What helps prevent dementia? Try exercise, not vitamin pills

by Marilynn Marchione

In this Tuesday, April 4, 2017 file photo, an elderly couple walks across a street near the Royal Palace in Madrid. If you want to save your brain, focus on keeping the rest of your body well with exercise and healthy habits rather than popping vitamin pills, say new World Health Organization guidelines for preventing dementia, released on Tuesday, May 14, 2019. (AP Photo/Francisco Seco)

If you want to save your brain, focus on keeping the rest of your body well with exercise and healthy habits rather than popping vitamin pills, new guidelines for preventing dementia advise.

15 may 2019--About 50 million people currently have dementia, and Alzheimer's disease is the most common type. Each year brings 10 million new cases, says the report released Tuesday by the World Health Organization.

Although age is the top risk factor, "dementia is not a natural or inevitable consequence of aging," it says.

Many health conditions and behaviors affect the odds of developing it, and research suggests that a third of cases are preventable, said Maria Carrillo, chief science officer of the Alzheimer's Association, which has published similar advice.

Since dementia is currently incurable and so many experimental therapies have failed, focusing on prevention may "give us more benefit in the shorter term," Carrillo said.

Much of the WHO's advice is common sense, and echoes what the U.S. National Institute on Aging says.

That includes getting enough exercise; treating other health conditions such as diabetes, high blood pressure and high cholesterol; having an active social life, and avoiding or curbing harmful habits such as smoking, overeating and drinking too much alcohol. Evidence is weak that some of these help preserve thinking skills, but they're known to aid general health, the WHO says.

Eating well, and possibly following a Mediterranean-style diet, may help prevent dementia, the guidelines say. But they take a firm stance against vitamin B or E pills, fish oil or multi-complex supplements that are promoted for brain health because there's strong research showing they don't work.

"There is currently no evidence to show that taking these supplements actually reduces the risk of cognitive decline and dementia, and in fact, we know that in high doses these can be harmful," said the WHO's Dr. Neerja Chowdhary.

"People should be looking for these nutrients through food ... not through supplements," Carrillo agreed.

The WHO also did not endorse games and other activities aimed at boosting thinking skills. These can be considered for people with normal capacities or mild impairment, but there's low to very low evidence of benefit.

There's not enough evidence to recommend antidepressants to reduce dementia risk although they may be used to treat depression, the report says. Hearing aids also may not reduce dementia risk, but older people should be screened for hearing loss and treated accordingly.

UWE mental health expert helps produce new dementia guidelines

A UWE Bristol professor in mental health is one of the key experts behind a new care pathway and Guide to Psychosocial Interventions in Dementia launched recently by the British Psychological Society.

10 dec 2014--Professor Richard Cheston is a clinical psychologist who worked with colleagues from five NHS Trusts to produce the documents which bring together current research and best practice in psychosocial care.

Dementia has been a key topic since the Prime Minister's Dementia Challenge highlighted the need for the UK to become dementia aware. Dementia was also on the agenda at the recent G7 summit.

The Guide to Psychosocial Interventions in Dementia offers an A to Z of approaches which can be used in this area to enable people to live well with dementia.

Professor Cheston said, "The documents highlight the importance of personalised pre-assessment counselling, skilful cognitive assessment, sympathetic communication of the diagnosis and appropriate post-diagnostic support and access to relevant psychosocial interventions. They provide clear recommendations and guidance not only to clinical psychologists working in the field but to their colleagues in other disciplines and partnership agencies working with people living with dementia."

By 2015 there will be 850,000 people with dementia in the UK including 40,000 younger people. One in six people aged 80 and over have dementia and there are 670,000 carers of people with dementia in the UK. Two-thirds of people with dementia live in the community while one-third live in a care home. Only 44% of people with dementia in England, Wales and Northern Ireland receive a diagnosis.

According to the Alzheimer's Society, up to a quarter of all general hospital beds in the UK are occupied by a person over 65 years who has dementia.

The guidelines are the output of a two-year project coordinated by Reinhard Guss of the Faculty of the Psychology of Older People (FPOP). The project involved consultation with service users, carers, and stakeholder groups such as the Alzheimer's Society, Dementia Action Alliance (DAA) and DEEP (The Dementia Engagement and Empowerment Project). They are supported by the Royal College of Psychiatrists Old Age Faculty and the Royal College of Nursing.

The documents Clinical Psychology in Early Stage Dementia Care Pathway and Guide to Psychosocial Interventions in Dementia can be downloaded from the British Psychological Society webpage.

Provided by University of the West of England

APA Releases Updated Guidelines for Treating Patients With Dementia

Marlene Busko
December 14, 2007 — The American Psychiatric Association (APA) has released a second edition of practice guidelines to assist psychiatrists caring for patients with Alzheimer's disease and other dementias. These guidelines update the original ones issued in 1997, and include stronger clinical evidence and useful insights.
The guidelines are published as a supplement to the December issue of the American Journal of Psychiatry.
"Stronger Evidence, Worth Reading"
"I think that we have been able to strengthen many of the recommendations that were made, because there have been a number of confirming studies," Peter V. Rabins, MD, of Johns Hopkins University School of Medicine, in Baltimore, Maryland, and chair of the guideline's work group, told Medscape Psychiatry. "There's really nothing new. It's just that the evidence is stronger."
"The bottom line is that there isn't really that much new," echoed David Knopman, MD, of the Mayo Clinic, in Rochester, Minnesota, and a member of the American Academy of Neurology, in a comment to Medscape Psychiatry. "I didn't see, nor would I expect to see, any earthshaking proposed changes in practice." It is a well-written document, he added. "It would be well worth the time to read through it, as it does touch on a number of issues regarding diagnosis and treatment in a thoughtful and well-written manner."
New Developments in Past Decade
In the 10 years since the initial guidelines were issued, new drugs have become available, and some of the evidence backing earlier recommendations has been strengthened, said Dr. Rabins.
"First, on the positive side, we now have 3 cholinesterase inhibitors approved by the Food and Drug Administration for the treatment of Alzheimer's disease, as well as memantine (Namenda, Forest Pharmaceuticals, Inc.), a drug from a new class," he elaborated.
Second, there is better evidence that nonpharmacologic intervention targeting the patient's emotional well being is beneficial. Third, there is stronger evidence that pharmacologic treatment of depression in patients with Alzheimer's disease is clearly better than placebo. Fourth, new evidence shows that providing caregivers with education and emotional support benefits them and the patient, he added.
"On the less positive side, we've withdrawn the recommendation for using vitamin E as a treatment for Alzheimer's disease, primarily because there have been no new studies to support its benefit, and health risks have been associated with high doses," he continued.
Also, in the past 2 years it has become clear that all antipsychotic drugs — both typical and atypical ones — confer an increased mortality risk on people with dementia.
Important Change: Limit Antipsychotics
For patients who have neuropsychiatric symptoms, such as agitation, delusion, hallucinations, and aggression, there is stronger evidence that nondrug treatment should be tried first, and that real efforts should be made to limit the use of antipsychotics in all settings — at home and in the long-term-care setting. "That is the most important way the guidelines will change practice," he noted.
"I think that real efforts need to be made to make sure that when antipsychotics are prescribed, they are both necessary and effective; when they are not effective, they should be discontinued," he added.
Formulating and Implementing a Treatment Plan
The 55-page guidelines include an executive summary in which recommendations are coded according to 3 levels of degree of clinical evidence. This section summarizes treatment recommendations for cognitive symptoms, psychosis, agitation, depression, and sleep disturbances, and also discusses psychotherapies, psychiatric management, treatments for elderly patients, and special issues for long-term care.
The section that follows this is an extensive guide for developing and implementing a stage-specific treatment plan for the individual patient. The last section details specific clinical features influencing the treatment plan.
Between January 2003 and December 2006, Dr. Rabins received speaking fees from AstraZeneca, Janssen, Eli Lilly and Company, Forest Pharmaceuticals, Inc., and Wyeth Pharmaceuticals. Financial disclosures for the other members of the work group are listed in the practice guideline. The Executive Committee on Practice Guidelines has reviewed the guidelines and found no evidence of influence from these relationships.