One Third of Dementia May Be Preventable

I was so excited to hear the announcement this morning during my routine rituals, which includes listening to CBC News World Report. One third of dementia may be preventable!

At the Alzheimer's Association International Conference 2017, the Lancet International Commission on Dementia Prevention, Intervention and Care reported that global dementia cases may be preventable through lifestyle factors that impact an individual's risk. These potential risk factors have been identified at multiple phases across a life-span, not just in old age. 

The Lancet Commission brings together 24 international experts to report on the huge strides that have been made in the knowledge and understanding of dementia risk factors, treatment and care. It aims to review the best available evidence and produce recommendations on how to best manage, or even prevent, the dementia epidemic.

While the findings of this Commission are not entirely a surprise to me, I am excited about the emerging evidence on what we should do to prevent and manage dementia. In my case, after my mum’s diagnosis, I spent the subsequent years researching the disease, specifically prevention methods. In light of my research, I made the conscious personal decision to institute a clean diet and daily exercise to my life in 2010.

However, there were things in the report that I found enlightening and was unaware of, including:

  • Approximately 35 per cent of all cases of dementia are attributable to nine potentially modifiable risk factors. 
  •  Many of the risk factors occur at particular life stages but some, such as smoking and hypertension, are likely to make a difference at all life stages. 
  • The nine modifiable risk factors include:
    • Early life - Education to a maximum of age 15
    • Mid-life - Hypertension; Obesity; Hearing loss
    • Later life - Depression; Diabetes; Physical inactivity; Smoking; Low social contact

At an individual level, many people have the potential to reduce their risk of cognitive decline, and perhaps the disease itself, through simple, healthful behaviour changes. This is incredibly empowering, especially when you consider that, according to the Alzheimer’s Disease Facts and Figures, by 2050, the number of people living with Alzheimer’s could reach 16 million.

After conducting a new review and meta-analysis, the Commission also outlined key recommendations for pharmacological and social interventions that are able to help manage the manifestations of dementia.

Among their key recommendations are:

  • Be ambitious about prevention - Intervene when there are established risk factors.
  • Treat cognitive symptoms - People with dementia should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia.
  • Individualize dementia care - Care should be tailored to unique individual and cultural needs, preferences, and priorities.
  • Care for family carers- As depression tends to run high with caregivers, assistance should be made available to reduce the risk and treat the symptoms.
  • Plan for the future-Discuss the future and important upcoming decisions
  • Manage neuropsychiatric symptoms – Manage the neuropsychiatric symptoms of dementia (i.e., agitation, low mood or psychosis) by addressing psychological, social, and environmental impacts, with drug treatment reserved for more severe symptoms.
  • Consider end of life- As one third of older people with dementia die, it is important to consider end of life, because they may be unable to make decisions about their care or express their needs and wishes.

While these can be difficult conversations to have with a loved one or family, by having a plan in place, it will time to properly grieve when the inevitable comes to pass. On a lighter note, effective prevention and care of dementia could not only vastly improve individuals with the disease and their families, but also the future of society.

I look forward to seeing changes at a public health level, but I understand that like most things, it starts with the individual.

On that note, a final word from Professor Gill Livingston, MD, from University College London and lead author of The Lancet Commission.

"While public health interventions will not prevent, or cure all potentially modifiable dementia, intervention for cardiovascular risk factors, mental health, and hearing may push back the onset of many people for years," said Professor Livingston.

To learn about the findings of the Lancet Commission, visit http://www.thelancet.com/commissions/dementia2017.

 

*The authors of the report stated that, due to lack of data, the study did not include dietary factors, alcohol use, visual impairment, air pollution and sleep.