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Current Issues| Volume 61, ISSUE 3, e157-e160, September 01, 2021

Cognitive Decline and Dementia Risk Reduction: Promoting Healthy Lifestyles and Blood Pressure Control

Published:May 15, 2021DOI:https://doi.org/10.1016/j.amepre.2021.03.005
Cognitive Decline and Dementia Risk Reduction: Promoting Healthy Lifestyles and Blood Pressure Control
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      There is an immediate need to increase public health focus on the prevention of Alzheimer disease and related dementias (ADRD). The population upward shift in age drives this imperative, with 1 in 5 Americans expected to be aged ≥65 years by 2030.
      Population Projections United States by State, Age and Sex, for the years 2004 - 2030
      Centers for Disease Control and Prevention. 2019; (Updated November 19)
      https://wonder.cdc.gov/wonder/help/PopulationProjections.html
      Date accessed: February 8, 2021
      In 2020, there were an estimated 5.8 million people aged ≥65 years with ADRD in the U.S., and as the population ages, the number of people with ADRD is expected to reach 8.4 million by 2030 and 13.8 million by 2050.
      2020 Alzheimer's disease facts and figures.
      Alzheimers Dement. 2020; 16: 391-460https://doi.org/10.1002/alz.12068
      Research shows that the modifiable risk factors for ADRD are, for the most part, the same risks associated with cardiovascular disease.
      2020 Alzheimer's disease facts and figures.
      Alzheimers Dement. 2020; 16: 391-460https://doi.org/10.1002/alz.12068
      , 
      • Livingston G
      • Huntley J
      • Sommerlad A
      • et al.
      Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
      Lancet. 2020; 396: 413-446https://doi.org/10.1016/S0140-6736(20)30367-6
      , 
      • Mukadam N
      • Sommerlad A
      • Huntley J
      • Livingston G
      Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data.
      Lancet Glob Health. 2019; 7: e596-e603https://doi.org/10.1016/S2214-109X(19)30074-9
      , 
      • Gottesman RF
      • Albert MS
      • Alonso A
      • et al.
      Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) cohort.
      JAMA Neurol. 2017; 74: 1246-1254https://doi.org/10.1001/jamaneurol.2017.1658
      , 
      National Academy of Sciences, Engineering, and Medicine
      Preventing Cognitive Decline and Dementia: A Way Forward.
      The National Academies Press, Washington, DC2017https://doi.org/10.17226/24782
      , 
      • Whelton PK
      • Carey RM
      • Aronow WS
      • et al.
      2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018;71(6):e140–e144].
      Hypertension. 2018; 71: e13-e115https://doi.org/10.1161/hyp.0000000000000066
      Similar to heart disease, ADRD takes years to develop, presenting an opportunity for risk reduction as research continues for improved symptomatic treatments and disease-modifying agents. Although the growing evidence supporting risk-factor modification for ADRD is encouraging, with the control of midlife hypertension as an important example, the evidence supporting lifestyle interventions for cardiac diseases is consistently high.
      2020 Alzheimer's disease facts and figures.
      Alzheimers Dement. 2020; 16: 391-460https://doi.org/10.1002/alz.12068
      ,
      • Livingston G
      • Huntley J
      • Sommerlad A
      • et al.
      Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
      Lancet. 2020; 396: 413-446https://doi.org/10.1016/S0140-6736(20)30367-6
      ,
      National Academy of Sciences, Engineering, and Medicine
      Preventing Cognitive Decline and Dementia: A Way Forward.
      The National Academies Press, Washington, DC2017https://doi.org/10.17226/24782
      , 
      • Whelton PK
      • Carey RM
      • Aronow WS
      • et al.
      2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018;71(6):e140–e144].
      Hypertension. 2018; 71: e13-e115https://doi.org/10.1161/hyp.0000000000000066
      , 
      • Williamson JD
      • Pajewski NM
      • et al.
      SPRINT MIND Investigators for the SPRINT Research Group
      Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial.
      JAMA. 321. 2019: 553-561https://doi.org/10.1001/jama.2018.21442
      , 
      • Hughes D
      • Judge C
      • Murphy R
      • et al.
      Association of blood pressure lowering with incident dementia or cognitive impairment: a systematic review and meta-analysis.
      JAMA. 2020; 323: 1934-1944https://doi.org/10.1001/jama.2020.4249
      There are numerous examples of successful heart health programs, and efforts to support brain health should complement the existing initiatives rather than compete for limited public health resources. In recent years, excellent lifestyle medicine and brain health resources have been developed to support the development of public health programs for the prevention of cognitive impairment and the care of ADRD.
      • Olivari BS
      • French ME
      • McGuire LC
      The public health Road Map to respond to the growing dementia crisis.
      Innov Aging. 2020; 4: igz043https://doi.org/10.1093/geroni/igz043
      , 

      Public health: state overview. Alzheimer's Association. https://www.alz.org/professionals/public-health/state-overview. Accessed February 8, 2021.

      , 

      Public Health Curriculum on Alzheimer's. Alzheimer's Association.https://www.alz.org/professionals/public-health/core-areas/educate-train-professionals/public-health-curriculum-on-alzheimer-s. Accessed February 8, 2021.

      , 
      American College of Preventive Medicine
      Lifestyle Medicine Core Competencies Program.
      American College of Preventive Medicine, Washington, DC2019
      https://www.acpm.org/education-events/continuing-medical-education/2019/lifestyle-medicine-core-competencies-program/
      Date accessed: February 8, 2021
      , 
      The Gerontological Society of America
      The GSA KAER toolkit for primary care teams.
      The Gerontological Society of America, Washington, DC2020
      https://www.geron.org/programs-services/brain-health-cognitive-impairment-and-dementia
      Date accessed: February 8, 2021
      The time is now to focus on brain health, building on ongoing epidemiologic and encouraging clinical research. In addressing this crisis, 1 key theme to understand is “What's good for the heart, is good for the brain.”
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        • Population Projections United States by State, Age and Sex, for the years 2004 - 2030
        Centers for Disease Control and Prevention. 2019; (Updated November 19)
        https://wonder.cdc.gov/wonder/help/PopulationProjections.html
        Date accessed: February 8, 2021
        View in Article
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        View in Article
        • Livingston G
        • Huntley J
        • Sommerlad A
        • et al.
        Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
        Lancet. 2020; 396: 413-446https://doi.org/10.1016/S0140-6736(20)30367-6
        View in Article
        • Mukadam N
        • Sommerlad A
        • Huntley J
        • Livingston G
        Population attributable fractions for risk factors for dementia in low-income and middle-income countries: an analysis using cross-sectional survey data.
        Lancet Glob Health. 2019; 7: e596-e603https://doi.org/10.1016/S2214-109X(19)30074-9
        View in Article
        • Gottesman RF
        • Albert MS
        • Alonso A
        • et al.
        Associations between midlife vascular risk factors and 25-year incident dementia in the Atherosclerosis Risk in Communities (ARIC) cohort.
        JAMA Neurol. 2017; 74: 1246-1254https://doi.org/10.1001/jamaneurol.2017.1658
        View in Article
        • National Academy of Sciences, Engineering, and Medicine
        Preventing Cognitive Decline and Dementia: A Way Forward.
        The National Academies Press, Washington, DC2017https://doi.org/10.17226/24782
        View in Article
        • Whelton PK
        • Carey RM
        • Aronow WS
        • et al.
        2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Hypertension. 2018;71(6):e140–e144].
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        View in Article
        • Williamson JD
        • Pajewski NM
        • et al.
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        Effect of intensive vs standard blood pressure control on probable dementia: a randomized clinical trial.
        JAMA. 321. 2019: 553-561https://doi.org/10.1001/jama.2018.21442
        View in Article
        • Hughes D
        • Judge C
        • Murphy R
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        JAMA. 2020; 323: 1934-1944https://doi.org/10.1001/jama.2020.4249
        View in Article
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        • French ME
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        View in Article

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        View in Article

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        (Published)
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      Article Info

      Publication History

      Published online: May 15, 2021

      Identification

      DOI: https://doi.org/10.1016/j.amepre.2021.03.005

      Copyright

      Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine.

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