La Organización Mundial de la Salud y el National Institute for Health and Care Excellence del Reino Unido recomiendan intervenciones sobre el estilo de vida y el comportamiento (el abandono del tabaquismo, reducir el consumo de alcohol, aumentar la actividad física, comer de forma saludable, mantener un peso saludable) para disminuir el riesgo de fragilidad y demencia.[51]World Health Organization. Risk reduction of cognitive decline and dementia. 2019 [internet publication].
https://www.who.int/mental_health/neurology/dementia/guidelines_risk_reduction/en
[52]National Institute for Health and Care Excellence. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset. Oct 2015 [internet publication].
https://www.nice.org.uk/guidance/ng16
Las evidencias de que la actividad física/el ejercicio pueden prevenir o retrasar el deterioro cognitivo en personas sin diagnóstico de demencia son equívocas.[53]Brasure M, Desai P, Davila H, et al. Physical activity interventions in preventing cognitive decline and Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018 Jan 2;168(1):30-8.
http://www.ncbi.nlm.nih.gov/pubmed/29255839?tool=bestpractice.com
[54]Larson EB, Wang L, Bowen JD, et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann Intern Med. 2006 Jan 17;144(2):73-81.
http://annals.org/aim/article/719427/exercise-associated-reduced-risk-incident-dementia-among-persons-65-years
http://www.ncbi.nlm.nih.gov/pubmed/16418406?tool=bestpractice.com
[55]Stephen R, Hongisto K, Solomon A, et al. Physical activity and Alzheimer's disease: a systematic review. J Gerontol A Biol Sci Med Sci. 2017 Jun 1;72(6):733-9.
https://academic.oup.com/biomedgerontology/article/72/6/733/2797763
http://www.ncbi.nlm.nih.gov/pubmed/28049634?tool=bestpractice.com
[56]Kivimäki M, Singh-Manoux A, Pentti J, et al. Physical inactivity, cardiometabolic disease, and risk of dementia: an individual-participant meta-analysis. BMJ. 2019 Apr 17;365:l1495.
https://www.bmj.com/content/365/bmj.l1495.long
http://www.ncbi.nlm.nih.gov/pubmed/30995986?tool=bestpractice.com
[57]Xu W, Wang HF, Wan Y, et al. Leisure time physical activity and dementia risk: a dose-response meta-analysis of prospective studies. BMJ Open. 2017 Oct 22;7(10):e014706.
https://bmjopen.bmj.com/content/7/10/e014706.long
http://www.ncbi.nlm.nih.gov/pubmed/29061599?tool=bestpractice.com
Un estudio de cohorte retrospectivo con casi 200,000 participantes concluyó que un estilo de vida saludable (definido por una puntuación ponderada que incluía ejercicio, no fumar actualmente, una dieta saludable y un consumo moderado de alcohol) se asociaba a un menor riesgo de demencia, independientemente del riesgo genético de demencia (bajo, intermedio, alto).[58]Lourida I, Hannon E, Littlejohns TJ, et al. Association of lifestyle and genetic risk with incidence of dementia. JAMA. 2019 Jul 14;322(5):430-7.
https://jamanetwork.com/journals/jama/fullarticle/2738355
http://www.ncbi.nlm.nih.gov/pubmed/31302669?tool=bestpractice.com
El manejo de los factores de riesgo cardiovascular en la mediana edad se ha asociado a una disminución de la demencia por todas las causas (es decir, tanto la demencia vascular, como la DTA).[59]Pase MP, Beiser A, Enserro D, et al. Association of ideal cardiovascular health with vascular brain injury and incident dementia. Stroke. 2016 May;47(5):1201-6.
http://stroke.ahajournals.org/content/47/5/1201.long
http://www.ncbi.nlm.nih.gov/pubmed/27073239?tool=bestpractice.com
[60]Sabia S, Fayosse A, Dumurgier J, et al. Association of ideal cardiovascular health at age 50 with incidence of dementia: 25 year follow-up of Whitehall II cohort study. BMJ. 2019 Aug 7;366:l4414.
https://www.bmj.com/content/366/bmj.l4414.long
http://www.ncbi.nlm.nih.gov/pubmed/31391187?tool=bestpractice.com
[61]Larsson SC, Markus HS. Does treating vascular risk factors prevent dementia and Alzheimer's disease? A systematic review and meta-analysis. J Alzheimers Dis. 2018;64(2):657-68.
http://www.ncbi.nlm.nih.gov/pubmed/29914039?tool=bestpractice.com
El consumo moderado de alcohol (1-14 unidades/semana) puede proteger contra la demencia.[21]Lee Y, Back JH, Kim J, et al. Systematic review of health behavioral risks and cognitive health in older adults. Int Psychogeriatr. 2010 Mar;22(2):174-87.
http://www.ncbi.nlm.nih.gov/pubmed/19883522?tool=bestpractice.com
[24]Sabia S, Fayosse A, Dumurgier J, et al. Alcohol consumption and risk of dementia: 23 year follow-up of Whitehall II cohort study. BMJ. 2018 Aug 1;362:k2927.
https://www.bmj.com/content/362/bmj.k2927.long
http://www.ncbi.nlm.nih.gov/pubmed/30068508?tool=bestpractice.com
Una declaración de consenso internacional basada en una revisión de la literatura concluyó que la reducción de la homocisteína ayuda a disminuir el riesgo de demencia.[62]Smith AD, Refsum H, Bottiglieri T, et al. Homocysteine and dementia: an international consensus statement. J Alzheimers Dis. 2018;62(2):561-70.
https://content.iospress.com/articles/journal-of-alzheimers-disease/jad171042
http://www.ncbi.nlm.nih.gov/pubmed/29480200?tool=bestpractice.com
Las revisiones sistemáticas de los ensayos controlados aleatorizados encontraron evidencias insuficientes para respaldar las siguientes intervenciones preventivas:[63]Fink HA, Jutkowitz E, McCarten JR, et al. Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018 Jan 2;168(1):39-51.
http://www.ncbi.nlm.nih.gov/pubmed/29255847?tool=bestpractice.com
[64]Jordan F, Quinn TJ, McGuinness B, et al. Aspirin and other non-steroidal anti-inflammatory drugs for the prevention of dementia. Cochrane Database Syst Rev. 2020 Apr 30;(4):CD011459.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011459.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/32352165?tool=bestpractice.com
[65]Butler M, Nelson VA, Davila H, et al. Over-the-counter supplement interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia: a systematic review. Ann Intern Med. 2018 Jan 2;168(1):52-62.
http://www.ncbi.nlm.nih.gov/pubmed/29255909?tool=bestpractice.com
[66]Butler M, McCreedy E, Nelson VA, et al. Does cognitive training prevent cognitive decline? A systematic review. Ann Intern Med. 2018 Jan 2;168(1):63-8.
http://www.ncbi.nlm.nih.gov/pubmed/29255842?tool=bestpractice.com
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For cognitively healthy older adults, do aspirin and non‐steroidal anti‐inflammatory drugs (NSAIDs) help prevent dementia?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.3177/fullMostrarme la respuesta
Medicamentos (antihipertensivos, estatinas, antiinflamatorios no esteroideos, ácido acetilsalicílico, antidiabéticos o inhibidores de la colinesterasa)
Suplementos sin receta médica (ácidos grasos omega-3, ginkgo biloba, vitaminas del grupo B, vitamina D con calcio, betacaroteno o multivitaminas)
Entrenamiento cognitivo.