英国国家卫生与临床优化研究所 (UK National Institute for Health and Care Excellence, NICE) 推荐在中年时期采用生活方式和行为干预(戒烟、减少饮酒、增加体力活动、采取健康饮食、维持健康体重)来降低身体虚弱和痴呆风险。[33]National Institute for Health and Care Excellence. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset. October 2015. https://www.nice.org.uk/ (last accessed 19 June 2017).https://www.nice.org.uk/guidance/ng16关于中年时期锻炼身体是否会改善认知功能并降低痴呆风险,最近的研究报道了相互矛盾的结果。[34]Sabia S, Dugravot A, Dartigues JF, et al. Physical activity, cognitive decline, and risk of dementia: 28 year follow-up of Whitehall II cohort study. BMJ. 2017 Jun 22 [Epub ahead of print].http://www.ncbi.nlm.nih.gov/pubmed/28642251?tool=bestpractice.com[35]Northey JM, Cherbuin N, Pumpa KL, et al. Exercise interventions for cognitive function in adults older than 50: a systematic review with meta-analysis. Br J Sports Med. 2017 Apr 24 [Epub ahead of print].http://www.ncbi.nlm.nih.gov/pubmed/28438770?tool=bestpractice.com来自芬兰的一项研究发现,适度饮用咖啡(而非茶)与痴呆风险降低有关。[36]Eskelinen MH, Ngnadu T, Tuomilehto J, et al. Midlife coffee and tea drinking and the risk of late-life dementia: a population-based CAIDE study. J Alzheimers Dis. 2009;16:85-91.http://www.ncbi.nlm.nih.gov/pubmed/19158424?tool=bestpractice.com
人们对认知培训和康复越来越感兴趣,并且现在有多种治疗方式可用。但是,目前几乎没有证据表明,认知训练可以改善轻度至中度 AD 患者的认知功能。[37]Bahar-Fuchs A, Clare L, Woods B. Cognitive training and cognitive rehabilitation for mild to moderate Alzheimer's disease and vascular dementia. Cochrane Database Syst Rev. 2013;(6):CD003260.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003260.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/23740535?tool=bestpractice.com尚无充分证据表明认知康复(包括补偿认知减退的识别策略)有效,因而不能推荐将其作为一种干预方法。认知培训对患阿尔茨海默病风险的长期影响尚不清楚,因为随访不足且缺乏高质量的数据。
控制中年的心血管危险因素与全因痴呆(即血管性痴呆和 AD)发病率降低有关。[38]Pase MP, Beiser A, Enserro D, et al. Association of ideal cardiovascular health with vascular brain injury and incident dementia. Stroke. 2016;47:1201-1206.http://stroke.ahajournals.org/content/47/5/1201.longhttp://www.ncbi.nlm.nih.gov/pubmed/27073239?tool=bestpractice.com
一项 Cochrane 综述发现,没有证据表明给予轻度认知障碍 (mild cognitive impairment, MCI) 患者维生素 E 可预防其进展为痴呆,也没有证明维生素 E 可以改善由 AD 引起的 MCI 或痴呆患者的认知功能。[39]Farina N, Llewellyn D, Isaac MGEKN, et al. Vitamin E for Alzheimer's dementia and mild cognitive impairment. Cochrane Database Syst Rev. 2017;(4):CD002854.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002854.pub5/fullhttp://www.ncbi.nlm.nih.gov/pubmed/28418065?tool=bestpractice.com [
]What are the benefits and harms of vitamin E in people with Alzheimer's dementia and in those with mild cognitive impairment?http://cochraneclinicalanswers.com/doi/10.1002/cca.1607/full显示答案 关于银杏制剂治疗与预防 AD 的证据,并未表明其在初级预防中有作用。[40]Vellas B, Coley N, Ousset PJ, et al; GuidAge Study Group. Long-term use of standardised Ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012;11:851-859.http://www.ncbi.nlm.nih.gov/pubmed/22959217?tool=bestpractice.com[41]DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008;300:2253-2262.http://jamanetwork.com/journals/jama/fullarticle/182920http://www.ncbi.nlm.nih.gov/pubmed/19017911?tool=bestpractice.com有研究表明,激素替代治疗(雌激素)可降低患阿尔茨海默病和其他类型痴呆的风险;但是,几乎没有高质量的证据。雌激素作为保护因素:低质量证据表明,激素替代疗法是这些患者的保护因素。一些研究设计质量差的观察性研究对雌激素与患 AD 风险之间的关系进行了评估。需要更多随机对照试验,以进一步阐明这种关系。随机对照试验和一项系统评价显示,没有证据表明这种治疗可有效降低患 AD 的风险。[42]Kawas C, Resnick S, Morrison A, et al. A prospective study of estrogen replacement therapy and the risk of developing Alzheimer's disease: the Baltimore Longitudinal Study of Aging. Neurology. 1997;48:1517-1521.http://www.ncbi.nlm.nih.gov/pubmed/9191758?tool=bestpractice.com[43]Tang MX, Jacobs D, Stern Y, et al. Effect of oestrogen during menopause on risk and age at onset of Alzheimer's disease. Lancet. 1996;348:429-432.http://www.ncbi.nlm.nih.gov/pubmed/8709781?tool=bestpractice.com[44]Hogervorst E, Yaffe K, Richards M, et al. Hormone replacement therapy to maintain cognitive function in women with dementia. Cochrane Database Syst Rev. 2009;(1):CD003799.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003799.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19160224?tool=bestpractice.com低质量的观察性(队列)研究或者受试者<200名且方法学存在缺陷的随机对照临床试验(RCT)。