A Life Course Approach to Dementia Prevention
Across the world, there is an unprecedented growth in the number of older people, with clear implications for the prevalence of cognitive decline and dementia. This review discusses the global burden of dementia on individuals and societies around the world, as well as the risk factors associated with dementia and cognitive impairment from a life course approach. Dementia and Mild Cognitive Impairment are etiologically discussed with a particular focus on the role of modifiable lifestyle behaviors and their biological mechanisms. The early life period is likely to be the most critical for the development of cognitive reserve (learning, and education); the midlife period is particularly sensitive to lifestyle behaviors, environmental exposures, head trauma or depression, while the later stage of life period seems to be more sensitive to the role of social support and networks, physical activities or hormone therapy. Some factors may overlap between these standard periods. For example, the development and control of vascular and metabolic risk factors have been shown to be particularly influential in middle life (the 40s to 60s), whereas mental and physical activity patterns may continue to moderate the risk of dementia from mid into later life. Interventions targeting healthy lifestyle (e.g. exercise, diet, nonsmoking, moderate drinking and social participation) may lead to robust effects throughout later life and could offer an increase in life expectancy and a lower risk of dementia.