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prevention of cognitive impairment

Also see: - cognitive impairment in the elderly - prevention of Alzheimer's disease - cardiac risk factor (for prevention of vascular dementia) Special laboratory: - ophthalmoscopy: - retinopathy may suggest small vessel disease in the brain increasing risk of cognitive impairment [18] Management: 1) avoid traumatic brain injury 2) improving cardiovascular health diminishes risk of dementia [21] - good cardiovascular health at age 20 years lowers risk for dementia in older age (life's simple 7) [24] - higher life's simple 7 scores at midlife associated with lower risk for dementia [42] - management of dyslipidemia [34] - control of systolic blood pressure & pulse pressure during midlife [15,34] - tobacco cessation [22,34] 3) exercise reduces the risk of dementia [1,4,22,32,34] - aerobic exercise that improves cardiorespiratory fitness benefits cognition in healthy older adults more than other forms of exercise (GRS11) [40] - 150 minutes of moderate-intensity aerobic physical activity per week, or 75 minutes of vigorous-intensity activity per week (WHO) - moderate intensity aerobic training or stretching, balance, & range-of-motion exercise may prevent cognitive decline in persons with mild cognitive impairment [44] - 30 minutes of exercise twice a week insufficient (GRS11) [40] - this statement may contradict other evidence presented here - social network more important if exercise insufficient (GRS11) [40] - 9 additional minutes a day of moderate to vigorous physical activity improves cognition in middle-aged adults [51] - exercise training may improve memory in elderly with intact cognition or mild cognitive impairment due to Alzheimer's disease [57] - an intensive program of exercise & functional activity training did not improve activities of daily living, physical activity, or quality of life; reduce falls; or improve any other secondary health outcomes in elderly (80 years) with mild cognitive impairment or early dementia, despite good compliance [60] 4) multicomponent strategy may help slow cognitive decline in elderly [14] - nutrition, exercise, cognitive training, cardiovascular risk reduction - engaging in physical, cognitive, & social activities can help lower risk for dementia [45] - healthy diet, exercise, social contact, cognitive activity, & no smoking or drinking may slow memory decline [50] - physical & mental activity lower risk for dementia [46] 5) WHO 7 lifestyle interventions to prevent cognitive decline: - 150 minutes of moderate-intensity aerobic physical activity per week, or 75 minutes of vigorous-intensity activity per week - quitting smoking - nutritional measures that focus on plant-based diets (Mediterranean diet, MIND diet) or intermittent fasting - stop harmful drinking. - cognitive training (a series of tasks designed to improve particular cognitive function) - social engagement - maintaining optimal weight [40] 6) Mediterranean diet in combination with exercise, reduces risk of cognitive impairment & dementia [6,22,34] - most studies describe Mediterranean diet rich in olive oil - omega-6 fatty acids as present in olive oil reduce oxidative stress & mitigate cognitive decline in older adults [36] - cognitive decline may be attenuated 63% with combination of high physical activity & high fruit & vegetable intake [43] - in a 20-year follow-up study, neither adherence to conventional dietary recommendations nor to modified Mediterranean diet were associated with reduced risk for developing all-cause dementia, Alzheimer's dementia, or vascular dementia [48] - a Mediterranean diet is associated with white matter microstructural integrity [53] - adherence to a MIND diet is associated with a reduced risk of dementia in middle-age & older adults [56] 7) consumption of green leafy vegetables [1-2 servings per day] & foods rich in phylloquinone (vitamin K), lutein, nitrate, folate, alpha-tocopherol, & kaempferol may slow cognitive impairment with older age [17] 8) blueberries & strawberries may slow cognitive decline in elderly women [7] - flavonols in general: also apples, appricots & cherries, oranges [62] 9) 600 mg (0.02 ounces) of flavonoids per day with 20% lower risk of cognitive decline than 150 mg (0.005 ounces) per day [31] - flavonoid-rich foods associated lower risk of dementia, especially among those at genetic risk or with depression [63] - tea, red wine, & berries main contributors of dietary flavonoids [63] 10) claims probably true but obtained from news articles - green leafy vegetables (spinach, kale, Swiss chard) - dark chocolate, coffee, green tea, avocados, broccoli - magnesium, fish especially salmon, choline (eggs), soy, nuts (walnuts) - curcumin, turmeric, ginger, cinnamon, sage, rosemary, quinoa - milk non-fat, low-fat, cheese (Mozzarella, goat, Cottage, Parmesan, Swiss) 11) low caloric diet & low carbohydrate diets associated with reduced risk of cognitive impairment [9] 12) dietary fiber, especially soluble fiber, linked to lower risk of dementia [38] - potatoes, but not fruits or vegetables show similar association [38] 13) weight management: control of midlife overweight & obesity [34] 14) management of diabetes mellitus [34] - metformin reduces risk of dementia in elderly with type 2 diabetes [61] 15) adequate sleep & good sleep hygiene may improve cognition in the elderly [16] 16) participation in new stimulating activities contributes to cognitive fitness & might delay cognitive decline [11,34] - exercise & computer classes seem to generate equivalent beneficial effects [11] - a strong social network helps maintain cognitive function [40] - internet use may prevent or delay dementia in older adults [58] 17) midlife & late-life social & cognitive activities diminish likelihood of late-life cognitive decline [13,23] 18) late-life participation in intellectual activities decreases odds of developing dementia (RR=0.7) [20,23] 19) a healthy lifestyle may reduce risk of dementia in genetically prone individuals (NNT=121 for 10 years) [22] - not smoking, regular physical activity, healthy diet, alcohol in moderation or not at all 30) low-to-moderate alcohol consumption may attenuate cognitive decline in middle-age & older aldults relative to abstinence or heavy drinking [29] - reducing hazardous or harmful drinking [34] 21) prevention of hospitalization in the elderly may diminish cognitive impairment [5] 22) bilingual persons may have delayed onset of dementia [10] - bilingual at an early age may improve learning & memory & improve memory in later life [55] 23) angiotensin receptor blockers may reduce indidence of dementia in patients with chronic hypertension [25] 24) hormone replacement therapy, especially if begun within 5 years of menopause may help prevent late-life cognitive impairment [26] 25) prevention & treatment of sensory impairment - cataract extraction associated with reduced risk of dementia (RR=0.71) [35] - hearing aids & cochlear implants may attenuate cognitive decline [49] - may reduce 3 year cognitive decline in older adults at increased risk [59] - not likely to benefit persons at low risk of cognitive decline [59] 26) pet ownership may provide protection against cognitive decline [37] 27) pharmaceutical lithium associated with decreased risk of dementia (RR=0.56) including Alzheimer's disease & vascular dementia [39] 28) 1-6 cups of tea/day may reduce risk of Alzheimer's disease 16-19% & reduce risk of vascular dementia 25-29% [41] 29) meditation may have benefits but does not modify volume of the insula or anterior cingulate cortex in older adults [47] 30) factors favorable associated with maintenance of cognitive function include: a) white race (RR = 1.72) b) high school education level or greater (RR = 2.75) c) ninth grade literacy level or greater (RR = 4.85) d) weekly moderate/vigorous exercise (RR = 1.31) e) not smoking (RR = 1.84) [3] NOT preventative: 1) medications, vitamins & herbal supplements do not prevent cognitive impairment [33] - multivitamin-minerals may provide some cognitive resilience, countering conversion to mild cognitive impairment (MCI), but not significantly reducing incidence of MCI over 3 years [54] 2) 81 mg of aspirin daily in women > 65 years of age [2] - ref [8] claims some benefit 3) no evidence to support use of low-dose aspirin or other NSAID of any class (celecoxib, rofecoxib or naproxen) for prevention of dementia; however there is evidence of harm (Cochrone review) [28] 4) ACE inhibitors (as a class) (see ACE inhibitors & dementia) 5) folic acid & vitamin B12 supplementation in elderly with elevated serum homocysteine [12] 6) DHA-rich fish oil [19] 7) vitamin D - vitamin D (2000 IU/day), omega-3 fatty acids (1 g/day), &/or strength-training does not prevent cognitive impairment in healthy adults > 70 years of age [30] - vitamin D supplementation reduces risk of dementia (40%) [52]

Related

ACE inhibitors & dementia cognitive impairment cognitive impairment in the elderly cognitive resilience

Specific

prevention of Alzheimer's disease/dementia

General

health maintenance (preventive medicine) in the elderly prophylaxis (prevention, ppx)

References

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