Neurology · Medical Literature
[Comment] Dementia prevention in Latin America and the Global South
Abstract
Dementia prevention is becoming a testable public health strategy. The 2024 Lancet Commission on dementia prevention, intervention, and care estimated that about 45% of dementia cases might be prevented or delayed by addressing 14 modifiable risk factors.1 Because the distribution and impact of these factors vary across populations and might be higher in Latin America,2 interventions based on diet, exercise, social engagement, and vascular care cannot simply be transferred from high-income settings to Latin America without cultural and contextual adaptation.
Clinical relevance
Does dementia prevention evidence from high-income countries — including the 2024 Lancet Commission's 14 modifiable risk factors and multidomain lifestyle interventions — translate directly to Latin America and the Global South, or must it be culturally and contextually adapted? __SNAPSHOT__ {"studyDesign":"Expert commentary (Comment) in a peer-reviewed journal; not an original research study","setting":"Not applicable (commentary reflecting on multinational data and the LatAm-FINGERS trial conducted across 11 Latin American countries)","sampleSize":"Not applicable (commentary); the LatAm-FINGERS trial referenced within n=1,065","population":"Implicit focus on older adults in Latin America and the Global South at elevated risk of dementia, a population historically underrepresented in dementia prevention research","intervention":"Culturally and contextually adapted multidomain lifestyle interventions targeting diet, exercise, social engagement, and vascular risk management","comparator":"Direct transfer of dementia prevention interventions developed in high-income settings without adaptation","primaryOutcome":"Not formally defined (commentary); the central argument concerns the necessity of cultural and contextual adaptation of dementia prevention strategies for Latin America and the Global South","followUp":"Not applicable","fundingSource":"Not reported in the abstract"}
Key findings
This Comment does not present original data. It argues that approximately 45% of dementia cases globally might be prevented or delayed by addressing 14 modifiable risk factors, as estimated by the 2024 Lancet Commission on dementia prevention, intervention, and care. The authors note that the distribution and impact of these risk factors may be higher in Latin America than in high-income settings — a claim supported by prior population-level data showing a weighted population attributable fraction (PAF) of 54.0% (95% CI 48.8–59.6%) for 12 modifiable risk factors across seven Latin American countries (Paradela et al., Lancet Global Health, 2024), compared with a global estimate of approximately 40–45%. The dominant drivers in Latin America identified in that supporting study were obesity (PAF 7%), physical inactivity (PAF 6%), and depression (PAF 5%). The Comment specifically endorses the LatAm-FINGERS trial (Crivelli et al., Lancet, 2026) as evidence that a rigorously adapted multidomain intervention can deliver cognitive benefits in Latin American populations. That trial (n=1,065; 11 countries; mean age 67.5 years) reported that participants receiving a systematic lifestyle intervention (SLI) showed 55% greater improvement in global cognitive composite scores over 2 years compared with a flexible lifestyle intervention (FLI) group. No p-values, confidence intervals, or absolute effect sizes from LatAm-FINGERS are reported within the Comment's abstract itself. All numerical values cited above derive from referenced studies, not from this Commentary.
Practice implications
This Commentary establishes the conceptual and epidemiological rationale for why dementia prevention strategies cannot be passively exported from high-income to low- and middle-income countries (LMICs). The 2024 Lancet Commission's 14-factor framework was largely derived from high-income country datasets, raising legitimate concerns about generalizability to populations with distinct risk factor profiles, socioeconomic contexts, and healthcare infrastructure. The authors argue — with supporting reference to the LatAm-FINGERS trial — that culturally adapted multidomain interventions are both feasible and effective in Latin America. What the Commentary does not establish: specific implementation protocols, cost-effectiveness, long-term dementia incidence reduction, or generalizability to sub-Saharan Africa, South Asia, or other Global South settings beyond Latin America. As only the abstract of the Commentary was available for this summary, the full scope of the authors' argument, any additional references cited, and any nuanced caveats may not be fully captured here. Clinicians and public health planners should treat this as a framework-level synthesis rather than a source of actionable clinical metrics. __LIMITATIONS__ 1. Study design: This is an expert commentary, the lowest tier of evidence — it presents no original data and cannot itself establish efficacy, safety, or generalizability. 2. Abstract-only availability: Only the abstract was provided; the full text may contain additional epidemiological detail, country-specific recommendations, and caveats not captured here. 3. Referencing vs. reporting: Key statistics (45% preventable dementia globally; ~54% PAF in Latin America; 55% cognition improvement in LatAm-FINGERS) originate from cited studies with their own methodological limitations, including cross-sectional survey designs (for PAF estimates), potential survival bias, and heterogeneous ascertainment methods across countries. 4. Generalizability: The 'Global South' framing is broad; the evidence base discussed is predominantly Latin American; data from Africa, South and Southeast Asia, and the Pacific are far more limited. 5. Risk factor communality and PAF methodology: PAF calculations assume independent elimination of risk factors, which overestimates prevention potential when factors are correlated and not fully modifiable. 6. Funding and conflict of interest: Not reported in the abstract; the LatAm-FINGERS trial was funded by the Alzheimer's Association, introducing potential advocacy influence on framing. 7. No dementia incidence endpoint: The LatAm-FINGERS trial measured cognitive composite scores, not clinically adjudicated dementia incidence, limiting conclusions about disease-level prevention. __BOTTOM_LINE_CATEGORY__ potentially_practice_informing __BOTTOM_LINE__ This Lancet Commentary by Fortea, Ikanga, and Resende contextualizes the 2024 Lancet Commission's dementia prevention framework within Latin America and the Global South, where population-attributable fractions for modifiable risk factors appear to exceed global estimates and where the LatAm-FINGERS trial has now demonstrated that culturally adapted multidomain lifestyle interventions can improve cognition in at-risk older adults. The central clinical and policy message is that dementia prevention is a testable public health strategy in LMICs, but interventions must be rigorously adapted to local culture, risk factor profiles, and health system capacities rather than simply transposed from high-income settings. This Commentary does not itself provide new trial data; clinicians and health systems should engage directly with the LatAm-FINGERS trial (Crivelli et al., Lancet, 2026) for the primary evidence base.