Alzheimer disease and other types of dementia are among the most common and feared conditions of older people. According to the CDC, nearly six million American currently suffer from on of these disorders. By 2060, experts project about 14 million people will have a diagnosis of Alzheimer disease. Needless to say, they do not deteriorate all by themselves. When a family member cannot function, the entire family, if they have one, suffers. That is why we are interested in ways to lower risk for dementia.
How Can You Achieve a Lower Risk for Dementia?
Until now, there have been no effective medications to reverse cognitive decline. The new FDA-approved anti-amyloid medications may slow deterioration modestly, but they don’t change the overall trajectory of dementia. We worry that these very pricy pharmaceuticals could leave too many older adults worse off rather than better. Consequently, we were pleased to read about a pilot study demonstrating that addressing multiple risk factors can reduce a person’s chances of cognitive decline.
What the Scientists Did:
Researchers from UCSF and Kaiser Permanente tested a personalized risk reduction program (JAMA Internal Medicine, Nov. 27, 2023). To do this, they recruited 172 older people who were at risk for cognitive dysfunction. Half the group was assigned to a health education program as controls during the two-year study. The other half got personalized coaching to improve their existing risk factors. Each person in the intervention group chose the risk factors for special focus.
What Risk Factors Did the Intervention Address?
In this trial, researchers helped each of the 82 persons in the intervention group address the specific risk factors relevant to them. People with two or fewer risk factors did not participate in the study. Neither did those who already had dementia or who lived in a skilled nursing facility. A health coach and a nurse interacted with the each volunteer every four to six weeks to set goals. They also monitored participants’ progress toward a lower risk for dementia.
People with a sedentary lifestyle are more likely to develop dementia. Health coaches helped individuals who chose to increase their physical activity sign up for exercise classes or work on increasing their step count.
When blood pressure frequently runs too high, people have a higher chance of cognitive decline. Those who had uncontrolled hypertension interacted with the study nurse every three months to adjust medications. The study also provided them with portable blood pressure monitors so that they could track their own responses.
Brains need sleep to function well. Poor sleep puts older individuals at risk for cognitive problems. Health coaches helped study volunteers who were not sleeping well to find ways of consistently improving their sleep.
We were disappointed to read that fewer than a fourth of the participants focused on reducing medications that have an adverse effect on cognition. Study nurses helped those who did want to reduce unhelpful medicines identify them and interacted with their doctors for the deprescribing process. This underappreciated approach has the potential to make a significant difference for many senior citizens.
Untreated depression interferes with cognitive capacity. Sometimes physicians diagnose depressed older people as having dementia although treating the depression may restore thought processes and memory. Health coaches and nurses worked together to help volunteers who chose to focus on treating their depression.
Improving blood sugar control can benefit the brain. Although fewer than 25% of the study volunteers chose to address this risk factor, nurses helped those who wished to do so. As a result, these individuals achieved significantly better blood glucose management.
Social isolation is an important risk factor for cognitive deterioration. Health coaches helped volunteers find ways to increase their social interactions. Consequently, people in the intervention group indicated better satisfaction with social activities at the end of the study.
Fewer than 10% of the volunteers were smokers at the outset of the study. Thus, it is no surprise that fewer than 25% chose to quit smoking or cut back on cigarettes.
Did Changing These Risk Factors Result in Lower Risk for Dementia?
The investigators administered a battery of cognitive tests to each participant at the beginning of the study and 6, 12, 18 and 24 months later. They calculated a composite cognitive score from the results. All the participants increased their scores, likely due to a practice effect. However, those who had worked to reduce their risk factors improved more. Although the absolute difference was modest, it was statistically significant. (The relative improvement is impressive: these folks did 74% better than those in the control group.)
Volunteers in the intervention portion of the study addressed 3.5 risk factors, on average, in the course of two years. The scientists concluded that this multidomain intervention led to a lower risk for dementia and improved quality of life.