Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
Is there A Way to Prevent Dementia and Cognitive Decline?
Posted in Addison's Disea... by Dr. Sharon Orrange on Apr 21, 2008

More than 33% of women and 20% of men over age 65 develop dementia, and many more develop a milder form of cognitive impairment. I think we can all appreciate the huge impact dementia has on the medical system and more importantly on the individuals and family members involved. Many of my patients who have loved ones experiencing cognitive decline ask me: Is there any way to prevent this from happening to me? Is there truth to the old adage "use it or lose it?" While there are risk factors for dementia we can't change (such as family history and age) we should focus on those risk factors we can change.

Does using your mind an hour a day really help prevent inevitable cognitive decline and dementia?

Well, at the annual meeting of the American Academy of Neurology, data from a large trial suggests this may be the case. Older adults with normal cognition (memory, attention, perception) who participated in a mental fitness program for 1 hour a day, 5 days a week for 8 weeks demonstrated significant improvements in memory and nonmemory tasks. Simply put, we should promote mental activity in our older family members including lifelong education.

Which risk factors for Dementia can we modify?

Obesity, cardiovascular disease, and physical and intellectual inactivity are areas patients can work on with their primary care doctors. Here are some simple strategies:

1) Your doctor should screen for depression and start effective treatment promptly: depression is a common and unrecognized cause of "concentration difficulties" which can look like early mental decline and forgetfulness and can be reversed with treatment of depression.

2) Reduce cardiovascular risk factors, such as high blood pressure, high cholesterol, diabetes, and obesity, especially during midlife.

3) Prevent head trauma (this is never good).

4) Promote mental stimulation.

5) Encourage physical activity (this is always good).

Which supplements, medications or diet changes will help prevent Dementia?

While there aren't any new preventative treatments for Dementia, we are working on it. Two recent studies have shown that a Mediterranean diet lowers the risk of Alzheimer's disease. There is no ONE Mediterranean diet but this is a diet typically high in fruits, vegetables, whole grains, beans, nuts and seeds, and olive oil with LOW TO MODERATE amounts of fish, poultry, and dairy products, and LITTLE red meat. We no longer recommend Vitamin E because of the evidence that came out in studies that Vitamin E supplementation increases the risk for all-cause mortality. Clinical trials are underway to explore the benefits of ginkgo, selenium, simvastatin (Zocor), estrogen (which looks like it will be of no benefit), and NSAIDs (motrin, ibuprofen) on dementia and cognitive decline. Stay tuned.

Dr O.


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My mother was diagnosed with alheimers disease two years ago after becoming very ill with COPD. She was on so many meds, they couldn't fit in two daily pill containers for am and pm. My brother who is a really bad alcoholic and lived with her, taking care of everything. Then he started bringing his low life friends in the house. I had her move in with me. Then she broke her hip and she was just so out of it. My kids were away at school so she went to live with my brother, who had her put on even more meds because she was becoming combative with my sister in law (we never actually saw this) and eventually she moved back in with me and the help of some part time caretakers while I was at work. I took her to my doctor that has a wellness center because she just never felt well and we felt she was on too many meds. He reduced her blood pressure meds immediately and had me wean her of the risperidone she was taking for combative behavior. She started doing cognitively better! I brought her back in 3 months and he further reduced her blood pressure meds because at 87, she may have needed to have higher blood pressure just so the blood could get to her brain. He also took her off of the aricept. She will never be the old "mom," but she now converses and it is so great to hear her laugh again. The doctor felt she was depressed, may have had a nervous breakdown because of what was happening in her house, was affected by the anesthesia long term due to her age and was way over-medicated. She still has dementia and cycles in and out of confusion, but it was vascular, not alzheimers. Alzheimers does not get better....
By Harmony8  Jul 17, 2009
Hey SharonHanson
I hear you...its so hard to study exposures like aspartame because they are so commonly used and dementia is so common..hard to see if there is a relationship but I can tell you i tell patients to stop anything with Aspartame and their headaches go away.
Dr O.
By DrOrrange  Jun 05, 2008
Will you post this at the neuropathy group - which is a subtopic of chronic pain -

By petitep  May 13, 2008
Dr. O I'd be interested to find out how neurotoxins such as aspartame, mycotoxins and endotoxins play a role in dementia. These also cause cognitive impairment and limiting exposure could be considered preventitive. However, those with Lyme disease have an incredible time getting a diagnosis and it's the same with mold exposure. Aspartame should be banned as it is a proven neurotoxin.
By SharonHanson  May 10, 2008
Oils EPA and DHA was very helpful in getting my thinking improved. Seemed fish oil didn't help but the plant source that the fish eat did help me the best. I also suffered from depression and had found medication to be very helpful too. It seems these oils support the fat the brain needs to function. Add that to your list. I tried ginko and never felt improved with that supplement. But suppose that my system didn't need more blood circulation. It is very good to figure out how different supplements work in the body.
By lizgirl  May 08, 2008
I concur with your opinion 100% Sharon. Intellectual (cognitive) exercise and growth due not stop unless there is an underlying cause. People can be cognitively alert well into their 100's if they stay physically active, fit and use the brains like you would a muscle. Use it or lose it applies to the brain as well as to the muscles.
By WJGonza  May 07, 2008
This seems like such a key issue as medical advancements continue to increase our lifespans. It seems to tie in to the idea, Perhaps innacurate? that some senior assisted group living homes don't focus on mentally stimulating activities.
By nicholas  May 07, 2008
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