Dementia Prevention, Intervention, and Care: A 2024 Review

This briefing document reviews key themes and findings from the "Dementia prevention, intervention, and care 2024 report" published in The Lancet. The report provides a comprehensive update on dementia, examining risk factors, diagnosis, treatment, and care.

Main Themes:

1. Shifting Demographics and Evolving Understanding: While the age-related incidence of dementia might be declining in some high-income countries due to factors like improved cardiovascular health and cognitive reserve, the overall number of people with dementia continues to rise due to aging populations.
2. Life-Course Approach to Risk Factors: The report emphasizes a life-course model for dementia risk, highlighting the influence of factors from early life through late life.
3. Importance of Modifiable Risk Factors: A significant portion of dementia cases can be attributed to modifiable risk factors, offering opportunities for prevention strategies.
4. Advances in Biomarkers and Diagnosis: Progress in biomarkers enhances the ability to identify and classify dementia subtypes, particularly Alzheimer’s disease.
5. Emerging Treatments and the Need for Improved Care: The advent of disease-modifying drugs, alongside advancements in psychosocial treatments, necessitates concurrent improvements in care models to support people with dementia and their families effectively.

Key Findings and Ideas:

Risk Factors:

• Early Life:Less education remains a significant risk factor (Population Attributable Fraction [PAF] = 5%).
• Midlife:Hearing loss (PAF = 7%), high LDL cholesterol (PAF = 7%), and depression (PAF = 3%) are major modifiable risk factors.
• Traumatic brain injury (PAF = 3%), physical inactivity (PAF = 2%), smoking (PAF = 2%), diabetes (PAF = 2%), and hypertension (PAF = 2%) also contribute significantly.
• Late Life:Social isolation (PAF = 5%), air pollution (PAF = 3%), and untreated vision loss (PAF = 2%) are important risk factors.
• Other factors:Excessive alcohol consumption is associated with increased dementia risk, while light-to-moderate alcohol consumption may have a protective effect.
• The role of menopause and hormone replacement therapy (HRT) in dementia risk remains unclear.

Treatment and Care:

• Cholinesterase inhibitors might offer modest benefits in slowing cognitive decline and reducing mortality in certain dementia subtypes.
• Managing behavioral and psychological symptoms of dementia (BPSD), such as agitation and psychosis, requires careful assessment and personalized interventions, prioritizing non-pharmacological approaches.
• Delirium superimposed on dementia is a significant concern, associated with further cognitive decline and poor outcomes.
• The report emphasizes the importance of comprehensive care models, including support for families and carers.

Conclusion:

The 2024 Lancet Commission report underscores the growing global challenge of dementia. While research continues to unravel the complexities of the disease, the report emphasizes the importance of a life-course approach to risk reduction, timely diagnosis, and comprehensive care that addresses the needs of individuals with dementia and their families.