New report summarises evidence-based approaches to dementia prevention, intervention and care

lancet

A new report from the Lancet Commission has summarised key points around dementia prevention, intervention and care. We are delighted Prof Karen Ritchie based at the Centre for Dementia Prevention was one of the co-authors of this paper.

While scientists have looked into possible treatments for dementia for decades, the prevention aspect of the disease has so far been less researched. We know that Alzheimer’s disease starts developing decades before dementia occurs – in effect, making dementia an illness of midlife that manifests in later life. It is therefore crucial to study a younger, midlife population in order to be able to identify these early risk factors that contribute towards eventual dementia. This is the aim of the UK wide PREVENT Dementia study and the European Prevention of Alzheimer’s Dementia (EPAD) project, both led from the Centre for Dementia Prevention.

The Lancet Commission results suggest that around 35% of dementia is attributable to a combination of the following nine risk factors: education to a maximum of age 11–12 years, mid-life high blood pressure, mid-life obesity, hearing loss, late-life depression, diabetes, physical inactivity, smoking, and social isolation. Interestingly, social isolation is thought to be a risk factor for dementia because it increases the risk of high blood pressure, coronary heart disease, and depression. The most beneficial diet to brain health is again suggested to be Mediterranean diet.

Possible treatments for dementia have not been developed and progress in research has not led to disease modifying drugs but to improvements in symptom management, treatment of associated pathology and protection of the person. The commission report concludes that we currently extend life expectancy and therefore, paradoxically, disease duration and dementia prevalence. On the assumption that dementia is neither treatable nor preventable care policy is currently largely based on a crisis-intervention model. The Lancet commission has extended the definition of care beyond crisis intervention to a life course approach, emphasising potential windows for early interventions such as starting prevention efforts in a normal healthy populations in their mid-life. Leading research in dementia prevention was covered in BBC Radio 4 (from 17 min 10 sec) and BBC news (from 19 min 50 sec) yesterday, focusing on the work Centre for Dementia Prevention does around identifying risk factors in mid-life.

There are multiple examples in the history of epidemiology of risk factor removal leading to significant decreases in disease incidence although the etiology remains unknown. The Lancet report drew on an earlier paper by one of the co-authors Karen Ritchie and colleagues where a potential 25% reduction of dementias was shown with elimination of cardiovascular risk factors and depression but only a 7% reduction with elimination of ApoE e4 gene. A significant finding in epidemiological evidence is the suggestion that risk factor elimination will be the most effective in mid-life.