Primary prevention

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Guide de pratique clinique pluridisciplinaire relatif à la collaboration dans la dispense de soins aux personnes âgées démentes résidant à domicile et leurs aidants prochesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2017Multidisciplinaire richtlijn voor thuiswonende oudere personen met dementie en hun mantelzorgersPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2017

The World Health Organization, the Centers for Disease Control and Prevention, and the UK National Institute for Health and Care Excellence recommend lifestyle and behavioral interventions (stopping smoking, reducing alcohol consumption, increased physical activity, eating healthily, maintaining a healthy weight) to decrease the risk of frailty and dementia.​​​[71][72]​​[73]​​

​One retrospective cohort study with nearly 200,000 participants concluded that a healthy lifestyle (defined by a weighted score that included exercise, no current smoking, healthy diet, and moderate alcohol consumption) was associated with a lower risk of dementia, irrespective of genetic risk for dementia (low, intermediate, high).[74]​ One 2020 systematic review suggested targeting 19 factors for prevention of dementia: ten with strong evidence (education, cognitive activity, high body mass index in later life, hyperhomocysteinemia, depression, stress, diabetes, head trauma, hypertension in midlife, and orthostatic hypotension) and nine with weaker evidence (obesity in midlife, weight loss in late life, physical activity, smoking, sleep, cerebrovascular disease, frailty, atrial fibrillation, and vitamin C).[75]

Some evidence suggests that physical activity/exercise may prevent or delay cognitive decline in people without a diagnosis of dementia.[76][77][78]​​​​[79][80]​​ 

Managing cardiovascular risk factors in middle age has been associated with a decrease in all-cause dementia (i.e., both vascular dementia and Alzheimer disease).[81][82][83]​​

This includes managing hypertension and cholesterol.[84][85]​ See Essential hypertension and Hypercholesterolemia.

Moderate alcohol consumption (1-14 units/week) may protect against dementia.[21]​​​​[22]

Provision of hearing aids for people with hearing loss may be beneficial.[21]​​​ One large cohort study reported that people with hearing loss who do not use hearing aids are at higher risk of dementia than people with hearing loss who do use hearing aids (HR 1.20 and 1.06, respectively).[28]

Encourage the use of helmets to reduce the risk of traumatic brain injury.[21]​​​

An international consensus statement based on a literature review concluded that lowering homocysteine helps to decrease dementia risk.[86]

Systematic reviews of randomized controlled trials found insufficient evidence to support the following preventive interventions:[87][88][89][90] [ Cochrane Clinical Answers logo ]

  • Drugs (nonsteroidal anti-inflammatory drugs [NSAIDs], aspirin, antidiabetic drugs, or cholinesterase inhibitors)

  • Supplements (omega-3 fatty acids, ginkgo biloba, B vitamins, vitamin D with calcium, beta-carotene, or multivitamins)

  • Cognitive training

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