Prevention

Recent scientific evidence shows that it is possible to reduce the risk to develop dementia by acting on different modifiable risk factors. These risk factors account for about 40% of the risk to develop dementia. Preventive measures can slow down the progression of cognitive decline through multi-domain lifestyle-interventions. As the effectiveness of these measures depends on many individual factors (general health, lifestyle, exercise, environment, genetics, etc.) the pdp develops an individual program for each patient.

If, despite preventive measures, dementia should occur with all known symptoms, pdp will ensure continuity of care by referring the participant and his relatives to appropriate information and care centres.

Risk factors

The pdp is based on scientific findings from previous research that identified several risk factors, which could delay or prevent risk of dementia. This is based on scientific findings from previous research indicating that lifestyle modifications play an instrumental role in cognitive health.

Cognitive inactivity. Some studies have suggested that engaging in mentally stimulating activities (such as reading books or newspapers, doing puzzles, doing artwork, playing parlor or board games, playing/listening to music, knitting etc.) is associated with better cognitive function as it may build brain reserve. This refers to the brain's resistance against potential pathologies and its ability to compensate for brain changes while still continuing to function as usual.

Smoking has been found in several recent studies to significantly increase the risk of mental decline and dementia. People who smoke have a higher risk of atherosclerosis and other types of vascular disease, which may be the underlying causes for the increased dementia risk.

Alcohol consumption, and especially excessive alcohol consumption or alcohol abuse can damage the brain and lead to dementia. Heavily drinking alcohol over a long period of time can lead to a brain volume reduction and in turn lead to issues in brain functioning.

High cholesterol. High levels of low-density lipoprotein (LDL), the so-called "bad" form of cholesterol, appear to significantly increase a person's risk of developing vascular dementia. Some research has also linked high cholesterol to an increased risk of Alzheimer's disease.

Depression. According to the MayoClinic, up to 40% of people with Alzheimer’s disease suffer from depression. Symptoms can vary, including apathy, loss of interest in activities and hobbies, social withdrawal (isolation), trouble concentrating and impaired thinking. Considering the fact that the symptoms of depression and dementia are very similar, it is sometimes difficult to determine whether cognitive difficulties are the cause or the consequence of dementia.

Social isolation. With increased age, it sometimes happens that people withdraw more and more from the social environment. However, this social withdrawal and feelings of loneliness have been shown to increase the risk of dementia due to fewer cognitively stimulating interactions. Furthermore, social isolation is associated with a higher incidence of depressive symptoms.

Physical inactivity. Regular exercise is recommended for improving physical and cognitive functions of patients with dementia. It also can help lower the possibility of developing other risk factors such as diabetes, hypertension, cardiovascular disease and obesity.

Hypertension. Long-term research studies have demonstrated that high blood pressure in mid-life is a key factor that can increase the risk of developing dementia in later life, particularly vascular dementia.

Non-Mediterranean diet. Evidence shows that following a specific diet reduces the odds of cognitive impairment. Mediterranean diets are traditionally high in fruits, vegetables, legumes and cereals, with moderate consumption of oily fish and dairy, and low in meat, sugar and saturated fat. Most fats also come from olive oil and alcohol is consumed in moderation. The diet is also associated with lower levels of stroke, type 2 diabetes, cardiovascular diseases and if followed strictly, may help slower rates of decline in memory and thinking.

Obesity. A recent study published in the International Journal of Epidemiology found that patients with a BMI corresponding overweight or obese levels were more likely to develop dementia. In addition, the study found that the association between obesity and dementia was independent of whether a person was a smoker, had hypertension or diabetes, or carried the APOE ε4 gene, a genetic risk factor for Alzheimer’s disease and related dementias.

Hearing loss. During a 12-year study, researchers found that mild hearing loss doubled dementia risk. Moderate loss tripled risk, and people with a severe hearing impairment were five times more likely to develop dementia. Hearing loss may contribute to faster brain deterioration, especially since the brain needs to work harder to process sound. Furthermore, it is hypothesized that the link between hearing loss and dementia might be mediated by other factors such as a tendency to withdraw from social interactions when hearing loss occurs.

Other identifiable risk factors

Research has also shown other identifiable risk factors affecting the likelihood of developing one or more kinds of dementia. Some of these factors are modifiable, while others are not.

Diabetes is a risk factor for both Alzheimer's disease and vascular dementia. It is also a known risk factor for atherosclerosis and stroke, both of which contribute to vascular dementia.

Renal dysfunction. Cognitive impairment is also associated with Chronic Kidney Disease (CKD). As kidney function reduces, patients suffering with the condition are at an increased risk of mild cognitive impairment, where they may have difficulties with memory, attention, and other executive functions.

Plasma homocysteine. Research has shown that a higher-than-average blood level of homocysteine, a type of amino acid, is a strong risk factor for the development of Alzheimer's disease and vascular dementia.

Atherosclerosis (and Cardiovascular disease) is the build-up of plaque – deposits of fatty substances, cholesterol, and other matter – in the inner lining of an artery. Atherosclerosis is a significant risk factor for vascular dementia because it interferes with the delivery of blood to the brain and can lead to stroke. It has also been shown that cardiovascular disease also poses an increased risk for cognitive decline (women’s study).

Age. The risk of Alzheimer's disease, vascular dementia, and several other dementias goes up significantly with advancing age.

Genetics/family history. Researchers have discovered a number of genes (for example: amyloid precursor protein; APP or presiniline 1; P1 and presiniline 2; P2; APO E 4) that increase the risk of developing Alzheimer's disease. Although people with a family history of Alzheimer's disease are generally considered to be at a heightened risk of developing the disease themselves, many people who have relatives with Alzheimer's disease never develop the disease, and many without a family history of the disease do get it. In most cases, it is impossible to predict a specific person's risk of the disorder based on family history alone. Abnormal genes are also clearly implicated as risk factors in Huntington's disease, FTDP-17, and several other kinds of dementia. Many people with Down's syndrome show neurological and behavioural signs of Alzheimer's disease by the time they reach middle age.