The Lancet Commissions 30TH JULY 2020
Key messages
• Three new modifiable risk factors for dementia
• New evidence supports adding three modifiable risk
factors—excessive alcohol consumption, head injury, and air pollution—to
our 2017 Lancet Commission on dementia prevention, intervention, and care life-course model of nine factors (less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and infrequent social contact).
• Modifying 12 risk factors might prevent or delay up to 40% of dementias.

• Be ambitious about prevention
• Prevention is about policy and individuals.
Contributions to the risk and mitigation of dementia begin early and continue throughout life, so it is never too early or too late. These actions require both public health programmes and individually tailored interventions. In addition to population strategies, policy should address high-risk groups to increase social, cognitive, and physical activity; and vascular health.
•

Specific actions for risk factors across the life course
• Aim to maintain systolic BP of 130 mm Hg or less in midlife from around age 40 years (antihypertensive
treatment for hypertension is the only known effective
preventive medication for dementia).
• Encourage use of hearing aids for hearing loss and
reduce hearing loss by protection of ears from excessive
noise exposure.
• Reduce exposure to air pollution and second-hand
tobacco smoke.
• Prevent head injury.
• Limit alcohol use, as alcohol misuse and drinking more
than 21 units weekly increase the risk of dementia.
• Avoid smoking uptake and support smoking cessation
to stop smoking, as this reduces the risk of dementia
even in later life.
• Provide all children with primary and secondary
education.
•
• Reduce obesity and the linked condition of diabetes. Sustain midlife, and possibly later life physical activity.

• Addressing other putative risk factors for dementia, like sleep, through lifestyle interventions, will improve general health.
Tackle inequality and protect people with dementia
• Many risk factors cluster around inequalities, which occur
particularly in Black, Asian, and minority ethnic groups and in vulnerable populations. Tackling these factors will involve not only health promotion but also societal action to improve the circumstances in which people live their lives. Examples include creating environments that have physical activity as a norm, reducing the population profile of blood pressure rising with age through better patterns of nutrition, and reducing potential excessive noise exposure.

• Dementia is rising more in low-income and middle- income countries (LMIC) than in high-income countries, because of population ageing and higher frequency of potentially modifiable risk factors. Preventative interventions might yield the largest dementia reductions in LMIC.

For those with dementia, recommendations are:
• Provide holistic post-diagnostic care
• Post-diagnostic care for people with dementia should
address physical and mental health, social care, and support. Most people with dementia have other illnesses and might struggle to look after their health and this might result in potentially preventable hospitalisations.
• Manage neuropsychiatric symptoms
• Specific multicomponent interventions decrease
neuropsychiatric symptoms in people with dementia and are the treatments of choice. Psychotropic drugs are often ineffective and might have severe adverse effects.
• Care for family carers
• Specific interventions for family carers have long-lasting
effects on depression and anxiety symptoms, increase quality of life, are cost-effective and might save money.