Risk reduction of cognitive decline and dementia: World Health Organisation (WHO) guidelines

Worldwide, around 50 million people have dementia and, with one new case every three seconds. The number of people with dementia is set to triple by 2050.

The below points provide a summary of the recently updated 96-page WHO document outlining how to reduce the risk of cognitive decline and dementia.

1. Physical Activity is recommended to prevent and reduce rate of cognitive decline. Physical activity has positive effect on brain structure and other factors, such as hypertension, cholesterol and insulin resistance; and improves immune function and anti-inflammatory properties.
   
   Aim for:
   - 150 min of moderate intensity OR 75 mins vigorous (or a combination of the two). Must be in at least 10 min bouts
   - Balance exercises 3+ per week
   - Muscle strengthening for all major muscle groups 2+ days each week
   
   
2. Avoid tobacco use.
   
   
3. Eat a Mediterranean-like and balanced diet is best to prevent and reduce rate of cognitive decline.
   
   Aim for:
   Less than 5g salt/day (~1 teaspoon)
   Less than 30% total energy from fats (saturated less than 10%)
   Less than 10% sugars = ~50g/day
   400g + of vegetables and fruits per day
   Include a variety of legumes, nuts, whole grains
   
   Supplements: Vitamins B and E, polyunsaturated fatty acids and multi-complex supplementation – NOT enough evidence to recommended for reducing risk of decline. Benefits do not outweigh adverse effects.
   
   
4. Alcohol use. There is a U-shaped relationship between alcohol consumption and cognitive function. There is not enough research to suggest the ideal amount that is protective toward dementia and/or cognitive decline. Thus, it is generally not recommended.
   
   
5. Include cognitive interventions (i.e., dancing, learning a new language).
   
   
6. Maintain social interactions and support (to prevent loneliness, depression).
   
   
7. Maintain weight (refer back to physical activity and nutrition interventions). Obesity at midlife increases risk of dementia, also related to diabetes, hypertension and high cholesterol, all of which are other risk factors for dementia.
   
   
8. Manage hypertension. There is a greater risk of cognitive decline if not managed at mid-life.
   
   
9. Manage diabetes: Poor glucose control is associated with increased risk of cognitive decline. Poor glucose control can also negatively affect hearing, cardiovascular disease, nephropathy (all of which are other risks for cognitive decline).
   
   
10. Manage high cholesterol. Particularly at mid-life, managing hypertension may reduce risk of cognitive decline.
    
    
11. Mange depression. Depression doubles the risk for dementia. There is a possible association between depression, noradrenergic changes and white matter lesions.
    
    
12. Manage hearing loss. Timely identification and management of hearing loss may reduce risk of cognitive decline and improve functional ability, social and emotional well-being.
    
    
    For the full document, refer to this link: https://apps.who.int/iris/bitstream/handle/10665/312180/9789241550543-eng.pdf