What are the recommended methods to prevent dementia?

How to Prevent Dementia

Implement a comprehensive multimodal lifestyle intervention targeting multiple modifiable risk factors simultaneously, as this approach can reduce dementia risk by up to 60% when adhering to 4-5 brain-healthy behaviors. 1

Cardiovascular Risk Management

Control blood pressure aggressively in midlife (starting around age 40), maintaining systolic BP ≤130 mm Hg, as antihypertensive treatment is the only known effective preventative medication for dementia. 2, 1

• Target untreated total cholesterol <200 mg/dL and fasting blood glucose <100 mg/dL 1
• Reduce obesity and actively manage diabetes, as both significantly increase dementia risk 2, 1
• Maintain body mass index <25 kg/m² 1

Physical Exercise

Engage in both aerobic exercise and resistance training of at least moderate intensity, as these improve global cognition, executive function, attention, and delayed recall. 2

• The WHO recommends 150-300 minutes of moderate-intensity aerobic activity per week, or 75-150 minutes of vigorous-intensity activity, plus muscle-strengthening activities at least 3 times weekly 2
• Exercise training for at least 6 months improves cognitive measures in patients with mild cognitive impairment 2, 1
• Recent evidence shows resistance exercises may have superior effects over other exercise modalities 2
• The minimal exercise dose for clinically relevant cognitive changes is 724 METs-min per week, with optimal benefits around 1200 METs-min per week 2
• Mind-body exercises (Tai Chi, Qigong) and dance show promising results but require larger trials for confirmation 2

Dietary Interventions

Adhere to a Mediterranean diet to decrease the risk of cognitive decline, as this has the strongest evidence among dietary patterns. 2

• Consume high levels of mono- and polyunsaturated fatty acids while minimizing saturated fatty acids 2
• Increase fruit and vegetable intake 2
• Mediterranean-style diets rich in polyunsaturated fatty acids, polyphenols, and antioxidants are particularly protective 1
• Include brain-healthy foods: nuts, berries, green leafy vegetables, and fish 2

Sensory Health Management

Screen for and treat hearing loss, as it is a significant modifiable midlife risk factor for dementia. 2, 1

• Ask patients if they have difficulty hearing in everyday life (rather than asking if they have hearing loss) 2
• If hearing loss is reported, confirm with audiometry and provide audiologic rehabilitation, which may include hearing aids 2
• Review medications for potential ototoxicity 2
• Protect ears from excessive noise exposure 2, 1

Sleep Optimization

Obtain a careful sleep history and treat sleep disorders, particularly obstructive sleep apnea, as these impact dementia risk. 2

• Screen for sleep apnea symptoms and refer for polysomnography when suspected 2
• Treat sleep apnea with continuous positive airway pressure (CPAP), which may improve cognition and decrease dementia risk 2
• Target 7-8 hours of sleep per night, avoiding severe sleep deprivation (<5 hours) 2

Lifestyle and Social Factors

Avoid smoking and support smoking cessation, as stopping reduces dementia risk even in later life. 2, 1

• Limit alcohol to light-to-moderate consumption 2, 1
• Prevent head injury through appropriate safety measures 2, 1
• Reduce exposure to air pollution and second-hand tobacco smoke 2, 1
• Pursue cognitively stimulating activities and maintain social connections to avoid isolation 1
• Ensure access to education, as higher educational attainment is protective 2, 1
• Treat depression, as it is a significant risk factor for cognitive decline 2, 1

Implementation Strategy

Begin preventive strategies in midlife (40s-50s) when intervention is most effective, focusing on the American Heart Association's Life's Simple 7. 1

The Life's Simple 7 includes: 1

• Non-smoking status
• Physical activity at goal levels
• BMI <25 kg/m²
• Healthy diet
• Untreated BP <120/80 mm Hg
• Untreated total cholesterol <200 mg/dL
• Fasting blood glucose <100 mg/dL

Perform personalized assessment of dementia risk factors in middle-aged and older adults, then implement multiple interventions simultaneously rather than single interventions. 1

Common Pitfalls to Avoid

• Do not rely on single interventions (e.g., only exercise or only diet), as multimodal approaches are significantly more effective 1
• Do not wait until symptoms appear before implementing preventive strategies; early intervention in midlife is critical 1
• Do not overlook hearing loss, which is often neglected but represents a significant modifiable risk factor 1
• Do not assume cognitive decline is normal aging rather than potentially preventable 1
• Do not neglect sleep disorders, particularly obstructive sleep apnea, which should be actively screened for and treated 1

By implementing this comprehensive approach, current evidence suggests that approximately 20-60% of Alzheimer's disease cases could potentially be prevented or delayed. 1