Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

doi:10.1016/S0140-6736(20)30367-6

Review

. 2020 Aug 8;396(10248):413-446.

doi: 10.1016/S0140-6736(20)30367-6. Epub 2020 Jul 30.

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Gill Livingston¹, Jonathan Huntley², Andrew Sommerlad², David Ames³, Clive Ballard⁴, Sube Banerjee⁵, Carol Brayne⁶, Alistair Burns⁷, Jiska Cohen-Mansfield⁸, Claudia Cooper², Sergi G Costafreda², Amit Dias⁹, Nick Fox¹⁰, Laura N Gitlin¹¹, Robert Howard², Helen C Kales¹², Mika Kivimäki¹³, Eric B Larson¹⁴, Adesola Ogunniyi¹⁵, Vasiliki Orgeta¹⁶, Karen Ritchie¹⁷, Kenneth Rockwood¹⁸, Elizabeth L Sampson¹⁹, Quincy Samus²⁰, Lon S Schneider²¹, Geir Selbæk²², Linda Teri²³, Naaheed Mukadam²

Affiliations

¹ Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK. Electronic address: g.livingston@ucl.ac.uk.
² Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
³ National Ageing Research Institute and Academic Unit for Psychiatry of Old Age, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁴ University of Exeter, Exeter, UK.
⁵ Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.
⁶ Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
⁷ Department of Old Age Psychiatry, University of Manchester, Manchester, UK.
⁸ Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel.
⁹ Department of Preventive and Social Medicine, Goa Medical College, Goa, India.
¹⁰ Dementia Research Centre, UK Dementia Research Institute, University College London, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
¹¹ Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MA, USA.
¹² Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA.
¹³ Department of Epidemiology and Public Health, University College London, London, UK.
¹⁴ Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
¹⁵ University College Hospital, Ibadan, Nigeria.
¹⁶ Division of Psychiatry, University College London, London, UK.
¹⁷ Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
¹⁸ Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada.
¹⁹ Division of Psychiatry, University College London, London, UK; Barnet, Enfield, and Haringey Mental Health Trust, London, UK.
²⁰ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MA, USA.
²¹ Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA.
²² Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway.
²³ Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA.

PMID: 32738937
PMCID: PMC7392084
DOI: 10.1016/S0140-6736(20)30367-6

Review

Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

Gill Livingston et al. Lancet. 2020.

. 2020 Aug 8;396(10248):413-446.

doi: 10.1016/S0140-6736(20)30367-6. Epub 2020 Jul 30.

Authors

Affiliations

¹ Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK. Electronic address: g.livingston@ucl.ac.uk.
² Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
³ National Ageing Research Institute and Academic Unit for Psychiatry of Old Age, University of Melbourne, Royal Melbourne Hospital, Parkville, VIC, Australia.
⁴ University of Exeter, Exeter, UK.
⁵ Faculty of Health: Medicine, Dentistry and Human Sciences, University of Plymouth, Plymouth, UK.
⁶ Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK.
⁷ Department of Old Age Psychiatry, University of Manchester, Manchester, UK.
⁸ Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel.
⁹ Department of Preventive and Social Medicine, Goa Medical College, Goa, India.
¹⁰ Dementia Research Centre, UK Dementia Research Institute, University College London, London, UK; Institute of Neurology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.
¹¹ Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MA, USA.
¹² Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, University of California, Sacramento, CA, USA.
¹³ Department of Epidemiology and Public Health, University College London, London, UK.
¹⁴ Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
¹⁵ University College Hospital, Ibadan, Nigeria.
¹⁶ Division of Psychiatry, University College London, London, UK.
¹⁷ Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
¹⁸ Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada.
¹⁹ Division of Psychiatry, University College London, London, UK; Barnet, Enfield, and Haringey Mental Health Trust, London, UK.
²⁰ Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MA, USA.
²¹ Department of Psychiatry and the Behavioural Sciences and Department of Neurology, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA.
²² Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Geriatric Department, Oslo University Hospital, Oslo, Norway.
²³ Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA.

PMID: 32738937
PMCID: PMC7392084
DOI: 10.1016/S0140-6736(20)30367-6

Erratum in

Department of Error.
[No authors listed] [No authors listed] Lancet. 2023 Sep 30;402(10408):1132. doi: 10.1016/S0140-6736(23)02043-3. Lancet. 2023. PMID: 37777334 No abstract available.

No abstract available

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Figures

**Figure 1**
Incidence rate ratio comparing new cohorts to old cohorts from five studies of dementia incidence IIDP Project in USA and Nigeria, Bordeaux study in France, and Rotterdam study in the Netherlands adjusted for age. Framingham Heart Study, USA, adjusted for age and sex. CFAS in the UK adjusted for age, sex, area, and deprivation. However, age-specific dementia prevalence is increasing in some other countries. IID=Indianapolis–Ibadan Dementia. CFAS=Cognitive Function and Ageing Study. Adapted from Wu et al, by permission of Springer Nature.

**Figure 2**
Possible brain mechanisms for enhancing or maintaining cognitive reserve and risk reduction of potentially modifiable risk factors in dementia

**Figure 3**
Pooled results of meta-analyses investigating objective cognitive outcomes of cognition-oriented treatment in older adults with and without cognitive impairment K represents the number of primary trials included in the analysis. If a review reported several effect sizes within each outcome domain, a composite was created and k denotes the range of the number of primary trials that contributed to the effect estimate. AMSTAR=A MeaSurement Tool to Assess systematic Reviews (max score 16). Adapted from Gavelin et al, by permission of Springer Nature.

**Figure 4**
Associations of antihypertensive medication use with incident dementia in those with high blood pressure Adapted from Ding et al, by permission of Elsevier.

**Figure 5**
Meta-analysis of relative risk of dementia associated with drinking more than 21 units of alcohol per week in midlife compared to lighter consumption of alcohol

**Figure 6**
Meta-analysis of relative risk of all-cause dementia associated with all severity midlife traumatic brain injury

**Figure 7**
Population attributable fraction of potentially modifiable risk factors for dementia

**Figure 8**
Proportion of patients with a diagnosis of dementia prescribed an antipsychotic drug (A) and those prescribed an anxiolytic, hypnotic, or antidepressant (B) CPRD=Clinical Practice Research Datalink. Reproduced from Donegan et al, by permission of Elsevier.

**Figure 9**
Systematic review and meta-analysis of hospitalisation rates of people with dementia compared to those without dementia controlled for age and sex Reproduced from Shepherd et al, by permission of Springer Nature.

**Figure 10**
Moderation analyses of the relationship between Alzheimer's disease pathology and clinical diagnosis of Alzheimer's dementia (adjusted for age, sex, and education) As frailty increased, the odds of a neuropathological diagnosis of Alzheimer disease corresponding to a clinical diagnosis decreased. Reproduced from Wallece et al, by permission of Elsevier.

See this image and copyright information in PMC

Comment in

Reducing Dementia Risk: The Latest Evidence to Guide Conversations With Older Adults.
Do J, Hill NL. Do J, et al. J Gerontol Nurs. 2023 Sep;49(9):3-5. doi: 10.3928/00989134-20230815-01. Epub 2023 Sep 1. J Gerontol Nurs. 2023. PMID: 37650850 No abstract available.

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References

1. Patterson C. Alzheimer's Disease International; London: 2018. World Alzheimer report 2018.
1. Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390:2673–2734. - PubMed
1. Nelson PT, Dickson DW, Trojanowski JQ, et al. Limbic-predominant age-related TDP-43 encephalopathy (LATE): consensus working group report. Brain. 2019;142:1503–1527. - PMC - PubMed
1. Collaborators GBDD. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106. - PMC - PubMed
1. Wu Y-T, Beiser AS, Breteler MMB, et al. The changing prevalence and incidence of dementia over time - current evidence. Nat Rev Neurol. 2017;13:327–339. - PubMed

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1. Abner EL, Nelson PT, Schmitt FA, et al. Self-reported head injury and risk of late-life impairment and AD pathology in an AD center cohort. Dement Geriatr Cogn Dis. 2014;37:294–306. - PMC - PubMed
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[1] Patterson C. Alzheimer's Disease International; London: 2018. World Alzheimer report 2018.

[2] Patterson C. Alzheimer's Disease International; London: 2018. World Alzheimer report 2018.

[3] Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390:2673–2734. - PubMed

[4] Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. Lancet. 2017;390:2673–2734. - PubMed

[5] Nelson PT, Dickson DW, Trojanowski JQ, et al. Limbic-predominant age-related TDP-43 encephalopathy (LATE): consensus working group report. Brain. 2019;142:1503–1527. - PMC - PubMed

[6] Nelson PT, Dickson DW, Trojanowski JQ, et al. Limbic-predominant age-related TDP-43 encephalopathy (LATE): consensus working group report. Brain. 2019;142:1503–1527. - PMC - PubMed

[7] Collaborators GBDD. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106. - PMC - PubMed

[8] Collaborators GBDD. Global, regional, and national burden of Alzheimer's disease and other dementias, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18:88–106. - PMC - PubMed

[9] Wu Y-T, Beiser AS, Breteler MMB, et al. The changing prevalence and incidence of dementia over time - current evidence. Nat Rev Neurol. 2017;13:327–339. - PubMed

[10] Wu Y-T, Beiser AS, Breteler MMB, et al. The changing prevalence and incidence of dementia over time - current evidence. Nat Rev Neurol. 2017;13:327–339. - PubMed

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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

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Dementia prevention, intervention, and care: 2020 report of the Lancet Commission

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