In a report presented at the Alzheimer’s Association International Conference 2017 (AAIC 2017) in London, The Lancet International Commission on Dementia Prevention, Intervention and Care reported that more than one third of global dementia cases may be preventable through addressing lifestyle factors that impact an individual’s risk. These potentially modifiable risk factors have been identified at multiple phases across the life-span, not just in old age.

The Lancet Commission’s report was simultaneously published in The Lancet and presented at AAIC 2017.

The Lancet Commission brings together 24 international experts to consolidate the huge strides that have been made in our knowledge and understanding of dementia risk factors, treatment and care, and the emerging knowledge as to what we should do to prevent and manage dementia. The Commission conducted a new review and meta-analysis; based on which they extended current models of risk by including hearing loss and social isolation. Incorporating potentially modifiable risk factors from across the life-span, they proposed a novel lifecourse model of risk, highlighting the opportunity for prevention.

Among their key recommendations are:

• Be ambitious about prevention. Interventions for established risk factors may have the potential to delay or prevent one third of dementias.

• Treat cognitive symptoms. To maximize cognition, people with Alzheimer’s dementia or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia.

• Individualize dementia care. Good dementia care spans medical, social and supportive care; and should be tailored to unique individual and cultural needs, preferences, and priorities.

• Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, and should be made available.

• Plan for the future. People with dementia and their families value discussions about the future and important upcoming decisions.

• Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia – including agitation, low mood or psychosis – is usually psychological, social, and environmental, with drug treatment reserved for more severe symptoms.

• Consider end of life. A third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether a patient has dementia as they may be unable to make decisions about their care or express their needs and wishes.

Focus on Prevention The Lancet Commission launched a novel life-span-based model of dementia risk, showing interventions that may maximize cognition, decrease distressing associated symptoms, reduce crises, and improve quality of life. The team estimate the contribution of each of the risk factors to the overall incidence of dementia, at the population level. The combined evidence to date shows that roughly 35 percent 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

More information about prevention in: 10 ways to love your brain

Growing evidence indicates that people can reduce their risk of cognitive decline by adopting key lifestyle habits. When possible, combine these habits to achieve maximum benefit for the brain and body. Start now. It’s never too late or too early to incorporate healthy habits.

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