Reducing the Prevalence of Dementia by Modifying Risk Factors

The prevalence of dementia in the United States is projected to triple in approximately the next 20 years, but there are several modifiable risk factors that could reduce the likelihood of developing the disease, Kristine Yaffe, MD, said in a plenary session at the American Association for Geriatric Psychiatry 2021 Annual Meeting.

Those risk factors also have the potential to teach researchers new information about the mechanisms of dementia and possible treatments, and identify who might be at highest risk, said Dr. Yaffe, Professor of Psychiatry, Neurology, and Epidemiology, University of California, San Francisco.

The risk factors with the most evidence are cardiovascular factors (eg, hypertension, obesity and diabetes), physical and cognitive activity, sleep, and traumatic brain injury, she explained. More research, especially randomized controlled trials and multidomain interventions, is needed to understand the impact of the risk factors at different times in the life course and the ways in which they increase the risk of dementia.

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Research suggests that 30% to 40% of dementia cases are attributable to such risk factors and could be prevented by modification of them, Dr. Yaffe said at the virtual meeting. In her research, she has found that even a slight modification can make a difference.

“From a public health point of view, if you can modify these risk factors even a little bit—so say you are physically active 20% more than you used to be—you could actually have a pretty big downstream difference on the reduction in dementia,” she explained.

As a whole, evidence on modifiable risk factors remains controversial, with some findings inconclusive and some advocating aggressive prevention measures, she said. She predicts primary prevention of dementia ultimately will include lifestyle strategies, which are low-cost and low-risk, used in combination with pharmacotherapies, much like the approach to cardiovascular disease.

“I think this will be really exciting. It won’t be dementia without much you can do about it,” she said. “We’ll have a drug for tau. We’ll have a drug for amyloid, maybe for inflammation, and we’ll also be able to offer lifestyle prevention in combination with these drugs.”

—Terri Airov

Reference
“Dementia Prevention at the Population Level: Modifiable Risk Factors.” Presented at the American Association for Geriatric Psychiatry 2021 Annual Meeting: Virtual; March 17, 2021.