People with dementia have more physical health problems than others of the same age but often receive less community health care and find it particularly difficult to access and organise care. Keeping people with dementia physically healthy is important for their cognition. Evidence-based interventions for carers can reduce depressive and anxiety symptoms over years and be cost-effective. Evidence is accumulating for the effectiveness, at least in the short term, of psychosocial interventions tailored to the patient's needs, to manage neuropsychiatric symptoms. Interventions should be individualised and consider the person as a whole, as well as their family carers. People with dementia have complex problems and symptoms in many domains. Wellbeing is the goal of much of dementia care. Blood biomarkers might hold promise for future diagnostic approaches and are more scalable than CSF and brain imaging markers. In the oldest adults (older than 90 years), in particular, mixed dementia is more common. Our understanding of dementia aetiology is shifting, with latest description of new pathological causes. Although accurate diagnosis is important for patients who have impairments and functional concerns and their families, no evidence exists to support pre-symptomatic diagnosis in everyday practice. In LMIC, not everyone has access to secondary education high rates of hypertension, obesity, and hearing loss exist, and the prevalence of diabetes and smoking are growing, thus an even greater proportion of dementia is potentially preventable.Īmyloid-β and tau biomarkers indicate risk of progression to Alzheimer's dementia but most people with normal cognition with only these biomarkers never develop the disease. Although behaviour change is difficult and some associations might not be purely causal, individuals have a huge potential to reduce their dementia risk. Depression might be a risk for dementia, but in later life dementia might cause depression. Sustained exercise in midlife, and possibly later life, protects from dementia, perhaps through decreasing obesity, diabetes, and cardiovascular risk. Using hearing aids appears to reduce the excess risk from hearing loss. We recommend keeping cognitively, physically, and socially active in midlife and later life although little evidence exists for any single specific activity protecting against dementia. Policy makers should expedite improvements in air quality, particularly in areas with high air pollution. Many countries have restricted this exposure. Passive smoking is a less considered modifiable risk factor for dementia. Stopping smoking, even in later life, ameliorates this risk. Midlife systolic blood pressure control should aim for 130 mm Hg or lower to delay or prevent dementia. Public health initiatives minimising head injury and decreasing harmful alcohol drinking could potentially reduce young-onset and later-life dementia. Policy should prioritise childhood education for all. Individuals who are most deprived need these changes the most and will derive the highest benefit.
#Notable solutions output manager ps to pdf error 1051 drivers#
Culture, poverty, and inequality are key drivers of the need for change. Early-life (younger than 45 years) risks, such as less education, affect cognitive reserve midlife (45–65 years), and later-life (older than 65 years) risk factors influence reserve and triggering of neuropathological developments. It is never too early and never too late in the life course for dementia prevention. Our new life-course model and evidence synthesis has paramount worldwide policy implications. The potential for prevention is high and might be higher in low-income and middle-income countries (LMIC) where more dementias occur. Together the 12 modifiable risk factors account for around 40% of worldwide dementias, which consequently could theoretically be prevented or delayed.
We have completed new reviews and meta-analyses and incorporated these into an updated 12 risk factor life-course model of dementia prevention.
These factors are excessive alcohol consumption, traumatic brain injury, and air pollution. We now add three more risk factors for dementia with newer, convincing evidence.
Overall, a growing body of evidence supports the nine potentially modifiable risk factors for dementia modelled by the 2017 Lancet Commission on dementia prevention, intervention, and care: less education, hypertension, hearing impairment, smoking, obesity, depression, physical inactivity, diabetes, and low social contact. However, the age-specific incidence of dementia has fallen in many countries, probably because of improvements in education, nutrition, health care, and lifestyle changes. The number of older people, including those living with dementia, is rising, as younger age mortality declines.
0 kommentar(er)
