The Lancet Commission has updated their report on the prevention and care of dementia, taking into account new research published since its last report in 2020. The report prioritizes systematic reviews and meta-analyses, performing new analyses where needed, and focuses on modifiable risk factors.
The extensive paper covers the various challenges of dementia research and notes that available data come disproportionately from higher-income countries. Study participants are more likely to have a high level of education and socioeconomic status and be of European descent, highlighting the need for more diverse and inclusive study populations.
The report summarizes research on 14 modifiable risk factors, 12 of which were previously known: less education, head injury, physical inactivity, smoking, excessive alcohol consumption, hypertension, obesity, diabetes, hearing loss, depression, infrequent social contact, and air pollution. Notably, two new risk factors are identified: high LDL cholesterol and vision loss. Sleep, diet, infection, menopause, mental health disorders of anxiety and schizophrenia, and post-traumatic stress disorder are excluded from the list of modifiable risk factors due to a lack of evidence.
The authors estimate that 45% of cases of dementia could be delayed or prevented by addressing these risk factors. “Although addressing risk factors at an early stage of life is desirable, there is also benefit from tackling risk throughout life; it is never too early or too late to reduce dementia risk,” the authors conclude.
Advances have been made in biomarker research in Alzheimer’s disease since the 2020 report, and the authors outline the utility of neuroimaging, cerebrospinal fluid, and blood-based biomarkers, cautioning that the latter two should be used only in patients who present with dementia or cognitive impairment to help confirm or rule out a diagnosis of Alzheimer’s. Although the authors don’t address skin-based testing for biomarkers, they state that ⍺-synuclein assays “are likely to have a large role in the future” in clinical practice.
The report goes on to discuss types of interventions, lessons learned from COVID-19, public health policy, progress in the development of disease-modifying treatments, and the role of technology in managing dementia.
With the prevalence of dementia set to increase worldwide, “It is even more important now, therefore, that care for people with dementia and their families is improved,” concludes the commission.
