Dementia: Dr Sara on benefits of being in nature
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Dementia is a broad category of conditions characterised by progressive brain decline. The most prominent is Alzheimer’s disease, which can affect memory, thinking skills and other mental abilities. Age is the most prevalent risk factor which engenders a sense of helplessness. However, there are many risk factors that are modifiable.
That’s the empowering conclusion of a study published in the Journal of Neurology, Neurosurgery & Psychiatry.
Reporting on the research, the BMJ drew attention to the “strong” evidence linking high blood pressure in midlife to Alzheimer’s risk.
All told, the study identified at least 10 risk factors that appear to have a significant impact on a person’s likelihood of developing Alzheimer’s that could be targeted with preventative steps.
Focusing on these factors, which include cognitive activity, high body mass index in late life, depression, diabetes, and high blood pressure, could provide clinicians with an evidence based guideline for prevention of Alzheimer’s disease.
However, a lot more research is needed to come up with other promising approaches to preventing the condition.
To identify the risk factors, an international team of researchers led by Professor Jin-Tai Yu at Fudan University in China, set out to review and analyse current evidence.
The researchers gathered 395 studies (243 observational prospective studies and 152 randomised controlled trials) that were suitable for their analysis.
From analysing these, they proposed 21 suggestions based on the consolidated evidence available that could be used in practice by clinicians to try to prevent Alzheimer’s disease.
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Within these, there were what they referred to as “Class I” suggestions to target 19 different factors.
Nearly two-thirds of these suggestions would involve targeting vascular risk factors (such as high blood pressure and cholesterol levels) and lifestyle, strengthening the importance of keeping healthy to prevent Alzheimer’s disease.
Ten of the suggestions included receiving as much education as possible in early life, participating in mentally stimulating activities such as reading, avoiding diabetes, stress, depression, head trauma, and high blood pressure in midlife.
According to the BMJ, a further nine suggestions had “slightly weaker evidence” to support them and included regular physical exercise, getting sufficient good quality sleep, maintaining a healthy body weight and good heart health in later life, avoiding smoking, and including vitamin C in the diet.
In contrast, two interventions were not recommended – oestrogen replacement therapy and use of acetylcholinesterase inhibitors (drugs that increase communication between nerve cells).
The authors pointed to some study limitations, such as the fact that observational studies cannot indicate a clear causal relationship and randomised controlled trials cannot be generalisable beyond the specific sample, intervention, dose and duration studied.
In addition, the values of their suggestions might be limited by geographic variability, definition of exposure and prevalence of risk factors at population level.
Nevertheless, the authors said this was the most comprehensive and large-scale systematic review and meta-analysis for Alzheimer’s disease to date, and the evidence based suggestions were put together by integrating a large amount of evidence from different types of existing research.
They concluded: “This study provides an advanced and contemporary survey of the evidence, suggesting that more high-quality observational prospective studies and randomised controlled trials are urgently needed to strengthen the evidence base for uncovering more promising approaches to preventing Alzheimer’s disease.”
In addition, the latest research suggests that other factors are also important, although this does not mean these factors are directly responsible for causing dementia.
These include:
- Hearing loss
- Untreated depression (though depression can also be one of the symptoms of Alzheimer’s disease)
- Loneliness or social isolation
- A sedentary lifestyle.
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