By Antonella Macerollo
For October 2020, we have selected the following Research paper:
Livingston G. et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet 2020 Aug 8;396(10248):413-446. doi: 10.1016/S0140-6736(20)30367-6. Epub 2020 Jul 30.
Our paper of the month is the 2020 dementia report performed by the Lancet Commission and especially focused on risk factors that might be modifiable to prevent the onset of dementia.
The 2017 Lancet Commission on dementia found nine potentially modifiable risk factors for dementia: lower education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes mellitus, and low social contact.
In the up-to-date report, three more risk factors were added: excessive alcohol consumption, traumatic brain injury, and air pollution.
Of note, the updated 12 risk factor life-course model of dementia prevention accounted for around 40% of worldwide dementias, which might be prevented or delayed.
It is important to consider that the potential for prevention might be higher in low-income and middle-income countries where more dementias occur.
Our paper of the month has significant potential impact for public health policy of countries of all over the world. Initiatives to minimise incidence of head injury and decrease alcohol intake could potentially reduce young-onset and later-life dementia. In mid-life, control of systolic hypertension could be the focus. Stopping smoking, even in later life, reduces risk in all age groups.
Political interventions could expedite improvements in air quality, particularly in areas with high air pollution.
The Lancet commission recommends keeping cognitively, physically, and socially active in midlife and later life.
Regular physical exercise is a protective factor for dementia, very likely due to decreased risk of obesity, diabetes mellitus, and cardiovascular risk.
Quality of life is the main aim of much of dementia care. There are several lines of evidence for the effectiveness of psychosocial interventions to manage neuropsychiatric symptoms (especially delirium).
Dementia patients have died disproportionately during the COVID-19 epidemic. Hospitalisations are commonly distressing and are associated with poor outcomes and high costs. Our paper of the month gives us a very important take home message: individuals have a huge opportunity to reduce their dementia risk!