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9 Protective/risk factors (Methods (Delphi (check literature, experts,…
9 Protective/risk factors
Risk factors
Barnes
Half of AD cases attributed to modifiable risk factors
(in order of importance)
Midlife obesity
Vascular problem
Not related to obesity at old age
Midlife hypertension
Depression
Diabetes
vascular mechanisms
glucose conentration, inflammation, beta-amloid metabolism
Physical inactivity
cariovascular risk
Direct effect on brain
Smoking
related to vascular disease
first thought to be beneficial
Neurotoxins
Low education
Deckers
Systematic literature review
Potential modifiable risk factors
Strong support(more)
diabetes
Smoking
Depression
Vegetable intake
physical activity
may directly affect brain independen from cardioprotective effects
cognitive training
may delay cognitive decline by increasing cognitive reserve
Hypertension
Midlife
mechanisms
atherosclerosis, white matter lesions, neuritic plaques and tangles, atrophy
Alcohol
Risk and protective factor
alcohol related brain damage
Hyperlipidemia
Cholesterol
in brain can accelerate AD
Need further investigation
coronary heart disease, renal dysfunction, diet, cognitive activity
4 phases
systematic review
Delphi first round
experts name potential factors and rank them
synthesis of information
Delphi second
gave experts list and experts gave weitghts
Interventions
FINGER
Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability
Older adults with risk for cardiovascular and dementia
Multidomain intervention
Diet
Exercise
Cognitive training
Vascular risk monotoring
Findings
a multidomain intervention could improve or maintain cognitive functioning in at risk elderly
Reijnders
Systematic review
Difficult to compare heterogeneous studies
evaluate effectiveness of cognitive interventions in healthy elderly and MCI
Looked at methodolical quality
Quite low
Interventions
Training, memory strategies, computerized training, psycho-education
findings
cognitive interventions can be effective
Memory performance, executive functioning, processing speed, attention, fluid intelligence, subjective cognitive performance
Active control
Effect on executive functioning, speed, attention and subjective memory function
MCI population
No effect
Cognitive interventions can have positive effect on cognitive function in healthy but not in MCI
Generelizability to untrained tasks
little evidence
Long term benefits
At least a few months
Limitations
publication bias
Only english
Only one person selected the papers
Protective factors
Mediterranean diet
High in olive oil, fruits, vegetables, nuts, seeds, beans and fish. Moderate wine or dairy. Low meat
Oxidative stress related to cognitive decline
protection by anti-oxidant rich food?
Study
3 groups
Control
Low fat
Diet+olive oil
Diet + nuts
Findings
No effect on depression
diet+nuts
improvement in memory (compared to control)
Diet + oil
Improved frontal function and global cognition
5-year randomized clinical trail
High cardiovascular risk
composite score
z-scores of all tests added and look at general score
2 test moments
Interpretation
Ontioxidants and antiinflammatory agents
reduced polyphenol
associated with memory
Vascular improvement
Methods
RCT
Randomized controlled trail
Delphi
check literature, experts
When it is not clear what the factors are
Systematic review
strict criteria for choosing studies
Effects of cognitive training