Neurology Practice Changers 2014

Bret S. Stetka, MD; Andrew N. Wilner, MD

Disclosures

December 08, 2014

In This Article

Dementia

Slowly but surely, progress is being made in determining ways to slow or delay cognitive decline. In the absence of disease-modifying therapies for dementia, a large body of data support lifestyle interventions and modifications as a means of working toward real, measurable improvements.

A study[22] published this past June in Alzheimer's and Dementia looked at the relationship between fish oil supplementation and indicators of cognitive decline in both healthy patients and those with mild cognitive impairment. Primary outcomes included global cognitive status and hippocampus, gray matter, cerebral cortex, and ventricular volumes. Taking fish oil supplements was associated with less brain atrophy and significantly attenuated cognitive decline per the Alzheimer's Disease Assessment Scale and the Mini-Mental State Examination (MMSE) in APOE-e–negative persons without normal cognition at baseline.

Work in rodents[23] published not long after in PLoS One reported that among rats exposed to high levels of alcohol, those given the omega-3 compound docosahexaenoic acid (DHA) experienced 90% less neuronal death and 90% less neuroinflammation than those not given DHA. The findings suggest that more research into the potential protective effects of fish oil against alcohol-related brain damage is warranted.

Evidence also continues to mount on the positive effects of the Mediterranean diet on cognition. A 2013 study[24] published in the Journal of Neurology, Neurosurgery, and Psychiatry reported that consumption of a Mediterranean dieted supplemented with extra-virgin olive oil or mixed nuts is associated with significantly improved MMSE scores. A Finnish study[25] found that persons who made healthy midlife dietary choices—many of which overlap with Mediterranean dietary patterns—had an almost 90% lower risk for dementia at 14-year follow-up; diets high in saturated fats, on the other hand, were associated with lower cognitive function at 21-year follow-up and an increased risk of being diagnosed with mild cognitive impairment (MCI).

Finally, exercise appears to be one of the most promising lifestyle-based approaches to dementia. Building on previous research, work[26] presented this year at the Alzheimer's Association International Conference 2014 found that mild, moderate, or vigorous midlife physical activity appears to protect cognitively normal adults from developing MCI, and those with MCI from progressing to dementia.

The current evidence base suggests that a variety of risk factors, many of which are lifestyle-related, contribute to dementia. A group at the University of California, San Francisco,[27] attributes up to one half of AD cases to the collective influence of diabetes, midlife hypertension, midlife obesity, smoking, depression, cognitive inactivity, and low physical activity. As Gary W. Small, MD, Parlow-Solomon Professor on Aging and professor of psychiatry and biobehavioral sciences at the David Geffen School of Medicine at UCLA, commented to Medscape earlier this year, in all likelihood a multipronged approach to dementia involving nutritional, physical exercise, and stress management components can effectively combat age-related cognitive decline. Relatedly, "There is more interest in these risk factors, so while we are waiting for science to catch up and find disease-modifying treatments, we should encourage our patients to live healthy lifestyles."

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