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==Overview==
==Overview==
'''Prevention of dementia''' is the attempt to avoid developing [[dementia]].
'''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.
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==
==Primary prevention==
{{Main|Prevention of dementia}}
===Lifestyle===
===Lifestyle===
<u>'''Mental activity'''</u>
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 <ref name="pmid25874613">{{cite journal |vauthors=Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S |title=Exercise programs for people with dementia |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD006489 |date=April 2015 |pmid=25874613 |doi=10.1002/14651858.CD006489.pub4 |url=}}</ref>
"Use it or Lose it" might be applied to the brain when it comes to dementia. Intellectual activities help keep the mind in shape in the older days.
Activities, such as reading, playing cards and board games and playing a musical instrument prevents dementia of both [[Alzheimer's]] and [[vascular dementia]] <ref name=wvdhhr>[http://www.wvdhhr.org/bph/oehp/hsc/dementia/prevent.htm West Virginia Department of Health and Human Resources (with further links to experiments respectively)]</ref>. The risk decreases proportionally to the frequency of activity.<ref name=wvdhhr/>


Not only activities during spare time seem to prevent dementia. What kind of occupation also matters, especially during the thirties, forties and fifties <ref name=wvdhhr/>. A good job in this case is any mentally demanding one.
====Behavioral Disturbance====
Recognition and treatment of delusions, [[Hallucination|hallucinations]], [[depression]], agitation, aggression, and sleep disturbances are important aspects of the care of patients with dementia.  


Why activity contributes to prevent dementia could be explained by a "brain reserve" built up by the brain; Additional connections between [[neuron]]s are created, connections more resistant to the deterioration seen in dementia <ref name=wvdhhr/>.
=====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.  


'''<u>Physical activity</u>'''
======Mental Activity======
Since [[vascular dementia]] is the second most common form of dementia (after [[Alzheimer's disease]]), decreasing risk factors for [[Cerebrovascular disease]] also decreases the risk factors for dementia. Thus, physical exercise, having good blood [[cholesterol]], healthy [[Body weight]] and [[Blood pressure]] lowers the risk of developing dementia <ref name=wvdhhr/>. An active lifestyle can almost halve the risk compared to a sedentary one <ref name=wvdhhr/>.
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<ref name="pmid22336813">{{cite journal |vauthors=Woods B, Aguirre E, Spector AE, Orrell M |title=Cognitive stimulation to improve cognitive functioning in people with dementia |journal=Cochrane Database Syst Rev |volume= |issue=2 |pages=CD005562 |date=February 2012 |pmid=22336813 |doi=10.1002/14651858.CD005562.pub2 |url=}}</ref>


The effect of physical activity isn't limited to vascular effects. For instance, it can give rise to new [[neurons]] in the brain, as well as releasing a substance that can protect them <ref name=wvdhhr/>.
======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.<ref name="pmid25874613">{{cite journal |vauthors=Forbes D, Forbes SC, Blake CM, Thiessen EJ, Forbes S |title=Exercise programs for people with dementia |journal=Cochrane Database Syst Rev |volume= |issue=4 |pages=CD006489 |date=April 2015 |pmid=25874613 |doi=10.1002/14651858.CD006489.pub4 |url=}}</ref> Studies showed that Physical therapy and occupational therapy  significantly  improved motor skills compared with controls.<ref name="pmid18171718">{{cite journal |vauthors=Graff MJ, Adang EM, Vernooij-Dassen MJ, Dekker J, Jönsson L, Thijssen M, Hoefnagels WH, Rikkert MG |title=Community occupational therapy for older patients with dementia and their care givers: cost effectiveness study |journal=BMJ |volume=336 |issue=7636 |pages=134–8 |date=January 2008 |pmid=18171718 |pmc=2206302 |doi=10.1136/bmj.39408.481898.BE |url=}}</ref>


Furthermore, physical activity has many other [[Physical_exercise#Exercise_benefits|Exercise benefits]].
'''Risk factor control'''


<u>'''Diet'''</u>
Controlling the risk factors for stroke, cardiovascular disease, and dementia  represent an important strategy for decreasing the incidence of dementia.<ref name="pmid25510382">{{cite journal |vauthors=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 |title=Vascular contributions to cognitive impairment and dementia including Alzheimer's disease |journal=Alzheimers Dement |volume=11 |issue=6 |pages=710–7 |date=June 2015 |pmid=25510382 |pmc=4731036 |doi=10.1016/j.jalz.2014.10.008 |url=}}</ref>
[[Obesity]] increases the risk of any dementia, but Alzheimer's in particular <ref name=wvdhhr/>.


However, what kind of food eaten also matters. '''Fish''' consumtion reduces the risk of Alzheimer's <ref name=wvdhhr/>. Fish is high in [[Docosahexaenoic acid]], an omega-3 fatty acid, especially in cold water fish such as salmon, tuna and halibut.
Patients whose vascular risk factors were treated had a slower decline in MMSE scores compared with those whose vascular risk factors were not treated. <ref name="pmid25730401">{{cite journal |vauthors=Sabayan B, Westendorp RG |title=Blood pressure control and cognitive impairment--why low is not always better |journal=JAMA Intern Med |volume=175 |issue=4 |pages=586–7 |date=April 2015 |pmid=25730401 |doi=10.1001/jamainternmed.2014.8202 |url=}}</ref>


Vegetables and nuts also benefit <ref name=wvdhhr/>, because of their high content of [[polyunsaturated fat]]s. Non-fish meat, on the other hand, increases the risk of Alzhemer's <ref name=wvdhhr/>, by its high content of [[Saturated fat]]. The moderate consumption of alcohol may reduce risk through improving vascular health and other mechanisms. <ref> Mulkamal, K.J., et al. Prospective study of alcohol consumption and risk of dementia in older adults. Journal of the American Medical Association, 2003 (March 19), 289, 1405-1413; Ganguli, M., et al. Alcohol consumption and cognitive function in late life: A longitudinal community study. Neurology, 2005, 65, 1210-12-17; Huang, W., et al. Alcohol consumption and incidence of dementia in a community sample aged 75 years and older. Journal of Clinical Epidemiology, 2002, 55(10), 959-964; Rodgers, B., et al. Non-linear relationships between cognitive function and alcohol consumption in young, middle-aged and older adults: The PATH Through Life Project. Addiction, 2005, 100(9), 1280-1290; Anstey, K. J., et al. Lower cognitive test scores observed in alcohol are associated with demographic, personality, and biological factors: The PATH Through Life Project. Addiction, 2005, 100(9), 1291-1301; Espeland, M., et al. Association between alcohol intake and domain-specific cognitive function in older women. Neuroepidemiology, 2006, 1(27), 1-12; Stampfer, M.J., et al'. Effects of moderate alcohol consumption on cognitive function in women. New England Journal of Medicine, 2005, 352, 245-253; Ruitenberg, A., et al. Alcohol consumption and risk of dementia: the Rotterdam Study. Lancet, 2002, 359(9303), 281-286; Scarmeas, N., et al. Mediterranean diet and risk for Alzheimer’s disease. Annals of Neurology, 2006 (published online April 18, 2006). </ref>
'''Alcohol'''
 
However, there is no certain effect of eating antioxidants <ref name=wvdhhr/>, such as [[beta carotene]], [[Vitamin C]] or [[Vitamin D]] Antioxidants lowers the level of [[Radical (chemistry)|free radicals]], and theoretically this could lower the risk of dementia by deceasing the damage on [[neurons]] caused by the free radicals.
 
[[Iron deficiency (medicine)|Iron deficiency]] is another risk factor for dementia <ref name=wvdhhr/>. A deficiency leads to insufficient amounts in the brain cells of [[heme]], a molecule with iron as one of the components. In an attempt to compensate, the brain cells produce excess amounts of the other components. These components react with oxygen, creating [[Radical (chemistry)|free radicals]] which damage the [[neurons]] of the brain.
 
===Medication===
 
<u>'''Hypertension medications'''</u>
The etiology of [[Vascular dementia]] includes [[hypertension]], and thus, lowering blood pressure with [[Antihypertensive]]s has a positive effect in the prevention of dementia, just as physical activity.
 
Furthermore, antihypertensives lowers the risk of not only vascular dementia, but also of developing [[Alzheimer's disease]], especially when using [[Potassium-sparing diuretic]]s<ref name=wvdhhr/>.
 
'''<u>Anti-diabetic drugs</u>'''
Diabetes mellitus is a risk factor for [[vascular dementia]], and is thus lowered with [[Anti-diabetic drug]]s<ref name=mayoclinic>[http://www.mayoclinic.com/health/diabetes-and-alzheimers/AZ00050 MayoClinic]</ref>.
 
Besides, [[Rosiglitazone]] (Avandia) improves memory and thinking ability to people with mild Alzheimer's disease. The mechanism of the effect might be due to the ability of the drug to reduce [[insulin resistance]]<ref name=wvdhhr/>. Thus, less insulin needs to be released to achieve its metabolic effects. Insulin in the bloodstream is a trigger of [[Amyloid beta]]-production<ref name=mayoclinic/>, so decreased insulin levels decrease the level of amyloid beta. This leads to less formation of [[amyloid]] plaques seen in Alzheimer's disease.
 
<u>'''NSAIDs'''</u>
[[Non-steroidal anti-inflammatory drug]]s (NSAIDs) decreases the risk of developing Alzheimer's<ref name=wvdhhr/>. However, the period of use has to be of a certain length before any effect can be seen. It should be longer than 2 years to have any effect <ref name=wvdhhr/>.
 
Alzheimer's disease causes inflammation in the [[neuron]]s by its deposits of [[amyloid beta]] peptides and [[Neurofibrillary tangle]]s. These deposits irritate the body by causing a release of e.g. [[cytokines]] and [[Acute phase protein]]s, leading to inflammation. When these substances accumulate over years they contribute to the effects of Alzheimer's<ref>[http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=10858586 Inflammation and Alzheimer's disease, Neurobiol Aging. 2000 May-Jun;21(3):383-421]</ref>. NSAIDs inhibit the formation of such inflammatory substances, and prevent the deteriorating effects.
 
<u>'''Vaccine'''</u>
There is yet no [[vaccine]] against dementia <ref name=wvdhhr/>. Such a vaccine could activate the body's own [[immune system]] to combat the [[beta amyloid]] plaques in Alzheimer's disease. One problem to overcome is overreaction from the immune system, leading to [[Encephalitis]] <ref name=wvdhhr/>.


Advise patients to limit alcohol consumption i.e , one drink per sitting and avoid after-dinner alcohol completely because of detrimental effects on sleep.
==References==
==References==
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[[Category:Neurology]]
[[Category:Psychiatry]]

Latest revision as of 19:15, 9 October 2020

Dementia Microchapters

Patient Information

Overview

Classification

Causes

Differential Diagnosis

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.

References

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 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.

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