Primary Prevention Recommendations for Reducing Risk of Cognitive Decline

From the UsAgainstAlzheimer's Risk Reduction Workgroup

  • For adults 45 years of age and older with established hypertension or type 2 diabetes, clinicians should manage the conditions according to guidelines with appropriate medications to help reduce the risk of cognitive decline, and clinicians should encourage optimal brain health in the same way they encourage cardiovascular health through other modifiable risk factors (or lifestyle interventions) such as physical activity, diet, and sleep to reduce the risk of cognitive decline.

  • Clinicians should conduct a physical activity assessment, at least annually, using practical and validated tools to identify adults 45 years of age and older who are sedentary or not meeting recommended levels of physical activity (150 minutes per week of moderate intensity) and who can decrease their risk of cognitive decline or worsening health.
  • For individuals not meeting recommended levels of physical activity, develop a plan using a safe, gradual approach that that starts with moderate-intensity physical activity that fits within a person’s lifestyle (e.g., walking, gardening, dancing, calisthenics) and is culturally acceptable.

  • Clinicians should routinely (if possible, at each visit) assess sleep quantity and quality in patients 45 years of age and older using a validated tool and ascertaining whether they take any medications to sleep.
  • For individuals getting insufficient or poor-quality sleep, clinicians should encourage getting 7 to 8 hours of sleep in a 24-hour period, including naps. Those with severe sleep complaints, which may indicate sleep apnea (e.g., snoring with stops of breathing, excessive daytime sleepiness), should be referred to a sleep clinic for diagnosis and treatment.

  • Clinicians should assess dietary eating patterns and habits, at least annually, with patients 45 years of age and older.
  • For individuals who indicate a less than optimal diet, clinicians should counsel patients about the value of a healthy diet and should broach the topic of culturally acceptable dietary interventions that directly and indirectly impact brain health at each annual encounter to suggest beneficial nutritional modifications.

  • Clinicians should annually or after patients’ major life events (e.g., death of loved one, change in living arrangements) perform an assessment using one or more validated tools (e.g., UCLA Loneliness Scale for assessing loneliness, Berkman-Syme Social Network Index for assessing social isolation) to identify adults 45 years of age and older experiencing loneliness or social isolation.
  • For those identified with elevated risk of social isolation or loneliness, clinicians should suggest strategies for enhancing social connection and activity and check in with them via phone or virtual meeting every few months to offer guidance or additional resources, as needed, to help prevent further declines in social activity.

  • During each scheduled visit, but at least annually, clinicians should ask patients 45 years of age and older about their level of cognitive stimulation or activity, which may include learning new skills or other stimulating activities they practice.
  • For individuals who indicate low levels of cognitive stimulation or activity, suggestions for cognitive stimulation should be made.

Kickstart | Approaches to Implement

Overview | Discuss Brain Health | Engage in Conversations About Protective Actions | Address Diverse Life Experiences | Discuss Memory and Cognition | Observe for Signs and Symptoms of Cognitive Impairment | Listen for Patient and Family Concerns About Cognition | Address Any Sensory Loss and Use Effective Communication Strategies | Use Health Questionnaires | Use Electronic Health Records | Primary Prevention Recommendations for Reducing Risk of Cognitive Decline | Warning Signs That Might Indicate Dementia | Resources for Patients About Brain Health | Kickstart References