Dementia primary prevention
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Dementia Microchapters |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Prevention of dementia is the attempt to avoid developing dementia. Although no cure for dementia is available, there are many ways to decrease the risk of acquiring dementia in the first place, including both lifestyle changes and medication. UK National Institute for Health and Care Excellence recommends lifestyle and behavioral interventions (stopping smoking, reducing alcohol consumption, increased physical activity, eating healthily, maintaining a healthy weight) to decrease the risk of frailty and dementia
Primary prevention
Lifestyle
Exercise programs improve physical functioning or at least slow the progression of functional decline in patients with dementia. Exercise programs do not appear to improve cognitive functioning in adults with dementia [1]
Behavioral Disturbance
Recognition and treatment of delusions, hallucinations, depression, agitation, aggression, and sleep disturbances are important aspects of the care of patients with dementia.
Nutrition
Decreased sense of smell is also common in dementia patients and can manifest itself as poor appetite and weight loss. Provision of high-calorie supplements can help with weight gain in patients with dementia. Ongoing eating problems are very common in advanced dementia patients.
Mental Activity
Use it or Lose it" might be applied to the brain when it comes to dementia. Cognitive stimulation programs benefit cognition, but that studies were of variable quality and further research is indicated[2]
Physical Activity
Exercise programs may improve physical functioning or at least slow the progression of functional decline in patients. Exercise programs do not appear to improve cognitive functioning in adults with dementia.[1] Studies showed that Physical therapy and occupational therapy significantly improved motor skills compared with controls.[3]
Risk factor control
Controlling the risk factors for stroke, cardiovascular disease, and dementia represent an important strategy for decreasing the incidence of dementia.[4]
Patients whose vascular risk factors were treated had a slower decline in MMSE scores compared with those whose vascular risk factors were not treated. [5]
Alcohol
Advise patients to limit alcohol consumption i.e , one drink per sitting and avoid after-dinner alcohol completely because of detrimental effects on sleep.
THERAPIES WITH UNPROVEN BENEFIT
Several treatment modalities with unproven benefit include:
- Estrogen replacement[6]
- Anti-inflammatory drugs[7]
- Ginkgo biloba[8]
- Statins
- Vitamin B[9]
- Omega-3 fatty acids
References
- ↑ 1.0 1.1 Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S (April 2015). "Exercise programs for people with dementia". Cochrane Database Syst Rev (4): CD006489. doi:10.1002/14651858.CD006489.pub4. PMID 25874613.
- ↑ Woods B, Aguirre E, Spector AE, Orrell M (February 2012). "Cognitive stimulation to improve cognitive functioning in people with dementia". Cochrane Database Syst Rev (2): CD005562. doi:10.1002/14651858.CD005562.pub2. PMID 22336813.
- ↑ Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jönsson L, Thijssen M, Hoefnagels WH, Rikkert MG (January 2008). "Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study". BMJ. 336 (7636): 134–8. doi:10.1136/bmj.39408.481898.BE. PMC 2206302. PMID 18171718.
- ↑ Snyder HM, Corriveau RA, Craft S, Faber JE, Greenberg SM, Knopman D, Lamb BT, Montine TJ, Nedergaard M, Schaffer CB, Schneider JA, Wellington C, Wilcock DM, Zipfel GJ, Zlokovic B, Bain LJ, Bosetti F, Galis ZS, Koroshetz W, Carrillo MC (June 2015). "Vascular contributions to cognitive impairment and dementia including Alzheimer's disease". Alzheimers Dement. 11 (6): 710–7. doi:10.1016/j.jalz.2014.10.008. PMC 4731036. PMID 25510382.
- ↑ Sabayan B, Westendorp RG (April 2015). "Blood pressure control and cognitive impairment--why low is not always better". JAMA Intern Med. 175 (4): 586–7. doi:10.1001/jamainternmed.2014.8202. PMID 25730401.
- ↑ Shumaker SA, Legault C, Rapp SR, Thal L, Wallace RB, Ockene JK, Hendrix SL, Jones BN, Assaf AR, Jackson RD, Kotchen JM, Wassertheil-Smoller S, Wactawski-Wende J (May 2003). "Estrogen plus progestin and the incidence of dementia and mild cognitive impairment in postmenopausal women: the Women's Health Initiative Memory Study: a randomized controlled trial". JAMA. 289 (20): 2651–62. doi:10.1001/jama.289.20.2651. PMID 12771112.
- ↑ Rogers J, Webster S, Lue LF, Brachova L, Civin WH, Emmerling M, Shivers B, Walker D, McGeer P (1996). "Inflammation and Alzheimer's disease pathogenesis". Neurobiol Aging. 17 (5): 681–6. doi:10.1016/0197-4580(96)00115-7. PMID 8892340.
- ↑ Angell M, Kassirer JP (September 1998). "Alternative medicine--the risks of untested and unregulated remedies". N Engl J Med. 339 (12): 839–41. doi:10.1056/NEJM199809173391210. PMID 9738094.
- ↑ Aisen PS, Schneider LS, Sano M, Diaz-Arrastia R, van Dyck CH, Weiner MF, Bottiglieri T, Jin S, Stokes KT, Thomas RG, Thal LJ (October 2008). "High-dose B vitamin supplementation and cognitive decline in Alzheimer disease: a randomized controlled trial". JAMA. 300 (15): 1774–83. doi:10.1001/jama.300.15.1774. PMC 2684821. PMID 18854539.