Institute of Social Medicine, Occupational Health and Public Health (ISAP), University of Leipzig, Ph.-Rosenthal-Str. 55, 04103, Leipzig, Germany.
Soc Psychiatry Psychiatr Epidemiol. 2018 Dec;53(12):1289-1301. doi: 10.1007/s00127-018-1598-7. Epub 2018 Sep 25.
With large numbers of people affected, no treatment in sight and continuing demographic change, the prevention of dementia is becoming a central public health issue.
We conducted a systematic meta-review including systematic reviews and meta-analyses of longitudinal observational studies on modifiable risk and protective factors for dementia published over the last 5 years.
Compelling evidence on a number of modifiable risk factors, mostly lifestyle factors, is available from longitudinal observational studies to inform primary preventive efforts.
Evidence stemming from preventive RCTs is limited. However, multi-domain interventions addressing a variety of risk factors at once seem promising with regard to high-risk individuals (selective preventive approach). However, we argue that it is time to move forward and discuss a public brain health agenda as a universal preventive approach. Based on a risk reduction strategy, the public brain health agenda suggests the following ten key actions: (1) increase physical activity, (2) foster social integration, (3) improve education and foster lifelong learning, (4) provide mentally stimulating workplaces, (5) foster a cognitively active lifestyle, (6) propose a healthy Mediterranean-like diet, (7) reduce alcohol consumption, (8) stop smoking, (9) prevent, diagnose and treat chronic conditions, and (10) reduce anticholinergic medication in the elderly.
受影响人数众多，尚无治疗方法，且人口结构持续变化，因此预防痴呆症正成为公共卫生的核心问题。
我们进行了一项系统的元综述，纳入了过去 5 年中关于可改变的痴呆症风险和保护因素的纵向观察性研究的系统评价和荟萃分析。
来自纵向观察性研究的大量证据表明，一些可改变的风险因素，主要是生活方式因素，可为初级预防工作提供信息。
来自预防性随机对照试验的证据有限。然而，针对多种风险因素的多领域干预措施对于高风险个体（选择性预防方法）似乎很有希望。然而，我们认为现在是时候向前推进，讨论作为一种普遍预防方法的公共大脑健康议程了。基于风险降低策略，公共大脑健康议程提出了以下 10 项关键行动：（1）增加身体活动，（2）促进社会融合，（3）改善教育并促进终身学习，（4）提供有智力刺激的工作场所，（5）培养认知活跃的生活方式，（6）提倡健康的地中海式饮食，（7）减少酒精摄入，（8）戒烟，（9）预防、诊断和治疗慢性疾病，以及（10）减少老年人的抗胆碱能药物。
