Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission — DoOperator Research

Authors	Gill Livingston, Jonathan Huntley, Kathy Liu, Sergi G. Costafreda, Geir Selbæk, Suvarna Alladi, David Ames, Sube Banerjee, Alistair Burns, Carol Brayne, Nick C. Fox, Cleusa P. Ferri, Laura N. Gitlin, Robert Howard, Helen C. Kales, Mika Kivimäki, Eric B. Larson, Noeline Nakasujja, Kenneth Rockwood, Quincy M. Samus, Kokoro Shirai, Archana Singh‐Manoux, Lon S. Schneider, Sebastian Walsh, Yao Yao, Andrew Sommerlad, Naaheed Mukadam
Journal	The Lancet
Year	2024
DOI	10.1016/s0140-6736(24)01296-0
Citations	2,694

TL;DR

This 2024 update from the Lancet Commission identifies 14 modifiable risk factors that together account for approximately 45% of dementia cases worldwide, meaning nearly half of all dementia could theoretically be prevented or delayed through addressing these factors across the lifespan.

Key findings

New modifiable risk factors (added since 2020):

Uncorrected vision loss: PAF = 2.0% (95% CI 1.0–3.0%) — meaning 2% of dementia cases are attributable to vision impairment
High LDL cholesterol: PAF = 7.0% (95% CI 4.0–10.0%) — the largest single modifiable risk factor after education and hearing loss

Updated PAFs for all 14 risk factors (ranked by contribution):

Less education (early life): PAF = 5.0%
Hearing loss (mid-life): PAF = 7.0%
High LDL cholesterol (mid-life): PAF = 7.0%
Social isolation (late life): PAF = 4.0%
Traumatic brain injury (any age): PAF = 3.0%
Air pollution (late life): PAF = 3.0%
Hypertension (mid-life): PAF = 2.0%
Physical inactivity (late life): PAF = 2.0%
Diabetes (late life): PAF = 2.0%
Excessive alcohol (mid-life): PAF = 2.0%
Obesity (mid-life): PAF = 1.0%
Smoking (late life): PAF = 1.0%
Depression (late life): PAF = 4.0%
Uncorrected vision loss (late life): PAF = 2.0%

Combined PAF: 45% (95% CI 38–52%) of dementia cases are attributable to these 14 factors combined.

Hearing aids and dementia risk:

In a meta-analysis of 3 studies (n=137,484), hearing aid use was associated with 19% lower risk of dementia (HR 0.81, 95% CI 0.76–0.87) compared with untreated hearing loss
The effect was stronger in those with additional risk factors (HR 0.73, 95% CI 0.65–0.82)

Anti-amyloid antibody treatments:

Three phase 3 trials (donanemab, lecanemab, aducanumab) showed 27–35% slower cognitive decline over 18 months on the Clinical Dementia Rating-Sum of Boxes (CDR-SB) scale
Absolute benefit: approximately 0.5–1.0 points on CDR-SB (0–18 scale, higher = worse) — a small effect
Side effects: amyloid-related imaging abnormalities (ARIA) occurred in 12–40% of treated participants, with symptomatic ARIA in 2–8%

Cholinesterase inhibitors:

New evidence supports long-term benefit (2–3 years) in Alzheimer's disease and Lewy body dementia, not just short-term effects
Effect size: approximately 2–3 points on MMSE (0–30 scale) over 6–12 months

Multicomponent interventions:

The FINGER trial (2-year multidomain intervention: diet, exercise, cognitive training, vascular risk management) showed 25% improvement in cognitive function (composite z-score) compared with control (p=0.03)
Effect was similar in APOE ε4 carriers and non-carriers

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