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expert reaction to The Lancet Commission 2020 report on dementia prevention, intervention and care

Researchers have conducted a Lancet Commission review into dementia prevention, intervention and care.

 

Dr Vanessa Raymont, Senior Clinical Researcher and Honorary Consultant Psychiatrist, University of Oxford and Director, Oxford Brain Health Clinical Trials Unit, said:

“This paper confirms the need to address some modifiable risk factors for developing dementia, such as alcohol consumption, head injury,and air pollution. Research has highlighted head injury as a potential contributor to dementia risk for many years, and this is a welcome drive to investigate how we can mitigate against this, especially as concern around injuries in contact sports has increased. It is vital we understand the relationship between head injury and dementia further though, in order to inform the public and policy makers.”

 

Prof Jennifer Rusted, Professor of Experimental Psychology, the University of Sussex, said:

“This review brings together research and opinion from a wide variety of sources into a sizeable overview of current knowledge regarding late life dementia.  

“The biggest known risk for late life dementia is genetic – specifically carriers of the Apolipoprotein E epsilon 4 genotype have 4-12 fold increase in likelihood of experiencing dementia in their lifetime.  

“In this article, the focus, however, is on the modifiable factors that we can address to reduce our chances of experiencing dementia in our lifetime.  This is vitally important since we have an ageing population and still have only symptomatic treatments for late life dementia.  

“While the newly added risk factors are important, the big picture here is that an individual’s dementia risk is a complex of many factors that impact differently through the lifespan, and lifestyle choices and changes can quite significantly reduce risk of dementia in later life. 

“The cumulative effect of multiple risk factors is an important message for the real world: if you can work to mitigate any of these multiple factors then you can at least push back the age at which cognitive impairment emerges to affect your independent living and quality of life. 

“The newly added risk factors themselves link dementia risk to social conditions, living conditions and life choices. In this regard, government and society as well as the individual must take some responsibility to act on the findings.  

“Policy recommendations include education across the lifespan and health policy that will have impact not only a person’ s risk for developing dementia, but for living well and independently in older adulthood.”

 

Professor Gavin Shaddick, Director of the Centre for Environmental Intelligence at the University of Exeter, said:

“This analysis is reflective of a growing body of evidence linking exposure to air pollution and dementia. Until recently only relatively few studies, often based on small numbers of people, reporting associations between poor air quality and dementia. Now, we’re seeing high-quality research based on millions of people, showing consistent findings that are replicated across different studies and in different regions. As such, we are now building a much clearer picture of the extent to which  air pollution contributes to the risk of dementia.

“It’s really significant that this influential Lancet Commission has highlighted the link between dementia and air pollution, because it’s one of the factors that it’s within our control to act upon. We now need governments around the world to work together to reduce air pollution, which would improve human health in a variety of ways, including reducing dementia risk.”

 

Prof John Hardy, Professor of Neuroscience, UCL, said:

“There is good epidemiological evidence that in incidence (numbers per age) of dementia has gone down over the last 30 years although the prevalence (total number of cases) has increased because of the ageing populations.  This has been a hidden health policy success and probably relates to better heart and general health in western societies.  This review systematically explores what may underlie these improvements so that public policy can direct efforts towards further incremental improvements.  Implementing these improvements (e.g. smoking and boxing cessation) will require political will and public education.”

 

Prof Tara Spires-Jones, UK Dementia Research Institute at The University of Edinburgh, and Deputy Director, Centre for Discovery Brain Sciences, University of Edinburgh, said:

The Lancet Commissions Report published today looks at data from many different studies around the world of risk factors for dementia.  This report is important as it highlights practical ways we can all try to reduce our risk of dementia including not smoking, keeping fit and healthy, and avoiding excessive drinking.  This report was a well-conducted compilation of a large amount of data. However, it is important to note that this type of association data does not prove causation leaving a lot of “chicken and egg” questions. For example, depression over age 65 is associated with a higher risk of dementia, but it is not clear from this type of data whether depression contributes to causing dementia since there is also evidence that the changes in the brain early in dementia cause depression. 

“This report estimates that 40% of dementias might be preventable with lifestyle changes which means that the remaining 60% are to the best of our knowledge caused by things people cannot control like their genes – so I hope that this report will not lead to people feeling like having dementia is their “fault”. In future, it is important to use the data in this report to keep working to understand how lifestyle can make the brain more vulnerable or resilient to dementia so that we can develop life changing treatments for people living with dementia.”

 

Prof Huw Williams, Clinical Neuropsychologist at the University of Exeter, and an expert on Traumatic Brain Injury., said:

“This analysis shows how the two big neuro-health conditions – Traumatic Brain Injury and dementia –  are intricately linked. We’ve known for years that repeated brain injury links to dementia, which makes sense, but the global evidence around brain injury was very mixed. We’ve seen some poor quality studies, lacking control groups and so on, but now more robust research does indicate casual links between brain injury and dementia”.

“This link is particularly worrying as research shows head injuries are increasing. Many result from car crashes, violence, assaults and falls. Some populations are particularly vulnerable – with the young from disadvantaged backgrounds, across the world, being more at risk. Some populations, such as civilians in war zones, are at enormous risk.”

“It’s fantastic to see this evidence robustly analysed, as our research tells us that we can take action to reduce head injuries, and their effects, which in turn could reduce dementia risk. For example through the “win-win” of introducing better, safer, greener, public transport and through working with susceptible groups such as refugees, children and young people from more disadvantaged backgrounds and people in occupations where injury is common, such as the military. We urgently need better rehabilitation and management too. Without support, people who have experienced head injury can drift into suicidality, crime. Now we know that brain injury can also increase dementia risk, it’s high time that global policy leaders took on board the evidence to build safer societies.”

 

Dr Rosa Sancho, Head of Research at Alzheimer’s Research UK, the UK’s leading dementia research charity, said:

“This collaborative report from dementia experts across the world highlights a number of potentially modifiable risk factors for dementia throughout a person’s life. Research is constantly uncovering more about dementia and this is the most comprehensive overview into dementia risk to date, building on previous work by this commission and moving our understanding forward.

“As new studies continue to develop the evidence base on dementia risk, the report has identified three new risk factors for dementia. More evidence on the complex topic of sleep is needed before we can make a judgement on its impact on dementia risk, but we hope this report will act as a catalyst for further research.

“With no treatments yet able to slow or stop the onset of dementia, taking action to reduce these risks is an important part of our strategy for tackling the condition. Prevention strategies must be underpinned by robust evidence and while our understanding of dementia risk is growing, there is still much we need to know about the different risk factors for dementia.

“This report underlines the importance of acting at a personal and policy level to reduce dementia risk. With Alzheimer’s Research UK’s Dementia Attitudes Monitor showing just a third of people think it’s possible to reduce their risk of developing dementia, there’s clearly much to do here to increase people’s awareness of the steps they can take. 

“While there’s no sure-fire way of preventing dementia, the best way to keep your brain healthy as you age is to stay physically and mentally active, eat a healthy balanced diet, not smoke, drink only within the recommended limits and keep weight, cholesterol and blood pressure in check.”

 

Prof  Bart De Strooper, Director of the UK Dementia Research Institute, said: 

“The advice given in the report is quite general and applies to most areas of health. We have long known that lifestyle changes such as reducing alcohol intake, not smoking, controlling blood pressure, and leading an active life, have a whole range of health benefits. These interventions may lead to healthier aging, which is great, but it is only one part of the picture. 

“The genetic make-up of an individual is at least as great a risk factor for Alzheimer’s disease as lifestyle, for example. We are gradually uncovering the molecular processes that go awry in neurodegenerative disorders and we need to use that knowledge to develop effective treatments. Ultimately, new medicines and interventions are needed if we really want to control the various diseases that lead to dementia. This is why it is so important to stay committed to the aims set out three years ago for the UK Dementia Research Institute. With the right infrastructure and funding, we will be able to fundamentally change the prospects of individuals at risk. 

“So alongside the nine recommendations made by this report, I would add the need for ambitious, sustained, and assured support for dementia research.”

 

Fiona Carragher, Director of Research and Influencing at Alzheimer’s Society, which part funded the Lancet Commission,  said:

On risk factors:

“Dementia is a global crisis affecting more than 50 million people, leaving devastated families in its wake. The news that 40% of dementia cases are, in theory, preventable is certainly welcome, but stopping thousands of people from being stripped of their memories, relationships and identities will rely on more than just this knowledge alone.

“While we don’t have all the answers yet, we can take action now to tackle the risk factors within our control, including excessive drinking, obesity and high blood pressure. Meanwhile, we need public health policies to address other factors, such as air pollution and inequalities in childhood education.

“This Lancet Commission update, part-funded by Alzheimer’s Society, must spur action from the Government. Greater investment in high quality, in-depth research will help inform how we can effectively tackle these risk factors and is vital if we are to buck the trend of increasing dementia cases.

“Medical research charities like Alzheimer’s Society, expect to see on average a 40% fall in research investment this financial year following a drastic fall in income due to the pandemic. So, to maintain progress in this chronically underfunded field, it’s critical the Government keeps its word and commits to doubling dementia research funding. This will allow researchers to address urgent, unanswered questions such as how risk factors interlink, how they affect people from different ethnic groups, and how best people can be supported to proactively address these risk factors throughout their lives.”

On Dementia Care – a holistic approach:

“Today’s findings underline why we need to consider every dimension of care for a complex condition like dementia – physical, mental health and social. But also we need to focus on family carers, who should be equal partners in dementia care.

“The 850,000 people across the UK with dementia have the right to the best care and support so, rather than simply surviving, they can live well. They deserve effective, accessible and timely diagnosis, proper post-diagnostic support, personalised ongoing care to live well and independently for as long as possible, and responsive, compassionate end of life care.

“Our dementia care researchers are building a picture of what good dementia care can look like. But it’s not being put into practice consistently across the country, and there is much more to learn. The Government needs to step up and commit to doubling dementia research funding, so they can improve standards of care at every single stage.”

 

‘Dementia prevention, intervention, and care: 2020 report of the Lancet Commission’ by Gill Livingston et al. was published in The Lancet at 17:30 UK time on Thursday 30th July.

DOI: 10.1016/S0140-6736(20)30367-6

 

Declared interests

Dr Rosa Sancho: No conflicts of interest

Fiona Carragher: Alzheimer’s Society part funded the Commission

None others received.

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