The 2020 report by the Lancet Commission on dementia prevention, intervention, and care emphasizes the growing prevalence of dementia as global life expectancy rises. While age-specific dementia rates have decreased in some regions due to improved education and lifestyle factors, the Commission highlights twelve modifiable risk factors that could potentially prevent or delay up to 40% of dementia cases. These risk factors now include excessive alcohol consumption, traumatic brain injury (TBI), and air pollution, in addition to those identified in 2017, such as hypertension, obesity, depression, diabetes, and low social contact. The Commission's model suggests that tackling these risks across different life stages can significantly impact dementia prevention, particularly in low- and middle-income countries (LMICs) where these risks are prevalent.

Policy recommendations in the report focus on lifelong approaches to dementia prevention. Early interventions, like increasing access to education, are crucial for building cognitive reserve, while midlife interventions aim to prevent the development of dementia-related neuropathologies. Public health strategies to minimize TBI, reduce harmful alcohol intake, and improve air quality are prioritized as preventative measures. The report further emphasizes the importance of physical, cognitive, and social engagement in mid- to later-life stages. Evidence suggests that actions like hearing aid use, blood pressure management, and smoking cessation can collectively reduce dementia risk, although challenges such as accessibility and inequality must be addressed to maximize prevention, especially in LMICs.

The report also notes recent advances in understanding dementia's biological markers, such as amyloid-β and tau, which can indicate Alzheimer's risk but are not definitive predictors of the disease in people without symptoms. The Commission advocates against pre-symptomatic dementia screening in routine practice, as current biomarkers lack sufficient predictive power. For those already experiencing dementia symptoms, the report highlights the benefits of personalized, holistic care approaches that address physical and mental health, emphasizing the effectiveness of psychosocial interventions and support for caregivers to improve the quality of life.

Ultimately, the Lancet Commission underscores the necessity of comprehensive dementia care. The report calls for better healthcare access for individuals with dementia, as they often face higher rates of physical health issues and hospitalization. Reducing hospitalizations and focusing on home care can lead to improved outcomes and reduced costs. The COVID-19 pandemic has highlighted the vulnerabilities of those with dementia, as they faced disproportionate mortality rates, underscoring the urgency for improved healthcare policies and practices to support this growing population.