The prevention of cognitive decline: risk factors and life strategies
Physical activity, proper diet and cognitive training seem to be important elements not only for maintaining a healthy and stimulating life, but also for decreasing the risk of cognitive decline during aging.
Neuroscience has long suggested that aging well is an achievable prospect. To be clear, while aging in itself is inevitable, the processes that regulate it can be managed through changes to one’s lifestyle and appropriate actions. This opportunity remains valid both in physiological aging and in the initial forms of pathological cognitive decline (Sherman, et al., 2017).
Currently we can estimate a control margin of 40% on the factors usually involved in the development of a neurodegenerative syndrome. The percentage is derived from studies that deal with the identification of risk factors: non-modifiable (age, gender, ethnic group, genetics), on which the margin for action is very low, and modifiable (lifestyle, education, nutrition) , on which there are important perspectives (Klimova, et al., 2017).
A recent study (Livingston et al., 2017) has identified, at different ages, specific factors that contribute to the global risk of dementia in old age: low schooling in youth; in adulthood, hypertension, obesity and sensory deficits such as hearing or vision loss; in old age, smoking, depression, physical inactivity, diabetes and social isolation.
Tipton and colleagues (Tipton, et al., 2018) identified additional factors implicated in the development of cognitive dysfunction, capable of increasing the risk of dementia:
In recent years, several studies have focused on modifiable risk factors in order to outline precise prevention strategies.
There appear to be 3 macro-areas of intervention that crucially influence the processes of neuroplasticity starting from adulthood: physical activity, healthy diet and cognitive training (Klimova et al., 2015).
It is now known that physical activity contributes to increase vascularization, energy metabolism, resistance to oxidative stress and favors the increase in the levels of neurotrophic factors involved in neuroplastic processes (NGF, BDNF). In the elderly population, motor activity also promotes the maintenance of independent daily functioning, promotes the efficiency of cognitive functions (in particular executive functions and memory), reduces the risk of dementia (Nuzum et al., 2020).
A healthy diet, in particular the Mediterranean diet, rich in antioxidant and anti-inflammatory elements has been shown to increase cognitive efficiency in the elderly population (Valls-Pedret et al., 2015) and represents one of the protective factors against the development of MCI -Mild Cognitive Impairment- and Alzheimer (Gardener et al., 2018).
Cognitive training, in accordance with The Scaffolding Theory of Aging and Cognition – Revised (Reuter-Lorenz et al., 2014), promotes neural efficiency mechanisms in adulthood and in aging strengthens the compensation mechanisms through strengthening of connectivity and neural recruitment in new regions, especially fronto-parietal. Cognitive training, when not conducted only on a single domain, is one of the factors that promote the maintenance of the efficiency of the central nervous system and that reduce the risk of incurring cognitive decline as we age (Baumgart et al., 2015) .
A Finnish longitudinal study (Ngandu et al., 2015) involving 1260 individuals in a multidimensional program for 2 years (nutritional intervention, exercise, cognitive training, cardiovascular risk monitoring) recorded a 25% improvement in test results neuropsychological in the subjects subjected to the trial, demonstrating how a combined approach has great potential in preventing cognitive decline.
Physical activity, proper diet and cognitive training can be identified as important elements for maintaining a healthy and stimulating life. They can also become tools through which to correct the risk of age-related cognitive decline.