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A growing body of evidence supports the key role of prevention in reducing the risk of developing Alzheimer’s disease (AD).1-3
Prevention of AD has therefore been recognized as one of the key strategic action areas of the World Health Organization (WHO) “Global action plan on the public health response to dementia 2017–2025”, which encourages the dissemination of an evidence-based approach to support policy and public health interventions.4 In this context, guidelines, and evidence-based studies have been published to support awareness of AD prevention and benefits of multi-domain interventions on brain health:
- WHO Guidelines on “Risk Reduction of Cognitive Decline and Dementia”
- These guidelines provide healthcare providers with evidence-based recommendations on lifestyle behaviours and interventions to delay or prevent cognitive decline and dementia in the general population.4
- View WHO guidelines
- Lancet Commission of Dementia Prevention, Intervention, and Care
- Several studies have shown a relationship between modifiable risk factors and the development of cognitive impairment and dementia. According to the 2020 report of Lancet Commission, up to 40% of dementias might be prevented or delayed by modifying 12 risks factors, including hypertension, obesity, smoking, and low physical activity throughout the course of life.5
- View Livingston et al.
- FINGER on the Importance of Lifestyle Interventions
- The 2-year prospective, controlled, large-scale Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER) showed that multidomain lifestyle interventions, like nutritional guidance, exercise, cognitive training, and management of vascular risk factors, have beneficial effects on cognition versus regular health advice.6
- The World-Wide FINGERS network was then launched to further investigate such multidomain interventions with the aim to generate high-quality scientific evidence to support public health and clinical decision-making.7
It is Never Too Early or Never Too Late in
Life for Alzheimer's Disease Prevention.8
Protective factors
Education
Risk factors
Hypertension, obesity and dyslipidaemia
APOE, other genetic factors, and familial aggregation
Unhealthy diet, alcohol misuse, smoking, diabetes mellitus, and depression
Some factors can differentially affect the risk of dementia and Alzheimer's disease in an individual depending on the time of exposure. Starting from early childhood, cognitive stimulation achieved through education, physical, cognitive, and social activities can enhance the brain's ability to respond to changes and it's ability to compensate for any damages that may occur in later life. Hypertension, obesity, and dyslipidemia increase dementia risk when a person is exposed during midlife. By contrast, other factors such as unhealthy diet can affect the risk over the entire course of an individual's life.8
An accurate diagnosis in the early stages of Alzheimer’s disease also offers the opportunity to implement tailored multidomain programs that can help individuals with AD maintain cognitive functions and prevent or delay further cognitive decline.7,9
How to Improve Brain Health
Physicians can empower their patients to take more control over their brain health by leading an open and continuous dialogue on the importance of protecting cognitive health.9
The following lifestyle changes may help individuals at risk of developing AD or those with a confirmed diagnosis of MCI due to AD to prevent or delay further cognitive decline.4-6,8
Physical Exercise
Maintaining regular physical exercise, such as walking to the grocery store or to the office, biking, stretching, or doing yoga have a positive effect on the heart, bones, mood, and the immune system, and are good for the brain, because they enhance learning and memory.1-3,6
Moreover, it has been shown that at least 2.5 hours of endurance sports (moderate-intensity aerobic physical activity) per week help improve physical fitness and preserve cognitive skills.1-3,6
Diet & Nutrition
A Mediterranean diet, particularly the consumption of fruit, vegetables, and fish, is associated with decreased risk of mild cognitive impairment and dementia.1-3,6
A healthy, balanced diet low in saturated fats also plays a crucial role in the prevention of many conditions that increase the risk of dementia, such as diabetes, obesity, hypertension, and heart disease.1-3,6
Smoking
Smokers are at higher risk of dementia than non-smokers. Stopping smoking is beneficial regardless of age.1-3,6
Alcohol Consumption
Heavy drinking on a regular basis can increase the risk of developing dementia. Reducing alcohol consumption or stopping it completely is beneficial for the brain.1-3,6
Social Engagement
Leading an active social life and maintaining frequent interactions with friends and family is strongly connected to brain health and well-being. Research suggests that social contact is a protective factor against age-related cognitive impairment.1-3,6
Sleep
Good-quality sleep has a profound impact on overall body and brain health, influencing energy level and mood. Studies have found that good-quality sleep may reduce the build-up of amyloid plaques in the brain, which are associated with Alzheimer’s disease and cognitive decline.1-3,6
A regular bedtime routine, abstaining from caffeine and alcohol close to bedtime, and averaging 7 to 8 hours of sleep per night may help to improve sleep.
Mental Fitness
Mental exercise is just as important as physical activity in keeping the brain healthy and fit.
Embracing new activities and continuing to learn new things throughout life, such as a new language or picking up a new hobby, help strengthen brain skills and make brain cells more resistant to the effects of ageing.
Examples of brain exercises that may help improve memory and problem-solving skills are reading, doing crossword or sudoku puzzles, playing chess, or electronic “brain games”.1-3,6
What’s next
Alzheimer’s Disease: The Silent Epidemic
Policy leadership and commitment is needed in Alzheimer's disease to optimise quality of care and support for patients, their caregivers and families.
References
1.Scheltens P, De Strooper B, Kivipelto M, et al. Alzheimer's disease. Lancet. 2021;397(10284):1577-1590.
2. Ko Y, Chye SM. Lifestyle intervention to prevent Alzheimer's disease [published online ahead of print, 2020 Aug 17]. Rev Neurosci. 2020;/j/revneuro.ahead-of-print/revneuro-2020-0072/revneuro-2020-0072.xml.
3. World Health Organization (WHO). Global action plan on the public health response to dementia 2017 - 2025. www.who.int/mental_health/neurology/dementia/action_plan_2017_2025/en/. Accessed May 24, 2021.
4. Risk Reduction of Cognitive Decline and Dementia: WHO Guidelines. Geneva: World Health Organization; 2019. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542796/. Accessed June 14 2021.
5. Livingston G, Huntley J, Sommerlad A, et al. Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. Lancet. 2020;396(10248):413-446.
6.Ngandu T, Lehtisalo J, Solomon A, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385(9984):2255-2263.
7.Rosenberg A, Mangialasche F, Ngandu T, Solomon A, Kivipelto M. Multidomain Interventions to Prevent Cognitive Impairment, Alzheimer's Disease, and Dementia: From FINGER to World-Wide FINGERS. J Prev Alzheimers Dis. 2020;7(1):29-36.
8.Kivipelto M, Mangialasche F, Ngandu T. Lifestyle interventions to prevent cognitive impairment, dementia and Alzheimer disease. Nat Rev Neurol. 2018;14(11):653-666.
9.Frisoni GB, Molinuevo JL, Altomare D, et al. Precision prevention of Alzheimer's and other dementias: Anticipating future needs in the control of risk factors and implementation of disease-modifying therapies. Alzheimers Dement. 2020;16(10):1457-1468.