One in three cases
of dementia preventable
University of Southern
California - Health Sciences
Managing lifestyle
factors such as hearing loss, smoking, hypertension and depression could
prevent one-third of the world's dementia cases, according to a report by the
first Lancet Commission on Dementia Prevention and Care. Presented
at the Alzheimer's Association International Conference (AAIC) 2017 and
published in The Lancet, the report also highlights the beneficial
effects of nonpharmacologic interventions such as social contact and exercise
for people with dementia."There's been a great deal of focus on developing medicines to prevent dementia, including Alzheimer's disease," says commission member and AAIC presenter Lon Schneider, MD, professor of psychiatry and the behavioral sciences at the Keck School of Medicine of USC.
"But we can't lose sight of the real major advances we've already made in treating dementia, including preventive approaches."
The commission brought
together 24 international experts to systematically review existing research
and provide evidence-based recommendations for treating and preventing
dementia. About 47 million people have dementia worldwide and that number is
expected to climb as high as 66 million by 2030 and 115 million by 2050.
Reducing dementia risk, beginning in childhood
The commission's report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia -- one in three cases -- is attributable to these risk factors, the report says.
By increasing
education in early life and addressing hearing loss, hypertension and obesity
in midlife, the incidence of dementia could be reduced by as much as 20
percent, combined.
In late life, stopping
smoking, treating depression, increasing physical activity, increasing social
contact and managing diabetes could reduce the incidence of dementia by another
15 percent.
"The potential
magnitude of the effect on dementia of reducing these risk factors is larger
than we could ever imagine the effect that current, experimental medications
could have," Schneider says. "Mitigating risk factors provides us a
powerful way to reduce the global burden of dementia."
A nonpharmacologic approach to treating dementia
The commission also examined the effect of nonpharmacologic interventions for people with dementia and concluded that they had an important role in treatment, especially when trying to address agitation and aggression.
"Antipsychotic
drugs are commonly used to treat agitation and aggression, but there is
substantial concern about these drugs because of an increased risk of death,
cardiovascular adverse events and infections, not to mention excessive
sedation," Schneider says.
The evidence showed
that psychological, social and environmental interventions such as social
contact and activities were superior to antipsychotic medications for treating
dementia-related agitation and aggression.
The commission also
found that nonpharmacologic interventions like group cognitive stimulation
therapy and exercise conferred some benefit in cognition as well.
The commission's full
report provides detailed recommendations in the areas of prevention, treating
cognitive symptoms, individualizing dementia care, caring for caregivers,
planning for the future following a dementia diagnosis, managing
neuropsychiatric symptoms and considering the end of life.