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Lancet adds alcohol, brain injury, pollution to list of risk factors

‘Be ambitious about prevention’ is a key message from The Lancet Commission’s 2020 report, Dementia Prevention, Intervention And Care – in which it revisits its 2017 report findings on this topic, and adds a further three modifiable risk factors for dementia: excessive alcohol consumption, traumatic brain injury and air pollution.

The 2020 publication reports on the growing body of evidence for the nine potentially modifiable risk factors for dementia first put forward by the Commission in 2017: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. It says new reviews and meta-analyses conducted by the international team behind the Commission have only confirmed the evidence for these nine factors.

It also says “newer, convincing” evidence now exists to support the conclusion that excessive alcohol consumption, traumatic brain injury and air pollution should be added to this list.

The Commission says that together the 12 modifiable risk factors account for around 40% of worldwide dementias, which theoretically could be prevented or delayed, and that the potential for prevention might even be higher in low- and middle-income countries where more dementias occur. It refers to its model as a “life-course model” of dementia prevention and urges action on the part of both individuals and policy makers to realise the significance of these findings.

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The report recommends some specific actions for risk factors across the life course, such as aiming to maintain systolic blood pressure of 130mm Hg or less in midlife from around age 40 years and encouraging use of hearing aids for hearing loss. It goes further to make recommendations aimed at supporting people who are already living with dementia: provide holistic post-diagnostic care, manage neuropsychiatric symptoms, and care for family carers.

The report was launched at the Alzheimer’s Association International Conference in July 2020. It is available to read in full in The Lancet at https://bit.ly/3hd2CGm

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