Dementia prevention: from idealism to realism
Authors: Abolfazl Avan, Vladimir Hachinski
Journal: The Lancet Neurology (2024)

The prevalence of dementia keeps rising, partly from increased longevity and partly because of reduced mortality of common chronic conditions (such as stroke and heart disease) and their reduced or delayed onset. In Japan, a country with the highest proportion of elderly people worldwide, the prevalence of dementia is escalating,1Avan A Hachinski V Global, regional, and national trends of dementia incidence and risk factors, 1990-2019: A Global Burden of Disease study.Alzheimers Dement. 2023; 19: 1281-1291Crossref PubMed Scopus (0) Google Scholar and efforts2The HGPI Dementia Policy Project TeamThe Future of Dementia Policy 2022: deepening dementia policies centered on people living with dementia and their families to lead global society. Health and Global Policy Institute, 2022Google Scholar have not been enough to prevent the disease. This situation holds true in many countries.3Institute for Health Metrics and Evaluation (IHME)GBD Results Tool. IHME, University of Washington, Seattle, WA2020Google Scholar The search for drugs to treat cognitive decline, rather than its prevention, is still the mainstay of dementia research. The number of patients is forecast to triple globally by 2050 and, in some regions, will quadruple.4GBD 2019 Dementia Forecasting CollaboratorsEstimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: an analysis for the Global Burden of Disease Study 2019.Lancet Public Health. 2022; 7: e105-e125Summary Full Text Full Text PDF PubMed Google Scholar The burden of dementia could rocket exponentially within the growing elderly population, increasing costs of care while, at the same time, countries have fewer working-age people. An urgent action plan for prevention throughout life is essential;5Hachinski V Takahashi R Preventing neurological disorders: are we being far-sighted enough. The Global Governance Project, London2023Google Scholar otherwise, the burden will become crushing. However, actions taken now might only lead to declining trends decades later. Our proposal would include the consideration for holistic brain health in all policies. A summary version of WHO's definition of brain health is "a state of optimal cerebral, mental, and social function in a safe, healthy, and supportive environment." We would encourage synergistic multidisciplinary collaboration to gather actionable information from current knowledge and to identify gaps. Countries should implement individual, community, and national approaches to fostering the neurological, psychological, and social components of brain health. These approaches to promote holistic brain health should be adapted according to cultural and political characteristics. Cost-effective preventive measures must be also implemented at the population level. Public-health campaigns should advocate for the ABC approach (ie, Activity and rest, Balanced diet and blood pressure control, and Connecting with others) to promote better brain health. While infectious epidemics can subside in a few years, ageing trends do not; the sooner prevention begins, the better our future will be. We declare no competing interests