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The Lancet Commission on dementia: 12 modifiable risk factors that could prevent or delay 40 percent of cases

Natalia Reoutova
06 Aug 2020

In its 2020 update, the Lancet Commission on dementia prevention, intervention, and care has added excessive alcohol consumption, traumatic brain injury (TBI), and air pollution to the nine potentially modifiable risk factors for dementia modelled in 2017, namely, less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact.

“Together, the 12 modifiable risk factors account for around 40 percent of dementia cases worldwide, which consequently could theoretically be prevented or delayed,” wrote the researchers. “The potential for prevention is high and might be higher in low-income and middle-income countries where more dementias occur.” [Lancet 2020, doi: 10.1016/S0140-6736(20)30367-6]

Heavy drinking is associated with brain changes, cognitive impairment, and dementia. [Alzheimers Res Ther 2019;11:1] A French 5-year longitudinal study of over 31 million people admitted to hospital found that alcohol use disorders were associated with increased dementia risk (hazard ratio [HR] for women, 3.3; HR for men, 3.4). The relationship was particularly clear in earlier-onset (65 years of age) dementia, where 56.6 percent of patients had an alcohol use disorder. [Lancet Public Health 2018;3:e124-e132]

On the other hand, a systematic review incorporating 45 studies of light to moderate drinking reported a reduced risk of dementia compared with not drinking (risk ratio, 0.7). [Curr Clin Pharmacol 2015;10:204-212] Drinking <21 units of alcohol per week might be associated with a lower risk of dementia. [JAMA Netw Open 2019;2:e1910319] The UK Whitehall study, with 23 years follow-up, included 9,087 participants aged 35–55 years at baseline. Results showed that drinking >21 units per week and long-term abstinence were both associated with a 17 percent increase in dementia compared with drinking <14 units per week. [BMJ 2018;362:k2927] Drinking >14 units per week was associated with right sided hippocampal atrophy on MRI. [BMJ 2017;357:j2353]

Single, severe TBI is associated with widespread hyperphosphorylated tau pathology. [Brain 2018; 141:2685-2699] A nationwide Danish cohort study of nearly 3 million people aged 50 years, followed for a mean of 10 years, found an increased risk of dementia (HR, 1.2) and Alzheimer’s disease (HR, 1.2) associated with TBI. Of note, dementia risk was highest in the 6 months after TBI (HR, 4.1) and increased with the number of injuries in people with TBI (HR for one TBI, 1.2; HR for ≥5 TBIs, 2.8). [Lancet Psychiatry 2018;5:424-431]

A cohort study of 28,815 older adults with concussion found the risk of dementia doubled, with one in six developing dementia over a mean follow-up of 3.9 years. However, those taking statins had a 13 percent lower risk of dementia vs those who were statin-free, as statins might mitigate injury-related brain oedema, oxidative stress, amyloid protein aggregation, and neuroinflammation. [JAMA Neurol 2019;76:887]

Air pollution and particulate pollutants are associated with poor health outcomes, including those related to non-communicable diseases. Animal models suggest that airborne particulate pollutants accelerate neurodegenerative processes through cerebrovascular and cardiovascular disease, Aβ deposition, and amyloid precursor protein processing. [Neurotoxicology 2016;56:235-253; Lancet 2017;389:718-726]

High nitrogen dioxide (NO2) concentration (>41.5 μg/m³; adjusted HR, 1.2), fine ambient particulate matter (PM)2.5 from traffic exhaust (HR, 1.1), and PM2.5 from residential wood burning (HR, 1.6 for a 1 μg/m³ increase) are associated with increased dementia incidence. [PLoS One 2018;13:e0198283; Environ Health Perspect 2016;124:306-312] A systematic review of studies until 2018, including 13 longitudinal studies with 1–15 years of follow-up of air pollutant exposure and incident dementia, found that exposure to PM2.5, NO2, and carbon monoxide were all associated with increased dementia risk. [Alzheimers Dis 2019;70:S145-S163]

“It is never too early and never too late in the life course for dementia prevention,” stressed the researchers. “Specific actions for [new] risk factors include: reducing exposure to air pollution, preventing head injury, and limiting alcohol use to <21 units per week.”

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Most Read Articles
Jairia Dela Cruz, 2 days ago
In patients with heart failure with reduced ejection fraction (HFrEF) receiving angiotensin-converting-enzyme (ACE) inhibitors, high dosing confers benefits for the risk of death or hospitalization that are similar to that obtained with lower dosing, according to a systematic review and meta-analysis.
11 Sep 2020
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06 Sep 2020
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4 days ago
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