Abstract
BackgroundAt present, dementia has no known cure. Interventions to delay onset and reduce prevalence of the disease are therefore focused on risk factor reduction. Previous population attributable risk estimates for western countries may have been underestimated as a result of the relatively low rates of midlife obesity and the lower weighting given to that variable in statistical models.MethodsLevin’s Attributable Risk which assumes independence of risk factors was used to calculate the proportion of dementia attributable to seven modifiable risk factors (midlife obesity, physical inactivity, smoking, low educational attainment, diabetes mellitus, midlife hypertension and depression) in Australia. Using a recently published modified formula and survey data from the Australia Diabetes, Obesity and Lifestyle Study, a more realistic population attributable risk estimate which accounts for non-independence of risk factors was calculated. Finally, the effect of a 5–20% reduction in each risk factor per decade on future dementia prevalence was computed.ResultsTaking into consideration that risk factors do not operate independently, a more conservative estimate of 48.4% of dementia cases (117,294 of 242,500 cases) was found to be attributable to the seven modifiable lifestyle factors under study. We calculated that if each risk factor was to be reduced by 5%, 10%, 15% and 20% per decade, dementia prevalence would be reduced by between 1.6 and 7.2% in 2020, 3.3–14.9% in 2030, 4.9–22.8% in 2040 and 6.6–30.7% in 2050.ConclusionOur largely theory-based findings suggest a strong case for greater investment in risk factor reduction programmes that target modifiable lifestyle factors, particularly increased engagement in physical activity. However, further data on risk factor treatment and dementia risk reduction from population-based studies are needed to investigate whether our estimates of potential dementia prevention are indeed realistic.
Highlights
IntroductionInterventions to delay onset and reduce prevalence of the disease are focused on risk factor reduction
At present, dementia has no known cure
Assuming independence of risk factors, we estimated that the seven risk factors examined contribute up to 57.0% of dementia cases in Australia
Summary
Interventions to delay onset and reduce prevalence of the disease are focused on risk factor reduction. US$600 billion spent on treatment and management [3, 4] This figure is projected to increase to well over 70 million people by 2030 [4]. Such worrying future prevalence estimates highlight the need for urgent intervention focused on risk reduction because even a modest delay in onset can result in significant public health gains. Research has shown that lifestyle factors (e.g. smoking habits, diet and physical inactivity) increase the risk of late-life dementia and that interventions targeting these can significantly reduce the population prevalence of
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