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Climacteric. 2014 Dec;17 Suppl 2:38-46. doi: 10.3109/13697137.2014.929650. Epub 2014 Aug 17.

Three midlife strategies to prevent cognitive impairment due to Alzheimer's disease.

Author information

1
Departments of Health Research and Policy (Epidemiology) and of Neurology and Neurological Sciences, Stanford University , Stanford, California , USA.

Abstract

The slow, progressive accumulation of pathology characteristic of Alzheimer's disease is the principal determinant of cognitive decline leading to dementia. Risk-reduction strategies during midlife focus on raising the clinical threshold for the appearance of cognitive symptoms and on reducing the extent of Alzheimer pathology. Best available evidence suggests an approach based on three, conceptually distinct strategies. (1) Raise the threshold for cognitive symptoms by improving brain health. To achieve this goal, the tactic is to reduce cerebrovascular risks mediated by hypertension, diabetes, cigarette smoking, and hyperlipidemia. (2) Raise the threshold for cognitive symptoms by enhancing cognitive reserve. Here, tactics focus on mental stimulation associated with occupation, leisure activities and social engagement. (3) Reduce the burden of Alzheimer pathology. The most promising tactic toward this end is regular aerobic exercise. Tactics in support of strategies to reduce cognitive impairment due to Alzheimer pathology are not yet substantiated by robust, consistent clinical trial evidence. There is pressing need for well-designed pragmatic trials to provide stronger evidence on preventive strategies for late-life cognitive decline and dementia.

KEYWORDS:

ALZHEIMER'S DISEASE; COGNITIVE IMPAIRMENT; COGNITIVE RESERVE; MIDLIFE; PHYSICAL ACTIVITY; PREVENTION

PMID:
24893836
PMCID:
PMC4236238
DOI:
10.3109/13697137.2014.929650
[Indexed for MEDLINE]
Free PMC Article

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