The hope is finally turning into a reality. Experts in healthcare have often said that the epidemic of lifestyle diseases can be delayed if not completely prevented. What is heartening is more evidence to support this is emerging each day holding out hope against the soaring scourge of cancer, diabetes and dementia. The most recent in this is a Lancet Commission report on dementia that has global experts spelling out “modifiable” risk factors.

The report, published on July 31st, adds two “new modifiable risk factors” for dementia – vision loss and high cholesterol for dementia to already identified 12 risk factors of head injury, physical inactivity, smoking, excessive alcohol consumption, hypertension, obesity, diabetes, hearing loss, depression, infrequent social contact, air pollution and even less education.

What matters is that it finds the “potential for prevention is high and, overall, nearly half of dementias could theoretically be prevented by eliminating these 14 risk factors.”

That by modifying these 14 risk factors could help prevent or delay nearly half of dementia cases is a hard to ignore beacon of hope. Albeit, sadly, there is also a gender component. The report also points to a first nationally representative dementia prevalence estimates in India which indicates “a higher prevalence in women, people with less education, and in rural settings.” The increased risk in women has been partly related to lack of opportunity in work and education, “leading to increased poverty, decreased access to medical care, and discrimination, all of which vary between cultures rather than between biological sexes.”

On the difference that is possible if steps are taken to eliminate some of the risk factors, it says, if in early life, if the scourge of less education is dealt with then there could be 7 per cent reduction in dementia prevalence. Similarly, in midlife, attending to hearing loss could help reduce the chances by as much as 8 per cent, traumatic brain injury by 3 per cent, hypertension by 2 per cent, alcohol and obesity, each if eliminated, could lower the prevalence chances by 1 per cent.

Also Read

In later life, elimination of smoking could help by 5 per cent, depression and social isolation each by 4 per cent, increased physical activity could help by 2 per cent and an equal benefit accrued with lower air pollution. Steps to prevent diabetes (a crucial lifestyle disease that many in India are prone to) could reduce the chance of dementia by 1 per cent.

Overall, for an individual the following seem crucial:

  • Ensure good quality education (which this could be a pointer to policy makers). The emphasis being to encourage cognitively stimulating activities in midlife to protect cognition.
  • Make hearing aids accessible for people with hearing loss and decrease harmful noise exposure to reduce hearing loss. This could also be for policy makers and town planners in times when growing urbanisation seems inevitable.
  • Treat depression effectively. While healthcare professionals have often cautioned on this, awareness on this and seeking right and early intervention may prove fruitful.
  • Encourage use of helmets and head protection in contact sports and on bicycles. In the Indian, context, it is no brainer that this needs to urgent attention with the roads teeming with two wheelers.
  • Encourage exercise because people who participate in sport and exercise are less likely to develop dementia. Even during the pandemic and later, healthcare professionals have often spoken about the benefits of physical activity with eye specialists also urging a ‘digital detox.’
  • Reduce cigarette smoking through education, pricing, and preventing smoking in public places and make smoking cessation advice accessible. There are enough and more public awareness campaigns on this but apparently the reality has still to sink in completely.
  • Prevent or reduce hypertension and maintain systolic blood pressure of 130 mm Hg or less from age 40 years. This may not come as new knowledge to anyone who has ever interacted with a family physician.
  • Detect and treat high LDL cholesterol from midlife. This observation by the report again hardly needs any elaboration in times when a whole generation is busy consuming cholesterol-rich foods at the click of a button.
  • Maintain a healthy weight and treat obesity as early as possible, which also helps to prevent diabetes. The dangers of this again hardly need elaboration in a country with some 101 million with diabetes and 136 million prediabetes.
  • Reduce high alcohol consumption through pricing and increased awareness of levels and risks of overconsumption. This may be a message for the policy-makers but is not something that needs added gyan or guidance.
  • Prioritise age-friendly and supportive community environments and housing and reduce social isolation by facilitating participation in activities and living with others. This observation by the report also should seem amply clear in times when most seem to spend time in solitude and in cyberspace.
  • Make screening and treatment for vision loss accessible for all. This again would be a message for policy planners, awareness on this and efforts to seek a remedy is no brainer.
  • Reduce exposure to air pollution. Not adding to the air pollution could a conscious effort each could at least work towards rather than wait for the government to formulate laws and impose restrictions – sometimes practical and many a times, impractical too.