Eye health and high cholesterol red flags for future dementia

Failing eyesight and high cholesterol could be two red flags for possible future dementia, research has concluded.

Treating these conditions early could help to lower the risk of dementia developing down the line, according to the report from the latest Lancet Commission on dementia prevention.

In all, the researchers, led by a team from University College London, identified 14 health issues that, if reduced or eliminated, they argue could theoretically prevent nearly half of dementias around the world. Tackling these health issues in England alone could save billions, a separate study has suggested.

Middle-aged people and poorer countries have the most to gain from targeting these risk factors, the commission added.

While this is positive, the bad news is that the number of people living with dementia could more than double to 153 million by 2050, the research predicted. However, nearly half (45%) of our risk of developing the disease can be changed.

Key risk factors identified include that an estimated 7% of cases are attributable to high low-density lipoprotein (LDL) or ‘bad’ cholesterol in mid-life from around age 40 years, and 2% of cases attributable to untreated vision loss in later life.

These new risk factors are in addition to 12 risk factors previously identified by the Lancet Commission in 2020. These were: lower levels of education, hearing impairment, high blood pressure, smoking, obesity, depression, physical inactivity, diabetes, excessive alcohol consumption, traumatic brain injury, air pollution and social isolation, which are linked with 40% of all dementia cases.

To reduce dementia risk throughout life, the commission has therefore outlined a number of key recommendations to be adopted by governments and individuals, including:

• Provide all children with good quality education and be cognitively active in midlife.

• Make hearing aids available for all those with hearing loss and reduce harmful noise exposure.

• Detect and treat high LDL cholesterol in midlife from around age 40 years.

• Make screening and treatment for vision impairment accessible to all.

• Treat depression effectively.

• Wear helmets and head protection in contact sports and on bikes.

• Prioritise supportive community environments and housing to increase social contact.

• Reduce exposure to air pollution through strict clean air policies.

• Expand measures to reduce smoking, such as price control, raising the minimum age of purchase, and smoking bans.

• Reduce sugar and salt content in food sold in stores and restaurants.

Lead author Professor Gill Livingston, professor of psychiatry of older people at UCL, said: “Healthy lifestyles that involve regular exercise, not smoking, cognitive activity in midlife (including outside formal education) and avoiding excess alcohol can not only lower dementia risk but may also push back dementia onset. So, if people do develop dementia, they are likely to live less years with it. This has huge quality of life implications for individuals as well as cost-saving benefits for societies.”

In a separate study in the journal The Lancet Healthy Longevity, published alongside the commission report, Professor Livingston, lead author Dr Naaheed Mukadam (UCL Psychiatry), and co-authors modelled the economic impact of implementing some of these recommendations, using England as an example.

The findings suggested that using population-level interventions of known effectiveness to tackle dementia risk factors could achieve cost savings of up to £4bn.

Dr Mukadam said: “Prioritising population-level approaches that improve primary prevention (eg, reducing salt and sugar intake) and effective health care for conditions like obesity and high blood pressure, restricting smoking and air pollution, and enabling all children to gain a good education, could have a profound effect on dementia prevalence and inequalities, as well as significant cost savings.”

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