Lifestyle-related factors in predementia and dementia syndromes

Abstract

Cognitive decline and dementia have a deep impact on the health and quality of life of older subjects and their caregivers. Since the therapeutic options currently available have demonstrated limited efficacy, the search for preventive strategies for cognitive decline and dementia are mandatory. A possible role of lifestyle-related factors was recently proposed for age-related changes of cognitive function, predementia syndromes and the cognitive decline of degenerative (Alzheimer’s disease [AD]) or vascular origin. At present, cumulative evidence suggests that vascular risk factors may be important in the development of mild cognitive impairment (MCI), dementia and AD. Moderate alcohol drinking has been proposed as a protective factor against MCI and dementia in several longitudinal studies, but contrasting findings also exist. The Mediterranean diet could therefore be an interesting model with which to further study the association between dietary patterns and cognitive functioning, given the suggested role of many components of this diet (monounsaturated fatty acids, polyunsaturated fatty acids, cereals and red wine) in contrasting cognitive impairment and dementia. The association between low education and predementia and dementia syndromes is supported by the majority of studies, but very few studies have investigated whether this association may be attributed with lifestyle factors that covary with education. Studies in the literature seem to identify in physical exercise one promising strategy in decreasing cognitive decline, but some of the limitations of these studies do not allow us to draw definite conclusions. At present, in older subjects, healthy diets, antioxidant supplements, the prevention of nutritional deficiencies, and moderate physical activity could be considered the first line of defense against the development and progression of predementia and dementia syndromes. However, in most cases, these were only observational studies, and results are awaited from large multicenter randomized clinical trials in older persons that may clarify the possible synergy, for example, between moderate exercise, physical activity and healthy Mediterranean diet on cognition in the elderly.

Keywords::

• alcohol
• Alzheimer’s disease
• dementia
• diet
• mild cognitive impairment
• monounsaturated fatty acid
• physical exercise
• polyunsaturated fatty acid
• vascular dementia

Acknowledgement

The authors wish to thank Azzura Di Comite and Michele Elia for skillful assistance.

Financial & competing interests disclosure

This study was supported by Italian Longitudinal Study on Ageing (ILSA; Italian National Research Council – CNR-Targeted Project on Ageing – Grants 9400419PF40 and 95973PF40), by Targeted Project on Mediterranean Diet (Italian National Research Council – CNR), by MURST 40% and 60%, and by AFORIGE (Associazione per la FOrmazione e la RIcerca in Geriatria). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.