Primary prevention of dementia: from modifiable risk factors to a public brain health agenda?

Hussenoeder, Felix S.; Riedel-Heller, Steffi G

doi:10.1007/s00127-018-1598-7

Cited by 51 publications

(38 citation statements)

References 79 publications

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“…Therefore, MCI may not so much affect social interactions as reflected in the facets intimacy and social participation. The fact that MCI was not associated with social participation can be seen as a potential resource for those affected by MCI, since frequency of engagement in social activities is linked to a lower risk of progression from mild to severe forms of cognitive impairment [11] and social activities are connected to reduced dementia risk [12].…”

Section: Discussionmentioning

confidence: 99%

Mild cognitive impairment and quality of life in the oldest old: a closer look

et al. 2020

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Purpose Mild cognitive impairment (MCI) is a widespread phenomenon, especially affecting older individuals. We will analyze in how far MCI affects different facets of quality of life (QOL). Methods We used a sample of 903 participants (110 with MCI) from the fifth follow-up of the German Study on Ageing, Cognition, and Dementia in Primary Care Patients (AgeCoDe), a prospective longitudinal study, to analyze the effects of MCI on different facets of the WHOQOL-OLD. We controlled for age, gender, marital status, education, living situation, daily living skills, and the ability to walk, see, and hear. Results Univariate analyses showed that individuals with MCI exhibited lower QOL with regard to the facets autonomy; past, present, and future activities; social participation; and intimacy, but less fears related to death and dying. No significant difference was shown with regard to the facet sensory abilities. In multivariate analyses controlling for age, gender, marital status, education, living situation, daily living skills, and the ability to walk, see and hear, MCI-status was significantly associated with QOL in the facet autonomy. Conclusion Effects of MCI go beyond cognition and significantly impact the lives of those affected. Further research and practice will benefit from utilizing specific facets of QOL rather than a total score.

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Section: Discussionmentioning

confidence: 99%

Mild cognitive impairment and quality of life in the oldest old: a closer look

et al. 2020

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“…This becomes particularly relevant in regard to the absence of effective treatment options. To date, lifestyle interventions might constitute the most cost-effective and sustainable option for dementia prevention [71]. Against this background, the results of AgeWell.de will make a highly relevant contribution to the growing body of knowledge on modifiable risk factors for dementia.…”

Section: Discussionmentioning

confidence: 99%

AgeWell.de – study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients

et al. 2019

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Background In the absence of treatment options, the WHO emphasizes the identification of effective prevention strategies as a key element to counteract the dementia epidemic. Regarding the complex nature of dementia, trials simultaneously targeting multiple risk factors should be particularly effective for prevention. So far, however, only few such multi-component trials have been launched, but yielding promising results. In Germany, comparable initiatives are lacking, and translation of these complex interventions into routine care was not yet done. Therefore, AgeWell.de will be conducted as the first multi-component prevention trial in Germany which is closely linked to the primary care setting. Methods AgeWell.de will be designed as a multi-centric, cluster-randomized controlled multi-component prevention trial. Participants will be older community-dwelling general practitioner (GP) patients (60–77 years; n = 1,152) with increased dementia risk according to CAIDE (Cardiovascular Risk Factors, Aging, and Incidence of Dementia) Dementia Risk Score. Recruitment will take place at 5 study sites across Germany. GP practices will be randomized to either intervention A (advanced) or B (basic). GPs will be blinded to their respective group assignment, as will be the statistician conducting the randomization. The multi-component intervention (A) includes nutritional counseling, physical activity, cognitive training, optimization of medication, management of vascular risk factors, social activity, and, if necessary, further specific interventions targeting grief and depression. Intervention B includes general health advice on the intervention components and GP treatment as usual. We hypothesize that over the 2-year follow-up period the intervention group A will benefit significantly from the intervention program in terms of preserved cognitive function/delayed cognitive decline (primary outcome), and other relevant (secondary) outcomes (e.g. quality of life, social activities, depressive symptomatology, cost-effectiveness). Discussion AgeWell.de will be the first multi-component trial targeting risk of cognitive decline in older adults in Germany. Compared to previous trials, AgeWell.de covers an even broader set of interventions suggested to be beneficial for the intended outcomes. The findings will add substantial knowledge on modifiable lifestyle factors to prevent or delay cognitive decline. Trial registration German Clinical Trials Register (reference number: DRKS00013555 ).

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“…For example, meta-analytic studies of middle-aged adults have demonstrated that greater engagement in physical activity associates with significant reductions in ADRD risk, with individuals who exercise regularly demonstrating an approximate 40% reduced risk [112]. Prospective studies have also linked various dietary patterns to differential ADRD outcomes [110,113,114]. Multiple intervention studies have reported similar findings, with numerous meta-analytic reviews suggesting that individuals randomized to participate in aerobic exercise training experience modest but appreciable increases in cognitive performance [115][116][117][118].…”

Section: Physical Activity Dietary Patterns and Neurocognitive Outcmentioning

confidence: 99%

“…Lifestyle factors, such as physical activity and healthier dietary patterns, are increasingly recognized as potential contributors to ADRD risk [18,[107][108][109][110][111]. For example, meta-analytic studies of middle-aged adults have demonstrated that greater engagement in physical activity associates with significant reductions in ADRD risk, with individuals who exercise regularly demonstrating an approximate 40% reduced risk [112].…”

Section: Physical Activity Dietary Patterns and Neurocognitive Outcmentioning

confidence: 99%

Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition

Smith

2019

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Alzheimer's disease and related dementias (ADRD) represent an increasingly urgent public health concern, with an increasing number of baby boomers now at risk. Due to a lack of efficacious therapies among symptomatic older adults, an increasing emphasis has been placed on preventive measures that can curb or even prevent ADRD development among middle-aged adults. Lifestyle modification using aerobic exercise and dietary modification represents one of the primary treatment modalities used to mitigate ADRD risk, with an increasing number of trials demonstrating that exercise and dietary change, individually and together, improve neurocognitive performance among middle-aged and older adults. Despite several optimistic findings, examination of treatment changes across lifestyle interventions reveals a variable pattern of improvements, with large individual differences across trials. The present review attempts to synthesize available literature linking lifestyle modification to neurocognitive changes, outline putative mechanisms of treatment improvement, and discuss discrepant trial findings. In addition, previous mechanistic assumptions linking lifestyle to neurocognition are discussed, with a focus on potential solutions to improve our understanding of individual neurocognitive differences in response to lifestyle modification. Specific recommendations include integration of contemporary causal inference approaches for analyzing parallel mechanistic pathways and treatment-exposure interactions. Methodological recommendations include trial multiphase optimization strategy (MOST) design approaches that leverage individual differences for improved treatment outcomes.

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Primary prevention of dementia: from modifiable risk factors to a public brain health agenda?

Cited by 51 publications

References 79 publications

Mild cognitive impairment and quality of life in the oldest old: a closer look

Mild cognitive impairment and quality of life in the oldest old: a closer look

AgeWell.de – study protocol of a pragmatic multi-center cluster-randomized controlled prevention trial against cognitive decline in older primary care patients

Pathways of Prevention: A Scoping Review of Dietary and Exercise Interventions for Neurocognition

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