With the expected dramatic increase in the incidence and prevalence of dementia, articles such as, Promising Strategies for the Prevention of Dementia, which serve to outline successful prevention and treatment strategies are of utmost importance. This is especially true given that a delay in the onset of Alzheimer’s by just five years would reduce the prevalence by more than one million cases. Some of the most promising strategies for this prevention include vascular risk factor control, cognitive and physical activity, social engagement, diet, and treatment of depression.
Vascular risk factor reduction
Although Alzheimer’s and vascular dementia have previously been thought of as distinct disorders, evidence exists that the two rarely occur in isolation. Additionally, the presence and severity of cerebrovascular pathologic findings appear to increase the risk and severity of Alzheimer’s. Therefore, improving ones cardiovascular health may also reduce the risk of dementia. Cardiovascular risk factors include hypertension, dyslipidemia, diabetes, and metabolic syndrome. Most importantly, each of these risk factors appears to be additive. Fortunately, studies indicate that people who receive treatment for hypertension, both in midlife and late-life have a reeducated risk of developing cognitive impairment. Likewise, statin therapy is associated with a reduced risk of Alzheimer’s and other dementias.
Older adults with higher educational attainment have a lower incidence of dementia, possibly due to cognitive reserve. This is true even in those with Alzheimer’s-related neuropathologic changes. In line with this, cognitive activity has been shown to reduce ones risk of cognitive decline. For instance, people who engage in mentally stimulating activities such as learning, reading, or playing games are less likely to develop dementia. It is now evident that occupation and leisure activities also play a role in improving cognitive reserve.
People who are physically active are at a reduced risk for cognitive decline and dementia. This benefit is seen after just four months of exercise training. With the new understanding of the role cardiovascular health plays in dementia, physical activity may help to alleviate vascular risks associated with Alzheimer’s.
People with limited social engagement may be more likely to develop dementia. Therefore, visits with friends and relatives, going to clubs, senior centers, attending religious activities, or volunteering may be protective against developing cognitive impairment. Interventions that include cognitive, physical, and social components may offer the best outcome in reducing cognitive impairment.
Many of the cardiovascular risk factors associated with dementia may be modified through diet. Elderly consuming a Mediterranean diet, having higher fruit and vegetable intake, and regular consumption of fish, may have a lower risk of developing dementia. Reasons behind are largely attributed to antioxidants and polyunsaturated fatty acids.
Many people with dementia also have depression, which in itself has been associated with reduced cognitive performance. It is unclear whether depression is a risk factor for dementia or whether it is a prodromal symptom. However, treatment of depression seems to improve cognitive function.