Lifestyle Interventions That Can Decrease Cognitive Decline

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Dear colleagues, I am Christoph Diener, a neurologist from the University of Duisburg-Essen in Germany. Today I’d like to talk about lifestyle and dementia.

The purpose of doing so now is very clear, as we are at the beginning of a new year, which is always a good time to change your life. This video is based on an editorial in the NEJM Journal Watch in January, which deals with lifestyle factors and dementia.[1]

Vascular Risk Factors

Let me start with the Atherosclerosis Risk in Communities (ARIC) study,[2] which was published in April last year in JAMA. This study recruited many patients, but this subgroup analysis looked at 322 who were an average of 52 years old at the beginning of the study 20 years ago. Patients underwent florbetapir PET scans between 2011 and 2013 and were assessed for vascular risk factors.

Researchers observed an increased late-brain amyloid load with elevated midlife body mass index (odds ratio [OR], 2.06), with one vascular risk factor at midlife (OR, 1.88) and with two vascular risk factors at midlife (OR, 2.88), which clearly shows that vascular risk factors increase the risk for amyloid deposition.

Importance of Physical Activity

The second study was published in Experimental Gerontology,[3] which looked at mild cognitive impairment and physical activity. In this subgroup analysis of the World Health Organization’s Study on Global Ageing and Adult Health (32,715 patients; mean age, 62 years), researchers defined the threshold for moderate-to-vigorous physical activity as 150 minutes of exercise per week. In patients who did not meet that threshold, there was an increased risk for mild cognitive impairment, with a hazard ratio of approximately 1.3 in the overall sample population and 1.8 in persons above 65 years. This clearly shows that physical activity might prevent mild cognitive impairment.

Biomarkers for Alzheimer Disease

The third study, published in Annals of Neurology,[4] looked at lifestyle factors and biomarkers for Alzheimer disease. Researchers investigated 430 individuals older than 60 years with amyloid PET, tau-PET, and MRI to look at brain atrophy. They found an increased risk for neurodegeneration on MRI, with a number of cardiovascular and metabolic conditions. For example, elevated cholesterol was correlated with increased tau-deposition.

Finnish Geriatric Intervention Study (FINGER)

The most impressive study in the past few years was the FINGER study, which was originally published in 2015 in the Lancet.[5] In a great secondary paper from the FINGER study group, published in 2017,[6] researchers randomized 1260 persons, age 60-70 years, to a program of lifestyle intervention (diet, exercise, cognitive training, and vascular risk management) or control (general health advice). The results clearly showed after 2 years that the intervention program was associated with less cognitive decline. Now, new subgroup analyses show that this is independent of baseline risk.

Recommendations

I really recommend that you read the most recent American Heart Association and American Stroke Association advisory on preservation of cognitive function.[7] The guidelines identified seven parameters which should be followed to prevent cognitive decline and dementia. These are: avoiding smoking, promoting regular physical activity, maintaining a healthy diet, and having a body mass index < 25 kg/m2, untreated blood pressure below 120 mm Hg, untreated total cholesterol < 200 mg/dL, and fasting glucose < 100 mg/dL.

I myself fulfill all of these criteria with one exception, which is that I have a little bit of difficulty with my body mass index. Following these recommendations, I am very optimistic that I can continue to do these kind of video blogs for the next few years.

Ladies and gentlemen, it’s time to change your lifestyle. It’s time to advise your patients about what they can do to prevent cognitive impairment and dementia by changing the way they live and by treating vascular risk factors.

I am Christoph Diener, from the University of Duisburg-Essen in Germany. Thank you for listening and watching.



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