In the last decade, important advances have been made in the fight against dementia. A critical victory in this context has been the debunking of the notion that cognitive decline and dementia are a natural part of aging. Current evidence indicates, in fact, that an individual’s lifestyle may be more important than we think in determining dementia risk, and this has significant clinical implications for how we treat older people.
Key among this growing body of evidence is a now-groundbreaking prospective intervention study by Finnish scientists that found that a two-year brain health program aimed at improving lifestyle was effective in reducing dementia risk by 30%. compared to traditional good health advice. Study participants were people in their 60s and 70s who had co-morbidities identified as risk factors for dementia and also had mild cognitive deficits. They also saw an improvement in their overall mental acuity of 25% (their memory was 40% better, their brain was 150% faster at performing mental tasks, and their problem-solving ability also increased by 80%). While 30% may not sound like a huge reduction in dementia risk, it’s worth noting that this is better than any currently approved drug we have for treating dementia. A crucial piece here is that this was the first prospective randomized controlled study of its kind, thus establishing causality between participation in a program aimed at multiple healthy brain behaviors, and reduced risk of dementia and improved mental acuity.
While these results are certainly exciting, what is the majority surprising about this study, As with others like it, it was that the program’s activities and schedule were possibly quite doable. – making its potential role in improving brain health even more promising. The participants exercised for an hour three to seven days a week. They recorded their food for three days and met with a nutritionist every few months, sometimes in groups and other times individually. They also did a cognitive training program that started with 10 group sessions and then progressed to self-paced computer-based brain training three times a week (10-15 minutes each day). Lastly, they met with their doctor every few months for advice on managing their chronic vascular and metabolic conditions. It’s important to note that combining multiple healthy behaviors was key, as previous studies with exercise, nutrition, or cognitive training alone did not show the same benefits for brain health.
While participation in such a program was possibly feasible (it did not require becoming an athlete and running a marathon), a critical consideration is the potential for wide translation of these types of interventions into clinical practice in the US. It is true that the contact and support offered is far greater than what the average person receives from their health care team, at least in the US (where the average person with Medicare only sees their primary health care provider a few times). 3 times a year). But having many points of contact did not mean that all visits were made by the primary care provider: the delivery of the intervention was a truly multidisciplinary effort; vascular/metabolic risk control visits were performed by physicians, exercise visits were performed by physiotherapists, nutrition visits were performed by nutritionists, and cognitive visits were performed or supervised by psychologists. The shared responsibility in delivering the intervention adds to the feasibility of implementing such a program in a primary care setting.
An important and often overlooked consideration about this study is that these clinically significant improvements were seen in participants who had early cognitive problems and associated comorbidities (this was part of their inclusion criteria). In fact, a secondary analysis of the results showed that even people with apolipoprotein E (APOE) allele status, the strongest known genetic risk factor for Alzheimer’s disease, maintained their cognitive benefits after participating in the program. There were indications of particularly beneficial effects in APOE carriers in terms of memory and global cognition, and ongoing studies are underway to investigate whether they benefit further from this type of program. These findings are encouraging because they show that even in the presence of cognitive deficits, lifestyle improvements are effective means of improving cognitive functioning and reducing future risk of dementia. Those with early cognitive deficits are particularly good candidates for these types of lifestyle interventions, highlighting the need for greater access to practical cognitive screening solutions in primary care. Proactive detection of cognitive deficits is critical because they do not necessarily arise on a routine office visit; many people do not raise these concerns with their health care team for a variety of reasons (denial, stigma, etc.).
Reducing high blood pressure, obesity, and physical inactivity by just 15% would prevent more than 400,000 cases of dementia in the US. The transformative power of these results raises the question of how we can leapfrog good advice from old-fashioned health to train and support our patients in achieving brain-healthy lifestyles. We need to detect cognitive deficits early enough to allow us to do something about it. We must also find ways to expand our clinical workforce to support behavior change. My own recent work with colleagues shows that older adults are primed to initiate healthy behavior, but don’t always know how to maintain it. Three critical ingredients of successful behavior change that they lacked were: self-efficacy (the likelihood of following through when faced with an obstacle), self-regulation (obstacle-solving), and social support. On the contrary, the main motivator was personalized advice: general recommendations were specifically pointed out as a source of disconnection. Multi-component interventions have many moving parts and will require creative approaches to increase coordination and communication between health care teams and provide the necessary training and support to help people successfully navigate and sustain changes in lifestyle. of life.
Proactive healthy habits and early detection of cognitive problems are critical to maximizing the impact of lifestyle interventions on brain health. Promising new therapeutic targets are being tested, indicating hope for the near future in the fight against dementia. But, borrowing the lessons of success in other areas of medicine, such as cancer therapies, the combination of successful therapeutic agents was necessary for optimal efficacy. Ideally, novel therapies will be introduced in combination with lifestyle interventions that will need to be personalized for each individual and anchored in reliable longitudinal metrics to allow for modifications as needed. Therefore, regardless of the availability of new treatments, a holistic approach will offer the greatest potential for improving efficacy and, perhaps most importantly, preserving quality of life.
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Source: news.google.com