Hearing & Cognition-The Lancet Commission: Dementia prevention, intervention, and care (2020)

The Lancet Commission: Dementia prevention, intervention, and care (2020)

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The 2020 Lancet Commission report updates evidence on dementia prevention, diagnosis, and care. Although the number of people with dementia is increasing as populations age, age-specific incidence has declined in some high-income countries. The Commission identifies 12 potentially modifiable risk factors across the life course: limited education, hypertension, hearing loss, traumatic brain injury, excessive alcohol use, obesity, smoking, depression, physical inactivity, social isolation, diabetes, and air pollution. Together, these factors are associated with about 40% of dementia cases, which might theoretically be prevented or delayed. The authors stress that prevention is relevant at every age and that reducing poverty and inequality is essential, particularly in low- and middle-income countries.<br /><br />Recommended measures include ensuring access to education, controlling midlife blood pressure (aiming for systolic pressure of 130 mm Hg or lower), treating hearing loss with hearing aids, preventing head injuries, limiting alcohol, stopping smoking, reducing air pollution, and supporting physical, cognitive, and social activity. Evidence does not establish that any particular activity prevents dementia, and some risk associations may be influenced by reverse causation or other factors.<br /><br />Biomarkers such as amyloid and tau can indicate increased risk, but most cognitively healthy people with these markers do not develop dementia within a useful prediction period; routine presymptomatic testing is therefore not supported. Blood biomarkers may offer more accessible diagnostic options in the future.<br /><br />For people living with dementia, care should be individualised and holistic, addressing physical and mental health, daily functioning, social needs, and family carers’ wellbeing. Tailored psychosocial approaches can help manage behavioural symptoms, while many psychotropic drugs have limited benefit and can cause harm. Supportive interventions for carers can improve mental health and may be cost-effective. The report also highlights dementia’s association with multimorbidity, hospitalisation, and delirium, urging better community and hospital care and greater attention to prevention and wellbeing.

Keywords

dementia prevention

Lancet Commission

modifiable risk factors

ageing population

blood pressure control

hearing loss

amyloid biomarkers

psychosocial care

carer support

air pollution