Key messages
1 The number of people with dementia is increasing globally
Although incidence in some countries has decreased.
2 Be ambitious about prevention
We recommend active treatment of hypertension in middle aged (45–65 years) and older people (aged older than 65 years) without dementia to reduce dementia incidence. Interventions for other risk factors including more childhood education, exercise, maintaining social engagement, reducing smoking, and management of hearing loss, depression, diabetes, and obesity might have the potential to delay or prevent a third of dementia cases.
3 Treat cognitive symptoms
To maximise cognition, people with Alzheimer’s disease or dementia with Lewy bodies should be offered cholinesterase inhibitors at all stages, or memantine for severe dementia. Cholinesterase inhibitors are not effective in mild cognitive impairment.
4 Individualise dementia care
Good dementia care spans medical, social, and supportive care; it should be tailored to unique individual and cultural needs, preferences, and priorities and should incorporate support for family carers.
5 Care for family carers
Family carers are at high risk of depression. Effective interventions, including STrAtegies for RelaTives (START) or Resources for Enhancing Alzheimer’s Caregiver Health intervention (REACH), reduce the risk of depression, treat the symptoms, and should be made available.
6 Plan for the future
People with dementia and their families value discussions about the future and decisions about possible attorneys to make decisions. Clinicians should consider capacity to make different types of decisions at diagnosis.
7 Protect people with dementia
People with dementia and society require protection from possible risks of the condition, including self-neglect, vulnerability (including to exploitation), managing money, driving, or using weapons. Risk assessment and management at all stages of the disease is essential, but it should be balanced against the person’s right to autonomy.
8 Manage neuropsychiatric symptoms
Management of the neuropsychiatric symptoms of dementia including agitation, low mood, or psychosis is usually psychological, social, and environmental, with pharmacological management reserved for individuals with more severe symptoms.
9 Consider end of life
A third of older people die with dementia, so it is essential that professionals working in end-of-life care consider whether a patient has dementia, because they might be unable to make decisions about their care and treatment or express their needs and wishes.
10 Technology
Technological interventions have the potential to improve care delivery but should not replace social contact.