An updated report by a group of specialists lists 12 modifiable factors that, if a person acts on them, could reduce their dementia risk. Before this update, the report had listed nine modifiable factors.
The 2020 report by the Lancet Commission on dementia prevention, intervention, and care appeared at the end of July in The Lancet. It provides some important updates to the previous document, which the journal published in 2017.
The Lancet Commission is a team comprising 28 experts on dementia from institutions all around the world. The report’s first author is Prof. Gill Livingston, from University College London in the United Kingdom.
The Commission also presented its conclusions at the Alzheimer’s Association International Conference (AAIC) in July, which this year took place online.
Report co-author and AAIC presenter Dr. Lon Schneider, from the Keck School of Medicine at the University of Southern California in Los Angeles, comments on the report. He says, “We are learning that tactics to avoid dementia begin early and continue throughout life, so it’s never too early or too late to take action.”
The updates: Head injury, alcohol, pollution
The Lancet Commission report from 2017 had already acknowledged that acting on certain modifiable factors could help reduce a person’s risk of developing certain forms of dementia.
That document listed nine such factors. These were:
- a lower level of education
- hearing loss
- hypertension
- obesity
- smoking
- depression
- social isolation
- physical inactivity
- diabetes
To these original nine factors, the new report has added head injuries, excessive alcohol intake, and air pollution. According to the experts behind this report, the 12 factors taken together “account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.”
Therefore, acting on those factors could help prevent a significant number of dementia cases, the experts suggest.
They also explain why they decided to add the three new factors to the guidelines.
For example, the researchers cite several studies linking traumatic brain injuries with dementia, including two nationwide cohort studies of around 3 million people each.
They also write that “[a]n increasing body of evidence is emerging on alcohol’s complex relationship with cognition and dementia outcomes from a variety of sources, including detailed cohorts and large-scale, record-based studies.”
Finally, they acknowledge the accumulating evidence about the role of pollution in cognitive impairment. However, they warn that proof of the causal mechanisms has only been available from animal research so far.
Which preventive steps to take
The Lancet Commission also explains which kinds of interventions might help mitigate the negative effects of the 12 risk factors.
In a nutshell, the experts recommend trying to prevent hearing loss, diabetes, hypertension, obesity, head injuries, and depression, as well as cutting back on smoking, reducing alcohol intake, and taking steps to reduce ambient air pollution.
They also suggest that increasing education levels, levels of physical activity, and social interaction could help reduce dementia risk.
At the policymaking level, the experts advise:
- ensuring that all children receive both primary and secondary education
- encouraging people to lead active lifestyles
- encouraging people to stop smoking tobacco
- taking action to reduce people’s exposure to polluted air
- encouraging people to reduce their alcohol intake to a maximum of 21 alcohol units per week (where 1 unit is the equivalent of 10 milliliters of pure alcohol)
- taking measures to prevent head injuries, especially in high risk occupations
- encouraging healthful diets and other lifestyle interventions that help prevent obesity and diabetes
- advising people to maintain a normal blood pressure — that is, a systolic blood pressure of up to 130 millimeters of mercury — from age 40 onward
- advising people to avoid exposure to high noise levels so as to prevent hearing loss, and encouraging those with existing hearing loss to use hearing aids
Commenting on the report, Prof. Jennifer Rusted — from the University of Sussex in the U.K. — says, “[T]he biggest known risk for late life dementia is genetic.” Prof. Rusted was not involved in the publication of the updated guidelines.
She adds: “In this article, the focus, however, is on the modifiable factors that we can address to reduce our chances of experiencing dementia in our lifetime. This is vitally important since we have an aging population and still have only symptomatic treatments for late life dementia.”
“The cumulative effect of multiple risk factors is an important message for the real world: If you can work to mitigate any of these multiple factors, then you can at least push back the age at which cognitive impairment emerges to affect your independent living and quality of life.”
– Prof. Jennifer Rusted
“The newly added risk factors themselves link dementia risk to social conditions, living conditions, and life choices. In this regard, government and society as well as the individual must take some responsibility to act on the findings,” she concludes.
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