Assessing the Degree to Which Dementia is Self-Inflicted

Risk of neurodegenerative disease is strongly connected to the health of the cardiovascular system. Lack of exercise and putting on excess weight significantly increase the risk of both cardiovascular disease and forms of dementia. You can’t use lifestyle choices to hold back aging entirely; the only way forward towards that goal is the research and development of therapies that can repair the cell and tissue damage that causes age-related degeneration. You can, however, at least make the choice to avoid self-sabotage, even if most other people do not do so in this sedentary age of cheap calories. How greatly can you benefit from a good lifestyle alone? Researchers here examine epidemiological data and estimate that about a third of dementia cases might be preventable, though I think the tone is a little self-congratulatory given the present poor state of treatment options and outcomes.

“There’s been a great deal of focus on developing medicines to prevent dementia, including Alzheimer’s disease. But we can’t lose sight of the real major advances we’ve already made in treating dementia, including preventive approaches.” A recent commission brought together international experts to systematically review existing research and provide evidence-based recommendations for treating and preventing dementia. About 47 million people have dementia worldwide and that number is expected to climb as high as 66 million by 2030 and 115 million by 2050.

The commission’s report identifies nine risk factors in early, mid- and late life that increase the likelihood of developing dementia. About 35 percent of dementia – one in three cases – is attributable to these risk factors, the report says. By increasing education in early life and addressing hearing loss, hypertension and obesity in midlife, the incidence of dementia could be reduced by as much as 20 percent, combined. In late life, stopping smoking, treating depression, increasing physical activity, increasing social contact and managing diabetes could reduce the incidence of dementia by another 15 percent. “The potential magnitude of the effect on dementia of reducing these risk factors is larger than we could ever imagine the effect that current, experimental medications could have. Mitigating risk factors provides us a powerful way to reduce the global burden of dementia.”

The commission also examined the effect of nonpharmacologic interventions for people with dementia and concluded that they had an important role in treatment, especially when trying to address agitation and aggression. “Antipsychotic drugs are commonly used to treat agitation and aggression, but there is substantial concern about these drugs because of an increased risk of death, cardiovascular adverse events, and infections.” The evidence showed that psychological, social and environmental interventions such as social contact and activities were superior to antipsychotic medications for treating dementia-related agitation and aggression. The commission also found that nonpharmacologic interventions like group cognitive stimulation therapy and exercise conferred some benefit in cognition as well.




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