- New report: How to prevent dementia
The risk of Dementia is proven to increase due to smoking, obesity, hearing loss, overweight, loneliness, air pollution, and several other factors. A new report from the international Lancet Commission has now added high cholesterol levels and declining vision to this list. If all 14 modifiable risk factors were eliminated, nearly half of global dementia cases could be prevented or at least delayed, according to the report. However, the calculation is not that simple.
No cure, but prevention
In Germany, an estimated 1.8 million people live with dementia, according to the German Alzheimer's Association. The term encompasses various diseases, including Alzheimer's, which lead to a loss of cognitive abilities. There is currently no cure.
The new report by the "Lancet Commission on dementia prevention, intervention, and care" states that 45 percent of dementia cases could be prevented or delayed if the 14 risk factors were eliminated. In 2020, the international group presented 12 of these risk factors: low education, hearing loss, hypertension, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injuries, air pollution, and social isolation.
The report has now added two more factors associated with nine percent of all dementia cases: approximately seven percent can be attributed to high LDL cholesterol levels after the age of about 40, and two percent to untreated late-life vision loss.
Conversely, this means that correcting declining vision and lowering LDL cholesterol to optimal levels in midlife can actually reduce the risk of dementia, explains Peter Berlit, General Secretary of the German Society of Neurology (DGN). These connections were expected but are now confirmed by the Lancet report and should be considered in medical treatment, for example by general practitioners.
Risk factors can reinforce each other
The neurologist emphasizes the interconnections between different risks: if declining hearing and vision are not corrected in time, they affect communication, which in turn affects cognitive abilities and social interactions: "Regular cognitive training and social isolation are also factors that play a role in dementia development."
Regarding the prevention potential estimated by the Lancet Commission, Berlit is cautious: the 45 percent is based on the addition of all mentioned risk factors, assuming they have been avoided since childhood: "Of course, that's unrealistic." Nevertheless, significant effects could be achieved if each individual and politics took appropriate measures.
Stefan Teipel from the German Center for Neurodegenerative Diseases (DZNE) in Rostock also says that the sum of preventable dementia cases across all risk factors is likely to be lower: "The study adds up the individual modifiable risks to nearly 45 percent. However, if several risk factors are influenced, there are synergistic effects, and the effects of risk reduction cannot simply be added up for individual individuals."
What's good for the brain is also good for the heart.
Berlit emphasizes that dementia prevention at the individual level involves more than just brain training through puzzles, learning foreign languages, or playing musical instruments: "That's all important. However, it's also proven that proper nutrition, such as the Mediterranean diet, minimal alcohol consumption, regular physical activity, and maintaining a healthy weight can lower the risk of dementia." All of this not only benefits the brain but also the heart. Corresponding behavior could be encouraged through bonus payments by health insurers.
Politically, risk factors such as air pollution and access to education need to be addressed, as recommended in the report. Children from disadvantaged families should be supported as early as kindergarten, says Berlit. Another political task is combating the effects of the climate crisis: "We already know that the risk of stroke is increased by the lack of nighttime cooling." In the area of dementia, the evidence is not yet extensive, but relevant studies are underway and may play a role in future Lancet reports.
Prevention from childhood
Berlit stresses that preventive measures should be taken from an age when dementia is not yet a concern. Central to this is making the contents of the report widely known. The doctor emphasizes: "Everyone must know that they can make a significant contribution to minimizing the risk of dementia, and other diseases, through a change in their lifestyle."
Such dementia prevention through a healthier lifestyle is already happening, according to Frank Jessen: "The prevalence of dementias is decreasing percentage-wise in many countries, including Germany, in relation to age." However, the number of older people is increasing rapidly, so the total number of dementia cases is slightly increasing. The director of the Clinic for Psychiatry and Psychotherapy at the University of Cologne explains: "If we didn't live healthier and didn't pay attention to factors like blood pressure, exercise, and nutrition, the numbers of dementia cases would be higher."
A "Brain Health Agenda" is needed in Germany
A German research group calculated last year what impact a reduction in risk factors could have here. Their study, published in the "German Medical Journal," found that if those factors could be reduced by 15% by 2033, it would reduce the number of dementia cases by 138,000 or 15%. Steffi Riedel-Heller, director of the Institute for Social Medicine, Occupational Medicine, and Public Health (ISAP) at the University of Leipzig, explains: "Behind every dementia case is a personal tragedy, for the person affected, their relatives, and the community in terms of healthcare costs. What an impact!" She calls for a "Brain Health Agenda" in Germany to bring this knowledge about modifiable risk factors to the people and, especially, to decision-makers in politics and society.
To further emphasize the importance of addressing modifiable risk factors for dementia prevention, Peter Berlit suggests, "General practitioners should consider the connections between factors like high LDL cholesterol levels and declining vision, and how correcting these issues can potentially reduce the risk of dementia." Additionally, Steffi Riedel-Heller advocates for a "Brain Health Agenda" in Germany to raise awareness about modifiable risk factors and encourage their reduction, stating, "Every percent reduction in these risk factors could contribute significantly to lowering the number of dementia cases."
