Dementia Prevention Information Is Confusing

Part of the responsibility of being a physician is keeping up with the medical literature. I subscribe to numerous print and on line journals and read volumes each day. My professional email is littered with summaries of journals. As the baby boomers age and 10,000 of them are enrolled in Medicare per day the emphasis on preventing and treating cognitive impairment leads to volumes of studies and reports daily. To say it is confusing is an understatement.

A recent report from the National Academies of Sciences, Engineering and Medicine has painted a more optimistic picture of potential interventions in its current report as compared to its 2010 report. In the 2010 report they had nothing to be positive about. In the current report that negativism has changed to “inconclusive but encouraging “evidence of staving off cognitive decline. Within the geriatric care community this group’s opinion is still contested by the National Institute of Aging and the Agency for Healthcare Research and Quality but the National Academy of Sciences felt it was appropriate to share its findings with the rest of us. They believe there is moderate evidence to support being active as something that we can do to stave off cognitive dysfunction. They are not asking us to become marathon runners or tri-athletes but just get up and keep moving for ninety minutes a day. There is additionally fairly good evidence that controlling our blood pressure especially during mid-life will help your chances of avoiding dementia. The most controversial area was whether cognitive training with brain teasers, puzzles, learning a new language is of value. I will advise my patients that if they can find a cognitive training activity they enjoy then they should pursue it because it certainly will not hurt. The paper did not address issues which we know are important to control such as avoiding smoking or excessive alcohol of narcotic intake.

At the same time that the National Academy of Sciences was offering a small ray of hope we see articles on artificially sweetened drinks being associated with increased risk of dementia. Add common medications like proton pump inhibitors (Nexium, Protonix, and Pepcid) and overactive bladder medicines to the list of drugs that can increase your risk of dementia. We also can add the cholesterol lowering medications called statins to the list of drugs that can increase your risk of dementia but primarily in inactive individuals.

The information is non-stop and it is never ending. A few years ago I attended a lecture by the head of one of the Harvard Medical School’s Geriatric Programs. The speaker was a family practitioner in her fifties or sixties who stressed the importance of getting plenty of exercise, eating in moderation, cultivating and maintaining relationships with friends, avoiding smoking, controlling your blood pressure and blood sugar and playing “ brain games” if you enjoyed them . It seems that with the latest publication of the National Academies of Sciences, Engineering and Medicine, not much has changed since then.

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