A Organização Mundial da Saúde e o National Institute for Health and Care Excellence do Reino Unido recomendam intervenções no estilo de vida e no comportamento (abandono do tabagismo, redução do consumo de álcool, aumento da atividade física, alimentação saudável, manutenção de um peso saudável) para diminuir o risco de fragilidade e demência.[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
São ambíguas as evidências de que atividades/exercícios físicos possam prevenir ou retardar o declínio cognitivo nas pessoas sem diagnóstico de demência.[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
Um estudo de coorte retrospectivo, realizado com quase 200,000 participantes, concluiu que um estilo de vida saudável (definido por um escore ponderado que inclui a prática de exercícios físicos, ausência de tabagismo atual, dieta saudável e consumo moderado de bebidas alcoólicas) foi associado a menor risco de demência, independentemente do risco genético de demência (baixo, intermediário e 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
O manejo de fatores de risco cardiovasculares na meia-idade tem sido associado a uma diminuição da demência por qualquer causa (ou seja, demência vascular e DA).[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
O consumo moderado de álcool (1-14 unidades/semana) pode proteger contra a demência.[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
Uma declaração de consenso internacional baseada em uma revisão da literatura concluiu que a redução da homocisteína ajuda a diminuir o risco de demência.[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
Revisões sistemáticas de ensaios clínicos randomizados e controlados encontraram evidências insuficientes para respaldar as seguintes intervenções 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/fullMostre-me a resposta
Medicamentos (anti-hipertensivos, estatinas, anti-inflamatórios não esteroidais, aspirina, medicamentos antidiabéticos ou inibidores da colinesterase)
Suplementos de venda livre (ácidos graxos ômega-3, ginkgo biloba, vitaminas B, vitamina D com cálcio, betacaroteno ou polivitamínicos)
Treinamento cognitivo.