The Lancet Commission

One Third of Dementia May Be Preventable - Seite 2

Among their key recommendations are:

• Be ambitious about prevention. Interventions for established risk factors may have the potential to delay or prevent one third of dementias.
• Treat cognitive symptoms. To maximize cognition, people with Alzheimer's dementia or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia.
• Individualize dementia care. Good dementia care spans medical, social and supportive care; and should be tailored to unique individual and cultural needs, preferences, and priorities.
• Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, and should be made available.
• Plan for the future. People with dementia and their families value discussions about the future and important upcoming decisions.
• Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia - including agitation, low mood or psychosis - is usually psychological, social, and environmental, with drug treatment reserved for more severe symptoms.
• Consider end of life. A third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether a patient has dementia as they may be unable to make decisions about their care or express their needs and wishes.

Focus on Prevention
The Lancet Commission launched a novel life-span-based model of dementia risk, showing interventions that may maximize cognition, decrease distressing associated symptoms, reduce crises, and improve quality of life. The team estimate the contribution of each of the risk factors to the overall incidence of dementia, at the population level. The combined evidence to date shows that roughly 35 percent of all cases of dementia are attributable to nine potentially modifiable risk factors. Many of the risk factors occur at particular life stages but some, such as smoking and hypertension, are likely to make a difference at all life stages. The nine modifiable risk factors include:

• Early life - Education to a maximum of age 15
• Mid-life - Hypertension; Obesity; Hearing loss
• Later life - Depression; Diabetes; Physical inactivity; Smoking; Low social contact

Risk factors that are more common account for a higher percentage of population risk. For instance, the authors estimate that eight percent (8%) of all dementia cases could be associated with poor early school education; and five percent (5%) could be associated with smoking. While the mechanism linking education, hypertension, diabetes and smoking to dementia is relatively well understood, the recognition of hearing loss as a potential risk factor is still new, and the research is at an earlier stage.