Prevention of dementia with holistic brain health

Your Editorial of June, 2023, declares that it is “time to get ready” for treatment of Alzheimer's disease,1The Lancet NeurologyTreatment for Alzheimer's disease: time to get ready.Lancet Neurol. 2023; 22: 455Summary Full Text Full Text PDF PubMed Scopus (0) Google Scholar but it is also “time to get ready” for prevention. The world is facing a growing crisis as the ageing population trends upwards, bearing a burden of dementia, while the birth rate trends downwards, resulting in fewer working-age people. Japan offers the most extreme example of these trends: life expectancy is now 85 years old, and the birth rate has declined to 1·3 births per woman, from 2·1 births per woman.2Hachinski V Takahashi R Preventing neurological disorders: are we being far-sighted enough.in: Kirton J Koch M Japan: the Hiroshima summit. The Global Governance Project, London2023: 62-63Google Scholar Immediate steps must be taken to slow the age-driven growing waves of dementia. The most prevalent, treatable, and preventable risk factor for dementia is hypertension, with a lifetime risk of 80%. Only half the people who have hypertension know that they have it, offering a great opportunity to delay, mitigate, and prevent dementia, along with stroke and ischaemic heart disease.3Hachinski V Brain health: curbing stroke, heart disease, and dementia—the 2020 Wartenberg lecture.Neurology. 2021; 97: 273-279Crossref Scopus (15) Google Scholar There are effective, widely available, and affordable drugs to treat hypertension. To avoid overwhelming health-care systems in the future, hypertension should be treated globally and systematically. Although lecanemab provides hope that a drug might one day slow cognitive deterioration, the search for a better one needs to go on. Another necessary step is to promote integral brain health4Hachinski V Integral brain health: cerebral/mental/social provisional definitions.Alzheimers Dement. 2023; (published online March 11.)https://doi.org/10.1002/alz.13010Crossref Scopus (4) Google Scholar throughout the life course.5WHOOptimizing brain health across the life course: WHO position paper. World Health Organization, Geneva2022Google Scholar We need treatments for today, but strategies for prevention of dementia and promotion of holistic brain health for tomorrow. I declare no competing interests Treatment for Alzheimer's disease: time to get readyAdvances in Alzheimer's disease research over the past two decades have led to innovations in biomarkers and diagnostic criteria, and have paved the way for the first disease-modifying trials with positive results. Drugs able to remove amyloid plaques from the brain are now starting to become available; efforts to slow cognitive decline are turning a corner. The translation of these breakthroughs into neurology clinics has begun and will have major implications for health-care systems, especially in regions where populations are ageing rapidly. Full-Text PDF The global challenge of hypertensionHigh systolic blood pressure is the top risk factor for attributable deaths and, in 2019, hypertension accounted for about a fifth of all deaths (around 11 million) globally. This highly preventable and treatable condition is the leading risk factor for ischaemic stroke and intracerebral haemorrhage and is implicated in other non-communicable diseases (NCDs), including cerebral small vessel disease and dementia. Despite widespread knowledge about how to diagnose and define hypertension, and the availability of effective and cheap antihypertensive drugs, the number of adults with high blood pressure has doubled since 1990, to about 1·3 billion in 2019. Full-Text PDF