Modifying 12 key risk factors could delay or prevent 40% of dementia cases, according to an updated report by the Lancet Commission. Many factors can be tackled late in life, the authors say.

The international group of 28 experts has added excessive alcohol intake and head injury in mid-life, as well as air pollution in later life (aged 65 and older), to a list of risk factors it established in 2017. Others include smoking, depression, social isolation, physical inactivity and diabetes later in life, mid-life hearing loss, hypertension and obesity, and less education early in life.

The commission recommends that clinicians, along with individuals and policy makers, aim for the following targets (summarized):

  • Systolic blood pressure of 130 mm Hg or less in midlife from around age 40 years
  • The use of hearing aids to address hearing loss 
  • Smoking avoidance, or smoking cessation (this reduces the risk of dementia even in later life)
  • Reduced exposure to air pollution and second-hand tobacco smoke
  • Head injury prevention
  • Limited alcohol use
  • Sustained physical activity in midlife, and possibly later-life
  • Obesity and diabetes prevention

“We are learning that tactics to avoid dementia begin early and continue throughout life, so it’s never too early or too late to take action,” said commission member Lon Schneider, M.D., co-director of the USC Alzheimer Disease Research Center’s clinical core and a professor at the University of Southern California.

The report’s authors also decried what they said is an outsized number of unnecessary hospitalizations for people living with dementia. A holistic, individualized and evidenced-based care model may allow more conditions to be managed outside of an acute-care setting, they wrote.

The new report was presented this week at the Alzheimer’s Association International Conference 2020.

Additional news from the Alzheimer’s Association International Conference 2020

Alzheimer’s risk factors may be measurable in adolescents and young adults: New research suggests that Alzheimer’s disease risk factors may be evident in teenagers and young adults. Measurable factors at these young ages include high blood pressure, high cholesterol and diabetes and education quality. African Americans are diagnosed with these conditions at a disproportionate rate, and therefore are more susceptible to dementia, the authors reported

Pimavanserin reduces dementia-related psychosis symptoms in late-stage trial: Trial participants treated with pimavanserin (Nuplazid) showed reduced psychotic symptoms and reduced risk of relapse when compared with a placebo cohort, investigators reported. The drug was effective regardless of dementia subtype or severity. No other treatment is currently licensed to treat dementia-related psychosis, according to the authors.