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Social Psychiatry and Psychiatric Epidemiology
Published in: Social Psychiatry and Psychiatric Epidemiology 12/2018

01-12-2018 | Invited Review

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

Authors: Felix S. Hussenoeder, Steffi G. Riedel-Heller

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 12/2018

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Abstract

Introduction

With large numbers of people affected, no treatment in sight and continuing demographic change, the prevention of dementia is becoming a central public health issue.

Methods

We conducted a systematic meta-review including systematic reviews and meta-analyses of longitudinal observational studies on modifiable risk and protective factors for dementia published over the last 5 years.

Results

Compelling evidence on a number of modifiable risk factors, mostly lifestyle factors, is available from longitudinal observational studies to inform primary preventive efforts.

Discussion

Evidence stemming from preventive RCTs is limited. However, multi-domain interventions addressing a variety of risk factors at once seem promising with regard to high-risk individuals (selective preventive approach). However, we argue that it is time to move forward and discuss a public brain health agenda as a universal preventive approach. Based on a risk reduction strategy, the public brain health agenda suggests the following ten key actions: (1) increase physical activity, (2) foster social integration, (3) improve education and foster lifelong learning, (4) provide mentally stimulating workplaces, (5) foster a cognitively active lifestyle, (6) propose a healthy Mediterranean-like diet, (7) reduce alcohol consumption, (8) stop smoking, (9) prevent, diagnose and treat chronic conditions, and (10) reduce anticholinergic medication in the elderly.
Literature
1.
2.
Alltag S, Nowossadeck S, Stein J, Hajek A, König H, Riedel-Heller SG et al (2017) Regionale Unterschiede bei demografischer Alterung [Small area variation in demographic aging—informal and formal nursing care ratios and care preferences of senior citizens inform health care planners]. Psychiatr Prax 44(7):413–416CrossRef
3.
Heßmann P, Dreier M, Brandes I, Dodel R, Baum E, Müller MJ et al (2018) Unterschiede in der Selbst- und Fremdbeurteilung gesundheitsbezogener Lebensqualität bei Patienten mit leichter kognitiver Beeinträchtigung und Demenz vom Alzheimer-Typ [Differences between self- and proxy-assessment of health-related quality of life in patients with mild cognitive impairment and Alzheimer’s disease]. Psychiatr Prax 45(2):78–86CrossRef
4.
Schweda M (2018) Das größte Unglück? Demenz zwischen persönlichem Erleben und gesellschaftlicher Repräsentation [The ultimate disaster? Dementia between personal experience and social representation]. Psychiatr Prax 45(S 01):S31–S35PubMed
5.
6.
Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D et al (2017) Dementia prevention, intervention, and care. Lancet 390(10113):2673–2734CrossRef
7.
Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM et al (2011) Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7(3):280–292CrossRef
8.
Christensen K, Thinggaard M, Oksuzyan A, Steenstrup T, Andersen-Ranberg K, Jeune B et al (2013) Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart. Lancet 382(9903):1507–1513CrossRef
9.
Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L et al (2013) A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 382(9902):1405–1412CrossRef
10.
Qiu C, von Strauss E, Bäckman L, Winblad B, Fratiglioni L (2013) Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden. Neurology 80(20):1888CrossRef
11.
Wu Y, Fratiglioni L, Matthews FE, Lobo A, Breteler MMB, Skoog I et al (2016) Dementia in western Europe: epidemiological evidence and implications for policy making. Lancet Neurol 15(1):116–124CrossRef
12.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRef
13.
Blondell SJ, Hammersley-Mather R, Veerman JL (2014) Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies. BMC Public Health 14:510CrossRef
14.
Deckers K, van Boxtel MPJ, Schiepers OJG, Vugt M de, Sanchez M, Anstey JL KJ et al (2015) Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry 30(3):234–246CrossRef
15.
Reiner M, Niermann C, Jekauc D, Woll A (2013) Long-term health benefits of physical activity—a systematic review of longitudinal studies. BMC Public Health 13:813CrossRef
16.
Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y (2014) Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health 14:643CrossRef
17.
Stephen R, Hongisto K, Solomon A, Lonnroos E (2017) Physical activity and Alzheimer’s disease: a systematic review. J Gerontol A Biol Sci Med Sci 72(6):733–739PubMed
18.
Guure CB, Ibrahim NA, Adam MB, Said SM (2017) Impact of physical activity on cognitive decline, dementia, and its subtypes: meta-analysis of prospective studies. Biomed Res Int 2017:9016924CrossRef
19.
Carvalho A, Rea IM, Parimon T, Cusack BJ (2014) Physical activity and cognitive function in individuals over 60 years of age: a systematic review. Clin Interv Aging 9:661–682PubMedPubMedCentral
20.
Llamas-Velasco S, Contador I, Villarejo-Galende A, Lora-Pablos D, Bermejo-Pareja F (2015) Physical activity as protective factor against dementia: a prospective population-based study (NEDICES). J Int Neuropsychol Soc 21(10):861–867CrossRef
21.
Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP et al (2015) Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 22:39–57CrossRef
22.
Xu W, Tan L, Wang H, Tan M, Tan L, Li J et al (2016) Education and risk of dementia: dose-response meta-analysis of prospective cohort studies. Mol Neurobiol 53(5):3113–3123CrossRef
23.
Stern Y (2002) What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 8(3):448–460CrossRef
24.
Then FS, Luck T, Luppa M, Thinschmidt M, Deckert S, Nieuwenhuijsen K et al (2014) Systematic review of the effect of the psychosocial working environment on cognition and dementia. Occup Environ Med 71(5):358CrossRef
25.
Then FS, Luck T, Heser K, Ernst A, Posselt T, Wiese B et al (2017) Which types of mental work demands may be associated with reduced risk of dementia? Alzheimers Dement 13(4):431–440CrossRef
26.
Yates LA, Ziser S, Spector A, Orrell M (2016) Cognitive leisure activities and future risk of cognitive impairment and dementia: systematic review and meta-analysis. Int Psychogeriatr 28(11):1791–1806CrossRef
27.
Cao L, Tan L, Wang H, Jiang T, Zhu X, Lu H et al (2016) Dietary patterns and risk of dementia: a systematic review and meta-analysis of cohort studies. Mol Neurobiol 53(9):6144–6154CrossRef
28.
Di Marco LY, Marzo A, Munoz-Ruiz M, Ikram MA, Kivipelto M, Ruefenacht D et al (2014) Modifiable lifestyle factors in dementia: a systematic review of longitudinal observational cohort studies. J Alzheimers Dis 42(1):119–135CrossRef
29.
Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC et al (2013) Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology 24(4):479–489CrossRef
30.
Singh B, Parsaik AK, Mielke MM, Erwin PJ, Knopman DS, Petersen RC et al (2014) Association of mediterranean diet with mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis 39(2):271–282CrossRef
31.
Panza F, Solfrizzi V, Barulli MR, Bonfiglio C, Guerra V, Osella A et al (2015) Coffee, tea, and caffeine consumption and prevention of late-life cognitive decline and dementia: a systematic review. J Nutr Health Aging 19(3):313–328CrossRef
32.
Barnard ND, Bunner AE, Agarwal U (2014) Saturated and trans fats and dementia: a systematic review. Neurobiol Aging 35(Suppl 2):S65–S73CrossRef
33.
Xu W, Wang H, Wan Y, Tan C, Li J, Tan L et al (2017) Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol 32(1):31–42CrossRef
34.
Sachdeva A, Chandra M, Choudhary M, Dayal P, Anand KS (2016) Alcohol-related dementia and neurocognitive impairment: a review study. Int J High Risk Behav Addict 5(3):e27976CrossRef
35.
Zhong G, Wang Y, Zhang Y, Guo JJ, Zhao Y (2015) Smoking is associated with an increased risk of dementia: a meta-analysis of prospective cohort studies with investigation of potential effect modifiers. PLoS One 10(3):e0118333CrossRef
36.
Stirland LE, O’Shea CI, Russ TC (2018) Passive smoking as a risk factor for dementia and cognitive impairment: systematic review of observational studies. Int Psychogeriatr 30(8):1177–1187CrossRef
37.
Levi Marpillat N, Macquin-Mavier I, Tropeano A, Bachoud-Levi A, Maison P (2013) Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 31(6):1073–1082CrossRef
38.
Rouch L, Cestac P, Hanon O, Cool C, Helmer C, Bouhanick B et al (2015) Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs 29(2):113–130CrossRef
39.
Tully PJ, Hanon O, Cosh S, Tzourio C (2016) Diuretic antihypertensive drugs and incident dementia risk: a systematic review, meta-analysis and meta-regression of prospective studies. J Hypertens 34(6):1027–1035CrossRef
40.
Chatterjee S, Peters SAE, Woodward M, Mejia Arango S, Batty GD, Beckett N et al (2016) Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 39(2):300–307PubMed
41.
Zhang J, Chen C, Hua S, Liao H, Wang M, Xiong Y et al (2017) An updated meta-analysis of cohort studies: diabetes and risk of Alzheimer’s disease. Diabetes Res Clin Pract 124:41–47CrossRef
42.
Ye F, Luo Y, Xiao J, Yu N, Yi G (2016) Impact of insulin sensitizers on the incidence of Dementia: a meta-analysis. Dement Geriatr Cogn Disord 41(5–6):251–260CrossRef
43.
Albanese E, Launer LJ, Egger M, Prince MJ, Giannakopoulos P, Wolters FJ et al (2017) Body mass index in midlife and dementia: systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies. Alzheimers Dement (Amst) 8:165–178
44.
Pedditizi E, Peters R, Beckett N (2016) The risk of overweight/obesity in mid-life and late life for the development of dementia: a systematic review and meta-analysis of longitudinal studies. Age Ageing 45(1):14–21CrossRef
45.
Emmerzaal TL, Kiliaan AJ, Gustafson DR (2015) 2003–2013: a decade of body mass index, Alzheimer’s disease, and dementia. J Alzheimers Dis 43(3):739–755CrossRef
46.
Zheng Y, Fan S, Liao W, Fang W, Xiao S, Liu J (2017) Hearing impairment and risk of Alzheimer’s disease: a meta-analysis of prospective cohort studies. Neurol Sci 38(2):233–239CrossRef
47.
Cherbuin N, Kim S, Anstey KJ (2015) Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis. BMJ Open 5(12):e008853CrossRef
48.
Heser K, Tebarth F, Wiese B, Eisele M, Bickel H, Köhler M et al (2013) Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe). Psychol Med 43(8):1597–1610CrossRef
49.
Julien J, Joubert S, Ferland M, Frenette LC, Boudreau-Duhaime MM, Malo-Veronneau L et al (2017) Association of traumatic brain injury and Alzheimer disease onset: a systematic review. Ann Phys Rehabil Med 60(5):347–356CrossRef
50.
Perry DC, Sturm VE, Peterson MJ, Pieper CF, Bullock T, Boeve BF et al (2016) Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis. J Neurosurg 124(2):511–526CrossRef
51.
Heser K, Luck T, Röhr S, Wiese B, Kaduszkiewicz H, Oey A et al (2018) Potentially inappropriate medication: association between the use of antidepressant drugs and the subsequent risk for dementia. J Affect Disord 226:28–35CrossRef
52.
Jessen F, Kaduszkiewicz H, Daerr M, Bickel H, Pentzek M, Riedel-Heller S et al (2010) Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 260(Suppl 2):S111–S115CrossRef
53.
Hill AB (2015) The environment and disease: association or causation? J R Soc Med 108(1):32–37CrossRef
54.
55.
Canadian Task Force on the Periodic Health Examination (1979) The periodic health examination. Can Med Assoc J 121(9):1193–1254
56.
Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95(2):2S–4SCrossRef
57.
58.
Andrieu S, Coley N, Lovestone S, Aisen PS, Vellas B (2015) Prevention of sporadic Alzheimer’s disease: lessons learned from clinical trials and future directions. Lancet Neurol 14(9):926–944CrossRef
59.
60.
61.
Dubois B, Epelbaum S, Santos A, Di Stefano F, Julian A, Michon A et al (2013) Alzheimer disease: from biomarkers to diagnosis. Démences: nouveaux concepts, nouveaux enjeux/Dementia: new concepts, new goals. Rev Neurol 169(10):744–751CrossRef
62.
Jack CR, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB et al (2018) NIA-AA research framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement 14(4):535–562CrossRef
63.
American Psychiatric Association (2013) DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, ArlingtonCrossRef
64.
Solomon A, Mangialasche F, Richard E, Andrieu S, Bennett DA, Breteler M et al (2014) Advances in the prevention of Alzheimer’s disease and dementia. J Intern Med 275(3):229–250CrossRef
65.
Mulder M, Ranchor AV, Sanderman R, Bouma J, van den Heuvel WJ (1998) The stability of lifestyle behaviour. Int J Epidemiol 27(2):199–207CrossRef
66.
Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R et al (2013) The Finnish geriatric intervention study to prevent cognitive impairment and disability (FINGER): study design and progress. Alzheimers Dement 9(6):657–665CrossRef
67.
Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R et al (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 385(9984):2255–2263CrossRef
68.
Williams JW, Plassmann BL, Burke JR, Benjamin S (2010) Preventing Alzheimer’s disease and cognitive decline: evidence report/technology assessment, vol 193. Agency for Healthcare Research and Quality (AHRQ), Rockville
69.
van Charante EPM, Richard E, Eurelings LS, van Dalen J, Ligthart SA, van Bussel EF et al (2016) Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet 388(10046):797–805CrossRef
70.
Barbera M, Mangialasche F, Jongstra S, Guillemont J, Ngandu T, Beishuizen C et al (2018) Designing an internet-based multidomain intervention for the prevention of cardiovascular disease and cognitive impairment in older adults: the HATICE trial. J Alzheimers Dis 62(2):649–663CrossRef
71.
72.
Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C (2014) Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 13(8):788–794CrossRef
73.
Luck T, Riedel-Heller SG (2016) Prävention von Alzheimer-Demenz in Deutschland: Eine Hochrechnung des möglichen Potenzials der Reduktion ausgewählter Risikofaktoren. Nervenarzt 87(11):1194–1200CrossRef
74.
Pratt M, Perez LG, Goenka S, Brownson RC, Bauman A, Sarmiento OL et al (2015) Can population levels of physical activity be increased? Global evidence and experience. Prog Cardiovasc Dis 57(4):356–367CrossRef
75.
McLeroy KR, Bibeau D, Steckler A, Glanz K et al (1988) An ecological perspective on health promotion programs. Health Educ Q 15(4):351–377CrossRef
76.
Bronfenbrenner U (1977) Toward an experimental ecology of human development. Am Psychol 32(7):513–531CrossRef
77.
Golden SD, Earp JAL (2012) Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav 39(3):364–372CrossRef
78.
Laal M (2011) Lifelong learning: what does it mean? Procedia Soc Behav Sci 28:470–474CrossRef
79.
Davis C, Bryan J, Hodgson J, Murphy K (2015) Definition of the Mediterranean diet; a literature review. Nutrients 7(11):9139–9153CrossRef
Metadata
Title
Primary prevention of dementia: from modifiable risk factors to a public brain health agenda?
Authors
Felix S. Hussenoeder
Steffi G. Riedel-Heller
Publication date
01-12-2018
Publisher
Springer Berlin Heidelberg
Published in
Social Psychiatry and Psychiatric Epidemiology / Issue 12/2018
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI
https://doi.org/10.1007/s00127-018-1598-7

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