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Table ES2Summary of findings on potential risk factors and interventions for cognitive decline

Direction of associationFactorsLevel of evidence
Increased risk
  • APOE e4 genotype
  • Low plasma selenium
  • Depressive disorder
  • Diabetes mellitus
  • Metabolic syndrome
  • Current tobacco use
Low
Decreased risk
  • Cognitive training*
High
  • Vegetable intake
  • Mediterranean diet
  • Omega-3 fatty acids*
  • Physical activity*
  • Non-cognitive, non-physical leisure activities
Low
No association High
  • Dehydroepiandosterone*
  • Cholinesterase inhibitors*
  • Multivitamin supplement*
  • Vitamins B6, B12 and folic acid supplements*
Moderate
  • Alcohol intake
  • Non-steroidal anti-inflammatory drugs*
  • Anti-hypertensive medication*
  • Homocysteine
  • Anxiety disorders
  • Hypertension
  • Obesity
  • Early childhood factors
  • Higher levels of education
  • Social network, social supports
Low
Inadequate evidence to assess association
  • Trace metals
  • Fat intake
  • High caloric intake
  • Gingko biloba*
  • Sleep apnea
  • Resiliency
  • Occupational level
  • Traumatic brain injury
  • Toxic environmental exposures
  • Agent Orange, Gulf War Syndrome
  • Genetic factors other than APOE
(Not applicable)
*

Data from observational studies and RCTs.

Not associated with decreased risk but may be associated with increased risk.

Abbreviations: APOE = apolipoprotein E gene; APOE e4 = epsilon 4 allele of the apolipoprotein E gene; HMG-CoA = 3-hydroxy-3-methylglutaryl-coenzyme A; RCTs = randomized controlled trials

GRADE criteria (see Methods section)

Data from observational studies and RCTs.

Not associated with decreased risk but may be associated with increased risk.

GRADE criteria (see Methods section)

From: Executive Summary

Cover of Preventing Alzheimer's Disease and Cognitive Decline
Preventing Alzheimer's Disease and Cognitive Decline.
Evidence Reports/Technology Assessments, No. 193.
Williams JW, Plassman BL, Burke J, et al.

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