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Dtsch Med Wochenschr 2019; 144(17): 1212-1217
DOI: 10.1055/a-0940-5452
Review
© Georg Thieme Verlag KG Stuttgart · New York

Demenz und metabolisch-vaskuläre Risikofaktoren: Möglichkeiten der Prävention

Dementia and Metabolic-Vascular Risk Factors: Strategies for Prevention
Ulrike Gonder
1   Freiberufliche Tätigkeit als diplomierte Ökotrophologin, Hünstetten (Taunus)
,
Clemens von Schacky
2   Präventive Kardiologie, Medizinische Klink I, LMU München und Omegametrix, Martinsried
,
Nicolai Worm
3   Deutsche Hochschule für Prävention und Gesundheitsmanagement, Saarbrücken
,
Benjamin Lechner
4   Medizinische Klinik und Poliklinik IV, Campus Innenstadt, Klinikum der Universität München
,
Markus Bock
5   Institut für Biochemie, Charité-Universitätsmedizin Berlin
6   Klinik und Poliklinik für Neurologie, Universitätsmedizin Mainz
,
Katharina Lechner
7   Technische Universität München, Fakultät für Medizin, Lehrstuhl für Präventive und Rehabilitative Sportmedizin, München
› Author Affiliations
Further Information

Publication History

Publication Date:
27 August 2019 (online)

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Zusammenfassung

Die Prävalenz der Demenz ist in den letzten Jahren gestiegen und nimmt mit dem Alter exponentiell zu. In Deutschland sind ca. 1,7 Mio. Menschen betroffen, die jährliche Neuerkrankungsrate wird auf 300 000 geschätzt. Der Begriff Demenz umfasst verschiedene Krankheitsformen mit unterschiedlichen Ätiologien. Dem demenziellen Syndrom des höheren Lebensalters liegen meist vaskuläre und metabolische Risikofaktoren zugrunde, die der klinischen Demenzmanifestation um Dekaden vorausgehen. Dies bietet ein enormes Zeitfenster für die Prävention, welche insbesondere vor dem Hintergrund weitgehend fehlender kurativer pharmakologischer Ansätze eine große Bedeutung erlangt. Lebensstilmaßnahmen, die eine hohe Nahrungsqualität und eine ausreichende Versorgung mit Omega-3-Fettsäuren, körperliche Aktivität und erholsamen Schlaf beinhalten, verbessern metabolische und vaskuläre Risikofaktoren und mindern das Demenzrisiko. Da multimodale Konzepte synergistisch wirken, versprechen sie den größten präventiven Nutzen.

Abstract

The prevalence of dementias is on the rise, increases exponentially with age and constitutes a major healthcare burden nationally and worldwide. Dementias are clinically heterogeneous and encompass numerous etiologies. Noteworthy, late onset dementias are closely related to vascular and metabolic risk factors in midlife. Cardiometabolic risk factors commonly precede the onset of cognitive decline for decades. This opens a huge window for prevention. Given the lack of established pharmacological options for treatment of most dementias, preventive strategies are of utmost importance. Several factors have been identified that have the potential to preserve a healthy metabolic phenotype and to attenuate the onset of late onset dementias. Evidence exists for low-risk lifestyle factors including a real food dietary pattern, an adequate supply with long chain omega-3 fatty acids, regular physical activity and restorative sleep, with multimodal concepts showing the greatest cumulative benefit.

Schlüsselwörter

Lebensstilfaktoren - Demenz - Prävention - Insulinresistenz - Ketonkörper

Key words

lifestyle factors - dementia - prevention - insulin resistance - ketone bodies
 

  • Literatur

  • 1 Livingston G, Sommerlad A, Orgeta V. et al. Dementia prevention, intervention, and care. Lancet 2017; 390: 2673-2734
    CrossrefPubMedSearch in Google Scholar
  • 2 Araújo J, Cai J, Stevens J. Prevalence of Optimal Metabolic Health in American Adults: National Health and Nutrition Examination Survey 2009–2016. Metab Syndr Relat Disord 2019; 17: 46-52
    CrossrefPubMedSearch in Google Scholar
  • 3 Gottesman RF, Schneider ALC, Zhou Y. et al. Association Between Midlife Vascular Risk Factors and Estimated Brain Amyloid Deposition. JAMA 2017; 317: 1443
    CrossrefPubMedSearch in Google Scholar
  • 4 Callisaya ML, Beare R, Moran C. et al. Type 2 diabetes mellitus, brain atrophy and cognitive decline in older people: a longitudinal study. Diabetologia 2019; 62: 448-458
    CrossrefPubMedSearch in Google Scholar
  • 5 de la Monte SM, Tong M, Daiello LA. et al. Early-Stage Alzheimer’s Disease Is Associated with Simultaneous Systemic and Central Nervous System Dysregulation of Insulin-Linked Metabolic Pathways. J Alzheimers Dis 2019; 68: 657-668 , DOI:10.3233/JAD-180906
    CrossrefPubMedSearch in Google Scholar
  • 6 Samieri C, Perier MC, Gaye B. et al. Association of Cardiovascular Health Level in Older Age With Cognitive Decline and Incident Dementia. JAMA 2018; 320: 657
    CrossrefPubMedSearch in Google Scholar
  • 7 Cunnane SC, Courchesne-Loyer A, St-Pierre V. et al. Can ketones compensate for deteriorating brain glucose uptake during aging? Implications for the risk and treatment of Alzheimer’s disease: Brain glucose and ketone uptake in Alzheimer’s disease. Ann N Y Acad Sci 2016; 1367: 12-20
    CrossrefPubMedSearch in Google Scholar
  • 8 Kullmann S, Heni M, Hallschmid M. et al. Brain Insulin Resistance at the Crossroads of Metabolic and Cognitive Disorders in Humans. Physiological Reviews 2016; 96: 1169-1209
    CrossrefPubMedSearch in Google Scholar
  • 9 Hooshmand B, Rusanen M, Ngandu T. et al. Serum Insulin and Cognitive Performance in Older Adults: A Longitudinal Study. Am J Med 2019; 132: 367-373
    CrossrefPubMedSearch in Google Scholar
  • 10 Croteau E, Castellano CA, Fortier M. et al. A cross-sectional comparison of brain glucose and ketone metabolism in cognitively healthy older adults, mild cognitive impairment and early Alzheimer’s disease. Exp Gerontol 2018; 107: 18-26
    CrossrefPubMedSearch in Google Scholar
  • 11 Willette AA, Bendlin BB, Starks EJ. et al. Association of Insulin Resistance With Cerebral Glucose Uptake in Late Middle-Aged Adults at Risk for Alzheimer Disease. JAMA Neurol 2015; 72: 1013
    CrossrefPubMedSearch in Google Scholar
  • 12 Ngandu T, Lehtisalo J, Solomon A. et al. 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 2015; 385: 2255-2263
    CrossrefPubMedSearch in Google Scholar
  • 13 Köbe T, Witte AV, Schnelle A. et al. Combined omega-3 fatty acids, aerobic exercise and cognitive stimulation prevents decline in gray matter volume of the frontal, parietal and cingulate cortex in patients with mild cognitive impairment. Neuroimage 2016; 131: 226-238
    CrossrefPubMedSearch in Google Scholar
  • 14 Solfrizzi V, Custodero C, Lozupone M. et al. Relationships of Dietary Patterns, Foods, and Micro- and Macronutrients with Alzheimer’s Disease and Late-Life Cognitive Disorders: A Systematic Review. J Alzheimers Dis 2017; 59: 815-849
    PubMedSearch in Google Scholar
  • 15 Cao L, Tan L, Wang HF. et al. Dietary Patterns and Risk of Dementia: a Systematic Review and Meta-Analysis of Cohort Studies. Mol Neurobiol 2016; 53: 6144-6154
    CrossrefPubMedSearch in Google Scholar
  • 16 Morris MC, Tangney CC, Wang Y. et al. MIND diet associated with reduced incidence of Alzheimer’s disease. Alzheimer’s & Dementia 2015; 11: 1007-1014
    CrossrefPubMedSearch in Google Scholar
  • 17 Kerti L, Witte AV, Winkler A. et al. Higher glucose levels associated with lower memory and reduced hippocampal microstructure. Neurology 2013; 81: 1746-1752
    CrossrefPubMedSearch in Google Scholar
  • 18 Hertz L, Chen Y, Waagepetersen HS. Effects of ketone bodies in Alzheimer’s disease in relation to neural hypometabolism, β-amyloid toxicity, and astrocyte function. J Neurochem 2015; 134: 7-20
    CrossrefPubMedSearch in Google Scholar
  • 19 Youm YH, Nguyen KY, Grant RW. et al. The ketone metabolite β-hydroxybutyrate blocks NLRP3 inflammasome–mediated inflammatory disease. Nature Medicine 2015; 21: 263-269
    CrossrefPubMedSearch in Google Scholar
  • 20 Bredesen D, Amos E, Canick J. et al. Reversal of cognitive decline in Alzheimer’s disease. Aging 2016; 8: 1250-1258
    CrossrefPubMedSearch in Google Scholar
  • 21 Zhang Y, Chen J, Qiu J. et al. Intakes of fish and polyunsaturated fatty acids and mild-to-severe cognitive impairment risks: a dose-response meta-analysis of 21 cohort studies. Am J Clin Nutr 2016; 103: 330-340
    PubMedSearch in Google Scholar
  • 22 Samieri C, Morris MC, Bennett DA. et al. Fish Intake, Genetic Predisposition to Alzheimer Disease, and Decline in Global Cognition and Memory in 5 Cohorts of Older Persons. Am J Epidemiol 2018; 187: 933-940
    CrossrefPubMedSearch in Google Scholar
  • 23 Bakre AT, Chen R, Khutan R. et al. Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis. Public Health Nutr 2018; 21: 1921-1932
    CrossrefPubMedSearch in Google Scholar
  • 24 Lukaschek K, von Schacky C, Kruse J. et al. Cognitive Impairment Is Associated with a Low Omega-3 Index in the Elderly: Results from the KORA-Age Study. Dement Geriatr Cogn Disord 2016; 42: 236-245
    CrossrefPubMedSearch in Google Scholar
  • 25 Kleber ME, Delgado GE, Lorkowski S. et al. Omega-3 fatty acids and mortality in patients referred for coronary angiography. The Ludwigshafen Risk and Cardiovascular Health Study. Atherosclerosis 2016; 252: 175-181
    CrossrefPubMedSearch in Google Scholar
  • 26 Külzow N, Witte AV, Kerti L. et al. Impact of Omega-3 Fatty Acid Supplementation on Memory Functions in Healthy Older Adults. J Alzheimers Dis 2016; 51: 713-725
    CrossrefPubMedSearch in Google Scholar
  • 27 Rice HB, Bernasconi A, Maki KC. et al. Conducting omega-3 clinical trials with cardiovascular outcomes: Proceedings of a workshop held at ISSFAL 2014. PLEFA 2016; 107: 30-42
    PubMedSearch in Google Scholar
  • 28 Eriksdotter M, Vedin I, Falahati F. et al. Plasma Fatty Acid Profiles in Relation to Cognition and Gender in Alzheimer’s Disease Patients During Oral Omega-3 Fatty Acid Supplementation: The OmegAD Study. J Alzheimers Dis 2015; 48: 805-812
    PubMedSearch in Google Scholar
  • 29 Nock TG, Chouinard-Watkins R, Plourde M. Carriers of an apolipoprotein E epsilon 4 allele are more vulnerable to a dietary deficiency in omega-3 fatty acids and cognitive decline. Biochim Biophys Acta Mol Cell Biol Lipids 2017; 1862: 1068-1078
    CrossrefPubMedSearch in Google Scholar
  • 30 Jernerén F, Elshorbagy AK, Oulhaj A. et al. Brain atrophy in cognitively impaired elderly: the importance of long-chain ω-3 fatty acids and B vitamin status in a randomized controlled trial. Am J Clin Nutr 2015; 102: 215-221
    CrossrefPubMedSearch in Google Scholar
  • 31 Oulhaj A, Jernerén F, Refsum H. et al. Omega-3 Fatty Acid Status Enhances the Prevention of Cognitive Decline by B Vitamins in Mild Cognitive Impairment. J Alzheimers Dis 2016; 50: 547-557
    CrossrefPubMedSearch in Google Scholar
  • 32 Lee J. The Relationship Between Physical Activity and Dementia: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Gerontol Nurs 2018; 44: 22-29
    CrossrefPubMedSearch in Google Scholar
  • 33 Rovio S, Kåreholt I, Helkala EL. et al. Leisure-time physical activity at midlife and the risk of dementia and Alzheimer’s disease. Lancet Neurol 2005; 4: 705-711
    CrossrefPubMedSearch in Google Scholar
  • 34 Kemps H, Kränkel N, Dörr M. et al. Exercise training for patients with type 2 diabetes and cardiovascular disease: What to pursue and how to do it. A Position Paper of the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2019
    PubMedSearch in Google Scholar
  • 35 Maliszewska-Cyna E, Lynch M, Oore JJ. et al. The Benefits of Exercise and Metabolic Interventions for the Prevention and Early Treatment of Alzheimer’s Disease. Curr Alzheimer Res 2017; 14: 47-60
    PubMedSearch in Google Scholar
  • 36 Leal LG, Lopes MA, Batista ML. Physical Exercise-Induced Myokines and Muscle-Adipose Tissue Crosstalk: A Review of Current Knowledge and the Implications for Health and Metabolic Diseases. Front Physiol 2018; 9: 1307 , doi:10.3389/fphys.2018.01307
    CrossrefPubMedSearch in Google Scholar
  • 37 Wang R, Holsinger RMD. Exercise-induced brain-derived neurotrophic factor expression: Therapeutic implications for Alzheimer’s dementia. Ageing Res Rev 2018; 48: 109-121
    CrossrefPubMedSearch in Google Scholar
  • 38 Reutrakul S, Van Cauter E. Sleep influences on obesity, insulin resistance, and risk of type 2 diabetes. Metab Clin Exp 2018; 84: 56-66
    CrossrefPubMedSearch in Google Scholar
  • 39 Irwin MR, Vitiello MV. Implications of sleep disturbance and inflammation for Alzheimer’s disease dementia. Lancet Neurol 2019; 18: 296-306
    CrossrefPubMedSearch in Google Scholar
  • 40 Taylor MK, Sullivan DK, Mahnken JD. et al. Feasibility and efficacy data from a ketogenic diet intervention in Alzheimer’s disease. Alzheimer’s & Dementia: Translational Research & Clinical Interventions 2018; 4: 28-36
    PubMedSearch in Google Scholar