TABLE 6.
Risk reduction
| Nutrition |
| 1a. We recommend adherence to a Mediterranean diet to decrease the risk of cognitive decline. 1B (91%) |
| 1b. We recommend a high level of consumption of mono‐ and polyunsaturated fatty acids and a low consumption of saturated fatty acids, to reduce the risk of cognitive decline. 1B (92%) |
| 1c. We recommend increasing fruit and vegetable intake. 1B (88%) |
| Physical Exercise |
| 2a. We recommend physical activity interventions of at least moderate intensity to improve cognitive outcomes among older adults. 1B (96%) |
| 2b. We recommend aerobic exercise and/or resistance training of at least moderate intensity to improve cognition outcomes among older adults. 1B (94%) |
| 2c. There is promising evidence that dance interventions and mind‐body exercise (for example, Tai Chi, Qigong) of moderate dose improve cognitive outcomes among older adults but results from larger, high quality trials are needed. 2B (84%) |
| 3a. We recommend physical activity interventions involving aerobic exercise to improve cognitive outcomes among people with mild cognitive impairment (MCI). 2B (94%) |
| 3b. We recommend aerobic exercise to improve cognitive outcomes among people with MCI. 2B (94%) |
| 3c. There is promising evidence to support resistance training and mind‐body exercise (eg, Tai Chi, Qigong) to improve cognitive outcomes among older adults with MCI but results from larger, high quality trials are needed. 2C (83%) |
| 4. We recommend physical activity interventions to reduce the risk of dementia, including Alzheimer's disease and vascular dementia. 2B (96%) |
| Hearing |
| 5a. Persons with cognitive complaints, MCI, or dementia (and their care partner, if there is one) should be questioned about symptoms of hearing loss to improve cognitive outcomes and risk reduction. It is recommended that persons are asked if they have any difficulty hearing in their everyday life (rather than asking if they have a hearing loss). 1B (93%) |
| 5b. If symptoms of hearing loss are reported, then hearing loss should be confirmed by audiometry conducted by an audiologist meeting provincial regulations for the practice of audiology. If confirmed, audiologic rehabilitation may be recommended. This rehabilitation may include behavioral counselling and techniques, and may or may not include the recommended use of a hearing aid or other device. 1A (98%). |
| 6. We recommend following the World Health Organization 2019 guidelines for risk reduction of cognitive decline and dementia 50 including: (a) audiological examination and/or otoscopic examination; (b) the review of medications for potential ototoxicity; (c) referral to otolaryngology for persons with chronic otitis media or who fail otoscopy. 1A (93%) |
| Sleep |
| 7a. A careful sleep history, including assessment of sleep time, and symptoms of sleep apnea, should be included in the assessment of any patient at risk for dementia. Patients in whom sleep apnea is suspected should be referred for polysomnography and/or sleep specialist consultation for consideration of treatment. 1C (96%) |
| 7b. Adults with sleep apnea should be treated with continuous positive airway pressure (CPAP), which may improve cognition and decrease the risk of dementia. 1C (96%) |
| 7c. Avoiding severe (<5 hours) sleep deprivation, and targeting 7‐8 hours of sleep per night, may improve cognition and decrease the risk of dementia. 1C (94%) |
| 7d. Although associated with incident cognitive decline and dementia, there is insufficient evidence to recommend treatment of insomnia, long sleep time, daytime napping, sleep fragmentation, circadian irregularity, or abnormal circadian phase with a goal of improving cognition and decreasing the risk of dementia. 3C (90%) |
| Cognitive Training and Stimulation |
| 8a. We recommend that when accessible empirically supported individual computer‐based and group cognitive training be proposed to people at risk, and those with a diagnosis of mild cognitive impairment or mild dementia. We recommend additional studies to optimize effective delivery of training, and evaluation of their cost effectiveness. No specific program can be endorsed at this time. 1B (83%) |
| 8b. We recommend that individuals be advised to increase or maintain their engagement in cognitively stimulating activities such as cognitively stimulating pastimes, volunteering, and long‐life learning. No particular activities can be suggested at this time but data suggest that engaging in a variety of cognitively stimulating activities is preferable. 1C (96%) |
| Social Engagement and Education |
| 9a. We recommend attention to social circumstances and supports across the life course, including poverty reduction strategies and opportunities for social engagement. 1B (90%) |
| 9b. We recommend support for educational attainment, particularly in early life (1B) but also for ongoing educational experiences in mid and later life. 1C (98%) |
| Frailty |
| 10. We recommend that interventions to manage frailty be used to reduce the overall burden of dementia in older adults. 1B (81%) |
| Medications |
| 11a. Exposure to medications known to exhibit highly anticholinergic properties should be minimized in older persons. Alternative medications should be used for specific indications where medications with anticholinergic properties are indicated (eg, depression, neuropathic pain, urge type urinary incontinence). 1B (100%) |
| 11b. Multidimensional health assessment for older adults, including of medication use, with the aim of identifying reversible or modifiable health conditions and rationalizing medication use. 1B (92%) |