Social Psychiatry and Psychiatric Epidemiology

, Volume 53, Issue 12, pp 1289–1301 | Cite as

Primary prevention of dementia: from modifiable risk factors to a public brain health agenda?

  • Felix S. Hussenoeder
  • Steffi G. Riedel-Heller
Invited Review



With large numbers of people affected, no treatment in sight and continuing demographic change, the prevention of dementia is becoming a central public health issue.


We conducted a systematic meta-review including systematic reviews and meta-analyses of longitudinal observational studies on modifiable risk and protective factors for dementia published over the last 5 years.


Compelling evidence on a number of modifiable risk factors, mostly lifestyle factors, is available from longitudinal observational studies to inform primary preventive efforts.


Evidence stemming from preventive RCTs is limited. However, multi-domain interventions addressing a variety of risk factors at once seem promising with regard to high-risk individuals (selective preventive approach). However, we argue that it is time to move forward and discuss a public brain health agenda as a universal preventive approach. Based on a risk reduction strategy, the public brain health agenda suggests the following ten key actions: (1) increase physical activity, (2) foster social integration, (3) improve education and foster lifelong learning, (4) provide mentally stimulating workplaces, (5) foster a cognitively active lifestyle, (6) propose a healthy Mediterranean-like diet, (7) reduce alcohol consumption, (8) stop smoking, (9) prevent, diagnose and treat chronic conditions, and (10) reduce anticholinergic medication in the elderly.


Dementia Risk factors Systematic review Brain health agenda Prevention 



This paper was supported by a grant from the Hans and Ilse Breuer Foundation. The authors thank Elise Paul, Ph.D. for her editing of this manuscript.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.


  1. 1.
    Dementia: number of people affected to triple in next 30 years. WHO. Accessed 18 July 2018
  2. 2.
    Alltag S, Nowossadeck S, Stein J, Hajek A, König H, Riedel-Heller SG et al (2017) Regionale Unterschiede bei demografischer Alterung [Small area variation in demographic aging—informal and formal nursing care ratios and care preferences of senior citizens inform health care planners]. Psychiatr Prax 44(7):413–416CrossRefGoogle Scholar
  3. 3.
    Heßmann P, Dreier M, Brandes I, Dodel R, Baum E, Müller MJ et al (2018) Unterschiede in der Selbst- und Fremdbeurteilung gesundheitsbezogener Lebensqualität bei Patienten mit leichter kognitiver Beeinträchtigung und Demenz vom Alzheimer-Typ [Differences between self- and proxy-assessment of health-related quality of life in patients with mild cognitive impairment and Alzheimer’s disease]. Psychiatr Prax 45(2):78–86CrossRefGoogle Scholar
  4. 4.
    Schweda M (2018) Das größte Unglück? Demenz zwischen persönlichem Erleben und gesellschaftlicher Repräsentation [The ultimate disaster? Dementia between personal experience and social representation]. Psychiatr Prax 45(S 01):S31–S35PubMedGoogle Scholar
  5. 5.
    Prince MJ, Wimo A, Guerchet MM, Ali GC, Wu Y, Prina M (2015) World Alzheimer report 2015—the global impact of dementia: Alzheimer’s disease international (an analysis of prevalence, incidence, cost and trends). Accessed 18 July 2018
  6. 6.
    Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D et al (2017) Dementia prevention, intervention, and care. Lancet 390(10113):2673–2734CrossRefGoogle Scholar
  7. 7.
    Sperling RA, Aisen PS, Beckett LA, Bennett DA, Craft S, Fagan AM et al (2011) Toward defining the preclinical stages of Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7(3):280–292CrossRefGoogle Scholar
  8. 8.
    Christensen K, Thinggaard M, Oksuzyan A, Steenstrup T, Andersen-Ranberg K, Jeune B et al (2013) Physical and cognitive functioning of people older than 90 years: a comparison of two Danish cohorts born 10 years apart. Lancet 382(9903):1507–1513CrossRefGoogle Scholar
  9. 9.
    Matthews FE, Arthur A, Barnes LE, Bond J, Jagger C, Robinson L et al (2013) A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet 382(9902):1405–1412CrossRefGoogle Scholar
  10. 10.
    Qiu C, von Strauss E, Bäckman L, Winblad B, Fratiglioni L (2013) Twenty-year changes in dementia occurrence suggest decreasing incidence in central Stockholm, Sweden. Neurology 80(20):1888CrossRefGoogle Scholar
  11. 11.
    Wu Y, Fratiglioni L, Matthews FE, Lobo A, Breteler MMB, Skoog I et al (2016) Dementia in western Europe: epidemiological evidence and implications for policy making. Lancet Neurol 15(1):116–124CrossRefGoogle Scholar
  12. 12.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRefGoogle Scholar
  13. 13.
    Blondell SJ, Hammersley-Mather R, Veerman JL (2014) Does physical activity prevent cognitive decline and dementia?: a systematic review and meta-analysis of longitudinal studies. BMC Public Health 14:510CrossRefGoogle Scholar
  14. 14.
    Deckers K, van Boxtel MPJ, Schiepers OJG, Vugt M de, Sanchez M, Anstey JL KJ et al (2015) Target risk factors for dementia prevention: a systematic review and Delphi consensus study on the evidence from observational studies. Int J Geriatr Psychiatry 30(3):234–246CrossRefGoogle Scholar
  15. 15.
    Reiner M, Niermann C, Jekauc D, Woll A (2013) Long-term health benefits of physical activity—a systematic review of longitudinal studies. BMC Public Health 13:813CrossRefGoogle Scholar
  16. 16.
    Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y (2014) Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health 14:643CrossRefGoogle Scholar
  17. 17.
    Stephen R, Hongisto K, Solomon A, Lonnroos E (2017) Physical activity and Alzheimer’s disease: a systematic review. J Gerontol A Biol Sci Med Sci 72(6):733–739PubMedGoogle Scholar
  18. 18.
    Guure CB, Ibrahim NA, Adam MB, Said SM (2017) Impact of physical activity on cognitive decline, dementia, and its subtypes: meta-analysis of prospective studies. Biomed Res Int 2017:9016924CrossRefGoogle Scholar
  19. 19.
    Carvalho A, Rea IM, Parimon T, Cusack BJ (2014) Physical activity and cognitive function in individuals over 60 years of age: a systematic review. Clin Interv Aging 9:661–682PubMedPubMedCentralGoogle Scholar
  20. 20.
    Llamas-Velasco S, Contador I, Villarejo-Galende A, Lora-Pablos D, Bermejo-Pareja F (2015) Physical activity as protective factor against dementia: a prospective population-based study (NEDICES). J Int Neuropsychol Soc 21(10):861–867CrossRefGoogle Scholar
  21. 21.
    Kuiper JS, Zuidersma M, Oude Voshaar RC, Zuidema SU, van den Heuvel ER, Stolk RP et al (2015) Social relationships and risk of dementia: a systematic review and meta-analysis of longitudinal cohort studies. Ageing Res Rev 22:39–57CrossRefGoogle Scholar
  22. 22.
    Xu W, Tan L, Wang H, Tan M, Tan L, Li J et al (2016) Education and risk of dementia: dose-response meta-analysis of prospective cohort studies. Mol Neurobiol 53(5):3113–3123CrossRefGoogle Scholar
  23. 23.
    Stern Y (2002) What is cognitive reserve? Theory and research application of the reserve concept. J Int Neuropsychol Soc 8(3):448–460CrossRefGoogle Scholar
  24. 24.
    Then FS, Luck T, Luppa M, Thinschmidt M, Deckert S, Nieuwenhuijsen K et al (2014) Systematic review of the effect of the psychosocial working environment on cognition and dementia. Occup Environ Med 71(5):358CrossRefGoogle Scholar
  25. 25.
    Then FS, Luck T, Heser K, Ernst A, Posselt T, Wiese B et al (2017) Which types of mental work demands may be associated with reduced risk of dementia? Alzheimers Dement 13(4):431–440CrossRefGoogle Scholar
  26. 26.
    Yates LA, Ziser S, Spector A, Orrell M (2016) Cognitive leisure activities and future risk of cognitive impairment and dementia: systematic review and meta-analysis. Int Psychogeriatr 28(11):1791–1806CrossRefGoogle Scholar
  27. 27.
    Cao L, Tan L, Wang H, Jiang T, Zhu X, Lu H et al (2016) Dietary patterns and risk of dementia: a systematic review and meta-analysis of cohort studies. Mol Neurobiol 53(9):6144–6154CrossRefGoogle Scholar
  28. 28.
    Di Marco LY, Marzo A, Munoz-Ruiz M, Ikram MA, Kivipelto M, Ruefenacht D et al (2014) Modifiable lifestyle factors in dementia: a systematic review of longitudinal observational cohort studies. J Alzheimers Dis 42(1):119–135CrossRefGoogle Scholar
  29. 29.
    Lourida I, Soni M, Thompson-Coon J, Purandare N, Lang IA, Ukoumunne OC et al (2013) Mediterranean diet, cognitive function, and dementia: a systematic review. Epidemiology 24(4):479–489CrossRefGoogle Scholar
  30. 30.
    Singh B, Parsaik AK, Mielke MM, Erwin PJ, Knopman DS, Petersen RC et al (2014) Association of mediterranean diet with mild cognitive impairment and Alzheimer’s disease: a systematic review and meta-analysis. J Alzheimers Dis 39(2):271–282CrossRefGoogle Scholar
  31. 31.
    Panza F, Solfrizzi V, Barulli MR, Bonfiglio C, Guerra V, Osella A et al (2015) Coffee, tea, and caffeine consumption and prevention of late-life cognitive decline and dementia: a systematic review. J Nutr Health Aging 19(3):313–328CrossRefGoogle Scholar
  32. 32.
    Barnard ND, Bunner AE, Agarwal U (2014) Saturated and trans fats and dementia: a systematic review. Neurobiol Aging 35(Suppl 2):S65–S73CrossRefGoogle Scholar
  33. 33.
    Xu W, Wang H, Wan Y, Tan C, Li J, Tan L et al (2017) Alcohol consumption and dementia risk: a dose-response meta-analysis of prospective studies. Eur J Epidemiol 32(1):31–42CrossRefGoogle Scholar
  34. 34.
    Sachdeva A, Chandra M, Choudhary M, Dayal P, Anand KS (2016) Alcohol-related dementia and neurocognitive impairment: a review study. Int J High Risk Behav Addict 5(3):e27976CrossRefGoogle Scholar
  35. 35.
    Zhong G, Wang Y, Zhang Y, Guo JJ, Zhao Y (2015) Smoking is associated with an increased risk of dementia: a meta-analysis of prospective cohort studies with investigation of potential effect modifiers. PLoS One 10(3):e0118333CrossRefGoogle Scholar
  36. 36.
    Stirland LE, O’Shea CI, Russ TC (2018) Passive smoking as a risk factor for dementia and cognitive impairment: systematic review of observational studies. Int Psychogeriatr 30(8):1177–1187CrossRefGoogle Scholar
  37. 37.
    Levi Marpillat N, Macquin-Mavier I, Tropeano A, Bachoud-Levi A, Maison P (2013) Antihypertensive classes, cognitive decline and incidence of dementia: a network meta-analysis. J Hypertens 31(6):1073–1082CrossRefGoogle Scholar
  38. 38.
    Rouch L, Cestac P, Hanon O, Cool C, Helmer C, Bouhanick B et al (2015) Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs 29(2):113–130CrossRefGoogle Scholar
  39. 39.
    Tully PJ, Hanon O, Cosh S, Tzourio C (2016) Diuretic antihypertensive drugs and incident dementia risk: a systematic review, meta-analysis and meta-regression of prospective studies. J Hypertens 34(6):1027–1035CrossRefGoogle Scholar
  40. 40.
    Chatterjee S, Peters SAE, Woodward M, Mejia Arango S, Batty GD, Beckett N et al (2016) Type 2 diabetes as a risk factor for dementia in women compared with men: a pooled analysis of 2.3 million people comprising more than 100,000 cases of dementia. Diabetes Care 39(2):300–307PubMedGoogle Scholar
  41. 41.
    Zhang J, Chen C, Hua S, Liao H, Wang M, Xiong Y et al (2017) An updated meta-analysis of cohort studies: diabetes and risk of Alzheimer’s disease. Diabetes Res Clin Pract 124:41–47CrossRefGoogle Scholar
  42. 42.
    Ye F, Luo Y, Xiao J, Yu N, Yi G (2016) Impact of insulin sensitizers on the incidence of Dementia: a meta-analysis. Dement Geriatr Cogn Disord 41(5–6):251–260CrossRefGoogle Scholar
  43. 43.
    Albanese E, Launer LJ, Egger M, Prince MJ, Giannakopoulos P, Wolters FJ et al (2017) Body mass index in midlife and dementia: systematic review and meta-regression analysis of 589,649 men and women followed in longitudinal studies. Alzheimers Dement (Amst) 8:165–178Google Scholar
  44. 44.
    Pedditizi E, Peters R, Beckett N (2016) The risk of overweight/obesity in mid-life and late life for the development of dementia: a systematic review and meta-analysis of longitudinal studies. Age Ageing 45(1):14–21CrossRefGoogle Scholar
  45. 45.
    Emmerzaal TL, Kiliaan AJ, Gustafson DR (2015) 2003–2013: a decade of body mass index, Alzheimer’s disease, and dementia. J Alzheimers Dis 43(3):739–755CrossRefGoogle Scholar
  46. 46.
    Zheng Y, Fan S, Liao W, Fang W, Xiao S, Liu J (2017) Hearing impairment and risk of Alzheimer’s disease: a meta-analysis of prospective cohort studies. Neurol Sci 38(2):233–239CrossRefGoogle Scholar
  47. 47.
    Cherbuin N, Kim S, Anstey KJ (2015) Dementia risk estimates associated with measures of depression: a systematic review and meta-analysis. BMJ Open 5(12):e008853CrossRefGoogle Scholar
  48. 48.
    Heser K, Tebarth F, Wiese B, Eisele M, Bickel H, Köhler M et al (2013) Age of major depression onset, depressive symptoms, and risk for subsequent dementia: results of the German study on ageing, cognition, and dementia in primary care patients (AgeCoDe). Psychol Med 43(8):1597–1610CrossRefGoogle Scholar
  49. 49.
    Julien J, Joubert S, Ferland M, Frenette LC, Boudreau-Duhaime MM, Malo-Veronneau L et al (2017) Association of traumatic brain injury and Alzheimer disease onset: a systematic review. Ann Phys Rehabil Med 60(5):347–356CrossRefGoogle Scholar
  50. 50.
    Perry DC, Sturm VE, Peterson MJ, Pieper CF, Bullock T, Boeve BF et al (2016) Association of traumatic brain injury with subsequent neurological and psychiatric disease: a meta-analysis. J Neurosurg 124(2):511–526CrossRefGoogle Scholar
  51. 51.
    Heser K, Luck T, Röhr S, Wiese B, Kaduszkiewicz H, Oey A et al (2018) Potentially inappropriate medication: association between the use of antidepressant drugs and the subsequent risk for dementia. J Affect Disord 226:28–35CrossRefGoogle Scholar
  52. 52.
    Jessen F, Kaduszkiewicz H, Daerr M, Bickel H, Pentzek M, Riedel-Heller S et al (2010) Anticholinergic drug use and risk for dementia: target for dementia prevention. Eur Arch Psychiatry Clin Neurosci 260(Suppl 2):S111–S115CrossRefGoogle Scholar
  53. 53.
    Hill AB (2015) The environment and disease: association or causation? J R Soc Med 108(1):32–37CrossRefGoogle Scholar
  54. 54.
    Luck T, Riedel-Heller SG, Luppa M, Wiese B, Köhler M, Jessen F et al (2014) Apolipoprotein E epsilon 4 genotype and a physically active lifestyle in late life: analysis of gene-environment interaction for the risk of dementia and Alzheimer’s disease dementia. Psychol Med 44(6):1319–1329. CrossRefPubMedGoogle Scholar
  55. 55.
    Canadian Task Force on the Periodic Health Examination (1979) The periodic health examination. Can Med Assoc J 121(9):1193–1254Google Scholar
  56. 56.
    Sackett DL (1989) Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest 95(2):2S–4SCrossRefGoogle Scholar
  57. 57.
    Concato J, Shah N, Horwitz RI (2000) Randomized, controlled trials, observational studies, and the hierarchy of research designs. N Engl J Med 342(25):1887–1892. CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Andrieu S, Coley N, Lovestone S, Aisen PS, Vellas B (2015) Prevention of sporadic Alzheimer’s disease: lessons learned from clinical trials and future directions. Lancet Neurol 14(9):926–944CrossRefGoogle Scholar
  59. 59.
    Lee Y (2018) Primary prevention of dementia: the future of population-based multidomain lifestyle interventions. J Prev Alzheimer’s Dis 5(1):5–7. CrossRefGoogle Scholar
  60. 60.
    Mangialasche F, Kivipelto M, Solomon A, Fratiglioni L (2012) Dementia prevention: current epidemiological evidence and future perspective. Alzheimer’s Res Ther 4(1):6. CrossRefGoogle Scholar
  61. 61.
    Dubois B, Epelbaum S, Santos A, Di Stefano F, Julian A, Michon A et al (2013) Alzheimer disease: from biomarkers to diagnosis. Démences: nouveaux concepts, nouveaux enjeux/Dementia: new concepts, new goals. Rev Neurol 169(10):744–751CrossRefGoogle Scholar
  62. 62.
    Jack CR, Bennett DA, Blennow K, Carrillo MC, Dunn B, Haeberlein SB et al (2018) NIA-AA research framework: toward a biological definition of Alzheimer’s disease. Alzheimers Dement 14(4):535–562CrossRefGoogle Scholar
  63. 63.
    American Psychiatric Association (2013) DSM-5 Task Force. Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association, ArlingtonCrossRefGoogle Scholar
  64. 64.
    Solomon A, Mangialasche F, Richard E, Andrieu S, Bennett DA, Breteler M et al (2014) Advances in the prevention of Alzheimer’s disease and dementia. J Intern Med 275(3):229–250CrossRefGoogle Scholar
  65. 65.
    Mulder M, Ranchor AV, Sanderman R, Bouma J, van den Heuvel WJ (1998) The stability of lifestyle behaviour. Int J Epidemiol 27(2):199–207CrossRefGoogle Scholar
  66. 66.
    Kivipelto M, Solomon A, Ahtiluoto S, Ngandu T, Lehtisalo J, Antikainen R et al (2013) The Finnish geriatric intervention study to prevent cognitive impairment and disability (FINGER): study design and progress. Alzheimers Dement 9(6):657–665CrossRefGoogle Scholar
  67. 67.
    Ngandu T, Lehtisalo J, Solomon A, Levälahti E, Ahtiluoto S, Antikainen R et al (2015) A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial. Lancet 385(9984):2255–2263CrossRefGoogle Scholar
  68. 68.
    Williams JW, Plassmann BL, Burke JR, Benjamin S (2010) Preventing Alzheimer’s disease and cognitive decline: evidence report/technology assessment, vol 193. Agency for Healthcare Research and Quality (AHRQ), RockvilleGoogle Scholar
  69. 69.
    van Charante EPM, Richard E, Eurelings LS, van Dalen J, Ligthart SA, van Bussel EF et al (2016) Effectiveness of a 6-year multidomain vascular care intervention to prevent dementia (preDIVA): a cluster-randomised controlled trial. Lancet 388(10046):797–805CrossRefGoogle Scholar
  70. 70.
    Barbera M, Mangialasche F, Jongstra S, Guillemont J, Ngandu T, Beishuizen C et al (2018) Designing an internet-based multidomain intervention for the prevention of cardiovascular disease and cognitive impairment in older adults: the HATICE trial. J Alzheimers Dis 62(2):649–663CrossRefGoogle Scholar
  71. 71.
    Wu Y-T, Beiser AS, Breteler MMB, Fratiglioni L, Helmer C, Hendrie HC et al (2017) The changing prevalence and incidence of dementia over time—current evidence. Nat Rev Neurol 13(6):327–339. CrossRefPubMedGoogle Scholar
  72. 72.
    Norton S, Matthews FE, Barnes DE, Yaffe K, Brayne C (2014) Potential for primary prevention of Alzheimer’s disease: an analysis of population-based data. Lancet Neurol 13(8):788–794CrossRefGoogle Scholar
  73. 73.
    Luck T, Riedel-Heller SG (2016) Prävention von Alzheimer-Demenz in Deutschland: Eine Hochrechnung des möglichen Potenzials der Reduktion ausgewählter Risikofaktoren. Nervenarzt 87(11):1194–1200CrossRefGoogle Scholar
  74. 74.
    Pratt M, Perez LG, Goenka S, Brownson RC, Bauman A, Sarmiento OL et al (2015) Can population levels of physical activity be increased? Global evidence and experience. Prog Cardiovasc Dis 57(4):356–367CrossRefGoogle Scholar
  75. 75.
    McLeroy KR, Bibeau D, Steckler A, Glanz K et al (1988) An ecological perspective on health promotion programs. Health Educ Q 15(4):351–377CrossRefGoogle Scholar
  76. 76.
    Bronfenbrenner U (1977) Toward an experimental ecology of human development. Am Psychol 32(7):513–531CrossRefGoogle Scholar
  77. 77.
    Golden SD, Earp JAL (2012) Social ecological approaches to individuals and their contexts: twenty years of health education & behavior health promotion interventions. Health Educ Behav 39(3):364–372CrossRefGoogle Scholar
  78. 78.
    Laal M (2011) Lifelong learning: what does it mean? Procedia Soc Behav Sci 28:470–474CrossRefGoogle Scholar
  79. 79.
    Davis C, Bryan J, Hodgson J, Murphy K (2015) Definition of the Mediterranean diet; a literature review. Nutrients 7(11):9139–9153CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Institute of Social Medicine, Occupational Health and Public Health (ISAP)University of LeipzigLeipzigGermany

Personalised recommendations