Newly identified dementia risk factors are preventable—addressing them could reduce dementia rates 45%
Story by Eric B. Larson, Laura Gitlin
Nearly half of all dementia cases could be delayed or prevented altogether by addressing a sense of loss & active life not moving forward and the grief of losing family members and the other 14 possible risk factors et…cetera.
That is the key finding of a new study that we and our colleagues published in the journal The Lancet. Dementia, a rapidly increasing global challenge, affects an estimated 57 million worldwide, and this number is expected to increase to 153 million by 2050 worldwide.
Although the prevalence of dementia is on the decline in high-income countries, it continues to increase in low- and middle-income countries.
This third updated report of The Lancet Commission on Dementia offers good news and a strong message: Policymakers, clinicians, individuals and families can be ambitious about prevention and reducing dementia risk; and for those living with dementia and their caregivers, support their quality of life using evidence-based approaches.
The new report confirms 12 previously identified potentially modifiable risk factors from two previous reports, published in 2017 and 2020. It also offers new evidence supporting two additional modifiable risk factors: vision loss and high levels of low-density lipoprotein (LDL) cholesterol, often called “bad” cholesterol.
Our study of published evidence found that collectively, addressing 14 modifiable risk factors could potentially reduce the prevalence of dementia by 45% worldwide. Even greater risk reductions could be possible in low- and middle-income countries and for people with low income in higher-income countries, given the higher prevalence of dementia, health disparities and risk factors in these populations.
The report further indicates that reducing these 14 risks can increase the number of healthy years of life and reduce the length of time that poor health affects people with dementia.Additionally, the report cites clinical trials showing that nonpharmacological approaches, such as using activities tailored to interests and abilities, can reduce dementia-related symptoms and improve quality of life.
We are a general internist and an applied sociologist and intervention scientist, and our work focuses on memory and wellness in older adults. Together with 25 other internationally recognized dementia experts under the leadership of psychiatry professor Dr. Gill Livingston, we carefully reviewed the evidence to derive recommendations for prevention, intervention and care.
Why it matters
The rapid growth of aging populations worldwide is a triumph of better public and personal health throughout the entire lifespan. Yet, given the lack of a dementia cure, this report highlights the importance of prevention as well as supporting quality of life for those with a dementia diagnosis. In the new report, our team proposed an ambitious program for preventing dementia that could be implemented at the individual, community and policy levels and across the life span from early life through mid and late life.
The key points include:
In early life, improving general education.
In midlife, addressing hearing loss, high LDL cholesterol, depression, traumatic brain injury, physical inactivity, diabetes, smoking, hypertension, obesity and excessive alcohol.
In later life, reducing social isolation, air pollution and vision loss.
Together, these add up to The Lancet Commission on Dementia’s estimate that 45% of dementia risk can be reduced. And an abundance of new research shows that when risk factors are addressed, such as exposure to air pollution, they are linked with improved cognition and likely reduction of dementia risk.
New evidence supports the notion that in high-income countries, reducing dementia risk can translate to more healthy years, years free of dementia and a shorter duration of ill health for people who develop dementia.
What still isn’t known:
The 45% reduction in dementia risk across the world’s population is based on a calculation that assumes that risk factors are causal and can be eliminated. It shows how dementia prevention is critical and the impact it would have on individuals and families.
The commission emphasized the need for more research to identify additional risk factors, test risk factor changes in clinical trials, provide guidance for public health efforts, and identify and evaluate strategies for implementing and scaling evidence-based programs that support people with dementia and caregivers.The updated report has a worldwide public health and research impact and is being widely disseminated. It serves as a guideline for clinicians and policymakers and outlines new research directions.
This article is republished from The Conversation under a Creative Commons license.
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Tackling 14 Modifiable Risk Factors Can Help Trim Dementia Risk
Yes, that’s correct! According to recent research, addressing 14 modifiable risk factors could potentially reduce the prevalence of dementia by 45% worldwide12. These risk factors include:
- Low education in early life
- Hearing loss in midlife
- Hypertension
- Obesity
- Smoking
- Depression
- Physical inactivity
- Diabetes
- Social isolation
- Excessive alcohol consumption
- Head injury
- Air pollution
- High LDL cholesterol
- Untreated vision loss
By addressing these factors from childhood through old age, we can significantly impact the global burden of dementia12.
Is there a specific risk factor you’re interested in learning more about
Learn more: 1medicalxpress.com 2neurosciencenews.com
3news-medical.net 4sciencealert.com 5medcentral.com
“New compelling evidence” has landed high low-density lipoprotein (LDL) cholesterol and untreated vision loss on a growing list of potentially modifiable risk factors for dementia, according to a Lancet Commission report on dementia prevention, intervention, and care.
“Previously, the evidence for cholesterol was quite mixed, but there’s been a large addition and it’s very clear that in mid-life having high LDL cholesterol is a risk factor and that treating it makes a difference,” lead author Gill Livingston, MD, professor of psychiatry of older people at University College London, told MedCentral.
“Certainly, here in the UK most people never get as far as a cardiologist and will be tested in primary care by the family physician and then treatment initiated,” she said. “So, they’re the ones that are seeing the huge numbers of people that could really make a difference.”
The Lancet Commission previously identified nine risk factors for dementia in its initial report, published in 2017, and added another three to the 2020 report. Those 12 risk factors are less education, hearing loss, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, air pollution, smoking, obesity, traumatic brain injury, and depression.
The updated report, published online July 31 in The Lancet, says that “nearly half of dementias could theoretically be prevented by eliminating these 14 risk factors” now identified.
“Previously, the evidence for cholesterol was quite mixed, but there’s been a large addition and it’s very clear that in mid-life having high LDL cholesterol is a risk factor and that treating it makes a difference,” lead author Gill Livingston, MD, professor of psychiatry of older people at University College London, told MedCentral.
“Certainly, here in the UK most people never get as far as a cardiologist and will be tested in primary care by the family physician and then treatment initiated,” she said. “So, they’re the ones that are seeing the huge numbers of people that could really make a difference.”
The Lancet Commission previously identified nine risk factors for dementia in its initial report, published in 2017, and added another three to the 2020 report. Those 12 risk factors are less education, hearing loss, hypertension, physical inactivity, diabetes, social isolation, excessive alcohol consumption, air pollution, smoking, obesity, traumatic brain injury, and depression.
The updated report, published online July 31 in The Lancet, says that “nearly half of dementias could theoretically be prevented by eliminating these 14 risk factors” now identified.
High LDL cholesterol in midlife accounts for about 7% of all dementia cases and untreated vision loss for 2%, the authors said. Vision loss wasn’t previously considered by the Commission but new meta-analyses show it is associated with pooled relative risks of dementia of 1.35 to 1.47.
High LDL cholesterol in midlife accounts for about 7% of all dementia cases and untreated vision loss for 2%.
“For those of us who study vision, we weren’t necessarily surprised it ended up as a new risk factor on the list, but it’s important for us that it’s there because it raises awareness,” Allison Sekuler, PhD, the Sandra Rotman Chair in Cognitive Neuroscience and vice president of research at Baycrest Health Sciences in Toronto, Canada, said. “When people find out that something is on this list, they take it a little bit more seriously, especially if it’s something like untreated vision loss that theoretically is so easy to reverse.”
Specific Actions to Reduce Dementia Risk Across the Lifespan
The Commission details specific actions to help reduce dementia risk, including:
- ensuring quality lifelong education
- making hearing aids accessible
- screening and treating vision loss
- encouraging physical exercise and the use of head protection
- treating depression effectively
- reducing cigarette smoking and high alcohol consumption
- preventing and treating high cholesterol, hypertension, and obesity
- reducing exposure to air pollution
- providing supportive community environments to reduce social isolation
“My key message is that there’s a lot you can do to prevent dementia,” Dr. Livingston said. “Some people will get it but if you make these modifications in your health and lifestyle, you will probably live a longer healthier life. And have fewer years of unhealthy life.”
The authors call on stakeholders to “be ambitious about prevention” and prioritize equity and the inclusion of high-risk groups in population-based policy.
“All the risk factors tend to cluster around people with less resources and it’s really important therefore to think about equity,” she said.
“There is a health inequity for sure and even within countries there’s not a level playing field,” Dr. Sekuler added. “Some parts of Canada are rural regions that just don’t have access. In Yukon, there isn’t a single neurologist.”
But Are There Causal Links to These Risk Factors?
“If we did simple things well such as screening for some of the factors identified in this report, with adequate resources to perform this, we have the potential to prevent dementia on a national scale,” Masud Husain, DPhil, FRCP, professor of neurology, University of Oxford, UK, told the Science Media Centre.
Klaus Ebmeier, MD, foundation chair of old age psychiatry, University of Oxford, sounded a more skeptical note, pointing out that the authors themselves write that “some associations might be only partial causal.”
“Newer genetically inspired methods (Mendelian randomization) have generally confirmed many of the postulated risk factors as non-causal,” he added. “The non-causal nature of the identified correlations often means that manipulations of such risk factors will not result in a prevention of dementia cases.”
Asked to respond, Dr. Livingston said Mendelian randomization studies often only look at select Mendelian risk factors without taking into account all the evidence.
“I think it’s a brilliant idea but it didn’t come down from Mount Sinai,” she said. “It’s not gospel. You have to look at the other evidence.”
“With many of these things we can’t do perfect studies but when you put together a number of studies it makes it extremely likely and, given the possibility or probability that they would decrease dementia, it’s obviously worthwhile continuing to pursue them,” she added.
What About Patients Who Already Have Dementia?
Although there’s been progress in disease-modifying treatments for Alzheimer’s disease, the authors take a tempered approach to amyloid-beta-targeting antibodies and recommend that full information is shared broadly.
What are some strategies to reduce dementia risk?
Reducing the risk of dementia involves a combination of lifestyle changes and proactive health management. Here are some effective strategies:
- Stay Physically Active: Engage in regular exercise, such as walking, swimming, or yoga. Aim for at least 150 minutes of moderate-intensity exercise per week.
- Healthy Diet: Follow a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats. The Mediterranean diet is often recommended for brain health.
- Mental Stimulation: Keep your brain active with activities like reading, puzzles, learning new skills, or playing musical instruments.
- Social Engagement: Maintain strong social connections and engage in community activities to reduce the risk of social isolation.
- Manage Cardiovascular Health: Control blood pressure, cholesterol, and blood sugar levels through diet, exercise, and medication if necessary.
- Avoid Smoking and Limit Alcohol: Quit smoking and limit alcohol consumption to reduce the risk of cognitive decline.
- Protect Your Head: Wear helmets when biking or engaging in contact sports to prevent head injuries.
- Get Quality Sleep: Aim for 7-9 hours of sleep per night and address any sleep disorders like sleep apnea.
- Manage Stress: Practice stress-reducing techniques such as meditation, deep breathing exercises, or mindfulness.
- Regular Health Check-ups: Visit your healthcare provider regularly to monitor and manage any health conditions.
Implementing these strategies can help maintain cognitive function and reduce the risk of developing dementia. Is there a particular area you’d like more information on?
“They have some cognitive benefit, quite a lot of cost, quite a lot of side effects and burden, and we don’t know yet about the long-term effects,” Dr. Livingston explained. “We’re early on, and the balance of the two can be seen in the European Medicines (Agency), which last week said no to lecanemab and the FDA said yes.”
The authors also recommend that “cerebrospinal fluid or blood biomarkers should be used clinically only in people with dementia or cognitive impairment to confirm or exclude a diagnosis of Alzheimer’s disease.”
They point out that biomarkers have been validated only in populations largely of white individuals, “limiting generalizability and raising health equity concerns.”
Disclosures: Dr. Livingston reports support for the manuscript from the Alzheimer’s Society, the Alzheimer’s Society UK, and UK Research and Innovation. She is supported by the University College London Hospitals’ National Institute for Health and Care Research (NIHR) Biomedical Research Centre, by the North Thames NIHR Applied Research Collaboration, and as an NIHR senior investigator. Co-author disclosures can be found in the paper.
Drs. Sekuler, Husain, and Ebmeier reported no conflicts of interest.
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