Lancet Study Emphasizes Prevention

Monday, September 21, 2015

September 21, 2015  A new study, published in the Lancet, suggests a primary preventation approach early in life in order to have the greatest effect on cognitive health later in life. Reducing risk factors, like depression and diabetes, and improving social determinants, such as education and living conditions also protects against dementia. The Columbia Aging Center's major tenet of primary prevention is exemplified by the results of this study and the Center holds firm to the belief that primary prevention, by way of policy planning and research, have the largest effect on reduction of later dementia occurrence and disability. Despite some promising results showing a decrease in dementia in certain age groups, life expectancy is still expected to increase, meaning that research and policy efforts are even more pressing. 

The abstract of the study is below. To view the full text, please click here

Dementia is receiving increasing attention from governments and politicians. Epidemiological research based on western European populations done 20 years ago provided key initial evidence for dementia policy making, but these estimates are now out of date because of changes in life expectancy, living conditions, and health profiles. To assess whether dementia occurrence has changed during the past 20–30 years, investigators of five different studies done in western Europe (Sweden [Stockholm and Gothenburg], the Netherlands [Rotterdam], the UK [England], and Spain [Zaragoza]) have compared dementia occurrence using consistent research methods between two timepoints in well-defined geographical areas. Findings from four of the five studies showed non-significant changes in overall dementia occurrence. The only significant reduction in overall prevalence was found in the study done in the UK, powered and designed explicitly from its outset to detect change across generations (decrease in prevalence of 22%; p=0·003). Findings from the study done in Zaragoza (Spain) showed a significant reduction in dementia prevalence in men (43%; p=0·0002). The studies estimating incidence done in Stockholm and Rotterdam reported non-significant reductions. Such reductions could be the outcomes from earlier population-level investments such as improved education and living conditions, and better prevention and treatment of vascular and chronic conditions. This evidence suggests that attention to optimum health early in life might benefit cognitive health late in life. Policy planning and future research should be balanced across primary (policies reducing risk and increasing cognitive reserve), secondary (early detection and screening), and tertiary (once dementia is present) prevention. Each has their place, but upstream primary prevention has the largest effect on reduction of later dementia occurrence and disability.