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Healthy Aging pp 169–180Cite as

Cognition and Health Ageing

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Abstract

Currently over 50 million people worldwide have dementia. Given the current lack of pharmacological disease-modifying therapy for dementia, it is important to emphasise preventative measures and strategies to reduce the risk of cognitive decline.

Established risk factors for cognitive decline can generally be divided into two overlapping groups: lifestyle factors and clinical/medical factors. Lifestyle factors that have been shown to increase the risk of cognitive decline and dementia include lower educational attainment, low physical activity, smoking, unhealthy diet and obesity, alcohol excess, poor sleep, and lack of social engagement. Clinical risk factors include midlife hypertension, diabetes, late-life depression, delirium, and culprit medication use, particularly those with anticholinergic properties.

Presently, guidance regarding prevention of cognitive decline is based primarily on evidence from observational studies rather than randomised control trials. This may be due to the fact that studies to date have not addressed key factors such as the long time lag between exposure to risk factors for cognitive decline and adverse outcomes.

It is also clear, however, that the biological mechanisms underlying cognitive decline are particularly complex, with interaction of connected risk factors with differing effects at different life stages. Given this complexity, it is not surprising that modification of a single risk factor or therapeutic strategy in isolation has generally been unsuccessful to date, and it is likely that prevention of cognitive decline is only feasible in this context using a multimodal approach.

Structured multimodal interventions have shown some promising initial results, including the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER). A multifaceted approach focusing on interventions, such as managing vascular risk factors, maintaining a healthy diet, and engaging in cognitively stimulating activity is therefore advised. The timing of such interventions is also important, however. We now know that the brain changes linked with Alzheimer’s disease begin decades before the onset of any clinically recognisable symptoms, so interventions to promote brain health, particularly management of BP and diabetes, should begin in midlife at the latest.

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Authors and Affiliations

  1. Centre for Ageing, Neurosciences and the Humanities, Tallaght University Hospital, Dublin, Ireland

    Robert Briggs

  2. Centre for Ageing, Neuroscience and the Humanities, Age-related Health Care, Tallaght University Hospital, Dublin, Ireland

    Sean P. Kennelly

  3. Centre for Ageing, Neurosciences and the Humanities, Trinity Centre for Health Sciences, Trinity College Dublin, Tallaght University Hospital, Dublin, Ireland

    Desmond O’Neill

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  1. Robert Briggs
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  3. Desmond O’Neill
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Correspondence to Robert Briggs .

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  1. Center on Aging and Departments of Family Medicine and Medicine, University of Connecticut School of Medicine, Farmington, CT, USA

    Patrick P. Coll

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Briggs, R., Kennelly, S.P., O’Neill, D. (2019). Cognition and Health Ageing. In: Coll, P. (eds) Healthy Aging. Springer, Cham. https://doi.org/10.1007/978-3-030-06200-2_15

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