Evidence-Based Prevention Guidelines of Alzheimer’s Disease

This most recent study published by Jin-Tai Yu et al in J Neurol Neurosurg Psychiatry (on Jul 20, 2020) completed a systematic review & meta-analysis of current evidence with prospective designs to propose evidence-based suggestions on Alzheimer’s Disease prevention.

Here is the summary of these guidelines:
(1) BMI and Weight Management:
  • Adults aged <65 years should maintain or lose weight through an appropriate balance of physical activity, caloric intake and formal behavioural programmes when indicated to maintain/achieve a BMI between 18.5 and 24.9 kg/m2 (Class I, level B)

  • Adults aged >65 years should not to be too skinny (Class I, level A4)

  • Adults aged >65 years with a trend of weight loss should be closely monitored for their cognitive status (Class I, Level B)

(2) Physical Exercise:
  • Individuals, especially those aged ≥65 years, should stick to regular physical exercise (Class I, Level B)
(3) Diabetes:
  • Stay away from diabetes via a healthier lifestyle and diabetic patients should be closely monitored for their cognitive decline (Class I, Level A4)
(4) Smoking:
  • People should not smoke and should avoid environmental tobacco smoke. Counselling, nicotine replacement and other pharmacotherapy as indicated should be provided in conjunction with a behavioural programme or formal smoking cessation programme (Class I, Level B)
(5) Head Trauma:
  • Protect your head from injuries (Class I, level A4)
(6) Depression:
  • Maintain a good condition of mental health and closely keep an eye on the cognitive status for those with depressive symptoms (Class I, Level A4)
(7) Stress:
  • Relax your mind and avoid daily stress (Class I, Level A4)
(8) Sleep:
  • Get sufficient and good quality sleep and consult a doctor or receive treatment when you have problem with sleep (Class I, Level B)
(9) Cognitive Activity:
  • Mentally stimulating activities should be encouraged, such as reading, playing chess, etc (Class I, Level A4)
(10) Education:
  • Receive as much education as possible in early life (Class I, level A4)
(11) Blood Pressure:
  • Individuals aged < 65 years should avoid hypertension via a healthier lifestyle (Class I, Level A4)

  • Individuals with orthostatic hypotension should be closely monitored for their cognition (Class I, Level A4)

(12) CVD:
  • Maintain a good condition of the cerebral vessels via a healthier lifestyle or medications to avoid atherosclerosis, low cerebral perfusion and any CVD. Individuals with stroke, especially cerebral microbleeding, should be carefully monitored for their cognitive change and take preventative measures as indicated to protect cognition (Class I, level B)
(13) Atrial Fibrillation:
  • Maintain a good cardiovascular condition and manage AF using pharmaceuticals (Class I, level B)
(14) Vitamin C:
  • Vitamin C in the diet or taken as supplements might help (Class I, Level B)
(15) High Homocysteine Level:
  • Have a regular blood examination for homocysteine level. Individuals with hyperhomocysteinaemia should be treated with vitamin B and/or folic acid and be followed with a focus on their cognition (Class I, Level A2)
NOT RECOMMENDED TREATMENT:
  1. Oestrogen replacement therapy (Level A2) and
  2. Acetylcholinesterase inhibitors (Level B).

REFERENCE:

  • Yu JT, Xu W, Tan CC, et al. Evidence-based prevention of Alzheimer’s disease: systematic review and meta-analysis of 243 observational prospective studies and 153 randomised controlled trials [published online ahead of print, 2020 Jul 20]. J Neurol Neurosurg Psychiatry. 2020 (Read Article)
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GERIATRIC PSYCHIATRY: NEUROCOGNITIVE DISORDERS

(1) Modifiable Predictors of Conversion of Mild Cognitive Impairment to Dementia. (Read Chapter)

(2) Alzheimer’s Disease: Comparing FDA Approved Medications. (Read Chapter)

(3) Identifying Dementia Patient at Risk of Unsafe Driving. (Read Chapter)

(4) Treatment Options of Sexually Inappropriate Behavior in Dementia. (Read Chapter)

(5) Behavioral Symptoms Management in Dementia: (a) Behavior Types & Clinical Relevance. (Read Chapter)

(6) Behavioral Symptoms Management in Dementia: (b) Evaluation and Differential Diagnosis. (Read Chapter)

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(8) Behavioral Symptoms Management in Dementia: (d) Depression and Treatment Options. (Read Chapter)

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