How to avoid dementia – based on universally accepted protocols from The Lancet August, 2020
The lancet Commission on Dementia Prevention, Intervention and Care makes global efforts to improve the lives of people with dementia and their caregivers. Their goal is to provide the most up-to-date evidence for the cause, prevention and treatment of dementia. They have created a 12 risk factor life-course model of dementia prevention, stressing that it is never too early and never too late in the life course for dementia prevention. This model was published in August of 2020 and is summarized below. The link to the full publication is here: https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext
The 12 modifying risk factors identified could prevent or delay up to 40% of dementias. However, it is stated, that people must be determined to prevent dementia both at the policy and individual levels. They suggest that the actions to modify these risk factors require both public health programs and individually tailored interventions.
The authors describe the importance of looking at the risk factors throughout the lifespan. Early life risk factors (education), midlife risk factors (hypertension, obesity, hearing loss, brain injuries, and alcohol misuse) and later life risk factors (smoking, depression, physical inactivity, social isolation, diabetes and air pollution) can all contribute to increased dementia risk.
The risk factor life-course model is comprised of these specific actions:
- Aim to maintain systolic blood pressure of 130 mmHg or less in midlife from around age 40 years (antihypertensive treatment for hypertension is the only known effective preventive medication for dementia).
- Encourage use of hearing aids for hearing loss and reduce hearing loss by protection of ears from excessive noise exposure.
- Reduce exposure to air pollution and second-hand tobacco smoke.
- Prevent head injury through public health initiatives.
- Limit alcohol use, as alcohol misuse and drinking more than 21 units weekly increase the risk of dementia.
- Avoid smoking uptake and support smoking cessation to stop smoking, as this reduces the risk of dementia even in later life.
- Provide all children with primary and secondary education.
- Reduce obesity and the linked condition of diabetes.
- Sustain midlife, and possibly later life physical activity.
- Address other putative risk factors for dementia, like sleep, through lifestyle interventions, as this will improve general health.
The article implores that we tackle inequality, since many risk factors cluster around inequalities, which occur particularly in Black, Asian, and minority ethnic groups and in vulnerable populations. This includes creating environments that have physical activity as a norm, reducing the population profile of blood pressure rising with age through better patterns of nutrition, and reducing potential excessive noise exposure. By incorporating preventative measures, populations in low and middle income countries may yield the greatest dementia reduction.