Preventing dementia

Physical activity is strongly recommended to reduce the risk of cognitive decline. A physically active lifestyle is linked to brain health, and physically active people seem less likely to develop cognitive decline, all-cause dementia, vascular dementia and Alzheimer disease when compared with inactive people. Especially, the highest levels of physical exercise seem to be the most protective. For adults 65 years and above, physical activity includes recreational or leisure-time physical activity, transportation (e.g. walking,  cycling or swimming), occupational (if the person is still engaged in work), household chores, play, games, sports or planned exercise, in the context of daily, family, and community activities. Physical activity will also improve cardiorespiratory and muscular fitness, bone and functional health, and reduce the risk of noncommunicable diseases and depression. Please consider aerobic activity and a moderate start with gradual progress to higher levels of physical activity.

NOTE: This information does not exempt medical monitoring or consultation.

Tobacco dependence is associated with dementia and cognitive decline as well as other disorders and age-related conditions. Tobacco dependence is also the leading cause of preventable death globally. It is in addition the major risk factor for a number of conditions, including many types of cancers, cardiovascular diseases and risk factors, and respiratory disorders, and its cessation has been demonstrated to significantly reduce these health risks. Tobacco cessation has also been associated with reduced depression, anxiety and stress, and improved mood and quality of life compared with continuing to smoke. Interventions to treat tobacco dependence can be very diverse, based on either or both behavioural strategies and various pharmacological treatments. Combinations of non-pharmacological and pharmacological approaches seem to be the most effective in supporting tobacco cessation.

NOTE: This information does not exempt medical monitoring or consultation.

A healthy diet throughout the life course plays a crucial role in optimal development, in maintaining health, preventing diseases and many of the conditions that increase the risk of dementia, such as diabetes and cardiovascular disease. Therefore, dietary factors may be involved in the development of dementia, both directly and through their role on other risk factors, and a healthy diet may have a great preventive potential for cognitive impairment. High adherence to the Mediterranean diet, the most extensively studied dietary approach, is associated with decreased risk of mild cognitive impairment and Alzheimer disease, and with better episodic memory and global cognition. The consumption of fruit, vegetables, legumes (e.g. lentils, beans), fish, nuts, olive oil, whole-grain foods and coffee are associated with decreased risk of dementia or cognitive impairment. Higher fish consumption has been linked to lower memory decline, as well as intake of polyunsaturated fatty acids (fish-derived). Reducing salt and sugar may also be advised.

NOTE: This information does not exempt medical monitoring or consultation.

Elevated serum cholesterol is one of the key modifiable cardiovascular risk factors. The prevalence of raised total cholesterol among countries seems to correlate with wealth: in high-income countries, more than 50% of adults have elevated total cholesterol level, more than double the rate in low-income countries. Raised levels of blood cholesterol could be related to an increased risk of dementia. Based on the severity of the dyslipidaemia [an abnormal amount of lipids (e.g. triglycerides, cholesterol and/or fat phospholipids) in the blood] and cardiovascular disease overall risk, lifestyle or pharmacological approaches can be undertaken to reduce blood cholesterol. Weight reduction and decreasing saturated fats in the diet (decreasing the consumption of food of animal origin) are the most common and effective lifestyle recommendations. However, dyslipidemia is often controlled and managed pharmacologically.

NOTE: This information does not exempt medical monitoring or consultation.

There is a substantial body of evidence linking depression to cognitive decline and dementia, and the presence of depression nearly doubles the risk of dementia. It is noteworthy to mention that cognitive impairment may be the main symptom of depression in the elderly; a phenomenon that used to be called pseudodementia. Timely treatment of depression can contribute decisively to reducing the risk of dementia. Non-pharmacological interventions could be helpful, such as psychoeducation (for the person and his or her family, as appropriate), addressing current psychosocial stressors, reactivating social networks, psychological treatment and or advice and regular follow-up.

NOTE: This information does not exempt medical monitoring or consultation.

The implications of hearing loss are often underestimated both at the individual and population level. Hearing impairment has debilitating consequences on functional ability and social and emotional well-being. Deteriorations in hearing impact on individuals’ ability to communicate with others, which in turn can result in feelings of frustration, isolation and loneliness. Older adult populations who already experience the isolating effects of age-related factors, such as diminished mobility, driving cessation, death of partners or living alone, are particularly vulnerable to these psychosocial impacts. Hearing loss is associated with increased risk of cognitive decline or dementia, and it can almost double the risk of incident dementia. Hearing loss and cognitive impairment or dementia, individually, and in combination, predict decreased functional ability and increased burden of care. Hearing loss interventions, therefore, have the potential to substantially improve outcomes for older people on multiple domains. Screening followed by provision of hearing aids are recommended for timely identification and management of hearing loss.

NOTE: This information does not exempt medical monitoring or consultation.

Overweight and obesity are some of the best characterised and established risks for a variety of noncommunicable diseases, and have been linked to a number of medical complications such as diabetes, cancer, premature mortality, and cardiovascular disease, both as direct risk factors as well as risks for other cardiovascular risk factors, such as high cholesterol and hypertension. Obesity has been steadily rising among older adults and a link has been established between excess fat body mass and cognitive impairment, and higher risk of dementia. Weight loss could indirectly reduce the risk of dementia by improving a variety of metabolic factors linked with the pathogenesis of cognitive impairment and dementia (i.e. glucose tolerance, insulin sensitivity, blood pressure, oxidative stress, and inflammation). However, a direct beneficial effect of weight reduction is also plausible. Although evidence of potential cognitive benefits of weight loss seem to be strongly associated with increased physical activity, intentional weight loss can improve performance in some cognitive domains, at least in people with obesity. Lifestyle practices that included both diet and physical activity components seem to show the best results.

NOTE: This information does not exempt medical monitoring or consultation.

Hypertension in mid-life has been associated with an increased risk of late life dementia. In particular, a pattern of increased blood pressure during mid-life followed by a rapid decrease in blood pressure later in life has been found in individuals who go on to develop dementia. There is mixed evidence relating to the reduction of blood pressure in late mid or late life and subsequent cognitive decline or dementia, however, there is evidence to show that the reduction of hypertension can have substantial benefits in reducing cardiovascular morbidity and mortality and thus improving overall health of the ageing population. Hypertension can be prevented through a range of lifestyle factors, including eating a healthy diet, maintaining a healthy weight and participating in an adequate amount of physical activity. It can also be controlled through antihypertensive medication.

NOTE: This information does not exempt medical monitoring or consultation.

The presence of late life diabetes may increase the risk of dementia. Poor glucose control has been associated with lower cognitive functioning and greater cognitive decline. In addition, the complications associated with diabetes, such as kidney damage, eye damage, hearing impairment and cardiovascular disease, have all been found to increase the risk of dementia. There is some evidence to suggest that treating the cardiovascular comorbidities associated with diabetes, such as high cholesterol and hypertension, may mediate the risk for dementia. Besides adequate therapy, these can be reduced or in some cases prevented through a range of lifestyle factors, including eating a healthy diet, maintaining a healthy weight and participating in an adequate amount of physical activity.

NOTE: This information does not exempt medical monitoring or consultation.

Excessive alcohol consumption is common in many countries and is one of the leading causes of general disability globally. There is extensive evidence on excessive alcohol as a risk factor for dementia and cognitive decline, being a direct cause in more than 200 diseases including risk factors for many other injury conditions. Screening and brief intervention in primary care is one of the most cost-effective means of reducing alcohol-attributable morbidity and deaths. Reducing, consuming at a non-harmful level or stopping alcohol consumption reduces the risk of cognitive decline and dementia.

NOTE: This information does not exempt medical monitoring or consultation.

Dementia is preceded by cognitive decline. The concept of cognitive reserve has been proposed as a protective factor that may reduce the risk of clinical onset of dementia and cognitive decline. Cognitive reserve refers to the brain’s ability to cope with or compensate for neuropathology or damage. Increased cognitive activity, when compared with low levels of cognitive activities, may stimulate (or increase) cognitive reserve and have a buffering effect against rapid cognitive decline as well as a significant reduction in the risk of mild cognitive impairment or Alzheimer disease. Increased cognitive activity can be achieved through cognitive stimulation and/or cognitive training. Cognitive stimulation refers to “participation in a range of activities aimed at improving cognitive and social functioning”, while cognitive training refers to “guided practice of specific standardised tasks designed to enhance particular cognitive functions”. Keeping the brain as active as possible, stimulating areas responsible for memory, attention and concentration, is highly recommended. This can be done by challenging the mind regularly and by participating in activities that involve cognitive skills, such as crossword games, board games, maths or number puzzles, jigsaw puzzles, or even learning a new language.

NOTE: This information does not exempt medical monitoring or consultation.

Social engagement is an important predictor of well- being throughout life and it can help prevent dementia. Social disengagement conversely, has been shown to place older individuals at increased risk of cognitive impairment and dementia. Lower social participation, less frequent social contact and loneliness are associated with higher rates of incident dementia. Social participation and social support are strongly connected to good health and well-being throughout life and social inclusion should be supported over the life-course. Maintaining healthy relationships and an active social network can help protect against dementia. Socialising with friends, participating in social groups, and/or volunteering in your community are ways to stay involved in regular social activities.

NOTE: This information does not exempt medical monitoring or consultation.