A Third of Dementia Cases Are Preventable

A profound new study suggests managing lifestyle factors such as hearing loss, smoking, hypertension, and depression could prevent one-third of the world’s dementia cases.

Moreover, researchers discovered nonpharmacologic interventions such as social contact and exercise can mitigate symptoms associated with dementia.

The report by the Lancet Commission on Dementia Prevention and Care was presented at the Alzheimer’s Association International Conference (AAIC) 2017. Study findings are published in The Lancet.

“There’s been a great deal of focus on developing medicines to prevent dementia, including Alzheimer’s disease,” says Lon Schneider, M.D., professor of psychiatry and the behavioral sciences at the Keck School of Medicine of University of Southern California.

“But we can’t lose sight of the real major advances we’ve already made in treating dementia, including preventive approaches.”

The commission brought together 24 international experts to systematically review existing research and provide evidence-based recommendations for treating and preventing dementia.

About 47 million people have dementia worldwide and that number is expected to climb as high as 66 million by 2030 and 115 million by 2050.

Interestingly, reducing dementia risk can begin in childhood.

The commission’s report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia — one in three cases — is attributable to these risk factors, the report says.

By increasing education in early life and addressing hearing loss, hypertension, and obesity in midlife, the incidence of dementia could be reduced by as much as 20 percent, combined.

In late life, stopping smoking, treating depression, increasing physical activity, increasing social contact, and managing diabetes could reduce the incidence of dementia by another 15 percent.

“The potential magnitude of the effect on dementia of reducing these risk factors is larger than we could ever imagine the effect that current, experimental medications could have,” Schneider says.

“Mitigating risk factors provides us a powerful way to reduce the global burden of dementia.”

The commission also examined the effect of nonpharmacologic interventions for people with dementia and concluded that they had an important role in treatment, especially when trying to address agitation and aggression.

Antipsychotic drugs are commonly used to treat agitation and aggression, but there is substantial concern about these drugs because of an increased risk of death, cardiovascular adverse events and infections, not to mention excessive sedation,” Schneider says.

The evidence showed that psychological, social and environmental interventions such as social contact and activities were superior to antipsychotic medications for treating dementia-related agitation and aggression.

The commission also found that nonpharmacologic interventions like group cognitive stimulation therapy and exercise conferred some benefit in cognition as well.

The commission’s full report provides detailed recommendations for the prevention and the management of dementia.

Topic areas include prevention, treating cognitive symptoms, individualizing dementia care, caring for caregivers, planning for the future following a dementia diagnosis, managing neuropsychiatric symptoms, and considering the end of life.

Source: University of Southern California Health Sciences/EurekAlert
Photo: One in three cases of dementia could be prevented by addressing nine lifestyle factors, according to a report from the first Lancet Commission on Dementia Prevention and Care. Credit: Keck Medicine of USC.