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Dementia prevention, intervention, and care.
2024 report of the Lancet standing Commission
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Multimorbidity and frailty
People with multimorbidity of chronic and severe illness are at increased risk of dementia, particularly if these illnesses begin in midlife.428,429 Up to 24% of people aged 50 years and older are estimated to have frailty, and frailty is more common in women.430
Obesity and weight
We previously discussed that obesity in midlife is a risk factor for dementia.2 A further systematic review and meta-analysis examining the association between obesity and dementia included 14 studies with 77 890 participants and identified that midlife obesity was associated with subsequent all-cause dementia (RR 1⋅31, 95% CI 1⋅02-1⋅68).206 Another study on central obesity, measured through waist circumference or waist-to-hip ratio, included 5 060 687 participants from 16 studies and showed that larger versus smaller waist circumference was associated with a greater risk of cognitive impairment and dementia (HR 1⋅10, 95% CI 1⋅05-1⋅15), and this risk was greater in people older than 65 years than other ages.207
Physical inactivity, exercise, and fitness
We previously concluded that the balance of evidence is that the link between exercise and dementia is likely to be bidirectional.2 Physical activity changes over a person's lifetime, decreasing when someone becomes ill; varies across cultures, socioeconomic status, and between sexes; and can occur at different levels of intensity, making it complex to study. Since the 2020 Lancet Commission, a systematic review and meta-analysis of 58 studies (n=257 983) exploring the link between physical activity and dementia identified that physical activity was associated with a decreased risk of all-cause dementia (RR 0⋅80, 95% CI 0⋅77-0⋅84) and Alzheimer's disease (0⋅86, 0⋅80-0⋅93) in short and long follow-ups of at least 20 years, regardless of baseline age.173
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