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CC Nov 2017 Prevention of Alzheimer's Disease

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echoecho's version from 2017-11-13 13:19

Section

Question Answer
It is estimated that by the year 2050, how many people will be affected by Alzheimer's Disease (AD)?131.5 million
AD is the most common _________ disease in the US?Neurodegenerative
AD is a major cause of morbidity and mortality and what other consequences?1) need for assisted and total care facility placement 2) financial burden to families and society
What are the non-modifiable factors associated with increased risk of AD?1) genetic factors 2) family hx 3) older age 4) HTN 5) head trauma 6) obesity 7) diabetes 8) hyperlipidemia
True or false? A number of environmental and lifestyle factors are thought to play an important role in the prevention of AD?true
*** In 2013, The Lancet launched a Commission to review available evidence and produce recommendations about how best to manage or prevent dementia, what were their findings?dementia is likely to be a clinically SILENT disorder that begins at midlife (40-65 years) and the terminal stage manifests as symptoms of dementia
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NUTRITION
Question Answer
Some studies link the amount of _____ _____ (found in dairy products and meats) and_____ ______ (found in many snack foods) with increased risk of Alzheimer's disease?1) saturated fat 2)trans fats
What allele is strongly associated with the development of AD? What is it's role?1)APOEE4 2) key role in transport of cholesterol
Accumulation of cholesterol in the blood may lead to increased _____ _____ production or accumulation in the brain and is the proposed mechanism to explain this connection?beta-amyloid
Adherence to what diet reduces the risk of vascular disease and is recommended for reduction of risk for AD?Mediterranean Diego
Describe what to eat in a Mediterranean diet?increased intake of fruits, vegetables, legumes (lentils, peas and beans), and whole grains
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MOVEMENT
Regular _____ _______ is associated with less cognitive decline later in life
Question Answer
Adults who exercised in ______were less likely to develop dementia at age 65 when compared to their sedentary peers?midlife
Controlled trials have demonstrated that _____ minutes of aerobic exercise (such as brisk walking) ____ days per week reduced brain atrophy and improved cognitive functioning?40; 4
True or false? Long-term studies that demonstrate a clear connection to prevention of AD are lacking?true
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MEDICATIONS
Question Answer
Vascular disease and elevated cholesterol are both risk factors for dementia, and some suggest that ____ may help reduce that risk?statins
***A 2015 Cochran review looked at 2 studies that included 26,340 people. There were limitations in the study and unfortunately, what was the conclusion?there is good evidence that statins given in late life to people at risk of vascular disease do NOT prevent cognitive decline or dementia
It is possible that statins used to reduce cholesterol _____ in life may reduce the development of AD, but further research is needed?early
True or false? There are some people who demonstrate the neuropathologic changes of AD but who do not exhibit the clinical symptoms of dementia?true
In a study done in the UK, people of African descent, living in the UK or US, who also have HTN, have an ________ risk of developing AD?increased
More aggressive control of HTN may ______ the risk for developing symptoms of AD?lower
*** No evidence yet exists from randomized double-blind and placebo-controlled trials on whether what anti-inflammatory medication is efficacious for patients diagnosed as having AD?ibuprofen
Have all large scale studies targeting the use of steroids and NSAIDs failed to show benefit in the prevention of AD?;yes
True or false? Although there is an association between reduced risk of AD and preservation of cognitive function with the use of NSAIDs and animal models exist that implicate inflammation as part of the pathological process of AD, there are no clear data to support the use of NSAIDs for prevention?true
True or false? There are a number of studies designed to assess the impact of other NSAIDs including Naproxen, but those data are not yet available?true
High levels of _____ have been found to preserve cognition in animal studies and the use of hormones has been investigated for possible prevention of AD in humans?estrogen
*** A 2008 Cochran review evaluated 24 studies over 5 years which included more than 10,000 women and found good evidence of what?NEITHER estrogen NOR estrogen/protestin combined therapy prevent cognitive decline
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VITAMINS, HERBS AND DIETARY SUPPLEMENTS
Question Answer
The anti-inflammatory effects of consumption of ______ _____ ______ ______ ______ has been considered for possible prevention of AD?omega 3 poly-unsaturated fatty acids (PUFAs)
What have observational studies showed regarding PUFAs?suggest a lower rate of cognitive decline in patients with diets high in omega-3 PUFA food sources but there is little evidence to support the use of these supplements
What were the findings of two studies involving > 3500 participants who were observed over 24-40 months?showed NO difference in rates of cognitive decline in those who used omega-3 PUFA supplements compared to placebo.
Unfortunately, over the 24-40 months that the patients were observe, participants in both arms of the study had either small or no cognitive decline overall and thus ______ studies are needed to better assess this intervention?longer
What was the findings of a study using ginkgo biloba 120 mg BID in 3,069 participants who had normal cognition or mild cognitive decline, followed for a median of 6.1 years?no difference was seen between the supplemented group compared to those taking placebo
What was the findings of a study where 2043 women took calcium 1000 mg with vit D 400 units daily compared to controls with cognition assessed with a battery of psychological tests over 8 years?found no difference in the two groups
What was the findings of vit E?it should be obtained through diet and there is little evidence that intake in supplement form affects the development or progression of dementia. Also vit E can increase risk of all-cause mortality
What was the findings of vit C?it should be obtained through diet and there is little evidence that intake in supplement form affects the development or progression of dementia.
What was the findings of vit B12 and/or folate?this deficiency can lead to cognitive decline, but there is no evidence that supplementation of these vitamins in patients with sufficient dietary intake improves outcome
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COGNITIVE AND SOCIAL ENGAGEMENT
Question Answer
Is maintenance of cognitive functioning with games and challenging tasks been associated with slowed age related cognitive decline?yes
What was the findings in 52 studies that were analyzed and evaluated more than 4900 cognitively health participants who used computerized cognitive training to preserve functioning and reduce risk of dementia?1) no improvements noted in executive function or attention 2) smal improvement in processing speed and working memory. 3) slightly more improvement noted in those who trained in a center with other older adults when compared to those who trained at home, possible due to the social interactions in the study design.
Is prevention of social or intellectual isolation associated with lower risk of development of AD? Is there clear data that demonstrations prevention?1) yes 2) no
Is hearing loss associated with an increased risk of cognitive impairment?yes
*** Although to date, no systematic review have been done to assess hearing loss and incident dementia, multiple studies found what about peripheral hearing loss?a significant risk factor for dementia
Are there any studies to date, that show clear evidence that a healthy lifestyle can prevent the development of Alzheimer's disease? Are there associations with healthy behaviors and reduced risk?1) yes 2) yes
Observational studies have linked what behaviors with a lower risk of cognitive impairment?1) physical activity 2) control of BP 3) correction of hearing loss 4) correction of diabetes
Do clinical trials support the use of prescription medications or vitamin / mineral / herbal supplementation for the prevention of cognitive decline?no
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SUMMARY
Question Answer
*** True or false? There is limited, long-term evidence that modification of lifestyle factors is effective for the prevention of Alzheimer's disease (AD)?true
*** True or false? There is limited data to support the use of dietary supplementation in the prevention of AD?true
*** Control of what factors reduces risk of vascular disease (a known risk factor for the development of AD)?1) HTN 2) DM 3) hyperlipidemia 4) obesity
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