Vision loss and cholesterol: New factors associated with dementia
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A new report in The Lancet identified untreated vision loss and high cholesterol as risk factors in the development of dementia.1
The Commission has now identified a total of 14 risk factors, with the latest ones, vision loss and high cholesterol, added to the list.
“Overall,” the Commission commented, “around 45% of cases of dementia are potentially preventable by addressing the 14 modifiable risk factors at different stages during the life course.”
Notably, these risk factors can be affected by changes in lifestyle. The factors mentioned previously that research has uncovered also can be addressed. “Evidence is increasing and is now stronger than before that tackling the many risk factors for dementia that we modelled previously (ie, less education, hearing loss, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption [ie, >21 UK units, equivalent to >12 US units], traumatic brain injury, air pollution, and social isolation),” according to the Commission’s report.
They underscored the importance of lifestyle interventions. “By incorporating these potentially reversible risk factors from different phases of the life-span and not just old age, we are able to propose a novel life-course model of risk, from which population attributable fractions have been derived to show the possible effect on future incidence of successful elimination of the most potent factors. We have brought together all this evidence and have calculated that more than a third of dementia cases might theoretically be preventable.”
Dementia has a huge societal impact. With about 47 million people living with dementia, the costs are staggering. “The 2015 global cost of dementia was estimated to be $818 billion in US dollars, and this figure will continue to increase as the number of people with dementia rises. Nearly 85% of costs are related to family and social, rather than medical, care. It might be that new medical care in the future, including public health measures, could replace and possibly reduce some of this cost,” the Commission commented.
The bottom-line message is that dementia is not an inevitable consequence of aging.
The key messages of the report are as follows.
- The number of people with dementia is increasing globally, although the incidence in some countries has decreased.
- Be ambitious about prevention. Recommended actions include active treatment of hypertension in middle-aged people 45–65 years and people older than 65 years without dementia. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity may delay/prevent a third of dementia cases.
- Treat cognitive symptoms to maximize cognition. Alzheimer’s disease or dementia with Lewy bodies can be treated with cholinesterase inhibitors at all stages other than mild impairment, or memantine for severe dementia.
- Individualize dementia care to include medical, social, and supportive care; this includes unique individual and cultural needs, preferences, and priorities and support for family carers.
- Care for family carers are at high risk of depression. The Commission recommends these interventions to reduce depression and treat symptoms: STrAtegies for RelaTives (START) or Resources for Enhancing Alzheimer’s Caregiver Health intervention (REACH).
- Plan for the future. This includes discussions about the future decision-making possibly by attorneys and the ability of clinicians to make different types of decisions at diagnosis.
- Protect people with dementia against self-neglect, vulnerability (including exploitation), managing money, driving, or using weapons.
- Manage neuropsychiatric symptoms that include agitation, low mood, or psychosis with psychologic, social, and environmental management; pharmacologic management is reserved for more severe symptoms.
- End-of-life decisions. Professionals working in end-of-life care should consider if a patient has dementia to ensure that decisions are made about their care and treatment and needs and wishes.
- Technology interventions can improve care delivery but should not replace social contact.
