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Lee M, Whitsel E, Avery C, Hughes TM, Griswold ME, Sedaghat S, Gottesman RF, Mosley TH, Heiss G, Lutsey PL. Variation in Population Attributable Fraction of Dementia Associated With Potentially Modifiable Risk Factors by Race and Ethnicity in the US. JAMA Netw Open. 2022 Jul 1;5(7):e2219672. PubMed.
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Mayo Clinic
This is a refreshing paper reminding the scientific community, the policymakers, and the public of the importance of prevention. If approximately 40 percent of dementia cases are associated with exposure to 12 modifiable risk factors, a lot can be done to modify the future.
The results do not surprise me, as they have strong face validity and make a lot of common sense. The racial and ethnic differences are novel but consistent with the patterns observed for other diseases.
The results of this study remind us that investing some of our societal money in improving education, improving general living conditions (e.g., facilitating physical exercise), and strengthening the primary prevention of common chronic diseases (e.g., hypertension and obesity) may be more prudent than putting all of our resources toward the search for a magic treatment for Alzheimer's disease or the development of expensive and invasive biomarkers to predict the future occurrence of the disease. Public health research may be a better investment than mechanistic research for the future health of the general population.
For the United States, in particular, the priority is to intervene with the three most impactful risk factors: physical inactivity, obesity, and hypertension. Unfortunately, these three risk factors often co-occur in the same individuals and can act synergistically. Once again, the solution is not a magic treatment but a slow and painful transformation of dietary habits and lifestyles. Dietary changes may require complex interventions at the individual level (e.g., nutritional education of children or teaching people how to prepare healthy food) and economic transformations (e.g., control and regulation of the production, advertisement, and sale of food). Some of the needed interventions may require dramatic political and economic decisions.
As clearly indicated by the authors, the next step is to develop intervention trials to demonstrate whether, and to which extent, modifying the risk factors alone or in combination does reduce the risk of dementia. A similar trial involving a multidomain intervention was conducted recently in Finland (FINGER trial). For some of the interventions, a formal trial may not be possible and observational data can be used. For example, a study of changes in the risk of dementia over time may reflect the effectiveness of an intervention at the population level.
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