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Lancet Commission: 10 key ways to improve dementia prevention

A report from the Lancet Commission on Dementia Prevention, Intervention, and Care identifies key issues that physicians should be aware of to improve treatment and prevention of the disease.

In 2015, the global cost of dementia was approximately $818 billion, according to study researcher Gill Livingston, MD, of University College London, and colleagues.

An estimated 85% of these costs are associated with family and social care vs. medical care.

To evaluate progress and emerging knowledge in the field of dementia, the Lancet established a Commission on Dementia Prevention, Intervention, and Care.

The Commission identified 10 key messages, including:

• The number of individuals with dementia is globally increasing, though some countries’ incidence has decreased.
• Actively treat hypertension in middle- and older-aged individuals without dementia to reduce dementia incidence. Interventions for increasing childhood education, exercise, social engagement, reducing smoking, management of hearing loss, depression, diabetes and obesity may potentially delay or prevent one-third of dementia cases.
• Treat cognitive symptoms. Offer cholinesterase inhibitors at all stages of Alzheimer’s disease and Lewy bodies dementia or memantine for severe dementia.
• Personalize dementia care.
• Provide or coordinate care for family carers.
• Discuss the future with patients and their families.
• Protect individuals with dementia from risks associated with the disease, such as self-neglect, vulnerability and driving.
• Manage neuropsychiatric symptoms.
• Consider that individuals with dementia may need to establish their needs and wishes regarding end-of-life care.
• Utilize technology.

“The Lancet Commission admirably focuses on a strategy that others have referred to as ‘care now, if cure later,’” Martin Prince, PhD, of King’s College London, wrote in an accompanying editorial. “While a cure, or a disease-modifying therapy, for dementia remains a distant prospect, there should be no delay in implementing available evidence on services, treatments, and care for people with dementia and their carers ... The limited coverage of these services must be addressed, urgently, with a balanced research agenda giving due priority to translating existing knowledge into policy and practice. Neglect will lead to inequity, given the limited capacity of [low and middle-income countries] to implement and benefit from advances in treatment and care.”

H elen Frankish , PhD, and Richard Horton, FRCP, of the Lancet, echoed this sentiment in a separate editorial. “The key messages of the Commission accord with the WHO Global Action Plan on the Public Health Response to Dementia (2017–2025), endorsed at the 2017 World Health Assembly (table),” they wrote. “We call on all governments to generate updated action plans for dementia, drawing on the latest evidence and incorporating awareness strategies and public health campaigns, to tackle the impending dementia crisis. This Lancet Commission will help inform the development and implementation of these strategies.” – by Amanda Oldt

Reference:

Frankish H, Horton R. Lancet. 2017;doi: 10.1016/S0140-6736(17)31757-9.

Livingston G, et al. Lancet. 2017;doi: 10.1016/S0140-6736(17)31363-6.

Prince M. Lancet. 2017;doi: 10.1016/S0140-6736(17)31756-7.

Presented at: Alzheimer’s Association International Conference; July 16-20, 2017; London.

Disclosure: Livingston reports receiving grants from Alzheimer’s Society, Economic and Social Research Council, and Alzheimer’s Research UK (ARUK), and non-financial support from University College London, London, during the conduct of the study. Prince reports receiving grants to my institution from Alzheimer’s Disease International, WHO, and the European Research Council. Frankish and Horton report no relevant financial disclosures.