Comment: Lancet report suggests 40% of dementia cases could be prevented or delayed by targeting 12 risk factors throughout life

Alcohol Aleksandar Karanov Red

Led by 28 dementia experts, the report builds on the nine risk factors identified in the 2017 Lancet Commission on dementia prevention, intervention and care. An up-to-date analysis of evidence on the prevention of dementia is presented, laying out a set of policies and lifestyle changes to achieve this.

Presented this week at the Alzheimer’s Association International Conference (AAIC 2020), the report suggests that up to 40% of dementia cases could be delayed or prevented with the modification of 12 risk factors over a person’s life. Combined, the three new risk factors added in this update are associated with 6% of all dementia cases – with an estimated 3% of cases attributable to head injuries in mid-life, 1% of cases to excessive alcohol consumption (of more than 21 units per week) in mid-life, and 2% to exposure to air pollution in later life. The remaining risk factors are linked with 34% of all dementia cases, with the greatest risk associated with lack of education in early life, hearing loss in mid-life and smoking in later life.

These interventions may lead to healthier ageing, which is great, but it is only one part of the picture. Prof Bart De Strooper, Director of the UK DRI

To address dementia risk, the authors call for nine 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.

In response to the report, Prof Bart De Strooper, Director of the UK DRI, said:

The advice given in the report is quite general and applies to most areas of health. We have long known that lifestyle changes such as reducing alcohol intake, not smoking, controlling blood pressure, and leading an active life, have a whole range of health benefits. These interventions may lead to healthier ageing, which is great, but it is only one part of the picture. 

The genetic make-up of an individual is at least as great a risk factor for Alzheimer’s disease as lifestyle, for example. We are gradually uncovering the molecular processes that go awry in neurodegenerative disorders and we need to use that knowledge to develop effective treatments. Ultimately, new medicines and interventions are needed if we really want to control the various diseases that lead to dementia. This is why it is so important to stay committed to the aims set out three years ago for the UK Dementia Research Institute. With the right infrastructure and funding, we will be able to fundamentally change the prospects of individuals at risk. 

So alongside the nine recommendations made by this report, I would add the need for ambitious, sustained, and assured support for dementia research.”

The full report can be found here.

Article published: 30 July 2020
Banner image: Aleksandar Karanov/

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