The World Health Organization estimates that close to half of dementia risk could be prevented or delayed.
The World Health Organization’s guideline on reducing the risk of cognitive decline and dementia has been updated for the first time in seven years, but researchers warn that the accessibility of care remains key.
Issued last week, new recommendations include engaging in cognitive stimulation via structured programs or everyday activities like reading or storytelling, alongside reducing exposure to household and ambient air pollution.
There was also a new recommendation against menopausal hormone therapy for reducing the risk of cognitive decline in postmenopausal women aged 65 years or older.
These were all graded as “conditional” in strength, with “very low” certainty of evidence.
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Other existing recommendations were validated or updated.
The strength of the recommendation for patients with normal cognition to reduce the risk of cognitive decline by participating in physical activity is now “strong”, with the evidence classed as “moderate”.
The recommendation against using supplementation of vitamins B and E, omega-3 polyunsaturated fatty acids (PUFA) and multivitamins/minerals has also been validated, with the strength of evidence at “strong” and the certainty of evidence at “moderate”.
Under the GRADE quality of evidence grading system used to compile the guidelines, “moderate” is the second-highest level of certainty.
UNSW Ageing Futures Institute researcher Professor Kaarin Anstey, who sat on the WHO’s guideline development group, told The Medical Republic that in order to be effective, the guidelines needed to be supported by governments and public health systems.
“The guidelines reflect our understanding of dementia prevention across the life course, and the fact that brain health is something we need to consider as a lifelong commitment,” she said.
“We need to underline the message that many cases of dementia may be prevented, and these guidelines are a vital step forward in reinforcing that.”
Recommendations to manage chronic diseases like HIV, hypertension, dyslipidaemia, hearing loss, diabetes and obesity – all of which typically fall into the domain of general practice – were listed as either “updated” or “validated”.
The WHO acknowledged that integrating dementia risk activities into existing primary services would enhance feasibility, reach and long-term sustainability for prevention programs; i.e. embedding interventions within existing systems increases the likelihood of being able to change structural factors.
“Equity considerations apply across all risk factors,” the WHO guidance read.
“Disparities in access to services, digital tools and health promoting environments have a particularly strong effect on older adults, rural communities, socioeconomically disadvantaged groups and populations in [lower- and middle-income countries].
“Therefore, an equity lens should be applied to all implementation strategies, to ensure that they reach all groups impacted by dementia.”
Read the full guideline update here.
