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

      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
      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.
      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.
      • Livingston G
      • Huntley J
      • Sommerlad A
      • et al.
      Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
      • 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.
      • 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.
      National Academy of Sciences, Engineering, and Medicine
      Preventing Cognitive Decline and Dementia: A Way Forward.
      • 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].
      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.
      ,
      • Livingston G
      • Huntley J
      • Sommerlad A
      • et al.
      Dementia prevention, intervention, and care: 2020 report of the Lancet Commission.
      ,
      National Academy of Sciences, Engineering, and Medicine
      Preventing Cognitive Decline and Dementia: A Way Forward.
      • 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].
      • 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.
      • 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.
      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.

      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.
      The Gerontological Society of America
      The GSA KAER toolkit for primary care teams.
      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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