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]National Institute for Health and Care Excellence. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset. Oct 2015 [internet publication].
https://www.nice.org.uk/guidance/ng16
[72]Omura JD, McGuire LC, Patel R, et al. Modifiable risk factors for alzheimer disease and related dementias among adults aged ≥45 years - United States, 2019. MMWR Morb Mortal Wkly Rep. 2022 May 20;71(20):680-5.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9129905
http://www.ncbi.nlm.nih.gov/pubmed/35587456?tool=bestpractice.com
[73]World Health Organization. Risk reduction of cognitive decline and dementia. 2019 [internet publication].
https://www.who.int/publications/i/item/9789241550543
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]Lourida I, Hannon E, Littlejohns TJ, et al. Association of lifestyle and genetic risk with incidence of dementia. JAMA. 2019 Jul 14;322(5):430-7.
https://jamanetwork.com/journals/jama/fullarticle/2738355
http://www.ncbi.nlm.nih.gov/pubmed/31302669?tool=bestpractice.com
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]Yu JT, Xu W, Tan CC, et al. Evidence-based prevention of Alzheimer's disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials. J Neurol Neurosurg Psychiatry. 2020 Nov;91(11):1201-9.
https://pmc.ncbi.nlm.nih.gov/articles/PMC7569385
http://www.ncbi.nlm.nih.gov/pubmed/32690803?tool=bestpractice.com
Some evidence suggests that physical activity/exercise may prevent or delay cognitive decline in people without a diagnosis of dementia.[76]Iso-Markku P, Kujala UM, Knittle K, et al. Physical activity as a protective factor for dementia and alzheimer's disease: systematic review, meta-analysis and quality assessment of cohort and case-control studies. Br J Sports Med. 2022 Jun;56(12):701-9.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9163715
http://www.ncbi.nlm.nih.gov/pubmed/35301183?tool=bestpractice.com
[77]Del Pozo Cruz B, Ahmadi M, Naismith SL, et al. Association of daily step count and intensity with incident dementia in 78 430 adults living in the UK. JAMA Neurol. 2022 Oct 1;79(10):1059-63.
https://pmc.ncbi.nlm.nih.gov/articles/PMC9449869
http://www.ncbi.nlm.nih.gov/pubmed/36066874?tool=bestpractice.com
[78]Brasure M, Desai P, Davila H, et al. Physical activity interventions in preventing cognitive decline and Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018 Jan 2;168(1):30-8.
http://www.ncbi.nlm.nih.gov/pubmed/29255839?tool=bestpractice.com
[79]Kivimäki M, Singh-Manoux A, Pentti J, et al. Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis. BMJ. 2019 Apr 17;365:l1495.
https://www.bmj.com/content/365/bmj.l1495.long
http://www.ncbi.nlm.nih.gov/pubmed/30995986?tool=bestpractice.com
[80]Xu W, Wang HF, Wan Y, et al. Leisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies. BMJ Open. 2017 Oct 22;7(10):e014706.
https://bmjopen.bmj.com/content/7/10/e014706.long
http://www.ncbi.nlm.nih.gov/pubmed/29061599?tool=bestpractice.com
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]Pase MP, Beiser A, Enserro D, et al. Association of ideal cardiovascular health with vascular brain injury and incident dementia. Stroke. 2016 May;47(5):1201-6.
http://stroke.ahajournals.org/content/47/5/1201.long
http://www.ncbi.nlm.nih.gov/pubmed/27073239?tool=bestpractice.com
[82]Sabia S, Fayosse A, Dumurgier J, et al. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. BMJ. 2019 Aug 7;366:l4414.
https://www.bmj.com/content/366/bmj.l4414.long
http://www.ncbi.nlm.nih.gov/pubmed/31391187?tool=bestpractice.com
[83]Larsson SC, Markus HS. Does treating vascular risk factors prevent dementia and Alzheimer's disease? A systematic review and meta-analysis. J Alzheimers Dis. 2018;64(2):657-68.
http://www.ncbi.nlm.nih.gov/pubmed/29914039?tool=bestpractice.com
This includes managing hypertension and cholesterol.[84]Peters R, Xu Y, Fitzgerald O, et al. Blood pressure lowering and prevention of dementia: an individual patient data meta-analysis. Eur Heart J. 2022 Dec 21;43(48):4980-90.
https://academic.oup.com/eurheartj/article/43/48/4980/6770632
http://www.ncbi.nlm.nih.gov/pubmed/36282295?tool=bestpractice.com
[85]Chu CS, Tseng PT, Stubbs B, et al. Use of statins and the risk of dementia and mild cognitive impairment: a systematic review and meta-analysis. Sci Rep. 2018 Apr 11;8(1):5804.
https://pmc.ncbi.nlm.nih.gov/articles/PMC5895617
http://www.ncbi.nlm.nih.gov/pubmed/29643479?tool=bestpractice.com
See Essential hypertension and Hypercholesterolemia.
Moderate alcohol consumption (1-14 units/week) may protect against dementia.[21]Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024 Aug 10;404(10452):572-628.
http://www.ncbi.nlm.nih.gov/pubmed/39096926?tool=bestpractice.com
[22]Sabia S, Fayosse A, Dumurgier J, et al. Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study. BMJ. 2018 Aug 1;362:k2927.
https://www.bmj.com/content/362/bmj.k2927.long
http://www.ncbi.nlm.nih.gov/pubmed/30068508?tool=bestpractice.com
Provision of hearing aids for people with hearing loss may be beneficial.[21]Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024 Aug 10;404(10452):572-628.
http://www.ncbi.nlm.nih.gov/pubmed/39096926?tool=bestpractice.com
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]Cantuaria ML, Pedersen ER, Waldorff FB, et al. Hearing loss, hearing aid use, and risk of dementia in older adults. JAMA Otolaryngol Head Neck Surg. 2024 Feb 1;150(2):157-64.
https://pmc.ncbi.nlm.nih.gov/articles/PMC10767640
http://www.ncbi.nlm.nih.gov/pubmed/38175662?tool=bestpractice.com
Encourage the use of helmets to reduce the risk of traumatic brain injury.[21]Livingston G, Huntley J, Liu KY, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing commission. Lancet. 2024 Aug 10;404(10452):572-628.
http://www.ncbi.nlm.nih.gov/pubmed/39096926?tool=bestpractice.com
An international consensus statement based on a literature review concluded that lowering homocysteine helps to decrease dementia risk.[86]Smith AD, Refsum H, Bottiglieri T, et al. Homocysteine and dementia: an international consensus statement. J Alzheimers Dis. 2018;62(2):561-70.
https://content.iospress.com/articles/journal-of-alzheimers-disease/jad171042
http://www.ncbi.nlm.nih.gov/pubmed/29480200?tool=bestpractice.com
Systematic reviews of randomized controlled trials found insufficient evidence to support the following preventive interventions:[87]Fink HA, Jutkowitz E, McCarten JR, et al. Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018 Jan 2;168(1):39-51.
http://www.ncbi.nlm.nih.gov/pubmed/29255847?tool=bestpractice.com
[88]Jordan F, Quinn TJ, McGuinness B, et al. Aspirin and other non-steroidal anti-inflammatory drugs for the prevention of dementia. Cochrane Database Syst Rev. 2020 Apr 30;(4):CD011459.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011459.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/32352165?tool=bestpractice.com
[89]Butler M, Nelson VA, Davila H, et al. Over-the-counter supplement interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018 Jan 2;168(1):52-62.
http://www.ncbi.nlm.nih.gov/pubmed/29255909?tool=bestpractice.com
[90]Butler M, McCreedy E, Nelson VA, et al. Does cognitive training prevent cognitive decline? A systematic review. Ann Intern Med. 2018 Jan 2;168(1):63-8.
http://www.ncbi.nlm.nih.gov/pubmed/29255842?tool=bestpractice.com
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For cognitively healthy older adults, do aspirin and non‐steroidal anti‐inflammatory drugs (NSAIDs) help prevent dementia?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.3177/fullShow me the answer
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