Prevention of Late-Life Dementia: No Magic Bullet
Authors: Eric B. Larson
Journal: Annals of Internal Medicine (2017)

Editorials2 January 2018Prevention of Late-Life Dementia: No Magic BulletEric B. Larson, MD, MPHEric B. Larson, MD, MPHKaiser Permanente Washington Health Research Institute, Seattle, Washington (E.B.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3026 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In describing the biodemography of human aging, noted demographer James Vaupel wrote that half of the children alive in 2010 in countries with the highest life expectancies may live to celebrate their 100th birthday. He also wrote about a related public health imperative: the high rates of Alzheimer disease and related dementias (ADRD) in persons older than 85 years. Quoting Shakespeare's As You Like It (“sans teeth, sans eyes, sans taste, sans everything”), Vaupel called cognitive impairment and sensory deprivation, especially vision and hearing loss, the “two scourges of senescence” (1).Since the early to mid-1980s, scientific attention and support ...References1. Vaupel JW. Biodemography of human ageing. Nature. 2010;464:536-42. [PMID: 20336136] doi:10.1038/nature08984 CrossrefMedlineGoogle Scholar2. Brasure M, Desai P, Davila H, Nelson VA, Calvert C, Jutkowitz E, et al. Physical activity interventions in preventing cognitive decline and Alzheimer-type dementia. A systematic review. Ann Intern Med. 2018;168:30-8. doi:10.7326/M17-1528 LinkGoogle Scholar3. Fink HA, Jutkowitz E, McCarten JR, Hemmy LS, Butler M, Davila H, et al. Pharmacologic interventions to prevent cognitive decline, mild cognitive impairment, and clinical Alzheimer-type dementia. A systematic review. Ann Intern Med. 2018;168:39-51. doi:10.7326/M17-1529 LinkGoogle Scholar4. Butler M, Nelson VA, Davila H, Ratner E, Fink HA, Hemmy LS, 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;168:52-62. doi:10.7326/M17-1530 LinkGoogle Scholar5. Butler M, McCreedy E, Nelson VA, Desai P, Ratner E, Fink HA, et al. Does cognitive training prevent cognitive decline? A systematic review. Ann Intern Med. 2018;168:63-8. doi:10.7326/M17-1531 LinkGoogle Scholar6. National Academies of Sciences, Engineering, and Medicine. Preventing Cognitive Decline and Dementia: A Way Forward. Washington, DC: National Academies Pr; 2017. Google Scholar7. Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, et al. Dementia prevention, intervention, and care. Lancet. 2017. [PMID: 28735855] doi:10.1016/S0140-6736(17)31363-6 CrossrefMedlineGoogle Scholar8. Lautenschlager NT, Cox KL, Flicker L, Foster JK, van Bockxmeer FM, Xiao J, et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA. 2008;300:1027-37. [PMID: 18768414] doi:10.1001/jama.300.9.1027 CrossrefMedlineGoogle Scholar9. Rebok GW, Ball K, Guey LT, Jones RN, Kim HY, King JW, et al; ACTIVE Study Group. Ten-year effects of the advanced cognitive training for independent and vital elderly cognitive training trial on cognition and everyday functioning in older adults. J Am Geriatr Soc. 2014;62:16-24. [PMID: 24417410] doi:10.1111/jgs.12607 CrossrefMedlineGoogle Scholar10. Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R, et al. A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet. 2015;385:2255-63. [PMID: 25771249] doi:10.1016/S0140-6736(15)60461-5 CrossrefMedlineGoogle Scholar11. Sonnen JA, Larson EB, Crane PK, Haneuse S, Li G, Schellenberg GD, et al. Pathological correlates of dementia in a longitudinal, population-based sample of aging. Ann Neurol. 2007;62:406-13. [PMID: 17879383] CrossrefMedlineGoogle Scholar12. Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175:401-7. [PMID: 25621434] doi:10.1001/jamainternmed.2014.7663 CrossrefMedlineGoogle Scholar13. Larson EB, DeClaire J. Enlightened Aging: Building Resilience for a Long, Active Life. Lanham, MD: Rowman & Littlefield; 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: Kaiser Permanente Washington Health Research Institute, Seattle, Washington (E.B.L.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3026.Corresponding Author: Eric B. Larson, MD, MPH, Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101; e-mail, larson.[email protected]org.This article was published at Annals.org on 19 December 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPhysical Activity Interventions in Preventing Cognitive Decline and Alzheimer-Type Dementia Michelle Brasure , Priyanka Desai , Heather Davila , Victoria A. Nelson , Collin Calvert , Eric Jutkowitz , Mary Butler , Howard A. Fink , Edward Ratner , Laura S. Hemmy , J. Riley McCarten , Terry R. Barclay , and Robert L. Kane Does Cognitive Training Prevent Cognitive Decline? Mary Butler , Ellen McCreedy , Victoria A. Nelson , Priyanka Desai , Edward Ratner , Howard A. Fink , Laura S. Hemmy , J. Riley McCarten , Terry R. Barclay , Michelle Brasure , Heather Davila , and Robert L. Kane Pharmacologic Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia Howard A. Fink , Eric Jutkowitz , J. Riley McCarten , Laura S. Hemmy , Mary Butler , Heather Davila , Edward Ratner , Collin Calvert , Terry R. Barclay , Michelle Brasure , Victoria A. Nelson , and Robert L. Kane Over-the-Counter Supplement Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia Mary Butler , Victoria A. Nelson , Heather Davila , Edward Ratner , Howard A. Fink , Laura S. Hemmy , J. Riley McCarten , Terry R. Barclay , Michelle Brasure , and Robert L. Kane Metrics Cited byLeveraging neuropathological data in pharmacoepidemiology: A promising approach for dementia prevention?The Association Between Anemia of Chronic Inflammation and Alzheimer’s Disease and Related DementiasPrevention of Dementia: Integrative Medicine and Its Differing EpistemologyBeliefs about benefits and harms of medications and supplements for brain healthThe turn towards prevention – moral narratives and the vascularization of Alzheimer’s diseasePossibilities of Dementia Prevention - It is Never Too Early to StartThe de-Alzheimerization of age-related dementias: implications for drug targets and approaches to effective therapeuticsThe Effects of the Digital Platform Support Monitoring and Reminder Technology for Mild Dementia (SMART4MD) for People With Mild Cognitive Impairment and Their Informal Carers: Protocol for a Pilot Randomized Controlled TrialAlzheimer’s disease (AD) therapeutics – 2: Beyond amyloid – Re-defining AD and its causality to discover effective therapeuticsA New Approach to Treating Neurodegenerative Otologic DisordersFizinio aktyvumo, medikamentinio gydymo, maisto papildų ir kognityvinių treniruočių įtaka Alzheimerio ligos, susijusių demencijų prevencijai ir kognityvinių gebėjimų išlaikymui 2 January 2018Volume 168, Issue 1Page: 77-79KeywordsAgingAlzheimer diseaseBrainDementiaExerciseHearingMedical risk factorsMild cognitive impairmentPrevention, policy, and public healthVision ePublished: 19 December 2017 Issue Published: 2 January 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. 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