Modifying the 14 risk factors identified by the Lancet Commission 2024 could prevent or delay the disease in approximately half of cases at risk of developing dementia.
Be Proactive to Prevent Dementia!
Preventing dementia involves interventions at the individual, national, and international levels. Population-based policies should prioritize equity and ensure the inclusion of high-risk groups. Actions to reduce dementia risk should start early in life and continue throughout life. Since risk factors for the disease may coexist in susceptible individuals, preventive interventions should generally be multi-component.
It should be remembered that risk factors can be modified independently of the presence of the APOE genetic finding. Multicomponent interventions addressing various risk factors may provide potential benefits for individuals with high or low genetic risk of dementia.
14 Lifelong Actions to Reduce Dementia Risk:
1) Ensure that quality education is accessible to all and promote mentally stimulating activities in middle age to maintain mental activity.
2) Hearing aids should be made accessible to people with hearing loss, and exposure to harmful noise should be reduced to minimize hearing loss.
3) Screening and treatment for vision loss should be made accessible to everyone.
4) Exposure to air pollution must be reduced.
5) The likelihood of developing dementia is lower in people who exercise; therefore, regular exercise should be encouraged and promoted.
6) Helmet use should be encouraged in contact sports and when cycling to protect the head from impact due to the risk of falling.
7) Smoking should be reduced through education and price control, smoking in public places should be prevented, and smoking cessation clinics should be consulted.
8) Excessive alcohol consumption should be reduced through education and price control, and awareness should be raised about excessive consumption levels and risks.
9) Maintaining a healthy weight and treating obesity as early as possible will help prevent diabetes.
10) Hypertension should be prevented or reduced, and systolic blood pressure should be kept at 130 mmHg or lower from the age of 40 onwards.
11) Diabetes should be prevented and glycemic control should be ensured.
12) High LDL cholesterol should be detected and treated from middle age onwards.
13) Depression should be treated effectively.
14) Priority should be given to age-friendly, supportive community environments and housing in society, social isolation should be reduced, and participation in activities and living with others should be facilitated.
Important Issues for People Diagnosed with Dementia:
-Interventions after diagnosis, including future planning (advance directives), help people live with dementia. It is important to teach multi-component coping interventions for family members and caregivers and management of neuropsychiatric symptoms, and the approach should be person-centered.
-There is clear evidence that coordinated, multi-component interventions are beneficial in the treatment of neuropsychiatric symptoms. Activity interventions also reduce neuropsychiatric symptoms. These interventions are beneficial activities for people with dementia to continue enjoying life and maintaining a sense of purpose. There is currently no evidence regarding the benefits of exercise as an intervention for neuropsychiatric symptoms.
-Cholinesterase inhibitors and memantine should be used for individuals with Alzheimer's disease and Lewy body dementia. These drugs have relatively few side effects and are inexpensive; they significantly alleviate cognitive impairment and there is good evidence of their long-term effects. These drugs are available in most high-income countries, although less so in low- and middle-income countries.
-There are promising developments in disease-modifying treatments for Alzheimer's disease. Some trials of antibodies targeting amyloid-β have shown reasonable efficacy in reducing deterioration after 18 months of treatment. However, the effects are limited, and the drugs have only been tested in individuals with mild disease. These treatments are currently licensed in only a limited number of countries. These treatments have significant side effects, and there is very little information about their long-term effects. The high cost of these treatments and the need for specialized medical personnel may limit their use and pose challenges for healthcare systems. Particularly for carriers of the APOE-ε4 genotype, unknown long-term effects, lack of data on effects in people with multimorbidity, and difficulties in monitoring efficacy and side effects require careful monitoring of people using amyloid-β-targeting antibodies.
-Cerebrospinal fluid (CSF) or blood biomarkers should be used to help confirm or rule out a diagnosis of Alzheimer's disease in individuals with clinically evident dementia or cognitive impairment. Biomarkers have been validated primarily in white populations; this limits generalizability and raises concerns about health equity.
-Dementia patients with acute physical illness requiring hospitalization deteriorate cognitively faster than other dementia patients. Maintaining physical health is important.
-COVID-19 has highlighted the vulnerability of dementia patients. Lessons must be learned from this pandemic.
Reference: Lancet 2024; 404: 572–628 (https://doi.org/10.1016/S0140-6736(24)01296-0)