Prevention of cognitive decline

| One of the great concerns of elderly people and their environment is the loss of cognitive faculties and the appearance of possible dementia.

For this reason, any measure that is useful for the prevention of the deterioration of the mental faculties is always welcome.

The measures that have been shown to be most effective for the prevention of cognitive deterioration are those that manage to control cardiovascular risk factors, due to their implication in the appearance of cognitive deterioration due to cerebrovascular accidents or due to the appearance of vascular dementia.

Thus, the avoidance of all those factors that can promote cerebrovascular disease or the different dementias of said origin will be the first measure to adopt.

Therefore, avoid and control factors such as:

• smoking
• high blood pressure
• diabetes
• dyslipidemia
• a healthy diet (low in refined sugars and saturated fat, rich in vegetables and fish)
• stress
• the practice of physical exercise
• control overweight

However, there are non-modifiable risk factors for the development of cognitive impairment, such as age, genetic factors, family history of dementia and the presence of Down syndrome. Other more uncertain influencing factors are race, previous history of head trauma, history of previous depressive syndrome, aluminum ingestion, exposure to magnetic fields, herpes simplex virus infection, advanced age of the mother at patient's birth, hypothyroidism, or family history of Down syndrome.

Currently there is not enough scientific evidence on the effectiveness of the use of drugs such as anti-inflammatory drugs or vitamin or antioxidant supplements on the prevention of cognitive deterioration. Therefore, its use as a protector against intellectual decline cannot be recommended under any circumstances.

However, there is evidence that people with a higher level of education and verbal ability during adulthood have a lower rate of dementia, which could represent a neuronal protective factor or be the expression of a greater neuronal reserve capacity.

To maintain memory, it is important to maintain brain activity. This means taking an interest in and thinking about the environment, acquiring new interests, and avoiding routine. It is necessary to interact with other people, know what happens in the lives of family and friends, collaborate in the tasks of the house, the community or the grandchildren. Many times it is possible to learn or acquire new skills: take a course, join a theater group, learn gardening or baking.

With regard to the early diagnosis of dementia, there is no evidence to recommend the systematic study of dementia in the general population or in elderly people; However, different societies and experts recommend screening in people over 75 years of age, institutionalized over 65 years of age, and those who have difficulties in performing the instrumental activities of daily life. Different psychometric tests will be useful in its diagnosis, as well as an emotional and functional assessment.

Once cognitive impairment has been diagnosed, it is still possible to maintain an attitude of prevention, in several points:

• Prevention of the evolution of deterioration: in vascular dementia, the control of cardiovascular risk factors can stabilize the loss of capacities; This is much more complicated in Alzheimer's disease, although there are drugs that slow this loss.
• Prevention of accidents: loss, errors of judgment (for example, in expenses), leaving the fire burning or the taps open, etc.
• Prevention of secondary complications: bronchial aspiration or skin pressure ulcers.
• Prevention of physical and mental exhaustion of relatives and caregivers.