Primary prevention recommendations to reduce the risk of cognitive decline

Abstract As much as 40% of dementia cases can be attributed to modifiable risk factors (Livingston et al., 2020). Much of that risk-reduction can be accomplished by changing behavior in midlife. In light of the emerging evidence that dementia may be preventable, UsAgainstAlzheimer’s convened a workgroup of national experts to develop new recommendations that primary care clinicians and general neurologists can use to initiate primary prevention conversations with their patients about cognitive decline. Few resources address steps that clinicians can take in their routine care to help patients reduce risk. Some relevant resources provide excellent guidance but tend to be more focused on early detection or slowing disease progression rather than primary prevention. The Risk Reduction Workgroup (RRWG) was convened to help address the need for clinicians to know how to discuss cognitive decline with their patients. The workgroup aligned on 11 recommendations for primary care clinicians and general neurologists. In addition the RRWG provide considerations for implementing the recommendations in clinical practice. The recommendations are mindful of social determinants of health, account for cultural differences, and are designed for general accessibility. This effort is part of a broader initiative by UsAgainstAlzheimer’s to address risk-reduction for cognitive decline and early interventions. Under the guidance of a multidisciplinary Provider Leadership Group consisting of representatives from some of the nation's largest health provider serving organizations, three independent workgroups are developing guidance and tools to assist providers in their clinical practice and improve health outcomes for patients at-risk for Alzheimer's and related dementias.

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INTERVENTIONS TO PREVENT COGNITIVE DECLINE AND DEMENTIA IN ADULTS WITHOUT COGNITIVE IMPAIRMENT: A SYSTEMATIC REVIEW

Journal of Prevention of Alzheimer's Disease ◽

10.14283/jpad.2015.36 ◽

2015 ◽

pp. 1-8

Author(s):

J.C. Barnett ◽

A. Bahar-Fuchs ◽

N. Cherbuin ◽

P. Herath ◽

K.J. Anstey

Keyword(s):

Cognitive Impairment ◽

Primary Prevention ◽

Cognitive Decline ◽

Cochrane Library ◽

Pharmacological Interventions ◽

Dementia Incidence ◽

Reduce Risk ◽

Randomised Controlled ◽

The Cochrane Library

Without preventative strategies, the burden of dementia is likely to increase rapidly worldwide. Primary prevention approaches involve modifying risk factors before symptoms of cognitive impairment develop. This review systematically assesses Randomised Controlled Trials (RCTs) and reviews of RCTs for their effectiveness in primary prevention. We searched Medline, the Cochrane Library, Web of Science and Psych-Info for relevant studies using pre-determined keywords. Both non-pharmacological and pharmacological interventions were considered. Inclusion criteria were sample size greater or equal to 50, at least 6 months of follow-up, and participants with no cognitive impairment at baseline. Outcomes included dementia incidence, cognitive decline and cognitive function. Study quality was rated using the Jadad criteria. Thirty-nine studies, 17 non-pharmacological and 22 pharmacological, were included. Results were heterogeneous across interventions and studies, with few significant effects. Studies investigating physical activity and calcium channel blocker treatment demonstrated significant effects in preventing cognitive decline. There were no conclusive results demonstrating overall capacity of assessed interventions to reduce risk of dementia. The review provides an overview of the current literature, and identifies areas in need of further research.

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Activity Engagement in Cognitive Aging: A Review of the Evidence

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld23.1.35 ◽

2013 ◽

Vol 23 (1) ◽

pp. 1-12 ◽

Cited By ~ 2

Author(s):

Yvonne Rogalski ◽

Muriel Quintana

Keyword(s):

Older Adults ◽

Cognitive Decline ◽

Cognitive Aging ◽

Social Activity ◽

Current Evidence ◽

Omega 3 ◽

Neuroprotective Effects ◽

Activity Engagement ◽

Age Related ◽

Age Related Cognitive Decline

The population of older adults is rapidly increasing, as is the number and type of products and interventions proposed to prevent or reduce the risk of age-related cognitive decline. Advocacy and prevention are part of the American Speech-Language-Hearing Association’s (ASHA’s) scope of practice documents, and speech-language pathologists must have basic awareness of the evidence contributing to healthy cognitive aging. In this article, we provide a brief overview outlining the evidence on activity engagement and its effects on cognition in older adults. We explore the current evidence around the activities of eating and drinking with a discussion on the potential benefits of omega-3 fatty acids, polyphenols, alcohol, and coffee. We investigate the evidence on the hypothesized neuroprotective effects of social activity, the evidence on computerized cognitive training, and the emerging behavioral and neuroimaging evidence on physical activity. We conclude that actively aging using a combination of several strategies may be our best line of defense against cognitive decline.

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The Use of Neuroplastic Principles Affects the Swallow Motor Plan of a Patient in Severe Cognitive Decline: A Case Study

Perspectives of the ASHA Special Interest Groups ◽

10.1044/persp1.sig15.79 ◽

2016 ◽

Vol 1 (15) ◽

pp. 79-83

Author(s):

Ed Bice ◽

Kristine E. Galek

Keyword(s):

Central Nervous System ◽

Cognitive Decline ◽

Full Range ◽

Movement Speed ◽

Positive Outcomes ◽

Verbal Cues ◽

Motor Plan ◽

Bolus Size ◽

The Central Nervous System

Dysphagia is common in patients with dementia. Dysphagia occurs as a result of changes in the sensory and motor function of the swallow (Easterling, 2007). It is known that the central nervous system can undergo experience-dependent plasticity, even in those individuals with dementia (Park & Bischof, 2013). The purpose of this study was to explore whether or not the use of neuroplastic principles would improve the swallow motor plan and produce positive outcomes of a patient in severe cognitive decline. The disordered swallow motor plan was manipulated by focusing on a neuroplastic principles of frequency (repetition), velocity of movement (speed of presentation), reversibility (Use it or Lose it), specificity and adaptation, intensity (bolus size), and salience (Crary & Carnaby-Mann, 2008). After five therapeutic sessions, the patient progressed from holding solids in her mouth with decreased swallow initiation to independently consuming a regular diet with full range of liquids with no oral retention and no verbal cues.

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