23 Jun 2017
Of all the diseases that afflict people in old age, people fear Alzheimers most. How can they protect themselves? A report from the National Academies of Science, Engineering, and Medicine (NASEM) acknowledges some possible steps, but stops short of issuing concrete recommendations. They base their report on a thorough review of the literature that finds modest but inconclusive evidence that cognitive training, blood pressure management, and regular physical activity prevent or delay cognitive decline. However, the data are still too weak to issue specific guidelines to the general public, wrote the committee of senior scientists led by Alan Leshner, CEO emeritus of the American Association for the Advancement of Science, and Story Landis, director emeritus of the National Institute of Neurological Disorders andStroke.
The evidence has not yet matured to the level that would support an assertive public health campaign, the authors wrote. However, the report does identify those interventions, supported by some evidence of benefit, that should be discussed with [people] who are actively seeking advice on steps they can take to maintain brain health as theyage.
Its a very balanced report that truly reflects the level of evidence currently available, said Edo Richard, Radboud University, Nijmegen, Netherlands, who did not contribute to the reportapartfrom presenting ata workshopthat helped inform it.We should always be open and honest with patients and the general public, so cannot tell people that by doing this they will prevent cognitive decline. We do notknow.
An NIH report in 2010 argued that there wasnt sufficient evidence to recommend any intervention to prevent cognitive decline or dementia (see May 2010 news). Since then, researchers have published more clinical trials, and have chipped away at the mechanisms underlying dementia pathology. In 2015, the National Institute on Aging commissioned the Agency for Healthcare Research & Quality (AHRQ) to review the latest evidence on prevention and write a reporton what they found. The NIA then asked the NASEM to put together a committee of experts to review the report and make recommendations for public health messaging and futureresearch.
Based on the AHRQ report, the NASEM committee highlights three areas where evidence is encouraging but inconclusive. The first is cognitive training, where a large, 10-year, randomized trial called ACTIVE (Advanced Cognitive Training for Independent and Vital Elderly) provided modest evidence that over time, an interactive intervention improved long-term cognitive function and helped people stay independent in their daily activities, provided they started out with normal cognition. No evidence yet suggests that training helps prevent or delay mild cognitive impairment or Alzheimers disease, theywrote.
Blood pressure control in midlife may also be helpful. Treating hypertension prevents stroke and cardiovascular diseaseboth risk factors for ADand a majority of dementia patients have some sign of these. Though clinical trial results disagree, prospective cohort studies and understanding of the cerebrovascular contribution to disease mechanisms suggest that controlling blood pressure could be protective. These authors deem this enough evidence to suggest careful management of blood pressure as a way to prevent, slow, or delayAlzheimers.
Lastly, they point to exercise as a possible protective factor. Many, but not all, clinical trials suggest it can reduce age-related cognitive decline. Positive trials take added support from prospective cohort studies and known biological mechanisms underpinningAlzheimers.
Leshner and colleagues suggest this information be featured on the NIH website and other publicly accessible outlets. That way, it can inform people who are interested in bettering their chances of healthy brain aging. They also support clinicians working cognitive benefits into their patient conversations when they prescribe these interventions for other conditions. Even so, the evidence remains too weak to warrant a broad-based public health campaign, the authors said. Richard brought up the added argument that since many of these studies, particularly the randomized controlledtrials, sample from selected populations, its questionable whether their results would generalize to the public atlarge.
How can researchers build a stronger case for prevention? More and better-quality randomized controlled trials, the committee wrote. Consistent results in those would increase their confidence. They recommend that the National Institutes of Health invest more money in this type of research. They also urge researchers to compare different types of cognitive training, blood pressure therapy, and exercise, to see which are most effective. In addition, studies must include more diverse racial, ethnic, and socioeconomic groups; studies should start when people are younger and follow them longer. Incorporating biomarkers could greatly improve these trials, they wrote. Recruiting people at higher risk for decline is also important, as is harmonizing cognitive outcomes across studies so scientists can poolresults.
Aside from the three interventions recommended in this report, the authors suggest scientists conduct randomized controlled trials on additional interventions that are supported by either observational and risk-factor studies or that make sense biologically. Possibilities include new anti-dementia, diabetes, depression, or lipid-lowering treatments; sleep and social-engagement interventions; and vitamin B12 plus folic acid supplements. The authors call out hormone replacement therapy, vitamin E, and gingko biloba as having no evidence ofbenefit.
The report can be download for free, though email registration is required.Gwyneth DickeyZakaib
No Available Comments
To make a comment you must login or register.
Continue reading here:
Preventing Dementia: Getting Closer to Recommendations - Alzforum
- Bio Identical Hormone replacement therapy "alternative medicine" OMT - June 1st, 2010 [June 1st, 2010]
- Healthbeat - Hormone Replacement Therapy - August 5th, 2010 [August 5th, 2010]
- Does Hormone Replacement Therapy increase breast cancer risks? - August 11th, 2010 [August 11th, 2010]
- Hormone replacement therapy increases risk of cancer - October 20th, 2010 [October 20th, 2010]
- Hormone Replacement Therapy Risky For Women - October 20th, 2010 [October 20th, 2010]
- Can Hormone Replacement Therapy Lead To Breast Cancer? - January 31st, 2011 [January 31st, 2011]
- Women Turning To Holistic Hormone Replacement Therapy - February 18th, 2011 [February 18th, 2011]
- Is Hormone Replacement Therapy Dangerous? - March 17th, 2011 [March 17th, 2011]
- Hormone Replacement Therapy Complications - May 8th, 2011 [May 8th, 2011]
- Hormone Replacement Therapy - May 10th, 2011 [May 10th, 2011]
- The New Growth Hormone Replacement Therapy - John Crisler, DO - May 13th, 2011 [May 13th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 2 of 6 - May 20th, 2011 [May 20th, 2011]
- Symptoms of Menopause (Menopause #2) - May 20th, 2011 [May 20th, 2011]
- How to Relieve Menopause Symptoms : Hormonal Replacement Therapy for Menopause - May 20th, 2011 [May 20th, 2011]
- HRT - Hormone Replacement Therapy - May 20th, 2011 [May 20th, 2011]
- What is hormone replacement therapy? - May 20th, 2011 [May 20th, 2011]
- Hormone Replacement Therapy and Breast Cancer - May 20th, 2011 [May 20th, 2011]
- Natural Treatments Instead of Hormone Replacement Therapy - May 20th, 2011 [May 20th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 1 of 6 - May 23rd, 2011 [May 23rd, 2011]
- Hormone Replacement Therapy for post-menopausal women - June 19th, 2011 [June 19th, 2011]
- Joe Rogan talking about hormone replacement therapy 6-14-2011 - June 25th, 2011 [June 25th, 2011]
- Hormone Replacement Therapy and Weight - June 25th, 2011 [June 25th, 2011]
- HRC Hormone Replacement Therapy - June 25th, 2011 [June 25th, 2011]
- Study Hormone Replacement Therapy Increases Breast Cancer Risk - kdka.com - June 25th, 2011 [June 25th, 2011]
- 020 - Neo Hormones - July 1st, 2011 [July 1st, 2011]
- Making Sense of Hormone Replacement Therapy - July 28th, 2011 [July 28th, 2011]
- HRT MTF Transition Report Week 10 - July 29th, 2011 [July 29th, 2011]
- Hormone Replacement - Part 2 - July 30th, 2011 [July 30th, 2011]
- Hormone Replacement - Part 1 - July 30th, 2011 [July 30th, 2011]
- Goldie Lookin Chain - HRT - August 9th, 2011 [August 9th, 2011]
- Natural Hormone Replacement Therapy - September 23rd, 2011 [September 23rd, 2011]
- Testosterone Replacement Therapy (TRT): Optimizing Clinical Outcomes - Michael Aziz, MD - September 24th, 2011 [September 24th, 2011]
- Thyroid Replacement Therapy - Ronald Rothenberg, MD - September 24th, 2011 [September 24th, 2011]
- Dr. Ralph Turner discusses Hormone Replacement Therapy. - September 24th, 2011 [September 24th, 2011]
- 1 year on HRT - September 24th, 2011 [September 24th, 2011]
- The Wiley Protocol - September 24th, 2011 [September 24th, 2011]
- My Journal with Low Testosterone TRT Replacement Therapy - September 24th, 2011 [September 24th, 2011]
- 12 years of HRT: My Transition in photos - September 24th, 2011 [September 24th, 2011]
- Dr. Steven Jepson talks about Bio-identical Hormone Replacment Therapy - September 25th, 2011 [September 25th, 2011]
- Estradiol Valerate Injection HRT (Part 3)of(3) - September 25th, 2011 [September 25th, 2011]
- Study: Post-Menopausal Hormone Therapy Increases Cancer Risk - September 25th, 2011 [September 25th, 2011]
- Bio-identical Hormone Replacement (anti-aging) Therapy - Westchase, Tampa, Florida - September 25th, 2011 [September 25th, 2011]
- natural hormone replacement - September 28th, 2011 [September 28th, 2011]
- 6 Month Hormone Effects (before and after) - September 28th, 2011 [September 28th, 2011]
- Jeff Life, MD - Cenegenics, Hormone Replacement Therapy - September 29th, 2011 [September 29th, 2011]
- Huge - September 30th, 2011 [September 30th, 2011]
- Transsexual hormones,Intramuscular injection, Progynon Depot,Estradiol - October 2nd, 2011 [October 2nd, 2011]
- Dr Whiting on Menopause and the Dangers of HRT - October 12th, 2011 [October 12th, 2011]
- Ahuviya Harel (ADF-Fuensalida) to Start Hormone Replacement Therapy - October 13th, 2011 [October 13th, 2011]
- Clomid Defined - Video - October 14th, 2011 [October 14th, 2011]
- Thyroid Hormone Replacement Therapy - Dr. Denis Rebic - Video - October 14th, 2011 [October 14th, 2011]
- Hormone Replacement Therapy - Video - October 14th, 2011 [October 14th, 2011]
- Dr. Pamela Smith - Bio-Identical Hormone Replacement - Video - October 15th, 2011 [October 15th, 2011]
- Jasper Carrott - Traffic - October 22nd, 2011 [October 22nd, 2011]
- VIDEO: Breast Cancer, Hormone Replacement Therapy Connection - Video - October 24th, 2011 [October 24th, 2011]
- Menopause and Hormone Replacement Therapy with Dr. Sulak - Video - October 24th, 2011 [October 24th, 2011]
- Menopause - October 24th, 2011 [October 24th, 2011]
- bio identical hormone replacement therapy raleigh durcham chaepl hill north carolina - Video - October 24th, 2011 [October 24th, 2011]
- Endocrine Related Hair Loss, Can Hormone Replacement Therapy Help Treat This? Friedman - Video - October 24th, 2011 [October 24th, 2011]
- Dr. Navarro Discusses Bio Identical Hormone Replacement Therapy - Video - October 24th, 2011 [October 24th, 2011]
- Hormone Replacement Therapy by the Book - Eldred Taylor, MD - Video - October 24th, 2011 [October 24th, 2011]
- Sangeeta Pati, MD, FACOG, discusses Hormone Replacement - Video - October 24th, 2011 [October 24th, 2011]
- Active Center's Dr. Gross Discusses Bio-Identical Hormone Replacement Therapy on NEWS 12 NJ - Video - October 28th, 2011 [October 28th, 2011]
- DALLAS ANTI-AGING MEDICINE BIO-IDENTICAL HORMONE THERAPY - Video - October 29th, 2011 [October 29th, 2011]
- Hormone Replacement Therapy and Menopause in Women - Video - November 8th, 2011 [November 8th, 2011]
- Amberen - Natural HRT Alternative Commercial - Video - November 9th, 2011 [November 9th, 2011]
- The Dangers of HRT - Video - November 11th, 2011 [November 11th, 2011]
- The Benefits and Risks of Male Hormone Replacement Therapy - Video - November 16th, 2011 [November 16th, 2011]
- Natural Menopause Treatment - Herbal HRT Alternative - Video - November 23rd, 2011 [November 23rd, 2011]
- Dr. Ian Thorneycroft - Hormone Replacement Therapy - Video - November 24th, 2011 [November 24th, 2011]
- Sarah,MTF Transgender 3months HRT - Video - November 24th, 2011 [November 24th, 2011]
- 26. ftm 1 month on t - Video - November 24th, 2011 [November 24th, 2011]
- Dr. Quint Jardine - Hormone Replacement Therapy with Pellets - Video - November 24th, 2011 [November 24th, 2011]
- 6 Month Changes MTF HRT - Video - November 24th, 2011 [November 24th, 2011]
- Medical Mondays: Will hormone replacement therapy increase my risk of breast cancer? - Video - December 6th, 2011 [December 6th, 2011]
- HRT EXPERIENCES NOT ALL GOOD - Video - December 8th, 2011 [December 8th, 2011]
- Sarah, MTF transgender 9 months HRT - Video - December 9th, 2011 [December 9th, 2011]
- Full: Effect of Testosterone Replacement Therapy on Prostate Tissue in Men with Late-Onset Hypogonadism (Dramatic Health) - Video - December 10th, 2011 [December 10th, 2011]
- Suzanne Somers on hormone therapy for menopause, part 3 of 6 - Video - December 11th, 2011 [December 11th, 2011]
- 1 Year HRT MTF Transition - Video - December 12th, 2011 [December 12th, 2011]