Preventing Dementia

Abstract

Suppl. 1 -S56The concept of primary prevention of dementia is relatively new but will assume increasing importance as dementia prevalence increases in our graying population 1 and as the etiological factors and molecular pathogenetic mechanisms of primary degenerative dementias become better understood. 2Current definitions of dementia require memory impairment and cognitive dysfunction in at least one other domain of sufficient degree to interfere with social functioning.3 In this review we emphasize prevention of dementia in individuals who are cognitively normal but may be at risk for dementia, or who are cognitively impaired but not yet demented. Potential preventative measures include avoidance or control of modifiable risk factors to prevent progression to clinically manifest dementia. Secondary prevention of the degenerative dementias is equivalent to treatment, which is discussed in a companion article in this series. Recent clinical trials have provided evidence for modest symptomatic stabilization with socalled cognitive enhancing agents. If effective retardive therapies or neuroregenerative strategies are developed, in the future it may be possible to delay progression or even partially reverse dementing illness.ABSTRACT: Primary prevention will become increasingly important as dementia prevalence increases and effective retardive therapies are developed. To date, only one randomized controlled trial (involving treatment of systolic hypertension) has demonstrated that the incidence of dementia can be reduced. Physicians should remain alert to possible secondary causes of dementia and correct these whenever possible. Primary and secondary prevention of stroke should reduce dementia related to cerebrovascular disease either directly or as a comorbid factor in Alzheimer's disease (AD). Epidemiological studies have revealed a number of risk factors for AD including genetic mutation, susceptibility genes, positive family history, Down's syndrome, age, sex, years of education, head trauma and neurotoxins. In casecontrol studies non-steroidal anti-inflammatory medication and estrogen replacement therapy appear to decrease the relative risk of developing AD. Further research to develop and test preventative therapies in AD and other dementias should be strongly encouraged.RÉSUMÉ: Prévention de la démence. La prévention primaire va devenir de plus en plus importante à mesure que la prévalence de la démence augmente et que des stratégies efficaces pour en retarder l'apparition sont développées. Pour l'instant, une seule étude randomisée contrôlée (traitement de l'hypertension systolique) a démontré que l'incidence de la démence peut être réduite. Les médecins devraient demeurer vigilants pour détecter la présence causes secondaires de démence et les corriger si possible. La prévention primaire et secondaire de l'accident vasculaire cérébral devrait diminuer l'incidence de la démence reliée à la maladie cérébrovasculaire, soit directement ou comme facteur de comorbidité dans la maladie d'Alzheimer (MA). Des étud...

Dementia is associated with iron-deficiency anemia in females: A population-based study

“…These findings are generally consistent with previous studies [2,4]. Our findings also imply that controlling these classical cardiovascular risks may be beneficial in reducing dementia risk.…”

“…Although extensive studies have examined the pathogenesis of dementia, risk factors and the pathomechanism of dementia are still not well known. Some risk factors such as susceptible genes, mild cognitive impairment, diabetes, hypertension, hyperlipidemia, and depression were suggested to be associated with increased risks of dementia [3][4][5][6][7][8][9].…”

Alzheimer's Disease, Cerebrovascular Disease, and the β-amyloid Cascade

“…However, it is worthwhile to briefly summarize our current understanding of the associations and possible mechanisms for each of those factors. [120][121][122] b) role of vascular risk factors…”

Primary Prevention and Delay of Onset of AD/Dementia

“…However researchers in the field have increasingly advocated that attention be turned to the possibility of preventing dementia. [42][43][44] Currently the primary prevention of AD/dementia should be understood as delaying the onset of diagnosable disease. In turn this delay will effectively eliminate a number of AD/dementia cases as individuals die of other causes before they cross the threshold of diagnosable disease.…”