August 14, 2017
Spurred by the 2013 G8 Dementia Summit in London and by the First WHO Ministerial Conference on Global Action Against Dementia in March 2015, The Lancet commissioned an expert project to review available evidence and recommend how best to manage and prevent dementia. The group’s report, “Dementia Prevention, Intervention, and Care,” was released to coincide with a symposium on the topic at this year’s Alzheimer’ Association International Conference, held in London July 16-20. The 65-page document, authored by 24 leading dementia researchers from Europe, North America, and Australia, delivers 10 key messages (see box below). Most address patient treatment and care. The one that captured the most attention, especially in the general media, was to “be ambitious about prevention,” since it concluded that a third of dementia cases might be delayed or prevented.
As outlined by Gill Livingston, a psychiatrist at University College London who led the effort, the commission arrived at that number by estimating the population-attributable fraction for a variety of risk factors, even those at play from an early age. “This is the very first life-course analysis of risk factors for dementia,” Livingston stressed in an AAIC press briefing. Livingston captured that life-course in a figure that many at AAIC, including commission member Eric Larson, Kaiser Foundation Health Plan of Washington, found compelling (see figure below). “Without sounding hyperbolic, I think this is just brilliant,” Larson told Alzforum. “It shows that the [dementia] condition has its roots throughout the life, which is true for other chronic conditions, such as vascular disease and even cancer,” he said.
Taken from the literature, poor childhood education; midlife hearing loss, hypertension, and obesity; and smoking, depression, physical inactivity, social isolation, and diabetes in late life emerged as modifiable risk factors for dementia.
Added together, they accounted for 35 percent of cases, the authors concluded. That compares to only 7 percent of cases attributable to ApoE, the strongest genetic risk factor for late-onset AD.
The report stresses treating midlife hypertension as an immediately actionable priority for physicians and patients, and claims that controlling the other risk factors would help reduce the number of dementia cases.