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Lifestyle choices that could reduce your risk of dementia

A new international study published in The Lancet medical journal suggests that roughly one third of dementia cases could potentially be prevented through healthier lifestyle choices.
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The study, entitled “Dementia prevention, intervention, and care,” was authored by The Lancet Commission on Dementia Prevention, Intervention, and Care as an attempt to summarize the balance of available evidence about dementia and make recommendations about the disease.

Dementia

Dementia is a broad category of brain diseases that cause a long term and often gradual decrease in the ability to think and remember that is great enough to affect a person’s daily functioning. It occurs mainly in people older than 65 years. The most common type of dementia is Alzheimer’s disease.

Globally, about 47 million people were living with dementia in 2015, and this number is projected to triple by 2050.

There is no known cure for dementia.

Risk factors

According to the study, lifestyle factors that contribute to the risk of dementia include:

  • Mid-life hearing loss (9%)
  • Failing to complete secondary education (8%)
  • Smoking (5%)
  • Failing to seek early treatment for depression (4%)
  • Physical inactivity (3%)
  • Social isolation (2%)
  • High blood pressure (2%)
  • Obesity (1%)
  • Type 2 diabetes – 1%

These lifestyle risk factors add up to 35%, and are potentially modifiable. In other words, roughly one third of dementia cases are potentially preventable through healthier lifestyle choices (the other 65% of dementia risk is thought to be potentially non-modifiable).

Key messages

The Commission’s advice on dementia includes the following:

1 The number of people with dementia is increasing globally

Although incidence in some countries has decreased.

2 Be ambitious about prevention

We recommend active treatment of hypertension in middle aged (45–65 years) and older people (aged older than 65 years) without dementia to reduce dementia incidence. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity might have the potential to delay or prevent a third of dementia cases.

3 Treat cognitive symptoms

To maximise cognition, people with Alzheimer’s disease or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia. Cholinesterase inhibitors are not effective in mild cognitive impairment.

4 Individualise dementia care

Good dementia care spans medical, social, and supportive care; it should be tailored to unique individual and cultural needs, preferences, and priorities and should incorporate support for family carers.

5 Care for family carers

Family carers are at high risk of depression. Effective interventions, including STrAtegies for RelaTives (START) or Resources for Enhancing Alzheimer’s Caregiver Health intervention (REACH), reduce the risk of depression, treat the symptoms, and should be made available.

6 Plan for the future

People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis.

7 Protect people with dementia

People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability (including to exploitation), managing money, driving, or using weapons. Risk assessment and management at all stages of the disease is essential, but it should be balanced against the person’s right to autonomy.

8 Manage neuropsychiatric symptoms

Management of the neuropsychiatric symptoms of dementia including agitation, low mood, or psychosis is usually psychological, social, and environmental, with pharmacological management reserved for individuals with more severe symptoms.

9 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, because they might be unable to make decisions about their care and treatment or express their needs and wishes.

10 Technology

Technological interventions have the potential to improve care delivery but should not replace social contact.

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