Targeting Risk Factors May Prevent Dementia, According to Lancet Commission
Johns Hopkins School of Nursing faculty Laura Gitlin provided expertise
Dementia can potentially be prevented by targeting specific risk factors like education in early life, hearing in midlife, and smoking later in life, according to newly published research by the Lancet Commission on Dementia Prevention, Intervention, and Care. The commission, of which Johns Hopkins School of Nursing (JHSON) faculty member Laura N. Gitlin, PhD, was a member, compiled current research and emerging knowledge about dementia to develop an analysis and plan for moving forward in care.
“This comprehensive paper offers a positive outlook for the future of care and prevention of dementia,” says Gitlin, director of the JHSON’s Center for Innovative Care in Aging. “Even though there is not yet a cure for dementia, we know that quality of life can be improved through evidence-based care including helping people living with dementia remain engaged in meaningful activities. We also recognize the potential for reducing dementia risk by changing lifestyle factors including improving access to education, physical activity, and reducing cardiovascular risks earlier in life.”
The report focused on nine risk sources including childhood education, midlife hearing loss, hypertension, and obesity, and late-life smoking, depression, physical inactivity, social isolation, and diabetes. Even though the diagnosis for dementia usually occurs later in life, the brain pathology begins years earlier, and the commission suggests that addressing these factors throughout the lifetime could potentially lead to a 30 percent reduction in dementia cases. Currently, more than $800 billion is spent a year on care and approximately 131 million people worldwide are expected to be living with the disease by 2050.
The report also places emphasis on the importance of care for those already with the disease. Gitlin has focused her research on improving care through nonpharmacologic approaches. She has developed interventions like New Ways for Better Days, Tailoring Activities for Persons with Dementia and Caregivers (T.A.P.), which helps treat dementia’s neuropsychiatric and behavioral symptoms and functional decline, and is currently investigating a web-based tool with Dr. Lyketsos (Hopkins) and Dr. Kales (University of Michigan) called WeCareAdvisor that provides family caregivers with specific strategies to address behavioral symptoms they find challenging.
A final takeaway of the commissioned report is the significant efforts of caregivers, who provide the majority of care for persons living at home. Family caregivers are at high risk of depression and anxiety disorders and typically have worse health, more work absences, and lower quality of life than caregivers of individuals without cognitive impairment. The NIH REACH (Resources for Enhancing Alzheimer’s Caregiver Health) initiative, of which Dr. Gitlin was one of the principal investigators, is a multicomponent intervention providing psychological support to family caregivers, education and skills, and is included in the Lancet report as important to relieving the burden among caregivers and reducing frequency of care home admissions for dementia patients.
Gitlin says improving dementia care is an important public health issue that must be addressed in part with raising awareness. “I was honored to be part of the Lancet Commission because it afforded an opportunity to reach a broad audience. Dementia is a critical worldwide public health concern that affects so many families and communities. We have made tremendous progress in terms of investigating ways to effectively support families, and now we must figure out ways to assure that all families have access to the wide array of evidence-based programs that can make life better for both persons living with dementia and their caregivers.”
Located in Baltimore, the Johns Hopkins School of Nursing is a globally-recognized leader in nursing education, research and practice and ranks No. 2 nationally among graduate schools of nursing and No. 2 for DNP programs in the U.S. News & World Report 2018 rankings. In addition, the school is ranked by QS World University as the No. 2 nursing school in the world and is No.1 by College Choice for its master’s program. The school is No. 1 among nursing schools for total Federal Research Grants and National Institutes of Health (NIH) funding. For more information, visit www.nursing.jhu.edu.