Dementia: Prevention

Prevention of dementia is not possible. However, attempts can be made to prevent forms of dementing changes by eliminating risk factors. Behavioral risk factors

• Diet
  • High intake of sweet drinks, especially if they contain artificial sweeteners
  • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
• Consumption of stimulants
  • Alcohol (woman: > 20 g/day; man: > 30 g/day); low-risk doses are no more than 20 grams for men and 10 grams for women
    • > 24 grams daily: 20% increased risk of dementia.
    • People with high alcohol consumption (men > 60 g/day; women 40/day) are more than 3 times more likely than others to develop dementia; onset often at younger ages
  • Tobacco (smoking)
    • Smoking over the age of 65: 60% increased risk.
• Physical activity
  • Low physical activity and movement
  • Physical inactivity: 40% increased risk
  • Professional soccer players (5-fold more likely to require dementia medication than non-athletes; including fewer goalkeepers than field players due to chronic traumatic brain injury (“concussion”) caused by repetitive headers or collisions)
• Psycho-social situation
  • Psychological stress
  • Social isolation
• Long sleep (> 9 hours; ratio of dementia mortality (death rate) in long sleepers to 1.63 (p = 0.03)).
• Overweight (BMI (body mass index) ≥ 25; obesity).
  • 60% increased risk of dementia
  • In middle years of life
  • Women who are obese in their mid-50s; after age 70, these women have been shown to have an increased risk of dementia
• Underweight
  • Women with a body mass index (BMI) of less than 20 kg/m2 were 2.93 times more likely to develop dementia than normal-weight women[Time of onset of dementia: 5 years after recruitment of women who were approximately 55 years old at the time of enrollment in the study].
• Android body fat distribution, that is, abdominal/visceral truncal central body fat (apple type) – high waist circumference or waist-to-hip ratio (THQ; waist-to-hip ratio (WHR)) is presentWhen waist circumference is measured according to the International Diabetes Federation (IDF, 2005) guideline, the following standard values apply:
  • Men < 94 cm
  • Women < 80 cm

  The German Obesity Society published somewhat more moderate figures for waist circumference in 2006: < 102 cm for men and < 88 cm for women.

Medication

• See below causes
• Including reduction of anticholinergics from middle age.

Environmental pollution – intoxications (poisonings).

• Anoxia, for example, due to anesthesia incident.
• Lead
• Carbon monoxide
• Solvent encephalopathy
• Air pollutants: particulate matter (PM2.5) and nitrogen oxides; seniors at greatest risk were those with heart failure or ischemic heart disease
• Drug-induced hyponatremia (sodium deficiency) such as from diuretics, antiepileptic drugs, or occasionally ACE inhibitors – this can lead to secondary dementia
• Perchloroethylene
• Mercury
• Heavy metal poisoning (arsenic, lead, mercury, thallium).

Prevention factors (protective factors)

• Biographical causes:
  • Married people had a 42 percent lower risk of developing dementia than lifelong singles
  • Education
    • Individuals who have at least a high school diploma
    • Cognitive reserve (based on education, job, and mental activity data across the lifespan): Dementia rates were about 40% lower in the third with the highest cognitive reserve than in the third with the lowest reserve
    • Education: possibly because it increases cognitive reserve in old age and positively influences health behaviors
  • Socioeconomic factors – social contacts in middle and late life.
• Mediterranean diet:
  • Risk reduction for mild cognitive impairment, MCI.
  • Slowing of brain atrophy in old age.
• Consumption of stimulants [see below WHO guidelines].
  • Smoking cessation
  • Alcohol reduction
    • However, moderate alcohol consumption (woman: < 20 g/day; man: < 30 g/day): weekly 1-14 units (1 unit = 8 g alcohol) should be protective
    • regular small amounts of alcohol can prevent dementia, even if initial cognitive impairment (MCI; mild cognitive impairment) is already present:
      • Low consumption (1-7 drinks per week): dementia incidence: -10%.
      • Moderate consumption (7 to 14 drinks per week): dementia incidence: -7 %.
      • Highest consumption (> 14 drinks per week): +72 %.
• Regular physical activity [see below WHO guidelines].
  • Risk reduction of 22 percent
  • Long-term study over 27 years failed to demonstrate a link between activity and dementia risk; also showed no association between physical activity levels and any cognitive decline over 15 years. The current Cochrane review on this topic confirms this.
• Weight management [see below WHO guidelines].
• Lifestyle interventions
  • Healthy diet, exercise, and cognitive brain training improved cognitive performance in seniors at increased risk for dementia.
  • Consideration of four factors, including smoking, physical activity, diet, and alcohol consumption, resulted in dementia rates about 35% higher among participants living fairly unhealthy lifestyles than among those with healthy lifestyles; among participants with unhealthy lifestyles and unfavorable genes, dementia incidence was 3-fold higher than among those living healthy lifestyles with favorable genes (1.8 versus 0.6%); an unhealthy lifestyle additionally and independently increased dementia rates by 40-50%.
• Sauna sessions: men who went to the sauna 4-7 times a week reduced their risk of dementia by 66 percent compared with those who saunas only once a week.
• Regular blood pressure monitoring in hypertensive patients [see below WHO guidelines].
• Treatment of diabetes mellitus, dyslipidemia, depression and hearing loss according to therapy guidelines [see below WHO guidelines].
• Medications:
  • Antihypertensive therapy (blood pressure-lowering measures): 43 percent lower risk of dementia in study participants who received antihypertensive medication compared with untreated hypertensive participants
  • Pioglitazone (drug in the oral antidiabetic/insulin sensitizer group) substantially reduces the risk of dementia for diabetics; when the drug was administered for at least two years, the risk of disease was 47% lower than in nondiabetics.
  • Similar results are available for metformin (belongs to the biguanide group).
  • Anticoagulation in patients with atrial fibrillation (VHF) leads to a reduction in dementia risk: incidence rate (frequency of new cases) for dementia was lower in the group with anticoagulation than in the group without anticoagulation (1.14 vs. 1.78 per 100 patient-years).ECS position paper: recommendations for the prevention of cognitive decline in patients with VHF:
    • Patients with AF and apoplexy risk factors should receive appropriate anticoagulation to prevent cognitive decline.
    • Preference for new oral anticoagulants (NOAKs) over vitamin K antagonists (VKAs).
      • If patients receive a VKA, drug levels should be at a high proportion within the therapeutic range (“time in therapeutic range”).
    • Lifestyle measures see above. ), which can reduce the risk of AF recurrence and apoplexy, could also have a positive impact on cognitive function.
    • Cognitive assessment should be performed in AF patients in whom cognitive decline is suspected.