MODERN TREATMENTS FOR DEMENTIA: A CALL FOR PREVENTION

Incidence

Evidence suggests that the prevalence of dementia in Western industrialised nations in individuals over the age of 70 is nearly 15 per cent (Carvalho et al., 2014). The prevalence of Alzheimer’s is just slightly less, with about one in 10 individuals (i.e., 10 per cent) over the age of 70 with this disease. Some modern research suggests that dementia prevention is comprised of three phases, including primary, secondary and tertiary prevention (Glynn et al., 2016). The identification of phases of dementia has been useful in predicting severity and determining onset (Glynn et al., 2016).

Predictors of Dementia

A recent review of dementiaand lifestyle factors that predict this condition revealed that dementia was significantly predicted by stress, substance abuse, low physical activity and diet (Wadd et al., 2014). Genetics also play a strong role in the risk of dementia, and there is currently no known preventative strategy to modify the risk of dementia based on genetic history (Bauman et al., 2016). Genetic therapy represents a promising in vivo procedure for potentially managing dementia (Bauman et al., 2016). However, this approach to managing and/or preventing dementia is still in development and modifiable lifestyle factors still represent the most impactful means of dementia prevention (Bauman et al., 2016).

Stress Management

Psychosocial stress appears to be the strongest predictor of dementia (Lincoln et al., 2014; Wadd et al., 2014). Research has shown that high levels of psychological, social and environmental stress are each predictive of dementia in healthy adults (Lincoln et al., 2014). Stress plays a clear role in the manifestation of dementia in those with genetic suscpetiability to this disease, as well as the long-term physiological damage caused by stress-induced chemicals (e.g., cortisol) on the brain (Ataollahi et al., 2014). Dementia results from both biological and environmental factors that adversely impact emotional health and psychophysiological functioning (Ataollahi et al., 2014; Patel et al., 2016). Recent research has found that reducing stress significantlylowers the population-wide risk of dementia(Lincoln et al., 2014). Therefore, any cognitive, behavioural or physical activity intervention that promotes relaxation and self-management of mood and affect is useful in combatting this condition. Examples include yoga, Tai Chi, massage, aromatherapy and art therapy (Ataollahi et al., 2014).

Social Support

Social support has recently been found to be an important predictor of emotional health and dementia in elderly population members within the UK (Leung, Orrell&Oregeta, 2015;Clarkson et al., 2016). Research has shown that meeting social support needsare important for promoting proper physical care in patients with dementia or high risk for this disease (Patel et al., 2016). The effects of social support on mental health outcomes have become increasingly documented in empirical research (Clarkson, et al., 2016).

Physical activity

A growing body of evidence has found support for the role of physical activity in preventing or delaying the onset of dementia (Forbes et al., 2014;Stubbs et al., 2014; Clarkson et al., 2016). A recent meta-analysis of intervention studies and cohorts found that systematic and consistent engagement in physical activity was associated with a relative risk reduction of 0.65 for cognitive decline and 0.86 for dementia (Blondell, Hammersley-Mather, &Veerman, 2014). These improvements in cognitive functioning due to physical activity are believed to be caused by a range of factors, including the regulation of neurochemicals that stimulate cognitive functioning, greater blood and oxygen flow throughout the brain and even psychological factors like improved confidence, self-esteem and social support/coping (Forbes et al., 2014). Finally, physical activity reduces stress, which is a significant predictor of dementia (Stubbs et al., 2014).

Dietary factors

Instead of medications, many therapists/doctors are now turning to dietary strategies and alternative medicine to combat dementia due to increased documentation of nutritional factors contributing this disease (Ngandu et al., 2015). Vitamin E, omega-3 fatty acids and gingko have all been clinically proven to be effective in delaying the onset of dementia (Ngandu et al., 2015). Some debate exists about the validity of existing research on these substances, although nutritional supplements appear to be beneficial as complements to medically based therapies in clinical management of dementia and potentially longitudinally beneficial in the prevention of this disease (Polidori& Schulz, 2014).

Avoidance of substance abuse

Substance abuse has been linked to early onset dementia in recent research (Beydoun et al., 2014; Wadd et al., 2014). Additionally, substances have been shown to strongly and positively relate to dementia outcomes within the UK (Fineberg et al., 2013). Subjects with higher rates of substance abuse, including alcohol, tobacco, and marijuana, have been shown to possess higher rates of dementia (Clarkson et al., 2016). Long-term alcohol use and abuse has deleterious effects on brain tissue, leading to impaired cognitive functioning (Leung et al., 2015). The biopsychological effects of alcohol on the brain work in the reserve of psychophysiological development, with the prefrontal cortex first affected and then subsequent areas of the brain that regulate decision making and daily functioning (Fineberg et al., 2013). These effects lead to memory loss, cognitive delay, slower and less accurate neuromuscular functioning and reduced ability to regulate mood and affect (Fineberg et al., 2013).

Conclusion

The purpose of this paper was to discuss modern approaches to preventing and treating dementia. Dementia is a complex medical and psychological condition that requires a multidimensional approach to treatment. Recent studies have found that medication may not be as effective as alternative therapies, such as diet and stress management. A growing trend in prevention research toward prevention has led to greater education and awareness of the risk factors for dementia and a cultural shift toward long-term healthy lifestyles to delay the onset of dementia or preclusion of its occurrence.

References

AtaollahiEshkoor, S., Hamid, T.A., Hassan Nudin, S.S.A. and Yoke Mun, C., 2014. Does substance abuse contribute to further risk of falls in dementia. Aging, Neuropsychology, and Cognition, 21(3), pp. 317-324.

Bauman, A., Merom, D., Bull, F.C., Buchner, D.M. and Singh, M.A.F., 2016. Updating the evidence for physical activity: summative reviews of the epidemiological evidence, prevalence, and interventions to promote “Active Aging”. The Gerontologist, 56(Suppl 2), pp.S268-S280.

Beydoun, M.A., Beydoun, H.A., Gamaldo, A.A., Teel, A., Zonderman, A.B. and Wang, Y., 2014. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health, 14(1), p.1. DOI: 10.1186/1471-2458-14-643.

Blondell, S.J., Hammersley-Mather, R. and Veerman, J.L., 2014. Does physical activity prevent cognitive decline and dementia?: A systematic review and meta-analysis of longitudinal studies. BMC Public Health, 14(1), p.1. DOI: 10.1186/1471-2458-14-510.

Carvalho, A., Rea, I.M., Parimon, T. and Cusack, B.J., 2014. Physical activity and cognitive function in individuals over 60 years of age: a systematic review. Journal of Clinical Interventions in Aging, 9, 661-682.

Clarkson, P., Giebel, C.M., Larbey, M., Roe, B., Challis, D., Hughes, J., Jolley, D., Poland, F. and Russell, I., 2016. A protocol for a systematic review of effective home support to people with dementia and their carers: components and impacts. Journal of Advanced Nursing, 72(1), pp.186-196.

Fineberg, N.A., Haddad, P.M., Carpenter, L., Gannon, B., Sharpe, R., Young, A.H., Joyce, E., Rowe, J., Wellsted, D., Nutt, D. and Sahakian, B.J., 2013. The size, burden and cost of disorders of the brain in the UK. Journal of Psychopharmacology. DOI: 0269881113495118.

Forbes, D., Thiessen, E.J., Blake, C.M., Forbes, S.S. and Forbes, S., 2014. Exercise programs for people with dementia. Sao Paulo Medical Journal,132(3), pp.195-196.

Glynn, R.W., Dolan, C., Shelley, E. and Lawlor, B., 2016. Evidence-based prevention and treatment of dementia. The Lancet Neurology, 15(10), pp.1006-1007.

Leung, P., Orrell, M. and Orgeta, V., 2015. Social support group interventions in people with dementia and mild cognitive impairment: a systematic review of the literature. International Journal of Geriatric Psychiatry, 30(1), pp.1-9.

Lincoln, P., Fenton, K., Alessi, C., Prince, M., Brayne, C., Wortmann, M., Patel, K., Deanfield, J. and Mwatsama, M., 2014. The Blackfriars Consensus on brain health and dementia. The Lancet, 383(9931), pp.1805-1806.

Ngandu, T., Lehtisalo, J., Solomon, A., Levälahti, E., Ahtiluoto, S., Antikainen, R., Bäckman, L., Hänninen, T., Jula, A., Laatikainen, T. and Lindström, J., 2015. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. The Lancet, 385(9984), pp.2255-2263.

Patel, V., Chisholm, D., Parikh, R., Charlson, F.J., Degenhardt, L., Dua, T., Ferrari, A.J., Hyman, S., Laxminarayan, R., Levin, C. and Lund, C., 2016. Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet, 387(10028), pp.1672-1685.

Polidori, M.C. and Schulz, R.J., 2014. Nutritional contributions to dementia prevention: main issues on antioxidant micronutrients. Genes & Nutrition,9(2), pp.1-11.

Stubbs, B., Eggermont, L., Soundy, A., Probst, M., Vandenbulcke, M. and Vancampfort, D., 2014. What are the factors associated with physical activity (PA) participation in community dwelling adults with dementia? A systematic review of PA correlates. Archives of Gerontology and Geriatrics,59(2), pp.195-203.

Wadd, S., Randall, J., Thake, A., Edwards, K., Galvani, S., McCabe, L. and Coleman, A., 2014. Alcohol misuse and cognitive impairment in older people: An exploratory study. Alcohol. [online] Available at: https://alcoholresearchuk.org/alcohol-insights/alcohol-misuse-and-cognitive-impairment-in-older-people-an-exploratory-study/. Accessed 26 Aug 2016


 

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