Dementia: Inevitable or Preventable?

Introduction
Dementia is a degenerative cognitive health issue that primarily affects the elderly population and is characterized by “impairments in cognitive and intellectual ability, memory, language, reasoning, and judgment,” all of which interfere with the individual’s ability to function in everyday life (Agency for Healthcare Research and Quality, 2014). The two most common forms of dementia are Alzheimer’s Disease and vascular dementia (Livingston et al., 2017). While not much is known about the etiology of dementia other than that it is related to cellular damage in the brain, there has been some success in identifying possible ways to prevent it. This paper will define dementia, its manifestations and types, discuss three research articles that deal with preventing dementia, and provide suggestions for future research on this topic.
Defining Dementia
Dementia is a neurodegenerative disorder that results in the irreversible loss of brain functionality. Alzheimer’s Disease is the most common form and results from neurons in the brain dying; frontotemporal disorders and Lewy body dementia are others; vascular dementia occurs as a result of blockages or bleeding blood vessels in the brain. Signs and symptoms of dementia tend to be progressive, and the earliest sign is worsening memory loss. Confusion, a lack of the ability to concentrate, apathy towards life and a general withdrawal from others, personality changes, and an inability to perform everyday tasks are all signs that the person may be suffering from dementia. There is no diagnosis for dementia though medical history and tests can provide doctors with a high degree of certainty about the condition of the individual.
Three Articles of Dementia Prevention
Livingston et al. (2017)
Livingston et al. (2017) argue that about one-third of cases of dementia may be preventable. Their article is based on existing evidence and correlations that other researchers have noted in the past. For instance, Livingston et al. (2017) note that a correlation between hypertension and later onset of dementia could be a reason to start taking preventive measures for dementia when one begins being treated for hypertension in one’s middle age. Some of the interventions that Livingston et al. (2017) recommend start as early as childhood with increased levels of childhood education in order to strengthen the child’s cognitive development and abilities. The researchers also recommend exercising regularly, not smoking, and having an active social life—which they not has positive stimulating effects on the brain and may help neurons from dying. One of the main keys to prevention, however, is to boost one’s resilience (Livingston et al., 2017).
Resilience can be increased through intellectual stimulation early in life and continued throughout one’s adulthood. The evidence suggests that the more engaged one’s mind is on a daily basis, the more likely the brain is to stay healthy. It is not a guarantee—for even the healthiest of individuals, who exercise and diet well, can suffer from heart attacks or strokes. However, what Livingtson et al. (2017) indicate is that building up one’s resilience can reduce the risk of dementia developing later in life—and the best way to boost resilience is through intellectual activity according to the findings of researchers who have shown that more highly educated individuals tends to have lower raters of dementia among them (Livingston et al., 2017).
Other factors that can help to prevent dementia according to Livingston et al. (2017) include exercise, which can reduce cognitive decline; avoiding a lifestyle that could lead to obesity or hypertension, as both of these have been linked to vascular dementia; avoiding smoking, which has neurotoxins that can negative impact cognitive processes; engaging in social outings so as to avoid depression, which is associated with cerebrovascular pathology and thus could impact neuronal health; and choosing a Mediterranean diet, which is associated with fewer vascular risks.
McCleery et al. (2018)
McCleery et al. (2018) focused on the role that vitamins and minerals can play in supporting and maintaining a health nervous system. They conducted a systematized review of existing literature on the role that vitamins and minerals can play on delaying dementia. Criteria for inclusion was placebo-controlled randomized trials for populations that were not suffering from vitamin or mineral deficiency. However, there was only one randomized controlled trial in all the existing journals, so they also included quasi-randomized trials.
McCleery et al. (2018) found that the vitamins and minerals that researchers had focused on in the past, totaling five trials in all, were B6, B12 and folic acid. One trial had focused on vitamin E and another on vitamin C. The researchers noted that because of the small sample of literature from which to assess the efficacy of vitamins and minerals’ affect on cognitive health, conclusions were limited. They judged, however, that vitamin E likely has no impact on prevention of dementia. For people with high tHcy, vitamin B can improve episodic memory, but that was the only finding from the literature.
Van Baal, Hoogendoorn and Fischer (2016)
Van Baal, Hoogendoorn and Fisher (2016) used a simulation model to examine the impact of physical activity on the prevention of dementia. They added to the model investments in long-term health and social care to see what impact these latter options would also have. They found, according to their model, that when individuals generally focus on taking care of their fundamental health by following the routine basic recommendations of dietitians and doctors, they are less likely to develop dementia-like symptoms in the long-term.
Summary
Of the three articles examined, the one by Livingston et al. (2017) was the most comprehensive and informative. Their article examined a wide variety of available research and studies showing what steps were associated with reducing the risk of dementia development and why these steps would be appropriate in a prevention protocol. The overall steps they recommended were to start early with children and encourage and promote cognitive development at a high level. Their research indicated that the more cognitively engaged a person is throughout one’s life, the less likely they are to have dementia-like symptoms later in life. The correlation this preventive step is based on was seen in a study focusing on the relationship between higher education and dementia: those who had higher education also had lower rates of dementia than those without. Thus, the recommendation of Livingston et al. (2017) that children should be engaged and challenged at a high cognitive level early on is predicated on the idea that lifelong habits are formed early on and that if one wants to promote higher education as a means of possibly preventing or reducing the risk of dementia development the best time to start that promotion is when children are young.
The other main preventive step that Livingston et al. (2017) recommended was simply to engage in routine exercise, avoid smoking, eat a healthy diet such as the Mediterranean diet, and maintain social contacts so as to reduce the risk of depression. All of these recommendations are consistent with the overall view of doctors as to what constitutes a healthy lifestyle, so there should be nothing surprising in these recommendations. What Livingston et al. (2017) do indicate, however, is that if one is maintaining a healthy physical and cognitive lifestyle and is engaged intellectually throughout one’s life and physical with exercise and social activity one is more likely to reduce the risk of dementia onset than those who do not take these basic, fundamental health-related steps.
Livingston’s recommendation is supported by the recommendation of Van Baal et al. (2016), who essentially arrived at the same conclusion via the use of their simulation model. Their conclusion was that if one focuses on leading a healthy lifestyle, investing in their own health by eating well and exercising, they are less likely to report dementia-like symptoms later in life. The two studies by these researchers thus both suggest the same preventive steps: eat right and exercise. Livingston et al. (2017) go a few steps further and also recommend other preventive steps: socializing throughout one’s life, maintaining a high level of cognitive engagement, and adhering to the Mediterranean diet.
McCleery et al. (2018) focused on preventing dementia through the use of vitamins and minerals. They found little evidence of any link between vitamin and mineral usage and the delay of dementia. However, one study did indicate that for people with high tHcy vitamin B could improve episodic memory. McCleery et al. (2018) recommended that the study’s trial be duplicated and further evidence with a larger sample be provided to support that finding.
Recommendations for Future Research
The role that vitamins and minerals could play on delaying dementia is an interesting concept, but it essentially is related to the concept of eating a healthy diet such as the Mediterranean diet, as recommended by Livingston et al. (2017). A long-term longitudinal study that implements the recommendations of Livingsteon et al. (2017) would be the best recommendation for future research going forward. A longitudinal study that spans nations and includes a high sample of a general population would be possible only within the right set of circumstances, but it is an intriguing idea to verify whether the promotion of a high level of cognitive engagement at an early age for children makes a difference on the onset of dementia in later age. It would be a study that would require multiple generations of researchers as it would be unlikely that the researcher to start off would be the same researcher to finish it. Nonetheless, a lifetime study of this nature could supply a great deal of data for examination.
Conclusion
Is dementia preventable? The indications from the literature suggest that it is possible to prevent approximately one-third of dementia cases; however, because the etiology of dementia is unknown (aside from the basic neurological issues that trigger it), total prevention or cure has not been found. The overall recommendation of researchers is to lead a healthy and cognitively stimulating life in order to reduce the risk of developing dementia later in life.
References
Agency for Healthcare Research and Quality. (2015). Non-pharmacologic Interventions for Agitation and Aggression in Dementia. U.S. Department of Health and Human Services. Retrieved from http://effectivehealthcare.ahrq.gov/index.cfm/search-for-guides-reviews-and-reports/?productid=1999&pageaction=displayproduct
Livingston, G., Sommerlad, A., Orgeta, V., Costafreda, S. G., Huntley, J., Ames, D., ... & Cooper, C. (2017). Dementia prevention, intervention, and care. The Lancet, 390(10113), 2673-2734.
McCleery, J., Abraham, R. P., Denton, D. A., Rutjes, A. W., Chong, L. Y., Al?Assaf, A.S., ... & Di Nisio, M. (2018). Vitamin and mineral supplementation for preventing dementia or delaying cognitive decline in people with mild cognitive impairment. Cochrane Database of Systematic Reviews, (11).
Van Baal, P. H., Hoogendoorn, M., & Fischer, A. (2016). Preventing dementia by promoting physical activity and the long-term impact on health and social care expenditures. Preventive medicine, 85, 78-83.