45% of dementias can be prevented with some easily implemented strategies

A study showed that about 45% of dementias are preventable through lifestyle modifications. The societal impacts of this research include reducing financial burdens on the health care system, improving social participation and population health, and improving quality of life for millions of Americans.

“Primary care clinicians can now start the conversation about cognitive health with their patients,” said Kendall M. Wasz, PA-C, a physician assistant specializing in memory care at Norton Neuroscience Institute. “We can get ahead of cognitive decline, and stop it or slow onset.”

Actionable steps to prevent dementia

The study revealed six topics with the strongest evidence to support dementia prevention: neurovascular risk management, physical activity, sleep, nutrition, social isolation and cognitive stimulation. Patients who may be at increased risk for developing Alzheimer’s disease and related dementias (ADRD) should be made aware of risks and strategies to optimize brain health.

Neurovascular risk management

There is a clear and documented association between cardiovascular health and cognitive function. Controlling hypertension, diabetes and existing cardiovascular conditions may slow the onset of cognitive decline.

Physical activity

There is a wealth of research supporting the benefits of physical activity. Despite this body of evidence, physical activity is not often discussed as a dementia prevention tactic. There are certain populations which are disproportionately affected by ADRD — women, persons with lower income and certain races or ethnicities. A gradual supportive approach to increasing physical activity is recommended.

Sleep

There is some evidence that sleep disturbances are strongly correlated with increased risk of cognitive decline. Sleep quality is not usually discussed as a dementia-prevention intervention. Poor sleep quality and conditions such as sleep apnea may be triggers for ADRD.

Nutrition

Diets including the Mediterranean diet, DASH (dietary approaches to stop hypertension), and MIND (Mediterranean and DASH intervention for neurodegenerative delay), are well known to provide multiple health benefits, including improved cognition in older people. It is recommended for clinicians to discuss the quality of patients’ diets and support them in improving their diet as needed.

Social activity

Social interaction is a key component of overall mental well-being. Loneliness and social isolation increase risk factors for general health and also may impact physical health. Clinicians should address social interaction as a way to stave off cognitive decline.

Cognitive stimulation

There is limited evidence of the effectiveness of cognitive stimulation in slowing cognitive decline. It may, however, be a mild buffer against it. Brain-stimulating activities should be included in conversations in the same manner as nutrition, physical activity or any lifestyle intervention that affects health.

While there are other factors that impact cognitive health, including alcohol consumption, obesity, head injuries and other conditions, these six topics provide the most actionable guidance for clinicians.

For clinicians

Educating and training clinicians to — in turn — educate patients about lifestyle interventions to protect against cognitive decline is critical. The use of nonpharmacological interventions should be promoted as it has been for diabetes and cardiovascular disease.

Next steps in dementia prevention research

Ideally, intervention trials should be instigated to demonstrate how modifying the risk factors alone or in combination may or may not reduce the risk of dementia, similar to the Finnish FINGER trial.

“These interventions are the first steps toward decreasing risk for cognitive decline,” Kendall said. “These are all very practical and actionable steps we can take with our patients right now.”