14 Risk Factors You Can Control: Stunning Strategies to Combat Dementia

The 2024 Lancet Commission report has identified vision loss and high cholesterol as new risk factors for dementia, adding to the 12 previously known factors. This comprehensive report emphasizes the importance of managing these factors early and throughout life, particularly for those with a genetic predisposition to dementia.

The Importance of Early and Lifelong Management

The Lancet Commission’s report underlines that managing risk factors from an early age and continuing throughout life is crucial in mitigating the risk of dementia. The report outlines 13 recommendations targeting both individuals and governments to reduce these risks. These recommendations include managing hearing and vision loss, maintaining cognitive and social activity, using head protection in sports, managing vascular risks such as high cholesterol and diabetes, improving air quality, and fostering supportive communities.

Potential Savings and Health Benefits

Research focusing on England suggests that implementing these measures could save approximately £4 billion by addressing risk factors such as excessive alcohol consumption, brain injuries, air pollution, smoking, obesity, and hypertension. This highlights the significant economic and health benefits of proactive risk management.

A Comprehensive Approach to Prevention

According to the third Lancet Commission on dementia prevention, intervention, and care, addressing 14 modifiable risk factors from childhood through adulthood could prevent or delay nearly half of dementia cases. This is particularly important as global life expectancy increases and the number of dementia cases is projected to rise significantly. These findings were presented at the Alzheimer’s Association International Conference (AAIC 2024).

New Risk Factors Identified

The new report identifies two additional risk factors associated with 9% of all dementia cases. An estimated 7% of cases are attributable to high low-density lipoprotein (LDL) or “bad” cholesterol in midlife (around age 40), and 2% of cases are due to untreated vision loss in later life. These new factors add to the 12 risk factors previously identified by the Lancet Commission in 2020, which include lower levels of education, hearing impairment, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury (TBI), air pollution, and social isolation. Combined, these factors are linked with 40% of all dementia cases.

Greatest Risk Factors in the Global Population

The new report estimates that the greatest risk factors for dementia globally are hearing impairment and high LDL cholesterol (7% each), followed by less education in early life and social isolation in later life (5% each). The Commission, authored by 27 world-leading dementia experts, calls for ambitious efforts by both governments and individuals to tackle these risks throughout life.

Tackling Dementia Globally

With the rapidly aging population worldwide, the number of people living with dementia is expected to almost triple by 2050, rising from 57 million in 2019 to 153 million. Increasing life expectancy is also driving a surge in dementia cases in low-income countries. Global health and social costs related to dementia are estimated at over $1 trillion annually.

Successes in High-Income Countries

In some high-income countries, including the USA and UK, the proportion of older people with dementia has fallen, particularly among those in socio-economically advantaged areas. The report suggests that this decline is partly due to building cognitive and physical resilience over the life course and reducing vascular damage through improved healthcare and lifestyle changes.

Addressing Inequities

The report notes that most national dementia plans do not specifically address diversity, equity, or inclusion of people from underserved cultures and ethnicities who are disproportionately affected by dementia risks. The authors stress the importance of targeting preventive efforts toward those who need them most, including those in low- and middle-income countries and socio-economically disadvantaged groups.

Recommendations for Risk Reduction

To reduce dementia risk throughout life, the Commission outlines 13 recommendations, including:

• Provide all children with good quality education and encourage cognitive activity in midlife.
• Make hearing aids available for those with hearing loss and reduce harmful noise exposure.
• Detect and treat high LDL cholesterol in midlife.
• Make screening and treatment for vision impairment accessible to all.
• Treat depression effectively.
• Wear helmets and head protection in contact sports and on bikes.
• Foster supportive community environments to increase social contact.
• Reduce exposure to air pollution through strict clean air policies.
• Implement measures to reduce smoking, such as price control, raising the minimum age of purchase, and smoking bans.
• Reduce sugar and salt content in food sold in stores and restaurants.

Economic Impact of Prevention

A separate study published in The Lancet Healthy Longevity journal modeled the economic impact of implementing these recommendations in England. The findings suggest that tackling dementia risk factors could achieve cost savings of more than £4 billion and over 70,000 quality-adjusted life-year (QALY) gains. The authors emphasize that the benefits could be even greater in low- and middle-income countries.

Advances in Research and Support

The report also discusses advances in blood biomarkers and Anti-amyloid β antibodies for Alzheimer’s disease. These developments could increase the scalability and reduce the cost of testing for accurate diagnosis. However, the authors call for more research and transparency regarding the short- and long-term side effects of new treatments.

Support for People Living with Dementia

The report stresses the need for more support for people living with dementia and their families. Many effective interventions, such as activity programs and cholinesterase inhibitors, are not widely available. The authors recommend providing multi-component coping interventions for family caregivers to reduce the risk of depression and anxiety.

Conclusion: A Comprehensive Strategy

The Lancet Commission report underscores the importance of a comprehensive strategy to reduce dementia risk. By addressing modifiable risk factors early and throughout life, it is possible to prevent or delay many cases of dementia, improve quality of life, and achieve significant cost savings. The report calls for urgent action from both governments and individuals to implement these recommendations and make healthy lifestyles achievable for everyone.