Aging and Dementia: Evidence-Based Treatments to Support Brain Health

Managing aging and dementia involves both nonpharmacologic and pharmacologic approaches aimed at reducing symptoms, slowing progression, and improving quality of life. Here’s an overview of effective strategies supported by research:

Nonpharmacologic Interventions (First-Line for Behavioral and Psychological Symptoms)

• Cognitive Stimulation Therapy: Activities designed to engage thinking skills and memory, such as Keep Your Brain Stronger for Longer: 201 Brain-Teasing Exercises for Anyone with Mild Cognitive Impairment
• Physical Exercise: Both aerobic and resistance exercises help maintain brain and body health.
• Cognitively Engaging Activities: Reading, puzzles, games, and other brain-challenging tasks.
• Social Interaction: Regular connection with friends, family, and community.
• Music and Art Therapy: Creative therapies, such as painting, that boost mood and cognitive function.
• Reminiscence Therapy: Reflecting on past experiences to stimulate memory using memory cards.
• Environmental Enrichment: Enhancing surroundings to encourage engagement and activity.

These approaches are supported by multiple randomized controlled trials and meta-analyses, showing modest but meaningful improvements in cognition and daily function. They are safe, well-tolerated, and a great foundation for brain health.^[2],[3]

Multidomain Lifestyle Interventions

• Healthy Diet: Mediterranean or heart-healthy diets help support brain function.
• Exercise: Regular physical activity combined with cognitive training.
• Cardiovascular Risk Management: Controlling blood pressure, cholesterol, and diabetes.

These combined strategies have shown small but statistically significant improvements in cognition for older adults at risk of decline.^{[3], [4]}

Additional Supportive Measures

• Optimizing sleep quality.
• Managing sensory deficits such as hearing and vision loss.
• Addressing cardiovascular and metabolic risk factors to promote successful cognitive aging.^[5],[6]

Pharmacologic Treatments for Dementia

• Cholinesterase Inhibitors: Donepezil, galantamine, rivastigmine offer modest benefits in mild to moderate stages.
• Memantine: Used alone or with cholinesterase inhibitors to support cognition and function.
• Anti-amyloid Monoclonal Antibodies: Approved for mild cognitive impairment and mild Alzheimer’s disease with modest slowing of decline but notable safety concerns.
• Brexpiprazole: Approved in the US for agitation in Alzheimer’s disease.
• Psychotropic medications have limited efficacy for behavioral symptoms and higher risk of side effects; nonpharmacologic methods are preferred.^[4],[7]

Prevention and Risk Reduction

• Regular physical activity
• Cognitive engagement
• Social interaction
• Healthy diet
• Smoking cessation
• Management of hypertension, diabetes, and depression
• Avoidance of anticholinergic medications
• Multifactorial interventions and delirium prevention in hospitalized older adults may also reduce risk.^[4],[5],[6]

Supporting Caregivers

Education for caregivers, safety planning, and establishing advanced care directives are crucial parts of comprehensive dementia care.^[1]

Recommended book for caregivers: The Caregiver's Guide to Dementia

Helpful Tools and Resources

• Cognitive Stimulation
• Physical Exercise Equipment for Seniors
• Memory & Brain Training Games
• Music Therapy CDs and Instruments

References

1. Arvanitakis Z, Shah RC, Bennett DA. Diagnosis and Management of Dementia: Review. JAMA. 2019;322(16):1589-1599. doi:10.1001/jama.2019.4782.
2. Luo G, Zhang J, Song Z, et al. Effectiveness of Non-Pharmacological Therapies on Cognitive Function in Patients With Dementia-a Network Meta-Analysis of Randomized Controlled Trials. Front Aging Neurosci. 2023;15:1131744. doi:10.3389/fnagi.2023.1131744.
3. Yaffe K, Vittinghoff E, Dublin S, et al. Effect of Personalized Risk-Reduction Strategies on Cognition and Dementia Risk Profile Among Older Adults: The SMARRT Randomized Clinical Trial. JAMA Intern Med. 2024;184(1):54-62. doi:10.1001/jamainternmed.2023.6279.
4. Reuben DB, Kremen S, Maust DT. Dementia Prevention and Treatment: A Narrative Review. JAMA Intern Med. 2024;184(5):563-572. doi:10.1001/jamainternmed.2023.8522.
5. Krivanek TJ, Gale SA, McFeeley BM, et al. Promoting Successful Cognitive Aging: A Ten-Year Update. J Alzheimers Dis. 2021;81(3):871-920. doi:10.3233/JAD-201462.
6. Yu JT, Xu W, Tan CC, et al. Evidence-Based Prevention of Alzheimer's Disease: Systematic Review and Meta-Analysis of 243 Observational Prospective Studies and 153 Randomised Controlled Trials. J Neurol Neurosurg Psychiatry. 2020;91(11):1201-1209. doi:10.1136/jnnp-2019-321913.
7. Jaqua EE, Tran MN, Hanna M. Alzheimer Disease: Treatment of Cognitive and Functional Symptoms. Am Fam Physician. 2024;110(3):281-293.