Healthy lifestyle for dementia prevention

Several indicators of cognitive function such as memory, reasoning, and psychomotor speed decline with aging. Differences in rates of change in cognitive function can be substantial between individuals.1 emphasizes the importance of identifying modifiable factors associated with favorable cognitive aging trajectories. Cognitive impairment can affect an individual’s and independent living, but this problem is also characteristic of Alzheimer’s disease and related dementias.

Lifestyle factors have received much attention as potential targets for prevention. lancet Dementia Prevention Committee,2 It lists 12 modifiable risk factors, three of which are lifestyle-related: alcohol consumption (>21 units/week), smoking, and physical inactivity. A linked study by Jia and his colleagues (doi:10.1136/bmj-2022-0729691)3 The China Cognition and Aging Study investigated the association between a healthy lifestyle and memory decline over 10 years in 29,000 participants (49% female, mean baseline age 72.2 years). bottom. The authors calculated a healthy lifestyle score by combining six factors: healthy eating, regular exercise, active social contact, active cognitive activity, no smoking and no drinking. The resulting scores were classified as favorable (4 to 6 elements), average (2 to 3), or unfavorable (0 to 1) on a healthy element range of 0 to 6.

These authors examined the association between healthy behavior and poor memory as measured by the Auditory Verbal Learning Test (AVLT). They found that individual healthy behavior was associated with slower memory decline over 10 years. was associated with The standardized score (z-score) of the AVLT showed that memory decline was 0.28 points slower in the good lifestyle group and 0.16 points slower in the average lifestyle group over the 10-year period than in the poor lifestyle group.

These results determine which of the six health behaviors included in the score (or specific combination) are the optimal goals for dementia prevention or at what point in life to focus prevention efforts. It doesn’t help. Further insights are also needed to determine whether the differences in memory decline observed in this study are clinically meaningful.

One notable finding was that healthy lifestyle scores were associated with 10-year memory decline in people with the APOE ε4 allele and those without this risk factor. am. APOE ε4 is the strongest known risk factor for Alzheimer’s disease and related dementias, and within the context of ongoing and future targeted prevention trials, this result is particularly important. These results support the idea that lifestyle changes may offset the detrimental effects of her APOE ε4 on cognitive decline and dementia.Four

Given the lack of effective treatments for Alzheimer’s disease and related dementias, prevention is important. However, definitions of a healthy lifestyle vary. Jia and his colleagues used his six scales to define a healthy lifestyle, but another recent study by Dhana and colleagues found that by omitting social contact he scored five scales. used.Five Jia and colleagues define drinking as unhealthy, while Dhana and colleagues define healthy as drinking between 1 and 15 units per week. As evidence emerges for a link between sleep duration and cognitive outcomes,6 Not sure if this variable should also be included. Additionally, the American Heart Association has developed an ideal cardiovascular health score by combining seven biological and lifestyle factors.7 This is also associated with a reduced risk of dementia.8

Of even greater concern is the age at which healthy behaviors need to be adopted. Future research on prevention should more extensively assess possible risk factors and identify specific exposures associated with greatest risk, as well as considering respective risk thresholds and age at exposure.

Cognitive decline and dementia risk may be shaped by multiple factors. The multifactorial risk paradigm introduced by the Framingham study has led to significant reductions in cardiovascular disease.9 A similar approach should be taken for dementia prevention, identifying not only the most important factors, but also the thresholds at which they matter and the age at which interventions are likely to be most effective. .Ten This public health priority is becoming increasingly urgent.