Latest expert advice about preventing cognitive decline and dementia

There are three steps people can take that might delay or prevent cognitive decline and dementia, a new report from a panel of experts has announced. The evidence is modest and it might turn out not to be true, they caution, but there are reasons to believe these strategies might help.

The panel was asked by The National Academies of Sciences, Engineering, and Medicine to examine the most recent evidence on steps that can be taken to prevent, slow, or delay the onset of age-related cognitive decline, mild cognitive impairment, and Alzheimer’s-type dementia. They issued their report in late June.

The three steps:

Cognitive training. This includes programs (which may or may not be computer-based) aimed at enhancing reasoning and problem solving, memory, and speed of processing.

The panel found good evidence that this can improve performance on a specific task, at least in the short term. What isn’t clear is how long this improvement lasts, whether getting better at one cognitive skill improves other cognitive skills, and whether this helps people better manage their daily activities, such as driving and remembering to take medications.

Blood pressure management for people with hypertension. Most dementia patients have cerebrovascular disease, such as small strokes and bleeding in the brain. This suggests that cerebrovascular disease might be involved in causing cognitive decline.

We know that improved control of blood pressure in patients with hypertension is linked to a lower risk of having or dying from a stroke. So it’s plausible that managing blood pressure in people with hypertension will both reduce the risk of stroke and cerebrovascular disease as well as the risk of dementia and cognitive decline, the experts said.

But we’ll never know for sure, the panel also conceded, because it would be unethical to do the kinds of studies that would be necessary. “It would not be appropriate to test blood pressure management’s cognitive effects directly with a control arm in which hypertensive individuals did not receive blood pressure management,” they said.

Increased physical activity. Some of the benefits of physical activity are known to help maintain the health of the brain and prevent cognitive decline. These benefits include lowering the risks of obesity, strokes, high blood pressure, and depression.

This led the panel to conclude that the evidence is sufficient to justify communicating to the public that increased physical activity for delaying or slowing age-related cognitive decline is supported by encouraging but inconclusive evidence.

“the public should have access to these results”

“Even though clinical trials have not conclusively supported the three interventions discussed in our report, the evidence is strong enough to suggest the public should at least have access to these results to help inform their decisions about how they can invest their time and resources to maintain brain health with aging,” the panel’s chair Alan I. Leshner said.

You can read or download for free the full report here: Preventing Cognitive Decline and Dementia: A Way Forward.

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