One third of all cases of dementia is preventable

The Lancet Commission “Dementia Prevention, Intervention and Care” published its report on 20 July 2017 in the prestigious journal Lancet (Livingston et al., Lancet, published online July 20, 2017). The authors describe dementia as the “greatest global challenge to health and social systems in the 21st century”.

By 2015, approximately 47 million people had been diagnosed with dementia, and according to current estimates, this number will triple by 2050. The cost of the disease was about $ 818 billion in 2015, and these will also increase dramatically as the number of elderly people worldwide continues to rise, which is, of course, due to the positive development of life expectancy. The prevalence of dementia therefore increases, i.e. the number of patients in a defined population, calculated as the quotient of the number of affected persons in a population and the number of all persons in this population. Interestingly, some recent studies show that the age-related incidence, i.e. the number of new cases in a defined population per unit of time, has declined in some industrialized countries in recent decades. People over the age of 65 are now cognitively healthier and more powerful than the cohorts of older generations of the same age. This must be due to the influence of modifiable risk factors. While in the past dementia has been accepted as a genetically determined, unalterable destiny, many recent studies show that there are a whole range of risk factors for dementia that each individual can influence and thereby reduce his risk of disease. The change in lifestyle can then mean that many people no longer experience the decay of their cognitive performance and die from another illness. But even the shift of the onset of disease by only a few years would have huge consequences for the affected, families and social systems.

According to the Lancet Commission’s calculations, about 35% of dementia cases could be avoided if these modifiable risk factors were eliminated. This is a huge number. They call for prevention as an ambitious task (“Be ambitious about prevention”). A key message of their very extensive paper is the following:

„We recommend active treatment of hypertension in middle aged (45–65 years) and older people (aged older than 65 years) without dementia to reduce dementia incidence. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity might have the potential to delay or prevent a third of dementia cases.“

At various points in the past, I had pointed out in this blog that the change of lifestyle factors can also lead to a better world, for example in my essay “Psychiatrists for a better world” (available only in German). This has been criticized again and again with the argument that here a nonsensical “self-optimization” is promoted. However, this is not about self-optimization, but about the creation of a world in which as many people as possible can live happily within the circle of their loved ones and develop their full potential. The American author and entrepreneur James Altucher writes very aptly in his book “Reinvent Yourself” (p. 226): “Society is made up of individuals. The only way to improve society is to come at it from a place of deep, individual satisfaction.”.