Dementia is not a disease itself but rather a group of symptoms that can accompany specific diseases and conditions associated with the brain. There are various forms of dementia, such as Alzheimer’s disease, vascular dementia, and Lewy body disease, to name a few. Dementia is a public health priority characterized not by age or social status, as many believe, but by disease. Much is yet to be understood about dementia; however, its symptoms include chronic loss of at least two brain functions, such as language, memory, judgment, or abstraction, which causes impairment in social and occupational functions. Those with dementia might suffer loss of independence and have a reduced quality of life, ultimately leading to death.
There are a number of risk factors associated with dementia, which can be brought about by a combination of genetic, biological, behavioral, social, and lifestyle factors. Some of these factors may increase the risk of developing dementia, while others related to lifestyle are likely to lower the risk. The greatest modifiable risk factors relate to age, which is the main risk factor for developing dementia. Currently, most cases of dementia are diagnosed late when there are also additional pathologies present. If the goal is to delay the onset of dementia, it would be important to develop methods to identify early-stage pathology and intervene at this ‘pre-clinical’ stage to prevent the disease from progressing to a clinical diagnosis, or even prevent the disease from ever occurring.
The Impact of Dementia on Individuals and Society
Dementia is an insidious, life-changing condition for all those diagnosed and those who care for them. The symptoms of memory and cognitive dysfunction profoundly change the life of an individual, disrupting the normal use of intellect, moods, emotions, and activities of daily living. Over time, their ability to function independently is lost, and increasingly they will rely on the care and support of family, friends, and professionals who work in health and social care. It is often demoralizing and distressing for people living with dementia, families, and caregivers. It presents a huge economic and social cost to countries worldwide. Most people diagnosed with dementia feel stigmatized and are socially isolated. However, to this day, these individuals have not been given the opportunities to increase their chances of reducing these burdens by enhancing the possibility of preventing the disease.
Those who care for someone living with dementia find it very stressful. Caregivers are at significant risk of physical and emotional illness, particularly anxiety and major depression. They also face increased strain in their relationships with the person living with dementia and others, as they are often responsible for many domains of their lives. The health and emotional well-being of a caregiver can have profound negative impacts on the ability of the individual living with dementia to remain at home. Alternatively, they may feel they can no longer fulfill their role as a caregiver and subsequently experience guilt and feel a heavy burden of responsibility. The cost of dementia to our societies and healthcare systems is a challenge to our current care infrastructure. One study found the annual cost per patient to be a significant amount, whereas the annual cost per patient over 65 years of age was higher. This money is used not only for direct medical expenditures but also for care administered by both formal and informal care teams. Stigma and social isolation can also impact the services and support people living with dementia can access. They still make the majority of their life’s contributions at home and in their communities. Services should support people to remain part of their community, maintaining a sense of independence and well-being.
Lifestyle Factors and Dementia Risk Reduction
The pandemic of dementia is expected to grow and overwhelm the U.S. health care system in the next 30 years, driving up medical expenses and causing family and societal burden. Dementia prevention is critical to not only reducing the group with significant cognitive decline but also care costs. Several studies in the past two decades suggest that lifestyle factors play an important role in the development of dementia. For seniors, living a healthy lifestyle, including increased physical activity, healthy eating, cognitive activities, and the avoidance of cardiovascular disease, may substantially decrease dementia risk.
Lifestyle modification has been shown by two genetic factors to decrease the percentage of Alzheimer’s disease cases by 20 percent. Despite the complexity of Alzheimer’s disease etiology being closely aligned, few pharmaceutical studies have been brisk. A significant number of community dementia risks and combined trials have found that various lifestyle interventions for healthy people have decreased diet-based cognitive decline. These studies revealed the prevention of Alzheimer’s disease in various ethnicities that were overweight by the same lifestyle changes as dementia. Our social appliance recommendations have been expanded. Only when we increase our cultural signals aggressively will we be able to decrease dementia rates.
Physical Activity and Exercise
Regular physical activity or more moderate-intensity activities that get a person to breathe a little harder and increase their heart rate have a well-established protective effect in older adults. For instance, dancing has been shown to improve brain function by influencing different brain parts, walking to improve executive function, resistance and balance training to reduce the risk of developing mild cognitive impairment, tai chi for improving global cognitive function and daily functioning, and swimming to enhance brain connectivity and build new brain cells. Moreover, the wide range of intensity, effort, and resources makes these activities suitable for both people who regularly engage in these activities and those who are unfamiliar. This makes regular engagement in these activities a suitable intervention or strategy for all groups in our society. Regular physical activity is significantly associated with optimal results on cognitive function tests in older adults.
Individuals who engage in the amount of physical activity according to the guidelines are at a decreased risk of various non-communicable diseases, including dementia. Engaging in any amount of physical activity can only be beneficial. It is best to do everyday tasks as part of everyday non-exercise activity; however, structured physical activity and structured exercise can offer additional positive health benefits. Obesity, high blood pressure, and other symptoms of poor heart health can result from not engaging in enough daily physical activity. As these factors contribute to the risk of developing dementia, it may be beneficial to engage in more than the amount of physical activity covered by the guidelines. Furthermore, this type of regular physical activity can help to reduce mental health problems and risk factors that can increase the risk of developing dementia, including depression, anxiety, high cholesterol, and contribute to improving sleep.
Healthy Diet and Nutrition
The rapidly increasing dementia rates worldwide and the incurability of most types of this condition motivate scientists to explore risk factors and preventive strategies. One of the scientifically supported ways of reducing the risk of cognitive decline is leading a healthy lifestyle. The focus is on three modifiable lifestyle factors that are related to dementia risk. Two of them, physical activity and cognitively stimulating activities, have been presented previously. The existing literature and new original research on the relationship between diet and dementia incidence will be analyzed.
People are more and more scared of having (or developing) dementia. At the same time, there are ongoing debates about the possibilities of dementia prevention or cure. The latest findings showed that the following dietary patterns were associated with lower dementia incidence: Mediterranean, MIND, and Mediterranean-DASH diet intervention for neurodegenerative delay. The Mediterranean diet stands out among this list due to the favorable results of randomized controlled trials on the efficacy of this dietary pattern in terms of the primary prevention of chronic diseases. The evidence that the Mediterranean diet, or the MIND diet, may reduce the risk of dementia is getting stronger. Importantly, the MIND diet is a more relaxed version of the Mediterranean diet and has six basic components: vegetables, berries, nuts, olive oil, whole grains, and fish. Therefore, it seems an easier and slower way to adopt a Mediterranean diet. What nutrients or components of food may influence brain functions? It has been claimed that maintaining better cognitive function is not merely a matter of what you eat but how you manage a balanced diet, that is, a diet that provides sufficient amounts of all vitamins and minerals that are essential for good health overall. Let’s turn our attention to the general principles of clinical nutrition, prevailing in the prevention of lifestyle-related chronic diseases, and the main areas of nutrients, food or food groups, and their importance in relation to dementia, cognitive function, or an Alzheimer’s disease diet. According to the latest findings, dementia increases at higher rates as people age, due to an increasingly sedentary life and weak dietary habits. Thus, adopting a healthier lifestyle reduces the risk of this condition. The following practical tips will help you to adopt such healthier eating habits: – Establish regular mealtimes each day – Eat at the table (avoid eating while working, watching television, etc.) – Take pleasure in eating to avoid the need to eat more at the next meal – Avoid eating when feeling stressed or worried – Drink water regularly – Eat breakfast, as children and adults who fail to eat breakfast regularly are at risk of low energy intake – Avoid skipping meals – Adjust portion size to your satiety limit to avoid overeating.
Cognitive Stimulation and Mental Activity
The human brain is capable of being stretched and challenged into old age. Engaging in mentally stimulating activities is thought to potentially lower the risk of developing dementia. This may include engaging in puzzles such as crossword or jigsaw puzzles, learning a new language, how to play an instrument, gardening, reading, and keeping up with news and current events. Engaging in new activities or hobbies that involve learning new physical skills that also require some concentration and memory, such as painting or crafts, can also be beneficial. Evidence indicates that learning and social interaction throughout life are important. Randomized controlled studies show cognitive stimulation can improve cognitive performance in people with mild or moderate dementia. Other evidence reviewed showed that cognitive stimulation may have a small impact in people without dementia. The ‘use it or lose it’ theory suggests that staying mentally active might build up a ‘cognitive reserve’ that helps maintain cognitive vitality. This is considered a key protective strategy to maintain and improve optimal cognitive and physical health and quality of life for people as they age. Technology can provide both cognitive stimulation and the important social interaction that can accompany learning. Many seniors are using technology to boost their mental engagement. Learning new technology is itself a way of keeping the brain alert and gaining new skills and knowledge. Strategies to incorporate intellectual activities in everyday life include decisions about how time is spent during the people’s day. While they are watching TV or spending much time in a sedentary behavior, they might be reducing their intellectual activity. They could speak to other people and perform other activities in order to increase their own cognitive ability. Give your brain a workout before TV! Try listening to the radio, reading a book or magazine, completing a crossword or sudoku puzzle, doing household tasks such as paying bills and cleaning, rearranging furniture, doing a household chore like washing the dishes, writing a letter, traveling by bus, train, tram, or walking to get around. Go out, and be present – have a coffee with a friend, shop at a new store, and visit a museum. Sedentary behaviors, including too much TV viewing, are also associated with poorer cognitive function. Some studies have found that the amount of time a person watches TV is associated with cognitive decline, while others have found that the amount of time that a person watches TV has no association with cognitive function. Television viewing may be a relaxation activity that is enjoyed in moderation for some, or it may be a marker of broader lifestyle patterns of physical inactivity or unhealthy lifestyle factors that elevate risk. In addition, factors such as content selection or question asking can turn TV into an active, more stimulating experience. Generally, most advice focuses on the importance of using TV passively and if you have a preference, how the likes of puzzles or a documentary can add value to the viewing experience. In conclusion, although researchers have not developed a solution, several preventive strategies can reduce the risk of developing challenging behaviors and appreciably delay their onset. It seems that a preventive multi-domain approach is required for planning and implementation of a proactive model for managing behavioral problems associated with dementia.
Medical Interventions and Treatments
When discussing a multi-faceted approach to lowering dementia risk, one must also take into consideration the medical interventions and treatments that have been tried or suggested to prevent cognitive decline. Some of the options that one might consider when trying to lower dementia risk by non-lifestyle interventions include the following: first, cardiovascular risk factors are often associated with Alzheimer’s-related cognitive decline, and treating these risk factors could reduce risk. Second, some treatments for other underlying health conditions, such as hypertension or diabetes, may reduce the risk of later dementia when using blood pressure or blood sugar management as a treatment tool. One might desire to treat hypertension to manage stroke risk, as that may, in turn, reduce Alzheimer’s risk. One might also be interested in further reducing dementia risk as an added potential benefit of treating underlying hormonal or metabolic conditions such as those experienced in hypothyroidism or diabetes, although more research is needed to draw these connections.
The list of suggested non-lifestyle interventions to promote cognition also includes a recommendation to address sleep disorders and improve sleep quality or duration. Normal aging is associated with reductions in sleep quality, sleep duration, and the time it takes to fall asleep. While the rate of change is faster in the earlier ages, this becomes more a part of the neuropsychiatric presentation that emerges as mild cognitive impairment and dementia. Additionally, a number of therapeutic options have been or currently are being investigated: acetylcholinesterase inhibitors for the treatment of mild cognitive impairment, for which there is no approved medication. Third, drugs to promote cognitive enhancement, especially in those who are healthy or those with mild cognitive impairment, are frequently written about and attempted. Importantly, many of these non-lifestyle recommendations may be difficult to research in this context for several reasons, including small effect sizes, ethical concerns about treating people for whom the drug has not been tested, and the difficulty of testing long-term medical treatments on clinically normal individuals.
The committee did note that many of these medical treatments are limited in their long-term effectiveness for the prevention of dementia, especially in those who have already developed mild cognitive impairment. The use of these treatments might be plausible in conjunction with lifestyle interventions with the aim of boosting the effects of those medications.
Management of Cardiovascular Risk Factors
Cardiovascular health is critical for maintaining cognitive function since the heart powers the brain. Managing high blood pressure or hypertension can help lower the risk of developing dementia. If the condition is left unmanaged, it can cause small amounts of bleeding in the brain, leading to brain damage and cognitive dysfunction. High cholesterol levels in the blood have also been reported to affect cognition by building up fatty deposits in arteries, blocking blood flow, and starving brain cells of necessary nutrients. High levels of bad cholesterol in the body might also influence toxic amyloid plaque development, a common sign of Alzheimer’s disease. Both problems can be managed using medication and a healthy lifestyle of exercise and a balanced diet. Blood pressure and cholesterol levels should be checked regularly, and treatment should begin as early as possible.
In the past decade, there has emerged reasonable evidence about effective strategies to encourage good cardiovascular health, and many healthcare practitioners and facilities have stepped up their efforts to find and treat cardiovascular health problems early. Although not directly focusing on neurological disorders such as Alzheimer’s disease, these activities could have a significant effect on preventing cognitive deterioration and prolonging cognitive longevity. Educating patients and caregivers about the importance of healthy blood pressure and cholesterol, encouraging them to make use of available screening and monitoring tools, and helping them to receive appropriate medications for these conditions could have a significant effect on their cognitive health throughout their lifespan. Developing a plan for collaboration among geriatrics, mental health providers, nursing home professionals, and age-services providers, with the aim of minimizing the public health impact of dementia by extending the time before individuals experience symptoms and providing preventive medical and social care is becoming an important goal of health systems around the world.
Treatment of Sleep Disorders
Cognitive and emotional consequences are emerging from research exploring the functional and structural differences associated with sleep disorders such as insomnia, sleep apnea, and other possible related processes, particularly where there is intensified brain activity during the night. Sleep disorders in later life can lead to rapid cognitive decline and a worsening of daytime dysfunction. The consequences of too little sleep or poor sleep in the non-elderly population include weight gain, metabolic changes, memory problems, and an increase in the formation of beta-amyloid protein, a hallmark of Alzheimer’s disease. Finally, in this section, low-intensity phototherapy for an extended daily period is recommended to help the blind. Bright light therapy provides benefits to those who can shift their body clock forward or backward, particularly those who are not totally blind.
Shorter sleep is associated with cognitive decay and too much sleep can be correlated with depression and anxiety. A study found that older adults who report good sleep experience less cognitive impairment over the following four years compared to older adults who report that falling asleep and staying asleep is problematic. In addition, three factors contribute to the association between insomnia and dementia: nighttime awakenings lead to poor recruitment of cerebrospinal fluid; nighttime awakenings and ApoE4 status lead to amyloid plaque formation and obstruction of CSF re-circulation in the brain. As a result, observational studies show that rapid eye movement sleep behavior disorder can significantly increase the future risk of Parkinson’s disease and dementia associated with Parkinson’s disease, as well as Alzheimer’s disease or other forms of dementia. Management and treatment are currently focused on preventing cognitive impairment and Parkinson’s disease. In summary, brief cognitive behavioral therapy using a combination approach or melatonin probably has short-term benefits for people with primary insomnia. If results lower the risk of dementia, there might be a very favorable cost-benefit ratio for treating sleep disorders, and prevention would have strategic impacts. In addition, evaluating sleep can help build interventions that prevent cognitive decline. Overall, the findings of new studies hold exciting potential.
Use of Cognitive Enhancing Drugs
Various medications, including AChE inhibitors, galantamine, memantine, cholinesterase inhibitors, and lecithin, are argued to either improve cognitive function in the first instance or to slow cognitive decline. A variety of potential mechanisms are proposed. In spite of an extensive literature, the use of cognitive enhancers in dementia continues to be the subject of controversy. Benefits of using cognitive enhancers may include improvements in cognitive function, higher sensitivity for cognitive change in response to treatment, and lower sample sizes required for intervention trials. Treatment with cognitive enhancing agents assists in the management of dementia symptoms, particularly for the abilities of daily living activities and behaviors. However, a number of potential adverse reactions to the use of cognitive enhancing drugs are possible, such as side effects, costs, medical complications, or false positives. Research evidence has demonstrated that not everyone has derived beneficial outcomes from taking cognitive enhancers. Additionally, there are ethical concerns and implications to be considered due to the issue of misdiagnosis. To date, there is insufficient research to prove that cognitive enhancers will be of any benefit. Cognitive enhancing drugs have failed to treat major neurocognitive impairment.
The treating physician will require additional information from the patient and from family members before making a decision about the use of medication. This may include contraindications, cost, progression of disease, dementia type, side effects, life expectancy, and other comorbid conditions. Individual patient factors, such as comorbidity, life expectancy, and available support systems, may determine the appropriateness of prescribing drug therapies. It is not yet known if dementia can be prevented by pharmacological means.
Social and Environmental Factors in Dementia Risk Reduction
While much attention in resisting cognitive decline is given to individual behaviors such as exercise, social activities, and nutrition, important risk factors can also be found in the social and built environment. A reduced possibility of cognitive problems occurs in people who have more social contacts and engagement in work, hobbies, and other interests. Cycling and walking in recreational centers, shopping centers, and social venues have also been linked to better cognitive performance and a lower dementia risk. The structural environment can influence cognitive health, and those with greater accessibility to playgrounds and entertainment locations have a lower dementia risk. Barriers to environmental access can increase social isolation and heighten the risk of dementia. Disadvantaged socioeconomic status and educational opportunities have been shown to have long-term effects on brain health.
Policies that create supportive environments are necessary to prevent dementia and are particularly important since socioeconomic status influences brain health over a lifetime. Engaging society in dementia prevention programs and developing dementia-friendly environments are considered essential. Municipalities and regional governments prioritize improvements in the local environment and health. Obesity, a risk factor for dementia, is less prevalent in parts of Europe with fewer food outlets than in English communities, emphasizing the role of the built environment. Interventions addressing social determinants of health must be put into place to help a larger population level. Several successful interventions in local projects have improved the accessibility of the environment and suitable social activities.