Commission of experts identifies nine modifiable risk factors for dementia

More than one-third of dementia cases may be theoretically preventable, according to a recent report that identified nine modifiable risk factors for the disease.

In the report, published online on July 20 by The Lancet, experts participating in the Lancet Commission on Dementia Prevention, Intervention, and Care presented what is known about how best to prevent and manage dementia. The commission identified nine modifiable risk factors for the disease, including hearing loss, which it derived from a new review and meta-analysis as part of the report.

The other key risk factors—low educational level in childhood, depression, diabetes, hypertension, obesity, smoking, physical inactivity, and social isolation—should be addressed in midlife to reduce the incidence of dementia, according to the report.

Other recommendations in the report include the following:

• Clinicians should offer cholinesterase inhibitors to treat cognitive symptoms in patients with Alzheimer's disease or Lewy body dementia, or memantine in patients with severe dementia. However, cholinesterase inhibitors cannot effectively treat mild cognitive impairment.
• Proper management of neuropsychiatric symptoms (e.g., agitation, low mood, psychosis) in patients with dementia typically involves psychological, social, and environmental interventions. Pharmacological management should be reserved for those with more severe symptoms.
• Technological interventions may improve care delivery but should not replace social contact.
• Dementia care should be individualized based on the patient's needs (both individual and cultural), preferences, and priorities, as well as include support for caregivers, who are at high risk for depression.

Fewer than half of patients with dementia have a formal diagnosis, which is frequently delayed due to the perception that it is a natural consequence of aging or due to patients' reluctance to seek help for their memory problems, an accompanying comment noted. “Screening all older people is not recommended because the benefits are uncertain, but case finding among those at high risk of dementia might be beneficial,” the authors suggested.

The disease selectively afflicts the old and frail, women, and people who are socioeconomically and educationally disadvantaged, an additional comment noted. “It dims the voices of those living with the condition, just when they most need to be heard. The dementia epidemic will be concentrated in [low-income and middle-income countries] where awareness is low, and resources to meet the demand are fewest,” the editorialist wrote.