Executive summary

This report explores dementia prevention in the Nordics and provides examples of preventive policies and practices. It also reviews these measures in relation to current evidence on dementia prevention, striving to strengthen Nordic co-operation in the field. 

The report is driven by the fact that an increasing number of people are at risk of developing dementia and other chronic diseases, which is a major challenge both to individuals and to the Nordic society and the healthcare systems. At the same time, new evidence on healthy lifestyle and other health promotive factors show that preventive measures pose a great opportunity to reduce the dementia risk. Most of the existing evidence on dementia prevention has been gathered over the past 10–15 years and includes research on recognised modifiable risk factors, as described by the 2020 Lancet Commission on Dementia Prevention, Intervention and Care, and the World Health Organization’s guidelines from 2019. The evidence shows that 12 risk factors can trigger the onset of dementia: physical inactivity, smoking, hypertension, head injury, excessive alcohol consumption, less education, social isolation, hearing impairment, diabetes, obesity, depression, and air pollution. These risk factors should be addressed with preventive measures on strategic and practical levels alike.* 

Methodologically, the knowledge base for this report rests on a descriptive analysis extracting, systematising, and presenting data from literature and documents, individual interviews, and information and discussion from a reference group. The participants in the reference group represented different sectors and levels in the Nordic countries and shared their expertise on how to lessen the risk of developing dementia.

This report describes the current policy and practice of dementia prevention in Norway, Iceland, Sweden, Denmark, and Finland with Åland Islands. While many risk factors for dementia also apply to the prevention of other non-communicable diseases (NCDs), it has not been possible in the current project to obtain a complete overview of all practices that might have an impact on the risk of developing dementia. The national and local level initiatives are presented with examples. The recommendations cover the dimensions of evidence and practice of dementia prevention in the Nordics, the importance of organisational aspects, interaction between preventing dementia and preventing NCDs, and proposals to improve dementia prevention across the Nordic region.

The Nordic countries have adopted a range of evidence-based measures against the risk of dementia and for maintaining good brain health, but none of these countries has so far used the full body of evidence on dementia prevention as the basis for a systematic prevention strategy from a comprehensive life-course perspective.

National level measures include free education for all, legalisation and regulation on tobacco and alcohol, awareness campaigns, public health guidelines and information on healthy food and physical activity, lifestyle counselling, risk factor monitoring, secondary prevention for high-risk groups, and tertiary prevention for those already diagnosed with dementia. Practical programmes and support at a local level are provided by voluntary organisations, healthcare centres, and municipalities. 

Dementia prevention requires a holistic approach, because lifestyle factors are commonly connected to preventing and reducing the risk of many diseases. Dementia prevention should therefore be integrated into preventing other NCDs as a part of a long-term strategy.

We have identified some areas for improvement in the implementation of preventive measures against dementia. There is, for example, a crucial lack of awareness both in the main population and in more vulnerable groups. Additionally, the implementation of practice should focus on making healthy lifestyle choices available to everyone, promoting brain health and supporting cognitive functionality during the whole lifespan. Prevention of specific risk factors for dementia, such as hearing loss and mental under stimulation, might not be accounted for and risk to be forgotten as powerful preventive measures.

Organisational aspects in the municipalities can support the implementation of dementia-preventive measures. A comprehensive municipal approach, with good local plans and legal structures in place, can make a marked difference. A broad prevention strategy across all sectors would strengthen the provision of prevention among high-risk groups in municipalities, including minority groups, those with lower income levels, and people with low health literacy. The unequal distribution of social determinants of health conditions in which people are born, grow up, live, work, and age are also important population-level factors in the regulation and legalisation efforts.    

It must be recognised that individuals with intellectual disabilities, especially those with Down syndrome, need comprehensive measures at the local level to mitigate the increased risk of early onset dementia. This includes healthy lifestyle counselling to combat obesity, providing good education, physical activity, healthy food, and social inclusion. National guidelines and programmes can support local efforts to prioritise these measures.

In some cases, it may be efficient to include primary and secondary dementia prevention in existing structures for the prevention of other NCDs. What is good for the heart is also good for the brain. Examples of local structures include Health-Promoting Communities and healthy lifestyle counselling and monitoring in public arenas such as schools, healthy life centres and primary healthcare centres.

It is also important to recognise that regulations and legislation to reduce the availability and consumption of alcohol and tobacco significantly protect brain health. Many countries already have comprehensive regulations and legislation on alcohol and tobacco in place. These measures should be preserved and recognised as part of dementia prevention. 

Continued Nordic–Baltic cooperation could contribute to further knowledge sharing on dementia prevention. A shared focus on developing this novel area can enhance dementia-prevention efforts in the Nordics and Baltics in the coming years.