You might be interested in…Dementia Prevention

Dementia is a rapidly growing global concern, causing significant challenges in social, health, and economic sectors. The prevalence of dementia is on the rise, affecting one in every 14 individuals over 65 in the UK. While much research has focused on curing or managing dementia, the emphasis on prevention has been relatively limited.

General Practitioners (GPs) now play a crucial role in actively preventing dementia. According to The Lancet Commission in 2020, targeting 12 modifiable risk factors throughout life could potentially prevent or delay dementia in 40% of patients. These factors include education levels, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, low social contact, excessive alcohol consumption, traumatic brain injury, and air pollution.

A recent update by The Lancet Commissions in 2024 highlighted the importance of systematic reviews and meta-analyses in understanding how cognitive and physical reserves develop over a lifetime. By addressing vascular damage through lifestyle changes like quitting smoking and managing high blood pressure, the incidence of age-related dementia can be reduced.

Evidence continues to strengthen the case for addressing modifiable risk factors to lower the risk of dementia. Recent research now identifies untreated vision loss and high LDL cholesterol as additional risk factors for dementia.

Despite the growing evidence, there is still limited knowledge about how GPs perceive their role in dementia prevention and the barriers they face. A qualitative study aimed to explore the perspectives of GPs on dementia prevention revealed that while GPs acknowledge the importance of dementia prevention, discussions on dementia risk are rarely explicit during patient consultations.

Advocates suggest adopting a team-based approach in primary care to facilitate dementia risk communication, especially targeting individuals already at risk through long-term condition reviews or NHS health checks.

Looking ahead, studies predict a rise in dementia prevalence, particularly in low-income and middle-income countries and among individuals with low socioeconomic status in high-income countries. Efforts are underway to reduce dementia risk factors in underserved populations through coach-supported mobile health interventions.

A recent trial showed promising results in reducing dementia risk factors among individuals with low socioeconomic status in the UK and the general population in China. While challenges exist in implementing such interventions, active participation among those reached suggests potential benefits in reducing cognitive decline and dementia risk.

While no randomized clinical trial has definitively proven the effectiveness of interventions in preventing dementia, addressing risk factors can offer other health benefits. Governments are encouraged to invest in dementia prevention strategies focusing on education, health-promoting environments, and overall well-being, particularly in low and middle income countries where resources may be limited.

References:

1. Livingston G et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020; 396(10248): 413–446. doi: 10.1016/S0140-6736(20)30367-6
2. Livingstone G et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. The Lancet Commissions Volume 404, Issue 10452p572-628August 10, 2024. doi: 10.1016/S0140-6736(24)01296-0
3. Jones D et al. Dementia prevention and the GP’s role: a qualitative interview study. Br J Gen Pract 2024 Mar 27;74(741):e242-e249. doi: 10.3399/BJGP.2023.0103 Print 2024 Apr.
4. Moll van Charante E et al. Prevention of dementia using mobile phone applications (PRODEMOS): a multinational, randomised, controlled effectiveness–implementation trial. Lancet Healthy Longev 2024; 5: e431–42 Published Online May 16, 2024 https://doi.org/10.1016/S2666-7568(24)00068-0
5. Reuben D et al. Dementia Prevention and Treatment A Narrative Review. JAMA Intern Med. 2024;184(5):563-572. doi:10.1001/jamainternmed.2023.8522
6. Stephan B et al. Population attributable fractions of modifiable risk factors for dementia: a systematic review and meta-analysis. Lancet Healthy Longev 2024; 5: e406–21. doi: 10.1016/S2666-7568(24)00061-8