Clinical relevance: The Lancet Commission’s 2024 update identifies untreated vision loss and high LDL cholesterol as new dementia risk factors, adding to the existing 12 like less education, hearing loss, and smoking.

The commission highlights building cognitive and physical strengths and mitigating vascular damage as crucial for reducing dementia risk. The report highlights the importance of policy interventions, especially in lower-income and marginalized communities, to reduce the burden of dementia risk factors. For those diagnosed with dementia, interventions such as multicomponent psychosocial support, cholinesterase inhibitors, and reducing air pollution can improve quality of life and reduce hospitalizations.

This year’s Lancet Commission dementia update includes two new modifiable risk factors – and new rays of hope for prevention.

As the world’s population ages, we’ve seen a corresponding uptick in dementia rates – variances in higher-income countries notwithstanding.

The Lancet Commission’s 2024 update points out that building cognitive and physical strengths as we age, while mitigating vascular damage, is particularly important for reducing one’s risk.

Reinforcement of Existing Risk Factors

This new report backs up established evidence that addressing various risk factors can significantly reduce the likelihood of developing dementia. Such risks include:

Less education. Hearing loss. Hypertension. Smoking. Obesity. Depression. Physical inactivity. Diabetes. Excessive alcohol consumption. Traumatic brain injury (TBI). Air pollution. And social isolation.

New evidence, according to the Lancet Commission’s report, now implicates untreated vision loss and high LDL cholesterol as additional risk factors. The commission also reported on a new meta-analysis of the risks associated with hearing loss and depression. Their findings further implicate these potential risks.

“Overall, these studies suggest that depression increases the risk of dementia at all adult ages, although in late life, some of the association is caused by preclinical dementia,” the commission reported. “We are therefore classifying depression as a midlife risk factor because there is a clear midlife risk.”

Plotting Dementia Prevention

The comprehensive life-course perspective of dementia prevention the report’s authors present integrates the 14 identified risk factors. The potential for prevention is substantial, the report insists. And, in theory, the authors argue that nearly half of dementia cases could be averted by eliminating them.

Additionally, the commission’s report points out that while individual efforts to ward off dementia risk are critical, policy interventions could help, especially in lower-income countries and in marginalized communities in high-income countries. These demographics typically carry the heavier burden of modifiable risks and are therefore more likely to develop dementia at a younger age.

Targeting Specific Dementia Risk Factors

The commission strongly suggests that a higher educational level acts as a bulwark against dementia. As a result, the report’s authors argue that ensuring that all children receive a quality education while promoting cognitive, physical, and social activities in midlife and late life can play a huge role in pushing back against rising dementia rates.

The evidence now shows that treating hearing loss, with hearing aids in particular, can mitigate dementia risk – along with treating depression and eliminating smoking.

“As severity of hearing loss increases, dementia risk increases: all four studies that investigated dose-response between hearing and dementia risk reported that every 10 dB decrease in hearing ability increased dementia risk, the authors wrote. “The magnitude of this risk increase varied between studies, from a 4 percent increase to a 24 percent increase in dementia risk per 10 dB decrease in hearing ability.”

Additionally, the commission insists that reducing air pollution has been linked to better cognition, prompting calls for policies to improve air quality.

Dementia Intervention

Finally, for those who’ve already received a diagnosis, intervention strategies can help physical health and improve one’s quality of life. Additionally, future planning can help cut back on hospitalizations.

At the same time, researchers and practitioners alike have begun to recognize the effectiveness of multicomponent psychosocial interventions for caregivers and for managing neuropsychiatric symptoms.

Cholinesterase inhibitors have also shown long-term benefits for Alzheimer’s patients and those struggling with Lewy body dementia.

Unfortunately, while anti-amyloid β antibody treatments have shown promise in slowing cognitive decline, they’re still expensive. And they remained plagued by extensive side effects.

A better understanding of dementia risks – and how to mitigate them – combined with both pharmacological and non-pharmacological interventions, provide a strong foundation for preventing, diagnosing, and treating the disease.

Further Reading

Research Sheds Light on Traumatic Brain Injuries

Obsessive-Compulsive Symptoms in Dementia

Researchers Uncover Five Different Types of Alzheimer’s