anticholinergic drugs, dementia, Alzheimer's, cognitive decline, preventing dementia

The prospect of dementia is just as frightening to many people as the possibility of a cancer diagnosis. With the population aging, increasing numbers of Americans will suffer from Alzheimer disease. Millions of us are interested in preventing dementia. This week there is conflicting news on whether and how we might reduce our risk.

Bad News on Preventing Dementia:

A series of meta-analyses looked at randomized studies and found little solid evidence of any interventions that prevent dementia. The authors examined data from drug trials as well as research on supplements and brain games. They also looked at studies of physical activity, such as tai chi.

One author concluded, “there’s no magic bullet.” That said, they did find some evidence that combining cognitive training, physical activity and a healthful diet might slow cognitive decline.

Quality of Studies:

Part of the problem is that too many of the studies on preventing dementia are not of the highest quality. The researchers note of the studies of drugs to delay dementia that they are limited due to “High attrition, short follow-up, inconsistent cognitive outcomes, and possible selective reporting and publication.” The studies of physical and mental training exercises and those of dietary supplements have similar flaws, if not worse.

All three reviews were published in the Annals of Internal Medicine, Dec. 19, 2017:

Fink et al, Annals of Internal Medicine, Dec. 19, 2017 (Drugs)

Brasure et al, Annals of Internal Medicine, Dec. 19, 2017 (Exercise)

Butler et al, Annals of Internal Medicine, Dec. 19, 2017 (OTC supplements)

Butler et al, Annals of Internal Medicine, Dec. 19, 2017 (Brain training)

These reviews were requested by the Agency for Healthcare Research and Quality and the National Institute on Aging.

A More Hopeful Outlook on Preventing Dementia:

A different review conducted for The Lancet Commission on Dementia Prevention, Intervention, and Care found that several common-sense health approaches can make a difference in the risk of dementia. Getting a good education in childhood reduces the risk by 8 percent. Not smoking, controlling weight, getting regular exercise, social interaction and blood sugar control all are important as people grow older, even if no one factor stands alone.

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