Suggests NIH, others carefully cue public about potential benefits of cognitive training, blood pressure management, exercise.
The National Institute on Aging (NIA) at the National Institutes of Health, commissioned experts for an extensive scientific review and to provide recommendations for public health messaging and future research priorities. In response to that request, a National Academies of Sciences, Engineering and Medicine (NASEM) committee has concluded that current evidence does not support a mass public education campaign to encourage people to adopt specific interventions to prevent cognitive decline or dementia.

Importantly, the committee also cited “encouraging although inconclusive” evidence for three specific types of interventions – cognitive training, blood pressure control for people with hypertension, and increased physical activity.

The full NASEM report, “Preventing Cognitive Decline and Dementia: A Way Forward,” can be viewed at www.nationalacademies.org/dementia.

The committee’s recommendations are based in large part on an NIA–requested and supported systematic evidence review by the Agency for Healthcare Research and Quality’s (AHRQ) Evidence–based Practice Center (EPC). The Minnesota EPC categorized hundreds of studies by strength and quality for the AHRQ part of the project.

The committee noted potential effects, as well as limitations of the evidence, for:

• Cognitive training – Interventions aimed at enhancing reasoning, memory, and speed of processing, to delay or slow age–related cognitive decline were found promising, based primarily on conclusions from the NIA–funded Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial and bolstered by additional data from prospective observational studies on the benefits of cognitively stimulating activities. The committee found no evidence to suggest that cognitive training might prevent, delay or slow development of Mild Cognitive Impairment (MCI) or Alzheimer’s, however.
• Blood pressure management for people with hypertension — Encouraging but inconclusive evidence suggests that blood pressure management, particularly in midlife, might prevent, delay or slow clinical Alzheimer’s–type dementia, according to the committee. While clinical trials in this area do not offer strong support for blood pressure management against Alzheimer’s, prospective population studies and what we have learned about the natural history and biology of the disease make it plausible, then, that blood pressure management for people with hypertension would also reduce their risk of dementia and cognitive decline, the report said. The committee pointed out the known cardiovascular benefits from well–managed blood pressure, which would be experienced while Alzheimer’s prevention is potentially addressed.
• Increased physical activity – Citing the many known health benefits of physical activity, the committee pointed to growing evidence that among these is the possible reduced risk of age–related cognitive decline. Here, too, the experts turned to what they called encouraging but inconclusive evidence, noting that clinical trials results in this area suggest effectiveness, taken together with observational studies and knowledge of neurobiological processes. There was not sufficient evidence to support increased physical activity as a preventive intervention for MCI or Alzheimer’s disease, however. Further, the committee could not find sufficient evidence to help determine which specific types of physical activity might be particularly effective for preventing cognitive decline and dementia.