Prevention

Question 1

Main focus points

Answer 1

Because there is no cure, lot of research into ways to prevent dementia or progression.

Finding individual differences in vulnerability
- What is diff in those who have brain pathology but no symptoms (50% of elderly have pathology but no symptoms)

Finding modifiable risk factors
- Diet, exercise, education, leisure, protective factors etc

Question 2

Cognitive reserve

Answer 2

Often used as theoretical model to explain discrepancy between dementia pathology in the brain and absence of symptoms

• The brains attempt to cope with the damage
• using preexisting cognitive processing or compensatory approaches
• high CR - better able to copy with same amount of brain damage than low CR
• fewer symptoms with same amount of damage

It is not possible to measure objectively, not 1 skill or domain, it’s all proxy

Not the same as brain reserve model or as adjusting for education

contributors:
- Education, occupation, leisure, life experience

Question 3

Brain reserve model

Answer 3

The bigger the brain the better protected against progressing pathology. More neurons to lose.

I.t.t. cognitive reserve which is brain function

Question 4

Estimating CR

Answer 4

Depends on the person
- education may not be best predictor

IQ or occupation may be best for non-native speakers and to indicate premorbid functioning

Question 5

Downside CR

Answer 5

once you do get diagnosed, the decline is steeper
- Compensation not possible anymore, takes over faster than in people w less CR

Question 6

Protective factors

Answer 6

psychological factors
- depression increases risk
- Conscientiousness reduces it, neuroticism increases

Lifestyle factors
- Healthy diet, no smoking, little alcohol, lots of exercise, social lifestyle

Cardiovascular risk factors
- obesity, diabetes and hypertension increase risk

Multilingualism (2 om)
- Cognitive activity overall reduces risk

Question 7

Lancet commission of dementia prevention

Answer 7

2024
- 14 modifiable risk factors
- Addressing these could prevent/delay up to 45% of dementia cases
- Life course approach; interventions across different life stages:

Early Life: Education and cognitive development.

Midlife: Managing hearing loss, hypertension, obesity, and high cholesterol, depression, TBI, smoking, physical inactivity

Later Life: social isolation, , air pollution, and visual loss

Explanations risk hearing loss: common cause, cognitive load, sensory, deficit, social isolation

Question 8

FINGER study

Answer 8

In Finland, intervention of 2 years increasing diet, exercise, cognitive training, vascular risk monitoring

Cognitive functioning improved more for intervention group, now similar studies throughout the world