Dementia prevention, intervention and care

The Lancet Commission on Dementia Prevention, Intervention, and Care has recently updated its guidance on modifiable factors that could be targeted to reduce risk of dementia. This is an area where traditional therapy and commentary medicine interventions have a role to play in helping people to improve risk factors for dementia and help people manage their health.

Some background on dementia

Worldwide around 50 million people live with dementia. This number is projected to increase to 152 million by 2050, predominantly in low-income and middle-income countries where around two-thirds of people with dementia live. [1]

Dementia is not a specific disease in its own right, but represents to a group of conditions involving impairment of at least two neural functions, such as memory loss and personality change that interferes with daily functioning. The most common causes of dementia include Alzheimer’s disease, vascular dementia and dementia with Lewy bodies.

Cognitive change associated with dementia can include memory loss (which is usually noticed by other people), difficulty communicating or finding words, difficulty with visual and spatial abilities (such as getting lost while driving), difficulty reasoning or problem-solving, difficulty handling complex tasks, difficulty with planning and organising, difficulty with coordination and motor functions, confusion and disorientation. [2]

Psychological changes can include personality changes, depression, anxiety, inappropriate behaviour, paranoia, agitation and/or hallucinations. [2]

Dementia in Australia

In 2021, it was estimated that there were between 386,200 and 472,000 Australians living with dementia [3].

Based on Australian Institute of Health & Welfare (AIHW) estimates, this is equivalent to 15 people with dementia per 1,000 Australians, which increases to 83 people with dementia per 1,000 Australians aged 65 and over.

Nearly two-thirds of Australians with dementia are women. [3]

Lancet Commission – factors that can be targeted to reduce risk of dementia

The 2017 Lancet Commission on Dementia Prevention, Intervention, and Care identified 9 modifiable factors that could be targeted to reduce risk of dementia, based on a growing body of evidence [1]. These factors included:

– less education

– hypertension

– hearing impairment

– smoking

– obesity at midlife

– depression

– physical inactivity

– diabetes

– low social contact/ depression.

An updated report in 2020 added the following risk factors to this list, in light of new research findings: [4]

– excessive alcohol consumption

– traumatic brain injury

– air pollution.

Accordingly, the estimated proportion of preventable cases of dementia increased from 35% in 2017 to approximately 40% in 2020.

Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.

The Lancet report authors conclude:

“the potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur. Our new life-course model and evidence synthesis has paramount worldwide policy implications. It is never too early and never too late in the life course for dementia prevention.”

Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve; midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments. Culture, poverty, and inequality are key drivers of the need for change. Individuals who are most deprived need these changes the most and will derive the highest benefit.

Lowering risk of dementia with natural medicine

The modifiable risk factors identified by the Lancet Commission generally fall in the range of lifestyle and nutritional modifications that could be made to improve physiological and mental wellbeing. A healthy lifestyle can help prevent cardiovascular diseases, such as stroke and heart attacks, which are themselves risk factors for Alzheimer’s disease and vascular dementia.

These factors are amenable to being aided by a range of traditional and complementary medicine interventions.

Natural therapies such as naturopathy, herbal medicine, homeopathy, acupuncture and nutrition provide options that can play a role in helping improve risk factors for dementia, such as cholesterol, hypertension, insomnia, depression and the impacts of chronic stress. Practices such as Tai chi, yoga and pilates are also supported by good evidence showing their ability to improve overall health and wellbeing.

There is a growing body of research for addressing these diseases using natural medicine interventions, along with preventing them in the first place.

Further information on the role that natural therapies can play in alleviating the risk factors for dementia can be read here and here.

Sources:

[1] Livingston G, et al. Dementia prevention, intervention, and care. Lancet. 2017 Dec 16;390(10113):2673-2734. doi: 10.1016/S0140-6736(17)31363-6.

[2] Dementia. MayoClinic. https://www.mayoclinic.org/diseases-conditions/dementia/symptoms-causes/syc-20352013

[3] Dementia in Australia. Australian Institute of Health & Welfare (AIHW), 2021. https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/summary

[4] Livingston G, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet Commissions. August 08, 2020;396(10248):413-446. doi: https://doi.org/10.1016/S0140-6736(20)30367-6

[5] Hooshmand B, et al. Antioxidants and Dementia: More Than Meets the Eye. Neurology. 2022;98:871–2. Available from: http://www.neurology.org/lookup/doi/10.1212/WNL.0000000000200718