“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, University College London,
UK. “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.”
Professor
Livingston continues: “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.”
To address
dementia risk, the authors call for 9 ambitious recommendations to be
undertaken by policymakers and by individuals:
- 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.
These actions are especially important in LMICs where
dementia rates are rising more rapidly than in high-income countries. This is a
result of increasing life expectancy, and a higher frequency of certain
dementia risk factors – such as lower rates of education; high rates of
hypertension, obesity, and hearing loss, and rapidly growing rates of diabetes.
Based on their past model including 9 risk factors,
the authors estimated that many more cases of dementia could be prevented in
LMICs, compared to globally. While globally the 9 risk factors were estimated
to contribute to 35% of all dementia cases, in China they might account for 40%
of cases, 41% in India and 56% in Latin America.
The authors
warn that estimates could be even higher, as they used conservative estimates
for the prevalence of these risk factors in these populations, and because they
do not account for the three new risk factors. The authors also note that
nearly all the evidence for dementia is from studies in high-income countries,
so risks might differ for LMICs and interventions might require modifying to
best support different cultures and environments.
The authors
note that the modelling for their prevention estimates globally and in LMICs
assumes that there is a causal relationship between risk factors and dementia,
but were careful to only include risk factors with strong evidence for a causal
link.
Report co-author, Professor Adesola Ogunniyi,
University of Ibadan, Nigeria, says:
“In low- and middle-income countries, the
higher prevalence of dementia risk factors means an even greater proportion of
dementia is potentially preventable than in “higher-income countries”. In this
context, national policies 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 low- and middle-income countries, so we
can better understand the risks particular to these settings.”
In the final
section of the report, the authors advocate for holistic and individualised
evidence-based care that addresses physical and mental health, social care, and
support that can accommodate complex needs. Keeping people with dementia
physically healthy is important for their cognition but they often have other
illnesses which they may struggle to manage on their own, resulting in
potentially harmful preventable hospitalisations.
They note that people with dementia are particularly
at risk from COVID-19 (due to age and having pre-existing illnesses, such as
hypertension), and that physical-distancing measures can be challenging for
dementia patients, who may find it difficult to adhere to the guidelines or
distressing to be unable to have contact with carers and family. The authors
call for people with unknown COVID-19 status to not be admitted to care homes
to protect the existing residents, regular testing of staff and asymptomatic as
well as symptomatic residents when there is exposure, not moving staff or
residents between homes, and more research into how to protect dementia
patients during the current pandemic and future public health emergencies.
