According to experts in the United States, a combination of some form of brain training, controlling blood pressure, and exercise, could well reduce mental decline in old age, thus reducing the risk of Alzheimer's-type dementia.
The National Academies of Sciences, Engineering, and Medicine have released a new report stating that there's encouraging, but inconclusive, evidence to support these three interventions for optimal brain health.
Alan Leshner is chair for the committee and CEO emeritus of the American Association for the Advancement of Science, and believes that the "evidence is strong enough" that members of the public should be informed about the results of the study in order to inform their decisions about how best to maintain their brain health as they age.
However, the report did note that additional research is required to understand and analyze their effectiveness. Earlier, in 2010, the Agency for Healthcare Research and Quality published a review which concluded that no recommendations could be made about any interventions to prevent cognitive decline and dementia because there was insufficient evidence. Since 2010, though, the understanding of dementia has advanced.
The NASEM report concluded that, based on all available evidence, the following three classes of interventions were supported by "encouraging but inconclusive" evidence.
Cognitive training, or brain training, which may or may not be computer-based, includes programs aimed at enhancing memory, reasoning, problem-solving, and the speed of processing. Blood pressure management is imperative for people with hypertension, especially during the ages between 35 and 65 years; and physical activity is believed to delay, or at least slow down, age-related cognitive decline.
Maree McCabe is Chief Executive Officer for Alzheimer's Australia. She believes that managing vascular health is critical for brain health.
"We know what's good for your heart is good for your brain and having a healthy vascular system certainly reduces the risk of vascular dementia."Alzheimer's Australia runs a program called Your Brain Matters, which includes exercising and keeping the brain active. Engaging in enjoyable activities and learning new things are all part of their risk-reduction program. According to Maree, evidence has shown that exercise can increase the volume of the hippocampus, which is the part of the brain where Alzheimer's disease starts.
"If you've got more volume in that area, then people if they get Alzheimer's disease will be slower to show clinical symptoms because there's more volume that the disease has got to get through."According to Marie, the evidence is there, and people should not wait to implement these simple lifestyle measures.
"If we could reduce the incidence of dementia by just five percent per year we would reduce the number of people who get it by 24 percent, and that would save the economy $120 billion dollars by 2056, not to mention ensure people have much happier and healthier lifestyles."Alzforum reported that Alzheimer's is the disease that people heading into old age fear the most, and people want to know how to protect themselves.
Alan Leshner, CEO emeritus of the American Association for the Advancement of Science, and Story Landis, director emeritus of the National Institute of Neurological Disorders and Stroke, were two of the leading scientists who released the report from the National Academics of Science, Engineering, and Medicine.
In their opinion, the data is still too weak to issue specific guidelines to the general public.
"The evidence has not yet matured to the level that would support an assertive public health campaign. However, the report does identify those interventions, supported by some evidence of benefit, that should be discussed with people who are actively seeking advice on steps they can take to maintain brain health as they age."Edo Richard from Radboud University, Nijmegen, Netherlands, did not contribute to the report, but described it as a balanced report that "truly reflects the level of evidence currently available."
"We should always be open and honest with patients and the general public, so cannot tell people that by doing this they will prevent cognitive decline. We do not know."The question remains, how can researchers build a stronger case for prevention? It appears the answer is to conduct more and better-quality randomized controlled trials.
Achieving consistent results in controlled trials would increase confidence. In addition, the authors suggest that randomized controlled trials be conducted by scientists on additional interventions, such as new treatments for diabetes, anti-dementia, lipid-lowering, and depression; vitamin B12 plus folic acid supplements; and sleep and social engagement interventions. In the authors' opinions, vitamin E, hormone replacement therapy, and ginkgo biloba have shown no evidence of benefit.
Women Fitness Magazine reported that the public in general are extremely concerned about dementia and cognitive impairment, and it has become very difficult for healthcare providers, policymakers, and for individuals to determine what, if anything, has been shown to prevent or reduce risk.
The National Institute on Aging commissioned experts to complete an extensive scientific review and provide recommendations for both future research priorities and for public health messaging. In response, the NASEM committee concluded that there is currently no evidence to support a mass public education campaign to encourage people to adopt specific interventions to prevent dementia or cognitive decline.
With regard to blood pressure control for people with hypertension, cognitive training, and increased physical activity, the committee cited "encouraging although inconclusive" evidence for these interventions.
NIA Director Richard J. Hodes, M.D. said that people are "urgently seeking ways to prevent dementia and cognitive decline," but that the strength of evidence must be considered before "personal and public investments" are made.
On the other hand, no negative consequences of brain training, exercise, and blood pressure lowering have been identified, causing many to wonder if these three practices should be adopted anyway.
The committee determined there was no evidence to suggest that cognitive training could prevent, delay, or slow the development of Alzheimer's or Mild Cognitive Impairment.
With regard to managing blood pressure in people with hypertension, the committee pointed out the known cardiovascular benefits from well-managed blood pressure, which would be experienced while potentially addressing the prevention of Alzheimer's.
And with exercise, the committee pointed to the growing evidence that increased physical activity shows encouraging but inconclusive evidence that there could be a reduced risk of age-related cognitive decline. Unfortunately, there's just not enough evidence to support increased physical activity as a preventative intervention for Alzheimer's or Mild Cognitive Impairment.
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