Diagnosis and treatment of dementia: 1. Risk assessment and primary prevention of Alzheimer disease

Abstract

Mr. A, a 45-year-old professional, presents for a routine health check-up, during which he states "I am quite worried about getting Alzheimer disease, just like my mother." He goes on to say "As you know, our family has been caring for her while she slowly deteriorated. A month ago, we had to move her to a long-term care facility. It is really taking a toll on our family. So I want to know what my chances are of escaping this terrible disease. I want to do everything I can to avoid my mother's fate." Mr. A then goes on to say that his mother, who is alive, had her first symptoms of dementia at the age of 74 years. To his knowledge, no other family members, including aunts and uncles, have been affected by dementia. Mr. A is relatively healthy. He has never smoked and rarely drinks alcohol. However, he has been taking medication for hypertension for over a year and has hyperlipi- Methods:We developed evidence-based guidelines using systematic literature searches, with specific criteria for study selection and quality assessment, and a clear and transparent decision-making process. We selected studies published from January 1996 to December 2005 that met the following criteria: dementia (all-cause, Alzheimer disease or vascular dementia) as the outcome; longitudinal cohort study; study population broadly reflective of Canadian demographics; and genetic risk factors and general risk factors (e.g., hypertension, education, occupation and chemical exposure) identified. We graded the strength of evidence using the criteria of the Canadian Task Force on Preventive Health Care.Results: Of 3424 articles on potentially modifiable risk factors for dementia, 1719 met our inclusion criteria; 60 were deemed to be of good or fair quality. Of 1721 articles on genetic risk factors, 62 that met our inclusion criteria were deemed to be of good or fair quality. On the basis of evidence from these articles, we made recommendations for the risk assessment and primary prevention of Alzheimer disease. For the primary prevention of Alzheimer's disease, there is good evidence for controlling vascular risk factors, especially hypertension (grade A), and weak or insufficient evidence for manipulation of lifestyle factors and prescribing of medications (grade C). There is good evidence to avoid estrogens and high-dose (> 400 IU/d) of vitamin E for this purpose (grade E). Genetic counselling and testing may be offered to at-risk individuals with an apparent autosomal dominant inheritance (grade B). Screening for the apolipoprotein E genotype in asymptomatic individuals in the general population is not recommended (grade E).

Effects of green tea, black tea and Rooibos tea on angiotensin-converting enzyme and nitric oxide in healthy volunteers

“…Further studies investigating regular long-term intake of tea remain to be performed. Diet is of great importance to human health (44)(45)(46)(47) . The prevention of CVD is attributed to a diversity of effects such as antioxidative (48) , antithrombotic and anti-inflammatory properties, activation of endothelial nitric oxide synthase and inhibition of LDL oxidation (49)(50)(51)(52)(53) .…”

Increased risk of dementia in patients with osteoporosis: a population-based retrospective cohort analysis

“…Osteoporosis and dementia have several common risk factors, including older age, female sex, smoking, excessive drinking, low levels of estrogen and vitamin D3, family history, and the ApoE genotype (Yaffe et al 2012). Other clinical conditions, such as cardiovascular diseases, depression, head trauma, and diabetes, might also be associated with osteoporosis (Patterson et al 2008). However, a possible causal relationship between osteoporosis and dementia has yet to be evaluated (Tan et al 2005).…”

Prevention of Alzheimer's disease: The role of the Mediterranean diet

“…In fact, it is the second most common cause of disability, right after depression 16 . Therefore, it is a devastating disease for patients, as it even takes away their sense of self, and also for families, which are strongly affected emotionally, physically, and financially by the rapidly increasing caregiver burden 14,15,17 .…”

“…Nevertheless, physicians should be cautious when advising patients about alcohol consumption given that excessive intake causes serious neurologic and other organ damage 17 .…”