Lancet lists 14 risk factors for dementia

The report recommends promoting exercise and sports, managing high blood pressure from age 40 and treating high cholesterol and obesity early in life. Representation Pic

About a year ago, Carol D'Souza's 95-year-old mother passed away after a decade-long battle with dementia. The diagnosis had come as a shock to the family, residents of Bandra West, who were largely unfamiliar with the condition. She was one of 38,43,118 individuals in the country living with dementia in 2019, and like many other families, Carol and her loved ones are still at a loss for answers about the cause and why it happened.

The Lancet Commission's latest report, released a few days ago, outlines 14 preventable risk factors for dementia. However, as Dr Pawan Ojha, a neurologist at Fortis Hiranandani Hospital, remarks, "We understand how dementia and Alzheimer's disease occur, but we do not fully grasp why they happen. It's likely we may never truly understand the underlying reasons."

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Answering a question in Lok Sabha in 2022, the health ministry cited the earlier Lancet report and noted that while there is no locally maintained data for dementia, it is estimated to rise to 1,14,22,692 in the country by 2050. Penned by 27 of the world's leading dementia experts, including Dr Suvarna Alladi at NIMHANS in Bangalore, the Lancet report identifies lower education levels in early childhood as a significant risk factor.

Furthermore, it states that in middle age, hearing loss, high cholesterol levels, depression, brain injury, physical inactivity, diabetes, smoking, hypertension, obesity and alcoholism can increase the likelihood of dementia to varying degrees. In later ages, the highest risk of developing dementia is social isolation, followed by air pollution and vision impairment. Dr Alladi could not respond till press time.

Explaining the connection between education levels and dementia, Dr Ojha said, "Higher education levels lead to more neural networks and connections in the brain. Individuals with more education develop greater cognitive reserves, thanks to increased synapses and neurotransmitter activity."

Reflections in data

When Carol, a psychologist and part of an Alzheimer's association, was informed about the findings of the research, she said, "My mother was very healthy; she exercised and enjoyed crossword puzzles. Among the risk factors mentioned, she had hypertension, was exposed to air pollution and may have experienced a bit of social isolation after losing her husband."

Considering these factors, Carol's mother would have had a 10 per cent risk of developing dementia. The Lancet study also noted that the incidence of dementia is higher in women than in men. Another Mumbai resident, Suraj Iyer, whose 78-year-old father is currently grappling with dementia and has forgotten everyone but his wife, said, "It took about four to five years for him to forget. Having a doctor in the family helped us understand what was happening to my father. He is now at an Alzheimer's care centre."

Unlike Carol, Suraj said he cannot identify any specific risk factors for his father based on the study. "In epidemiological terms, risk factors are variables that increase the likelihood of developing a particular disease. While having certain risk factors does not guarantee that someone will acquire the disease, it does elevate the probability. In the case of dementia, it provides some answers in the form of possibilities," Dr Ojha said.

Act now or suffer later

The Lancet Commission report offers solutions to combat the rising incidence of dementia, but these measures cannot be implemented without government intervention. "Our cities are not built to provide safe space to be healthy; even physical activity on Mumbai roads can put someone at risk of getting run over by a car. The recommendations in the report aim to ensure quality of life for citizens. If they are not implemented, we will certainly face a public health emergency in the future," Dr Ojha said.

The report urges countries to address several critical areas: making hearing aids accessible to those with hearing loss, ensuring high-quality education for all and curtailing tobacco consumption. It also recommends promoting exercise and sports, managing high blood pressure from age 40 and treating high cholesterol and obesity early in life. Additionally, it emphasises the need to reduce drinking, prevent social isolation, screen for vision impairment and cut down on air pollution exposure.

Dr Ojha, who also works on stroke prevention, added, "From my experience, interacting with bureaucrats, there is a sense that they have the will to act. The government needs to strive to implement these recommendations now that they are on paper."