GHP July 2017

24 GHP / July 2017 NEWS , These potentially modifiable risk factors have been identified at multiple phases across the life-span, not just in old age. The Lancet Commission’s report was simultaneously published in The Lancet and presented at AAIC 2017. Also at AAIC 2017, the U.S. National Institute on Aging (NIA) announced inaugural research grants to investigate health disparities in Alzheimer’s disease. “The findings are extremely hopeful,” said Maria Carrillo, PhD, chief science officer at the Alzheimer’s Association. “At an individual level, many people have the potential to reduce their risk of cognitive decline, and perhaps dementia, through simple, healthful behaviour changes. At a public health level, interventions based on this evidence could be extremely powerful in managing the global human and economic costs of Alzheimer’s disease and other dementias.” The Alzheimer’s Association offers 10 Ways to Love Your Brain, including practical guidance to reduce your dementia risk based on the latest research. The Lancet International Commission on Dementia Prevention, Intervention and Care The Lancet Commission brings together 24 international experts to consolidate the huge strides that have been made in our knowledge and understanding of dementia risk factors, treatment and care, and the emerging 1612GH13 One Third of Dementia May Be Preventable In a report presented on July 20th, at the Alzheimer’s Association International Conference 2017 (AAIC 2017) inLondon, The Lancet International Commission onDementia Prevention, Intervention andCare reported thatmore than one third of global dementia casesmay be preventable through addressing lifestyle factors that impact an individual’s risk. knowledge as to what we should do to prevent and manage dementia. The commission conducted a new review and meta-analysis; based on which they extended current models of risk by including hearing loss and social isolation. Incorporating potentially modifiable risk factors from across the life-span, they proposed a novel life-course model of risk, highlighting the opportunity for prevention. Among their key recommendations are: • Be ambitious about prevention. Interventions for established risk factors may have the potential to delay or prevent one third of dementias. • Treat cognitive symptoms. To maximise cognition, people with Alzheimer’s dementia or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia. • Individualise dementia care. Good dementia care spans medical, social and supportive care; and should be tailored to unique individual and cultural needs, preferences, and priorities. • Care for family carers. Family carers are at high risk of depression. Effective interventions reduce the risk and treat the symptoms, and should be made available. • Plan for the future. People with dementia and their families value discussions about the future and important upcoming decisions. • Manage neuropsychiatric symptoms. Management of the neuropsychiatric symptoms of dementia - including agitation, low mood or psychosis - is usually psychological, social, and environmental, with drug treatment reserved for more severe symptoms. • Consider end of life. A third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether a patient has dementia as they may be unable to make decisions about their care or express their needs and wishes. Focus on Prevention The Lancet Commission launched a novel life-span-based model of dementia risk, showing interventions that may maximise cognition, decrease distressing associated symptoms, reduce crises, and improve quality of life. The team estimate the contribution of each of the risk factors to the overall incidence of dementia, at the population level. The combined evidence to date shows that roughly 35% of all cases of dementia are attributable to nine potentially modifiable risk factors. Many of the risk factors occur at life stages but some, such as smoking and hypertension, are likely to make a difference at all life stages. The nine modifiable risk factors include: • Early life - Education to a maximum of age 15 • Mid-life - Hypertension; Obesity; Hearing loss • Later life - Depression; Diabetes; Physical inactivity; Smoking; Low social contact Risk factors that are more common account for a higher percentage of population risk. For instance, the authors estimate that 8% of all dementia cases could be associated with poor early school education; and 5% could be associated with smoking. While the mechanism linking education, hypertension, diabetes and smoking to dementia is relatively well understood, the recognition of hearing loss as a potential risk factor is still new, and the research is at an earlier stage. The commission’s report delivered recommendations for targeted public health strategies that the researchers expect will significantly lower the global burden of Alzheimer’s and other dementias. For example: • The authors strongly recommend vigorously treating hypertension in middle aged and older people without dementia to reduce dementia incidence. • Other recommended interventions include more childhood education, getting regular exercise, maintaining social engagement, stopping smoking, and management of hearing loss, depression, diabetes, and obesity. The authors stated that, due to lack of data, the study did not include dietary factors, alcohol use, visual impairment, air pollution and sleep.