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Millions of cases of dementia could be prevented or delayed by reducing a range of risk factors such as smoking or air pollution, according to a major new study, although outside experts warn that such measures may only go some way to preventing it. The debilitating condition, which slowly robs people of their memory, cognitive abilities, language and independence, currently affects more than 55 million people worldwide.
Dementia is caused by a variety of diseases, the most common of which is Alzheimer’s. A large review of the available evidence published in The Lancet journal on Wednesday said that “prevention has a very high potential” in the fight against dementia. The study follows a previous report in 2020 that also stressed the importance of prevention.
At that time, the international team of researchers estimated that 40 percent of dementia cases were linked to 12 risk factors. These factors included low level of education, hearing problems, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol drinking, traumatic brain injury, air pollution and social isolation. The latest update adds two more risk factors: vision loss and high cholesterol. “In theory, about half of dementia could be prevented by eliminating these 14 risk factors,” the study says.
The European Union rejected the new drug
Despite decades of research and billions of dollars spent, there has been no cure or truly effective drug for dementia. But since the beginning of last year, two Alzheimer’s treatments have been approved in the United States: Biogen’s lecanemab and Eli Lilly’s donanemab. They work by targeting the buildup of two proteins – tau and amyloid beta – that are thought to be one of the main pathways to disease progression.
However, the drugs’ benefits are modest, they have serious side effects, and they are often very expensive. Unlike the US, the EU’s drug regulator refused to approve lecanemab last week, and it is still considering donanemab. Some researchers hope that the fact that the new drugs work means they will pave the way for more effective treatments in the future.
Others prefer to focus on ways to prevent dementia in the first place. Masood Husain, a neurologist at the University of Oxford in the UK, said focusing on risk factors would be “far more cost-effective than developing high-tech treatments that have so far been disappointing in their effects on people with established dementia”.
‘How much more could we have done?’
The Lancet study was welcomed by experts in the field, among whom there is hardly any debate about the importance of prevention. However, some said the idea that nearly half of dementia cases could be prevented needed to be put into perspective. It has not been proven that risk factors directly cause dementia, as the study authors acknowledged. For example, is it the dementia that is causing the depression, not the other way around?
It’s also difficult to separate risk factors from one another, although the researchers tried. Some may be intrinsically linked, such as depression and isolation, or smoking and high blood pressure. Above all, many risk factors are social scourges that have long proven impossible to address fully. The study makes a number of different recommendations, ranging from the personal – such as wearing a helmet when cycling – to the governmental, such as improving access to education.
“It’s not clear whether we will ever be able to eliminate any of these risk factors completely,” Charles Marshall, a neurologist at Queen Mary University of London, told AFP. “We already have public health programmes to reduce smoking and hypertension (high blood pressure), so how much more can we do?” Tara Speirs-Jones, a neuroscientist at the University of Edinburgh, said it was important “that we don’t blame people with dementia for their brain disease”.
He said this is because “it is clear that a large proportion of dementia is not preventable because of genes and things beyond people’s control, such as educational opportunities as children.”
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