Dementia prevention, intervention, and care

Be ambitious about the prevention of dementia is one of the ideas coming out of a report “Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Worldwide around 50 million people live with dementia, and this number is projected to increase to 152 million by 2050. Back in 2017, the Commission found that there was a growing body of evidence that supported the fact that there are nine potentially modifiable risk factors for dementia reported in  Lancet Commission on dementia prevention, intervention, and care. These are

1.    Little or no education

2.    Hypertension

3.    Hearing impairment

4.    Smoking

5.    Obesity

6.    Depression

7.    Physical inactivity

8.    Diabetes,

9.    Isolation or low social contact.

Since 2017, the Commission has found three more risk factors for dementia with newer, convincing evidence that points to 3 more preventable dementia risk factors which are:

1.    Head injuries

2.    Excessive alcohol consumption in midlife

3.    Air pollution exposure in later life

To prevent or delay dementia, the commission recommended that primary and elementary education programs, take steps to modify these 12 risk factors might prevent or delay up to 40% of dementias. Specifically, the Commission recommended that governments take action to fund programs to prevent obesity and diabetes, and to reduce air pollution and to reduce second-hand smoke exposure. They also recommended programs to help people prevent smoking initiation, hearing loss, and head injuries. They also recommended that there be programs to encourage hearing aid use and smoking cessation amongst adults

Governments should actively encourage people to maintain systolic blood pressure of 130 mm Hg or lower in midlife, and to limit alcohol to fewer than 21 servings per week, and to maintain an active lifestyle.

Taking steps to fund and run programs aimed at preventing dementia is more fiscally responsible from a government's perspective as well it is positive from an individual perspective. If a person is diagnosed with dementia, they have more complex problems and symptoms in many domains. Interventions should be individualized and consider the person, as well as their family carers. Evidence is accumulating for the effectiveness, at least in the short term, of psychosocial interventions tailored to the patient’s needs, to manage neuropsychiatric symptoms. Evidence-based interventions for carers can reduce depressive and anxiety symptoms over years and be cost-effective.

Keeping people with dementia physically healthy is important for their cognition. People with dementia have more physical health problems than others of the same age but often receive less community health care and find it particularly difficult to access and organize care. People with dementia have more hospital admissions than other older people, including illnesses that are potentially manageable at home. They have died disproportionately in the COVID-19 epidemic.

Hospitalizations are distressing and are associated with poor outcomes and high costs. Health-care professionals should consider dementia in older people without known dementia who have frequent admissions or who develop delirium. Delirium is common in people with dementia and contributes to cognitive decline. In the hospital, care including appropriate sensory stimulation, ensuring fluid intake, and avoiding infections might reduce delirium incidence. Acting now on dementia prevention, intervention, and care will vastly improve living and dying for individuals with dementia and their families, and thus society.