Strategies to Slow the Onset or Progression of Dementia
| Strategy | Comments | Evidence |
|---|---|---|
| Maintain general health | Diet, exercise, cardiovascular risk factors | Level B |
| Intellectual achievement | Challenging work. | Level B |
| Memory games have been shown to increase dendrites. | ||
| Acetylcholinesterase inhibitors | Induce limited improvement in responders that can last 1 or more years. | Level A |
| β-Secretase inhibition | Critical enzyme in the production of β-amyloid. | Basic research |
| Inhibitors capable of crossing the blood-brain barrier are under development. | ||
| Immunotherapy | Antibodies to β-amyloid increase its clearance from the brain in mice. | Basic research in humans has begun. |
| Vitamin E (antioxidant) | Has been demonstrated to slow Alzheimer disease progression in humans but did not improve function. | Level A |
| Other antioxidants (ginkgo biloba, vitamin C, selegiline) | Results are inconsistent, ranging from no benefit to minimal delayed progression. | Inconsistent, probably not effective. |
| Estrogen | Alters cholinergic, serotonergic, and catecholaminergic neurotransmitter systems but increases incidence of ASHD. | Inconsistent, possibly limited by side effects. |
| Nonsteroidal anti-inflammatory drugs (NSAIDs) | Effective only if started in the preclinical phase and used for a minimum of 2 years | Level B but limited by side effects. Some inconsistency in clinical trials, especially with cyclooxygenase 2 inhibitors. |
| 3-Hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) | There is observational evidence that aggressive treatment of hypertension and hyperlipidemia retards onset of Alzheimer disease. | Level B |