain injury, air pollution, smoking, obesity, and high blood pressure could save over £4 billion and yield more than 70,000 quality-adjusted life-year (QALY) gains.
ADVANCES IN DEMENTIA RESEARCH AND SUPPORT
The report also highlights promising advances in blood biomarkers and Anti-amyloid β antibodies for Alzheimer’s disease. However, the authors call for more research and transparency regarding the long-term effects of these treatments.
SUPPORT FOR PEOPLE LIVING WITH DEMENTIA
The report calls for increased support for people living with dementia and their families. Effective interventions, such as activity programs and cholinesterase inhibitors, are still not widely available in many countries. Providing multi-component coping interventions for family caregivers is also recommended.
The third Lancet Commission on dementia prevention underscores the importance of addressing modifiable risk factors from childhood to reduce the global burden of dementia. By implementing comprehensive prevention strategies and supporting those affected by dementia, societies can improve quality of life and achieve significant economic savings.
