”DEMENTIA DEEMED HIGHLY PREVENTABLE”
When you learn that in the United States, 2 out of 3 (67%) patients with dementia are women, that women have a longer life expectancy than men, and that 50% of Americans over age 85 have dementia, you realize there are a lot of people, especially elderly women, with cognitive issues. That’s a sobering thought. To think that just because you live a long life, you have a 50-50 chance of having dementia, is worrisome and distressing. Age is one of the factors for dementia, of course, but it’s not one of the factors we can do anything about.
Fortunately, however, researchers at the University of Cambridge in the United Kingdom have deemed dementia a global public health priority and formed a commission to study modifiable risk factors for dementia. Their hope was to identify factors that would be used to “derive a population-level intervention framework for dementia risk reduction.” In plain language, they looked at lifestyle factors and medical disorders which could be altered or minimized with the goal of reducing the incidence of dementia in the elderly. By aggressively identifying and modifying these factors, it is hoped dementia can be prevented. Their findings were published in April 2024, in the prestigious British medical journal, The Lancet.
The commission on dementia compiled information from several observational studies and arrived at 14 “modifiable lifecourse risk factors.” The aim of the study was to find the most likely factors that could contribute to the development of dementia and to control them as strictly as possible.
The fourteen (14) risk factors are as follows:
1. Low education attainment
2. Traumatic brain injury
3. Hearing and/or vision loss
4. Hypertension—high blood pressure
5. Excess alcohol intake
6. Obesity
7. Cigarette smoking, tobacco abuse
8. Depression
9. Social interaction—lack thereof
10. Physical inactivity
11. Air pollution
12. Diabetes
13. Diet and LDL-C
14. Coronary Heart Disease
Low Education Attainment: It’s a known fact that intellectual under-stimulation and low level of education contribute to dementia. Encouraging educational pursuits prevents deterioration later in life. Exercising the mind is as good as exercising the body.
Traumatic Brain Injury: TBI’s are known to cause cognitive and behavioral problems later in life. Mandatory helmets for bicycle and motorcycle riders, contact sports, and playground activities plus auto seatbelts are common preventive measures.
Hearing and Vision Loss: The hearing impaired often are mistakenly labeled demented. Occupational and recreational noise exposure can be controlled to prevent hearing loss later in life. Improving vision helps intellectual stimulation.
Hypertension: High BP can cause brain cell death. BP control is a well-known recommendation for the prevention of cerebrovascular and cardiovascular disorders.
Excess Alcohol Intake: Repeated alcohol exposure over many years harms brain cells and can cause dementia. Limiting intake prevents brain cell damage.
Obesity: A risk factor for so many disorders, obesity indirectly causes dementia by allowing other problems to have free rein. All organ systems work harder in an obese individual.
Cigarette Smoking: An incredibly harmful addiction known to accelerate hardening of the arteries, and in the brain and coronaries, it has particularly harmful effects. Tobacco avoidance generally leads to better health and longevity.
Depression: Leads to loneliness and neglect of personal care, hygiene, diet, and exercise which cause dementia to take root.
Social Isolation: Lack of intellectual interaction with others leads to hopelessness and personal neglect. Dementia is a late effect.
Physical Inactivity: Exercise is helpful for any problem. Inactivity leads to idleness of body and mind.
Air Pollution: Carbon Monoxide and particulate matter in the atmosphere are harmful in many ways. Clean air eliminates toxins we breathe. Eliminating gas stoves reduces indoor pollution.
Diabetes: Diabetes Type 2 is a vascular inflammatory disease which can have an affect on brain cells. Proper diet, weight control, and exercise can delay the onset of diabetes and prevent dementia.
Diet and LDL-C: Diets low in saturated fat, low in carbs, and high in vegetables promote weight loss and reduce arteriosclerosis.
Coronary Heart Disease: A general indication of poor health habits resulting in arteriosclerosis. If it’s present in the coronaries it’s present in the brain as well.
Identifying these 14 risk factors for dementia resulted in researchers recommending 26 interventions that would reduce the impact of these factors in the development of dementia. Some are listed above. They admitted, however, they could not attach direct causality to these 14 factors, but stated “each of these risk factors also represent valid targets for public health policy in their own right.” That is, modifying these risk factors is good health care policy even if it may not prevent dementia.
Dementias are untreatable, unchangeable, chronic progressive disorders. Once dementia begins, nothing currently available will stop it or treat it effectively. Namenda, Aricept, Exelon, Nuedexta, and others are approved for dementia and are often prescribed, but any improvement they generate is very difficult to assess. Experts say “close to 50% of cases of dementia worldwide can be prevented or delayed by improving 14 modifiable risk factors,” and that’s what this post is all about. The best “treatment” is prevention. By aggressively treating these modifiable risk factors, the hope is dementia will be less likely to occur or will not occur at all even though no direct correlation to these risk factors is provable.
References: Manson JE. Dementia Deemed Highly Preventable Medscape OB/GYN 2024 August 14.
Walsh S, Wallace L, Kuhn I, Mytton O, Lafortune L, Wills W, Mukadam N, Braine C. Population-level interventions for the primary prevention of dementia: a complex evidence review. The Lancet 2024 April;70:1-22.
