This week, the World Health Organization (WHO) announced the release of a 96-page report: Risk reduction of cognitive decline and dementia, a set of guidelines for behaviors and interventions that aim to delay or prevent cognitive decline and dementia.
The guidelines are intended for adults with normal cognition
as well as for those with "mild cognitive impairment" (MCI).
Dementia is a rapidly growing public health problem. According to WHO, around 50 million people have dementia and, with one new case every three seconds, the number of people with dementia is set to triple to 152 million in the next 30 years. It is also a global problem; about 60% of people with dementia live in low and middle-income countries. Since there is no cure for the condition, WHO says it is imperative to focus on modifiable risk factors in order to delay the onset or slow the progression of the disease.
Risk reduction is just one of seven action areas identified by WHO as part of their Global Action Plan on the Public Health Response to Dementia 2017-2025. The other six areas of action include: strengthening information systems for dementia; diagnosis, treatment and care; supporting the caregivers of people with dementia; and research and innovation.
Twelve interventions to reduce the risk of cognitive decline/dementia were identified and evaluated by WHO.
Some of the interventions had two or three sub-components.
Recommendations for the interventions were qualified as either "strong" or "conditional" for adults with normal cognition and adults with mild cognitive impairment.
If the distinction between adults with normal cognition and
adults with MCI is not made, then the intervention applies
to both groups.
Strong recommendations imply that most people should follow the recommended intervention. Conditional recommendations imply that different choices may be appropriate for individual patients. In three of the twelve interventions, the committee determined that there was insufficient evidence to recommend them specifically for reducing the risk of cognitive decline and/or dementia. However, for good health and wellbeing, those interventions should still be provided.
Interventions Strongly Recommended- Regular exercise or physical activity to reduce the risk of cognitive decline and dementia (for adults with normal cognition)
- Quitting smoking to reduce the risk of cognitive decline and dementia
- Managing high blood pressure according to WHO guidelines
- Diabetes: Managing diabetes with medications and/or lifestyle interventions according to existing WHO guidelines
- Nutrition: Healthy Diet according to WHO recommendations (see full report for specific recommendations)
- Nutrition: Health care providers should NOT recommend Vitamins B and E as a way to reduce the risk of cognitive decline and/or dementia
- Regular exercise or physical activity to reduce the risk of cognitive decline (for adults with mild cognitive impairment or MCI)
- Managing high blood pressure to reduce the risk of cognitive decline and/or dementia
- Weight management to reduce risk of cognitive decline and/or dementia
- Diabetes: Managing of diabetes in adults to reduce risk of cognitive decline and/or dementia
- Reducing unhealthy cholesterol levels to reduce risk of cognitive decline and dementia
- Nutrition: Mediterranean-like diet to reduce risk of cognitive decline and/or dementia
- Stopping harmful alcohol use to reduce risk of cognitive decline and/or dementia
- Cognitive interventions (cognitive stimulation or cognitive training) to reduce risk of cognitive decline and/or dementia
- Use of antidepressants for the management of depression
- Management of hearing loss through use of hearing aids
- Staying socially active
Sources and More Reading:
- News release from WHO on the risk reduction guidelines: https://www.who.int/news-room/detail/14-05-2019-adopting-a-healthy-lifestyle-helps-reduce-the-risk-of-dementia
This May 14, 2019 news release from WHO provides an overview of the newly released guidelines. The bottom line recommendation is to have a healthy lifestyle.
- WHO Guidelines for Risk Reduction of Cognitive Decline and Dementia https://www.who.int/mental_health/neurology/dementia/guidelines_risk_reduction/en/
The 96-page report provides research methodology, glossary, participants on the committees, literature review terms, and more information about each of the reviewed interventions. The "quality of evidence" assessments supporting the recommendations are also provided in the report.
- "Regular crosswords and number puzzles linked to sharper brain in later life:" Science Daily, May 16, 2019: Science Daily Release
Reports highlights of a study recently published in the International Journal of Geriatric Psychiatry. Conducted by the University of Exeter Medical School and King's College London, it involved over 19,000 cognitively healthy participants between the ages of 50 and 93.
The participants reported how frequently they performed number puzzles such as Sudoku and word puzzles such as crossword puzzles. They were given online cognitive tests that assessed 14 cognitive areas including attention, reasoning, and memory. "For each measure, the group who never performed word puzzles performed most poorly, with the group who reported occasional puzzle use also performing more poorly than virtually every other group."
Dr. Anne Corbett, lead researcher said, "We can't say that playing these puzzles necessarily reduces the risk of dementia in later life but this research supports previous findings that indicate regular use of word and number puzzles helps keep our brains working better for longer."
(International Journal of Geriatric Psychiatry abstracts: "The relationship between the frequency of number-puzzle use and baseline cognitive function in a large online sample of adults aged 50 and over."Int J Geriatr Psychiatry. 2019 Feb 11. doi: 10.1002/gps.5085. "An online investigation of the relationship between the frequency of word puzzle use and cognitive function in a large sample of older adults." Int J Geriatr Psychiatry. 2019 Feb 11. doi: 10.1002/gps.5085.)