Lifestyle interventions to reduce cardiovascular risk such as regular exercise, eating a balanced diet, low to moderate
alcohol intake and being a non-smoker also seem to protect against age-related cognitive decline. A healthy lifestyle,
both mental and physical, is the best preventative defence.2
Hypertension, stroke and small vessel disease, diabetes, hyperlipidaemia, obesity and hyperhomocysteinaemia have all
been associated with an increased risk of age-related cognitive decline.2
An increased level of fitness is associated with improved memory and learning and a reduction in age-related cognitive
Consumption of small quantities of alcohol (one standard unit of alcohol a day) on a regular basis is thought to stimulate
the hippocampus, therefore counteracting cognitive decline. This follows a U or J shaped curve where teetotal or heavy
drinkers are disadvantaged.2
A healthy, balanced diet rich in antioxidants (e.g. blueberries, strawberries, cocoa, tea) and omega-3 (e.g. oily fish)
may help to slow age-related cognitive decline.6,14 It is preferable (and safer) to use naturally occurring
sources of antioxidants and omega-3 oils than supplement forms.
Gingko biloba is a commonly used supplement for memory loss. In an analysis of 36 trials, it was concluded that gingko
biloba appears to be safe with no excess side effects, however there is no consistent or reliable evidence that it has
any clinically significant benefit for people with dementia or cognitive impairment.15
Antioxidant supplements such as vitamin A, vitamin E and beta-carotene show no significant improvement in longevity,
in fact they may actually increase mortality.16
Also see BPJ 14 “Antioxidants
There is no pharmacological treatment for delaying age-related cognitive decline or improving mild cognitive impairment.
Cholinesterase inhibitors such as donepezil, galantamine and rivastigmine are often used to temporarily stop or slow
cognitive and functional decline in people with Alzheimer-type dementia and dementia associated with Parkinson’s disease.
Clinical trials show mixed evidence of their effectiveness. These medications are not subsidised.
There is no quality clinical evidence to support the use of oestrogen or hormone replacement therapy to prevent or treat
cognitive decline. Some studies report evidence of increased mortality with these treatments.
A higher level of education or occupational attainment is considered to be a protective factor against age-related cognitive
decline.2 However it is never too late to start exercising the brain. There is growing evidence that participating
in activities such as reading, puzzles, computer activities and crafts reduces the risk of age-related cognitive decline.17 Social
interaction is beneficial too. In a study involving almost 1000 elderly people, it was discovered that those who participated
less frequently in social activity, had a more rapid rate of decline in cognitive function.18
In addition to exercising the brain, there are several strategies that can be adopted to help memory recall:1
- Place commonly lost items in the same spot every time
- Write things down e.g. make a “to do” list
- Say words out loud e.g. “I have turned off the iron”, repeat a persons name after being introduced
- Use memory aids e.g. notepad, diary, wristwatch alarm, voice recorder
- Group items using mnemonics e.g. alphabetise a list, create an acronym or acrostic (using the first letter of each
item to form a sentence), use rhymes or create a story to connect the information
- Concentrate and relax when trying to remember
- Sleep on it – research has shown that the brain continues to solve a problem while we sleep
Best practice tip: Encourage elderly patients to take up dancing!
This combines physical activity, brain exercise (counting rhythms, learning steps etc) and social interaction. Some patients
may prefer to join a walking or exercise group.