How to retard dementia progression?

Strategies to Slow Dementia Progression

A comprehensive approach including physical exercise, Mediterranean diet, cognitive stimulation, hearing assessment, and sleep management is most effective for slowing dementia progression. 1

Physical Exercise Interventions

• Aerobic exercise and resistance training of at least moderate intensity are strongly recommended to improve cognitive outcomes and slow dementia progression in older adults 1
• Physical activity interventions are effective in reducing the risk of Alzheimer's disease and vascular dementia 1
• For those with mild cognitive impairment (MCI), aerobic exercise specifically shows benefits for cognitive outcomes 1
• Mind-body exercises such as Tai Chi and Qigong show promising evidence for cognitive improvement, though more research is needed 1
• The minimal exercise dose associated with clinically relevant changes in cognition is approximately 724 METs-min per week, with resistance exercises showing superior effects over other modalities 1

Nutritional Interventions

• Adherence to a Mediterranean diet is strongly recommended to decrease the risk of cognitive decline 1
• High consumption of mono- and polyunsaturated fatty acids and low consumption of saturated fatty acids reduces the risk of cognitive decline 1
• Increased fruit and vegetable intake is recommended for brain health 1, 2
• Fish and omega-3 fatty acids (particularly DHA) are associated with prevention of cognitive decline in prospective studies 1

Cognitive Stimulation and Social Engagement

• Individuals should increase or maintain engagement in cognitively stimulating activities such as reading, playing chess, volunteering, and lifelong learning 1
• Group cognitive stimulation therapy is recommended for people with mild to moderate dementia 1
• Computer-based and group cognitive training should be proposed to people at risk and those with MCI or mild dementia 1
• Social engagement and support across the lifespan are recommended, including opportunities for social interaction 1
• Educational attainment, particularly in early life but also ongoing education in mid and later life, is protective 1

Hearing Assessment and Management

• Assess and address hearing impairment, as it is associated with the development of dementia 1
• Individuals should be asked if they have difficulty hearing in everyday life 1
• If hearing loss is reported, it should be confirmed by audiometry and appropriate rehabilitation provided 1
• Follow WHO guidelines for risk reduction including audiological examination, review of medications for ototoxicity, and referral to specialists when needed 1

Sleep Management

• A careful sleep history should be included in the assessment of any patient at risk for dementia 1
• Adults with sleep apnea should be treated with continuous positive airway pressure (CPAP) 1
• Target 7-8 hours of sleep per night and avoid severe sleep deprivation (less than 5 hours) 1
• Refer to specialized sleep clinics for further assessment if sleep abnormalities are suspected 1

Medication Management

• Minimize exposure to medications with highly anticholinergic properties in older persons 1
• For those with moderate to severe Alzheimer's disease, FDA-approved medications like memantine may help slow cognitive decline 3
• Cholinesterase inhibitors like donepezil may provide symptomatic benefits but do not alter the underlying disease process 4
• Conduct multidimensional health assessments for older adults to identify reversible health conditions and rationalize medication use 1

Additional Lifestyle Factors

• Manage frailty to reduce the overall burden of dementia in older adults 1
• Multimodal interventions that include adoption of an active lifestyle are particularly effective 5
• Address vision impairment, as vision correction could improve cognitive functioning 1
• Engage in intellectually stimulating activities, which are associated with better cognition, especially in individuals with family history of dementia 6

Common Pitfalls to Avoid

• Focusing solely on pharmacological interventions when non-pharmacological approaches should take precedence 1
• Waiting until cognitive symptoms appear before implementing preventive strategies 6
• Neglecting to assess for sleep disorders, particularly sleep apnea, which can accelerate cognitive decline 1
• Overlooking hearing impairment as a significant risk factor for dementia 1
• Failing to provide adequate support for caregivers, who benefit from psychosocial and psychoeducational interventions 1