ALZHEIMER'S - 12 RISK FACTORS

Modifying 12 risk factors throughout life could delay or prevent 40% of dementia cases, according to an updated report by the Lancet Commission on dementia prevention, intervention and care, presented at the International Alzheimer’s Association Conference.

ALZHEIMER’S IN OLDER PEOPLE

Dementia affects around 50 million people worldwide, a figure expected to more than triple by 2050, especially in low- and middle-income countries, where approximately two-thirds of people with dementia live, according to the report. Women are also more likely to develop dementia than men.

However, in certain countries, such as the United States, England and France, the proportion of older people with dementia has decreased, probably partly due to lifestyle changes, demonstrating the possibility of reducing dementia through preventive measures, says Schneider.

The report also advocates holistic, individualised and evidence-based care for dementia patients, who usually have more hospital admissions due to conditions that could potentially be managed at home and who have a higher risk of suffering from COVID-19. In addition, it recommends offering interventions to family members who care for patients and who are at risk of developing depression and anxiety.

12 MODIFIABLE RISK FACTORS

These are 12 risk factors associated with poorer health outcomes which, if modified, can prevent the development of this disease or delay its progression. They are:

EDUCATIONAL LEVEL

The length of schooling is the indicator most commonly used, along with the type of academic training. In general, cognitive stimulation during childhood and adolescence has a greater impact on dementia prevention than in other age groups. This does not refer to the value of cognitive stimulation as a treatment for cognitive impairment and/or dementia. Nor does it mean that it is not useful or recommended as dementia prevention at other ages, but rather highlights the importance of what is acquired during the early stages of life.

HEARING

Uncorrected hearing loss in adulthood of 25 dB or more has been associated with dementia. There are several hypotheses, as adult hearing loss is a condition that is intuitively more associated with dementia in older people, but the relationship is present.

TRAUMATIC BRAIN INJURIES

Both the number and severity of these injuries are relevant, and the extent of damage to brain tissue is also taken into account. Population-based measures such as the implementation of helmet use, for example, have shown results in preventing individual consequences.

HIGH BLOOD PRESSURE

Controlling blood pressure (BP) levels is relevant as a preventive measure against dementia at any age, but especially during adulthood. Particular emphasis is placed on systolic blood pressure above 140 mmHg in adulthood. The pharmacological strategy used is not as important as the resulting control of BP levels.

PHYSICAL ACTIVITY

The ideal level of physical activity is complex to establish in terms of individual recommendations. Preferences and limitations inherent to different age groups, generations, cultures and social classes must be considered. The benefits of physical exercise are global in terms of health; however, paradoxically, certain types of exercise (especially those that are more isometric and performed at home) do not always achieve the expected results in terms of specific health measures.

DIABETES

Results are contradictory regarding whether better glucose control or a specific medication has greater evidence in reducing dementia prevalence. What is clearer is the role of diabetes as a risk factor for cognitive decline.

ALCOHOL

The amount and duration of alcohol consumption are related not only to some early-onset dementias, but also to all types of dementia.

OBESITY

The presence of obesity in adulthood has been associated with dementia. Weight loss has also been considered a protective factor compared to those who remain obese.

SMOKING

As with obesity, stopping active tobacco consumption at any age also has benefits in terms of reducing the risk of developing dementia.

DEPRESSION

Depression and dementia overlap in such a way that even their differential diagnosis or simultaneous presence is complex to distinguish. It is untreated depressive episodes that appear to be associated with the onset of dementia.

SOCIALISATION

A low number or absence of social contacts and isolation (more subjective), beyond the fact that they may be a prodrome of cognitive decline, are risk factors for dementia.

ENVIRONMENTAL POLLUTION

The main measures refer to concentrations of nitrogen dioxide and particles related to traffic emissions. Higher concentrations of both have been associated with a higher risk of dementia. As a curiosity, it is worth noting that populations of people over 90 years old are often found in rural environments.

Despite the extensive information available regarding dementia prevention and dementia in general, there are still important gaps in knowledge. The impression is that there is still much to be done in this field, but there is also much to be done in implementing everything we know works. It is also necessary to avoid and highlight those things that have been proven not to work, or at least have not shown any beneficial effects, except for the manufacturer of the product.