Lifestyle factors known to influence dementia risk

With two parents who have suffered dementia, I am always an avid reader of anything which indicates we may have some control over this terrible disease.

Anyway, experts have increased the number of lifestyle factors known to influence our risk of developing dementia from nine to 12. Taking action on these factors across the life course could delay or prevent the condition in 40 per cent of people who would otherwise develop dementia.

Professor Clive Ballard, of the University of Exeter, is an author on an update to The Lancet Commission on dementia prevention, intervention, and care, which is being presented at the Alzheimer’s Association International Conference (AAIC 2020).

The report highlights nine recommendations for policymakers and individuals to help reduce risk, including providing primary and secondary education for all children, decreasing harmful alcohol drinking, preventing head injury, using hearing aids, protecting ears from high noise levels, and urgently improving air quality.

The three new risk factors to be added are:

  • excessive alcohol intake
  • head injury in mid-life
  • exposure to air pollution in later life.

 

Combined, they are associated with six per cent of the risk of developing dementia– with an estimated three per cent of risk attributable to head injuries in mid-life, one per cent of risk to excessive alcohol consumption (of more than 21 units per week) in mid-life, and  two per cent to exposure to air pollution in later life.

 

The remaining risk factors are associated with 34 per cent of the risk. These include:

  • effectively treating hypertension, diabetes and obesity from mid-life
  • exercising from mid-life.

The factors associated with the greatest proportion of risk in the population are:

  • less education in early life
  • hearing loss in mid-life
  • smoking in later life (seven per cent, eight per cent, and five per cent, respectively).

Professor Clive Ballard, Dean and Pro-Vice Chancellor of the University of Exeter, said: “Our findings present an exciting opportunity to improve millions of lives across the world by preventing or delaying dementia, through healthier lifestyle to include more exercise, being a healthy weight and stopping smoking; and good medical treatment of risk factors like high blood pressure.

“One important less well known risk factor is hearing loss in mid-life, with emerging evidence that wearing hearing aids may be protective. This presented an important public health message – if you’re having hearing problems, getting tested in mid life and wearing a hearing aid if needed could have multiple benefits.

“This analysis shows there’s real potential to improve brain health by taking action here in the UK, and to an even greater extent in low and middle-income countries.”

Professor Ballard is one of 28 world-leading dementia experts to author the report, which builds on the nine risk factors identified in the 2017 Lancet Commission, and provides an up-to-date analysis of the best evidence on the prevention of dementia. The new report calls for nations and individuals to be ambitious about preventing dementia and lays out a set of policies and lifestyle changes to help prevent dementia.

To address dementia risk, the authors call for 9 ambitious recommendations to be undertaken by policymakers and by individuals:

  • Aim to maintain systolic blood pressure of 130 mm Hg or less in midlife from around age 40 years.
  • Encourage use of hearing aids for hearing loss and reduce hearing loss by protecting ears from high noise levels.
  • Reduce exposure to air pollution and second-hand tobacco smoke.
  • Prevent head injury (particularly by targeting high risk occupations and transport)
  • Prevent alcohol misuse and limit drinking to less than 21 units per week.
  • Stop smoking uptake and support individuals to stop smoking (which the authors stress is beneficial at any age).
  • Provide all children with primary and secondary education.
  • Lead an active life into mid, and possibly later life.
  • Reduce obesity and diabetes.

 

They note that people with dementia are particularly at risk from COVID-19 (due to age and having pre-existing illnesses, such as hypertension), and that physical-distancing measures can be challenging for dementia patients, who may find it difficult to adhere to the guidelines or distressing to be unable to have contact with carers and family. The authors call for people with unknown COVID-19 status to not be admitted to care homes to protect the existing residents, regular testing of staff and asymptomatic as well as symptomatic residents when there is exposure, not moving staff or residents between homes, and more research into how to protect dementia patients during the current pandemic and future public health emergencies.

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