Risk reduction of cognitive decline and dementia - WHO Guidelines

SUMMARY OF RECOMMENDATIONS

Physical activity interventionsPhysical activity should be recommended to adults with normal cognition to reduce the risk of cognitive decline.Quality of evidence: moderateStrength of the recommendation: strongPhysical activity may be recommended to adults with mild cognitive impairment to reduce the risk of cognitive decline.Quality of evidence: lowStrength of the recommendation: conditional

Tobacco cessation interventionsInterventions for tobacco cessation should be offered to adults who use tobacco since they may reduce the risk of cognitive decline and dementia in addition to other health benefits. Quality of evidence: lowStrength of the recommendation: strong

Nutritional interventionsThe Mediterranean-like diet may be recommended to adults with normal cognition and mild cognitive impairment to reduce the risk of cognitive decline and/or dementia. Quality of evidence: moderateStrength of the recommendation: conditionalA healthy, balanced diet should be recommended to all adults based on WHO recommendations on healthy diet.Quality of evidence: low to high (for different dietary components)Strength of the recommendation: conditionalVitamins B and E, polyunsaturated fatty acids and multi-complex supplementation should not be recommended to reduce the risk of cognitive decline and/or dementia. Quality of evidence: moderateStrength of the recommendation: strong

Interventions for alcohol use disordersInterventions aimed at reducing or ceasing hazardous and harmful drinking should be offered to adults with normal cognition and mild cognitive impairment to reduce the risk of cognitive decline and/or dementia in addition to other health benefits. Quality of evidence: moderate (for observational evidence) Strength of the recommendation: conditional

Cognitive interventionsCognitive training may be offered to older adults with normal cognition and with mild cognitive impairment to reduce the risk of cognitive decline and/or dementia. Quality of evidence: very low to low Strength of the recommendation: conditional

Social activityThere is insufficient evidence for social activity and reduction of risk of cognitive decline/dementia.Social participation and social support are strongly connected to good health and well-being throughout life and social inclusion should be supported over the life-course.xiiiExecutive SummaryWeight managementInterventions for mid-life overweight and/or obesity may be offered to reduce the risk of cognitive decline and/or dementia.Quality of evidence: low to moderateStrength of the recommendation: conditional

Management of hypertensionManagement of hypertension should be offered to adults with hypertension according to existing WHO guidelines.Quality of evidence: low to high (for different interventions)Strength of the recommendation: strongManagement of hypertension may be offered to adults with hypertension to reduce the risk of cognitive decline and/or dementia.Quality of evidence: very low (in relation to dementia outcomes) Strength of the recommendation: conditional

Management of diabetes mellitusThe management of diabetes in the form of medications and/or lifestyle interventions should be offered to adults with diabetes according to existing WHO guidelines. Quality of evidence: very low to moderate (for different interventions) Strength of the recommendation: strongThe management of diabetes may be offered to adults with diabetes to reduce the risk of cognitive decline and/or dementia. Quality of evidence: very low Strength of the recommendation: conditional

Management of depressionThere is currently insufficient evidence to recommend the use of antidepressant medicines for reducing the risk of cognitive decline and/or dementia.The management of depression in the form of antidepressants and/or psychological interventions should be provided to adults with depression according to existing WHO mhGAP guidelines.

 Management of hearing lossThere is insufficient evidence to recommend use of hearing aids to reduce the risk of cognitive decline and/or dementia.Screening followed by provision of hearing aids should be offered to older people for timely identification and management of hearing loss as recommended in the WHO ICOPE guidelines.