Lancet Commission: Over a Third of Dementia Cases May be Preventable
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Relate why dementia is projected to be a global health crisis over the upcoming decades 2. List the modifiable risk factors for dementia
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Due to an aging population, approximately 50 million people worldwide have dementia, projected to increase to 75 million by 2030 and to 132 million by 2050
Symptoms occur late in life but pathology begins early
Delay in onset of 1 year could prevent more than 9 million cases of dementia by 2050
Delay in onset by 5 years could reduce worldwide prevalence by 50%
Livingston et al., under the auspices of The Lancet Commission (Lancet, 2017) investigated the most current evidence regarding diagnosis and treatment of dementia and cognitive impairment
As part of this comprehensive review, the Lancet Commission also assessed the evidence related to the impact of modifiable risk factors on dementia, including risk reducing interventions
The authors reviewed guidelines and literature to assess modifiable risk factors and interventions
‘All cause’ dementia was used rather than cause-specific dementia because more data was available
International studies were included so that results could be more generalizable
The authors focused on estimating the ‘Population Attributable Fraction’ (PAF), which is the percentage reduction in new cases over a given time if a particular risk factor is eliminated
The Lancet Commission identified the following modifiable risk factors for dementia (PAF scores are weighted to provide the unique, relative contribution of each risk factor to the overall PAF):
Age < 18 years
Education no greater than primary school (PAF=7.5%): relative risk 1.6 (95% CI 1.26-2.01)
Age 45-65 years
Hypertension (PAF=2.0%): relative risk 1.6 (95% CI 1.16-2.24)
Obesity (PAF=0.8%): relative risk 1.6 (95% CI 1.34-1.92)
Hearing loss (PAF=9.1%): relative risk 1.9 (95% CI 1.38-2.73)
Age > 65 years
Smoking (PAF=5.5%): relative risk 1.6 (95% CI 1.15-2.20)
Depression (PAF=4.0%): relative risk 1.9 (95% CI 1.55-2.33)
Physical inactivity (PAF=2.6%): relative risk 1.4 (95% CI 1.16-1.67)
Social isolation (PAF=5.9%): relative risk 1.6 (95% CI 1.32-1.85)
Diabetes (PAF=1.2%): relative risk 1.5 (95% CI 1.33-1.79)
Risk Factor Prevention
An unexpected decline in dementia has been reported in the US, UK, Canada, Sweden and Netherlands but increased in China and Japan while stable in Nigeria
US reported decreased age-specific prevalence was associated with an increase in education
While certain lifestyle factors may be improving, concern remains around increasing mid-life rates of obesity
Age remains an unmodifiable factor, with 80% of dementias occurring in individuals ≥ 75 years
Concept of ‘resilience’ and ‘cognitive reserve’: more brain reserve can tolerate more neuropathology
Reserve related to brain anatomical substrate or adaptability of cognition
In theory, less reserve leads to earlier onset dementia
May explain benefit of education/learning, exercise, blood pressure control
Hearing loss: No studies available as to whether hearing aids may delay dementia
Physical Activity: Observational studies demonstrate that exercise has a protective effect against cognitive decline, dementia and Alzheimer’s disease
RCTs are conflicting regarding effects and type of physical activity
Multiple benefits in older people including improved balance, mood, reduced mortality and improved function
Validated large scale dementia prevention programs are not yet available
Research into multimodal strategies is ongoing
Interventions to Prevent Dementia
RCTs suggest that this diet may help with decline in cognition but not dementia (although benefit may be underestimated due to issues related to the study)
There is data to support engaging in cognitively stimulating activities to improve cognition and reduce dementia
Commercial brain training tools have been promoted but not validated
Data suggests social engagement will delay onset of dementia but no evidence for prevention
Living alone, never married, divorced, or widowed have an increased risk of all-cause dementia
Dementia risk elevated for those with little social activity but data insufficient to confirm causation
Trials do not support the following interventions to prevent dementia:
Estrogen hormone therapy
Ginkgo biloba extract
The Lancet Commission concludes that interventions for modifiable risk factors have the potential to delay or prevent a third of dementia cases
The authors suggest that while caution in interpreting PAF is advisable,
There is good evidence that treatment of hypertension reduces dementia incidence and preliminary evidence that modification of several risk factors has a beneficial effect on cognition. The interventions most likely to be beneficial (increasing education in early life, increasing physical activity and social engagement, reducing smoking, treating hypertension, diabetes, and hearing impairment) are safe and confer other health benefits.
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
NOT ENOUGH CME HOURS
It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan