"No Magic Bullet" for Preventing Dementia in Older Age

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

There's "no magic bullet" for preventing late-life dementia, an editorialist concludes in the Annals of Internal Medicine. His comments follow analysis of four evidence-based reviews of randomized trials of preventive interventions in adults without dementia.

Here are some of the reviews' findings:

• Physical activity: Evidence was insufficient that single-component interventions — for example, aerobic or resistance training — improved cognition or prevented dementia in those without cognitive impairment. A multipart intervention including activity, diet, and cognitive training appeared to improve cognitive test measures, but the evidence was low-strength.

• Medication: Evidence did not support use of any of the following for preventing cognitive decline in adults with normal cognition or mild cognitive impairment: antihypertensives, statins, nonsteroidal anti-inflammatory drugs, aspirin, diabetes drugs, or cholinesterase inhibitors.

• Over-the-counter supplements: Evidence was insufficient to support use of any OTC supplement, including omega-3 fatty acids, ginkgo biloba, B vitamins, vitamin D with calcium, beta-carotene, or multivitamins.

• Cognitive training: Cognitive training seemed to improve test performance only in the domain trained, such as processing speed. Evidence was insufficient that training prevented or delayed cognitive decline.

The editorialist, also looking at prior evidence reviews, advocates for a "common-sense" approach. Namely, he advises patients to focus on "regular physical activity; control of vascular risk factors, including preventing or effectively managing diabetes; not smoking; and maintaining a healthy diet and weight."