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The new guidelines published by the World Health Organization (WHO) focus on lifestyle supplements to reduce cognitive decline and dementia.
The new guidelines are designed to "provide health care providers with the knowledge base that governments, policymakers and other stakeholders need to reduce the risk of cognitive decline and dementia through a public health approach", writes Dr. Ren Minghui, Assistant Director General, Universal. Health coverage / Communicable and noncommunicable diseases, WHO, in a preface to the guidelines.
The increase in dementia and Alzheimer's disease is alarming and is expected to double every 20 years, from 47 million people in 2015 to 75 million in 2030 and 131 million in 2050.
This means that in the next 30 years, "the number of people with dementia is expected to triple [and] we must do everything in our power to reduce our risk of dementia, "said in a press release the Director-General of WHO, Tedros Adhanom Ghebreyesus, MSc, PhD.
The guidelines are a component of the WHO Global Action Plan for Public Health Response to Dementia 2017-2025, a comprehensive approach to dementia reduction launched in 2017 that also includes strengthening dementia information systems, improving diagnosis, treatment and care; support caregivers of people with dementia; and research and innovation.
"The scientific evidence gathered for these guidelines confirms what we have suspected for some time, namely that what is good for our heart is also for our brains," Ghebreyesus said.
Physical activity
Physical activity should be recommended for adults with normal cognition to reduce the risk of cognitive decline.
The authors indicate that "the physical activity interventions evaluated in the included trials used a lot of resources because they are usually supervised and conducted in an institution, but some aspects of these interventions could be adapted to specific contexts. and could be modified. " carried out by trained and supported non-specialists. "
There are "potentially lower costs for aerobic training, compared to resistance [training]"They note.
Smoking cessation interventions should be offered to adult tobacco users as they can reduce the risk of cognitive decline and dementia, as well as provide other health benefits.
One of the barriers to implementing these interventions is that they require "a lot of resources because they may require professional guidance and supervision," write the authors.
Group counseling and e-interventions can reduce costs.
Diet
The Mediterranean diet may be recommended for adults with normal cognition and mild cognitive impairment (MCI) to reduce the risk of cognitive decline and / or dementia.
A healthy and balanced diet should be recommended to all adults, in accordance with WHO recommendations for healthy eating.
Vitamins B and E, polyunsaturated fatty acids and complex multivitamin supplementation should not be recommended to reduce the risk of cognitive decline and / or dementia (evidence quality: moderate, strength of recommendation: strong).
The researchers examined nine different interventions / comparisons:
· Multicomplex vs placebo supplement in adults with normal cognition
· Multicomplex vs placebo supplement in adults with MCI
· Polyunsaturated fatty acids vs placebo
· Vitamin B vs placebo
· Vitamin E vs placebo
Six polyphenols vs a placebo
· Protein vs placebo supplementation
· Chicken essence vs placebo
· Mediterranean diet vs alternative or usual diet
Polyphenols were the only category of supplements and nutraceuticals that have been shown to have consistently beneficial effects on cognition, although the evidence has been found to be of "poor quality".
The authors concluded that, overall, dietary changes were "safe" and "rare" adverse events, although vitamin E and protein supplements at high doses may have "unanticipated side effects".
Consumption of alcohol
Interventions to reduce or stop the use of harmful or harmful alcoholic beverages should be offered to adults with normal cognition or MCI to reduce the risk of cognitive decline and / or dementia, in addition to other benefits. for health.
Although researchers have not been able to identify specific systematic reviews or single studies on the effect of an alcohol reduction intervention on the risk of dementia and / or cognitive decline, a " large number of observational evidence "correlates high alcohol consumption with dementia. Group orientation and electronic interventions can be helpful in reducing the cost of interventions.
Cognitive training may be offered to older people with normal cognition or mild cognitive impairment to reduce the risk of cognitive decline and / or dementia.
There was no evidence of the impact of cognitive stimulation compared to usual care, nor any intervention on cognitive function in elderly people with MCI or incident dementia. However, "low quality evidence" suggests that cognitive training may reduce incident dementia and improve cognitive functions and activities of daily living for adults with MCI.
Evidence of social activity and reduced risk of cognitive decline / dementia is insufficient.
Social participation and social support are closely linked to lifelong health and well-being, and social inclusion should be supported throughout life.
Weight management
The authors note that the results of the research "are probably favorable to the intervention" but "further research is needed to determine the type, form and duration of activity related to social activities that would be effective." for the intended results ".
Interventions in case of overweight and / or obesity at mid-life may be proposed to reduce the risk of cognitive decline and / or dementia (quality of evidence: low to moderate; strength of recommendation: conditional ).
The authors note that moderate-quality evidence "suggests that weight loss through lifestyle interventions improves cognitive performance, at least in some areas," the main barriers to implementation. being the cost, lack of motivation, lack of time and physical limitations.
The authors recommend that individuals follow the WHO recommendations for overweight and obesity.
Hypertension management should be offered to hypertensive adults in accordance with current WHO guidelines.
Hypertension management can be offered to hypertensive adults to reduce the risk of cognitive decline and / or dementia (quality of evidence: very low [in relation to dementia outcomes]; strength of the recommendation: conditional).
The cost of antihypertensive drugs depends on the drug administered, but they can be "profitable", add the authors.
Blood glucose, cholesterol
The authors recommend the WHO Set of interventions for the control of essential noncommunicable diseases (PEN) for primary health care in low-resource settings (2010) as a relevant guideline.
The management of diabetes in the form of drugs and / or lifestyle interventions should be offered to adults with diabetes in accordance with current WHO guidelines.
The authors note that diabetes medications and physical activity are already recommended as treatment options for diabetic patients, highlighting the important role of diet and physical activity as well as lowering blood sugar levels.
Management of dyslipidemia in the 40s can be proposed to reduce the risk of cognitive decline and dementia (quality of evidence: low, strength of recommendation: conditional).
The authors encourage a "life-changing perspective … since … detecting dyslipidemia earlier in life could have beneficial effects and that is why the timing of the intervention is particularly important ".
They note that their evidence suggests that control of dyslipidemia by statin therapy in older adults (≥ 65 years) "does not appear to affect the incidence of dementia (evidence of poor quality) and / or cognitive decline (evidence of average quality). "
Depression
At present, there is insufficient evidence to recommend the use of antidepressants to reduce the risk of cognitive decline and / or dementia.
Management of depression as antidepressants and / or psychological interventions should be provided to adults with depression in accordance with existing WHO guidelines on mhGAP.
The authors note that there is some evidence to support the use of the antidepressant vortioxetine to reduce the risk of cognitive decline / dementia.
Evidence is insufficient to recommend the use of hearing aids to reduce the risk of cognitive decline and / or dementia.
Screening for the provision of hearing aids should be made available to older people for rapid identification and management of hearing loss, as recommended by the WHO ICOPE guidelines.
Some research has suggested that the use of hearing aids may be associated with improvements in cognitive function, but the benefits were limited.
There is also no data available on the cost of hearing aid interventions in the included studies. The resources required for hearing aid interventions will likely involve costs associated with hearing assessments, audiology appointments, and hearing devices, which will vary according to health care policies and countries.
Any national approach to dementia must include support for caregivers of people with dementia, according to Devora Kestel, MSc, director of the department of Mental Health and Addiction at WHO.
"People with dementia are very often family members who need to significantly adjust their family and professional lives to care for their loved ones," she said in a statement. Press.
"That's why the WHO created iSupport, an online training program providing dementia caregivers with advice on comprehensive care management, behavior change management, and managing their own lives." health, "she added.
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