Notes from a Doctor's Practice

More than 33% of women and 20% of men over age 65 develop dementia, and many more develop a milder form of cognitive impairment. I think we can all appreciate the huge impact dementia has on the medical system and more importantly on the individuals and family members involved. Many of my patients who have loved ones experiencing cognitive decline ask me: Is there any way to prevent this from happening to me? Is there truth to the old adage "use it or lose it?" While there are risk factors for dementia we can't change (such as family history and age) we should focus on those risk factors we can change.

Does using your mind an hour a day really help prevent inevitable cognitive decline and dementia?

Well, at the annual meeting of the American Academy of Neurology, data from a large trial suggests this may be the case. Older adults with normal cognition (memory, attention, perception) who participated in a mental fitness program for 1 hour a day, 5 days a week for 8 weeks demonstrated significant improvements in memory and nonmemory tasks. Simply put, we should promote mental activity in our older family members including lifelong education.

Which risk factors for Dementia can we modify?

Obesity, cardiovascular disease, and physical and intellectual inactivity are areas patients can work on with their primary care doctors. Here are some simple strategies:

1) Your doctor should screen for depression and start effective treatment promptly: depression is a common and unrecognized cause of "concentration difficulties" which can look like early mental decline and forgetfulnessm and can be reversed with treatment of depression.

2) Reduce cardiovascular risk factors, such as high blood pressure, high cholesterol, diabetes, and obesity, especially during midlife.

3) Prevent head trauma (this is never good).

4) Promote mental stimulation.

5) Encourage physical activity (this is always good).

Which supplements, medications or diet changes will help prevent Dementia?

While there aren't any new preventative treatments for Dementia, we are working on it. Two recent studies have shown that a Mediterranean diet lowers the risk of Alzheimer's disease. There is no ONE Mediterranean diet but this is a diet typically high in fruits, vegetables, whole grains, beans, nuts and seeds, and olive oil with LOW TO MODERATE amounts of fish, poultry, and dairy products, and LITTLE red meat. We no longer recommend Vitamin E because of the evidence that came out in studies that Vitamin E supplementation increases the risk for all-cause mortality. Clinical trials are underway to explore the benefits of ginkgo, selenium, simvastatin (Zocor), estrogen (which looks like it will be of no benefit), and NSAIDs (motrin, ibuprofen) on dementia and cognitive decline. Stay tuned.

Dr O.