The World Health Organization (WHO) has released new guidelines advising that people can reduce their risk for dementia by reducing modifiable risk factors such as smoking, drinking too much alcohol and not being active enough.
The guidelines recommend exercising regularly and following a healthy lifestyle, rather than relying on vitamin supplements or other pills.
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According to the WHO, around 50 million people globally are suffering from Alzheimer’s disease or another form of dementia, with one new case being diagnosed every three seconds. Almost 10 million new cases of dementia arise every year and the number of people diagnosed with the condition is set to triple by 2050.
Dementia represents a huge economic burden on society; the cost associated with providing dementia patients with the care and support they need is expected to reach US$2 trillion per year by 2030.
Dementia is characterized by a decline in cognitive function that is beyond what would usually be expected as a result of normal aging. The condition affects memory, learning capacity, language ability, comprehension, cognition, judgment, and calculation.
Dementia can arise from a range of diseases and through brain injuries such as stroke. The condition is a leading cause of disability and dependency among older individuals and no curative treatment has yet been developed.
Given the increasing number of new cases, the heavy social and economic impact and the absence of a cure, the WHO says it is imperative that people try to reduce modifiable risk factors for the condition.
‘What is good for our heart is also good for our brain’
One of several action areas included in the Global action plan on the public health response to dementia 2017–2025 is focused on risk reduction. Other action areas covered in the guidelines include diagnosis, treatment and care; the strengthening of information systems; supporting carers of dementia patients; and research and innovation.
“In the next 30 years, the number of people with dementia is expected to triple,” says WHO Director-General, Tedros Adhanom Ghebreyesus.
We need to do everything we can to reduce our risk of dementia. The scientific evidence gathered for these Guidelines confirm what we have suspected for some time, that what is good for our heart, is also good for our brain.”
Tedros Adhanom Ghebreyesus, WHO Director-General
The guidelines were designed to provide healthcare professionals with the knowledge they need to advise patients on the measures they can take to reduce their risk for cognitive decline and dementia. They also serve as a knowledge base for governments, planning authorities and policymakers to develop programs and policies that will help encourage people to adopt a healthy lifestyle.
Although aging is one of the main risk factors, dementia “is not a natural or inevitable consequence of aging," the guidelines advise. A range of diseases and lifestyle factors increase the risk for developing dementia and scientists estimate that in around one-third of cases, dementia is preventable, says Maria Carrillo, Chief Science Officer of the Alzheimer's Association.
Since the disease is not curable and so many experimental treatments have proved to be ineffective, targeting risk factors for the condition and focusing on prevention may be more beneficial in the shorter term, she adds.
A significant proportion of the advice given in the WHO guidelines echoes what could be referred to as common sense. Recommendations include getting sufficient exercise; managing health problems such as diabetes, hypertension and high cholesterol; being socially active; and avoiding or reducing harmful lifestyle habits such as smoking, overeating and excessive alcohol intake.
Other recommendations covered in the guidelines advise on nutritional and cognitive interventions and how to manage depression and hearing loss.
The WHO says that, although there is not a strong evidence base to suggest that such interventions will preserve cognition, they do encourage a lifestyle that is known to be good for overall health.
The guidelines say that healthy eating plans such as following a Mediterranean diet may help to reduce the risk for dementia, but that people cannot expect supplements such as vitamin pills or fish oil to help. The WHO highlights that strong evidence does exist to show that such shortcuts are not effective.
"There is currently no evidence to show that taking these supplements actually reduces the risk of cognitive decline and dementia, and in fact, we know that in high doses these can be harmful," says WHO's Technical Officer Neerja Chowdhary. Carrillo agrees that people should be looking to obtain nutrients through eating whole foods rather than using supplements.
The guidelines also do not endorse engaging in activities aimed at boosting cognition such as puzzles and games, saying that whilst these could be good for people with normal cognition or only mild impairment, there is little research showing that they are actually beneficial in terms of preventing dementia.
Among WHO’s recommendations for managing this growing public health issue is the creation of national policies and plans.
Director of the Department of Mental Health and Substance Abuse at WHO, Dévora Kestel, says an essential part of this is ensuring that carers of people with dementia are supported:
Dementia carers are very often family members who need to make considerable adjustments to their family and professional lives to care for their loved ones. This is why WHO created iSupport. iSupport is an online training programme providing carers of people with dementia with advice on overall management of care, dealing with behaviour changes and how to look after their own health.”
Currently, iSupport is available for use in eight countries, with more expected to follow in the future.
WHO: iSupport - an online training programme for caregivers of people with dementia
World Health Organisation Press Release. 14th May 2019. Adopting a healthy lifestyle helps reduce the risk of dementia. who.int/news-room.
World Health Organisation. 2019. Risk reduction of cognitive decline and dementia. (The Guidelines are available in multiple languages and audio forms). who.int/mental_health.