Prevention

Can dementia be prevented? Researchers have explored that question with a number of studies relating to diet, physical exercise, intellectual activity and social engagement.

Diet

Researchers have proposed that a variety of micronutrients are important in reducing one’s risk of dementia. These include vitamin E and a variety of B vitamins. None has been reliably shown to have a beneficial effect in preventing cognitive decline.

Studies by multiple researchers have shown an association between a Mediterranean-style diet and a reduced risk and reduced incidence of dementia. The Mediterranean-style diet is typically characterized by consumption of whole grains, vegetables and fruits. Fish and/or poultry are consumed in smaller amounts and constitute the main source of animal protein. Dairy is typically consumed as yogurt or cheese. Nuts are consumed as an additional source of protein and vitamins. Olive oil serves as the primary source of saturated fat. Sweets and other animal proteins are consumed in much smaller amounts.

The reproducibility of this finding – the ability of independent researchers to confirm the results — stands in contrast to the often conflicting findings produced from studies that attempt to isolate specific components of the diet. It seems likely that rather than one specific micronutrient conveying a protective effect, a variety of micronutrients work in concert to promote brain health.

Exercise

Regular physical exercise remains important throughout the lifespan. In addition to the physical health benefits that we generally recognize as being associated with regular exercise, there are benefits for mood and cognitive function as well.

Numerous studies of populations in the United States and around the world have identified an association between regular physical exercise and decreased risk of developing Alzhiemer’s disease or dementia. Regular physical activity reduces the risk of cardiovascular and cerebrovascular disease, improves blood sugar control and helps to maintain bone density. Regular physical activity can elevate the mood and reduce stress.

In people with Alzheimer’s disease, maintaining regular physical exercise is associated with a slower rate of cognitive and functional decline and decreased rates of neuropsychiatric symptoms (depression, anxiety, agitation). For some patients, becoming involved in a regular routine of physical activity may decrease psychiatric symptoms even after they have begun to appear. Although we do not entirely understand the reasons that underlie these associations, it seems likely that regular exercise improves blood flow to the brain, which may have a protective effect and improve the brain’s resilience when it is exposed to oxidative or other metabolic stresses associated with aging.

We recommend that older individuals continue regular physical activity for as long as possible. This helps to maintain physical health and muscle mass, while reducing the risks of medical complications associated with inactivity. There is no single physical activity that is superior to others. The best studied and characterized is simply walking. Some people enjoy using an indoor exercise machine, such as a treadmill or stationary bicycle, when weather makes outdoor exercise unpleasant. For some patients, other health issues may decrease exercise capacity or make these types of exercises difficult. Participating in household chores or other adaptive exercise techniques should be encouraged to help a person remain physically active.

As always, you should check with your primary care doctor before beginning any exercise program. Your doctor may help to tailor an exercise regimen by providing advice about which exercises to avoid in addition to making recommendations about the intensity and duration of activity. For people who have physical disabilities, referral to a physical therapist or a balance therapy center may aid in constructing a tailored exercise regimen. We have heard from patients who enjoy using a gaming system such as the Wii to remain physically active and to improve their sense of balance. Obviously, no clinical trial exists to confirm the usefulness of this, but several patients have commented that they enjoy the experience and that it provides an opportunity to spend time with their grandchildren.

Intellectual activity

Similar to physical exercise, higher degrees of intellectual activity are associated with a decreased risk of developing Alzheimer’s disease or dementia. For those already having Alzheimer’s disease, increased intellectual activity is associated with a slower clinical progression of symptoms and lower rates of neuropsychiatric symptoms. These findings have been validated by numerous studies of large population, both within the United States and worldwide.

Also analogous to physical exercise, no single type of intellectual activity has been shown to be superior to others. Some studies have looked at associations between solving crossword puzzles or the sentence complexity in a personal diary and found that increased intellectual activity was associated with a reduced risk of cognitive decline. One of the best studies defined intellectual activity broadly, including activities such as reading, gardening, attending classes, knitting or going to the symphony. Results of this study were reproduced, leading to the conclusion that the best recommendation is to find mentally stimulating activities that a person enjoys and then provide opportunities to engage in them.

The Internet provides a variety of “mental gymnastics” websites, including the AARP Web site. If a person enjoys these types of games, they may provide one useful avenue to remain intellectually active. One concern with these types of activities is a potential for increased social isolation associated with long periods of personal computer use. Thus, while computer-based activities may provide one aspect of intellectual activity, they should not constitute the bulk of intellectual activity.

Mental training has not generally proven beneficial at maintaining functional status or activities of daily living. Over the years, a variety of mental training programs have been suggested. In those that have been tested, improvements on the activity may be noted, suggesting that participants do learn how to perform the test or activity better. However, none have shown that this improvement on the test translated into a benefit for overall cognitive functioning or improvement in activities of daily life.

Remaining socially engaged

Social connectedness is important throughout our lives. Those contacts with family, friends, church and community have held us in good stead throughout our life and remain important as we age. Higher levels of social connectedness are associated with better general health and also a better outlook for people having disease relative to people with the same disease who have poor levels of social connectedness.

A higher degree of social connection is associated with a decreased risk of developing Alzheimer’s disease or dementia. It is also associated with a slower rate of cognitive decline among those having Alzheimer’s disease or dementia.

Remaining socially connected can present a challenge for older individuals. Physical barriers, including health issues, may make traveling to visit friends or family more difficult. Driving may no longer be safe, particularly for people with significant visual or cognitive impairment. Depression may also play a role, and numerous studies have emphasized that depression symptoms are under-recognized in people over age 65. People who have memory or other cognitive difficulties may feel self-conscious about these problems, even among close friends.

While acknowledging these and other potential barriers to maintaining social connectedness, we emphasize that the importance of regular social contact is fundamental to our health and to our psychological and spiritual well-being. Community resources may exist to help older individuals  overcome physical and transportation barriers. In the Greater Cincinnati-Northern Kentucky area, organizations such as the Southwest Ohio Council on Aging and the greater Cincinnati chapter of the Alzheimer’s Association may help in identifying community resources specific to your needs. Physical or balance therapy may help to overcome physical disability. Depression is a treatable condition, and if you suspect this may be playing a role, this should be brought to the attention of your physicians. Many people find that having a memory problem is not uncommon among older individuals and that acknowledging this with friends or family may even further strengthen existing relationships.

Preventing trauma to the brain

Trauma to the brain, for which there is no effective treatment, is also a risk factor for dementia. Simple daily habits can reduce your risk of an accident that results in neurotrauma.

  • Always wear a seat belt
  • Always obey highway laws
  • Always wear a helmet when bicycling, skateboarding, or riding a motorcycle
  • Do not talk on a cell phone or send or view text messages while driving
  • Following a seizure, do not drive until cleared by your doctor
  • Hold on to handrails when using stairs
  • Never stand on the top step of a ladder
  • Wear skid-resistant footwear in wintery weather
  • Enter unfamiliar bodies of water feet-first
  • When diving, make sure the water is 10- to 12-feet deep