Zusammenfassung
Die Lebenserwartung nimmt linear zu und der ältere Teil der europäischen Bevölkerung wächst rasch im Vergleich zum jüngeren. Aber Demenz wächst noch rascher, denn sie nimmt im Alter exponentiell zu; wenn wir nichts tun, wird sie eine große Last. Die Diskussion ist bisher auf die Behandlung konzentriert, die Prävention ist vernachlässigt. Die Therapie der Demenz ist aber von begrenzter Wirkung. Im Gegensatz zu einer weit verbreiteten Meinung ist Prävention möglich. Genetische Faktoren alleine dominieren das Schicksal des Denkens nur in etwa 3 % der Fälle. Neben dem Alter haben Lebensstil und die vaskulären Risikofaktoren großen Einfluss. Hoher Blutdruck vervierfacht das Risiko, Diabetes verdoppelt die Gefahr von beiden, der vaskulären und der Alzheimer-Demenz. Vor allem die zerebrale Mikroangiopathie ist stark assoziiert mit Alzheimer-Demenz, sie triggert den Circulus vitiosus, der zur Amyloidablagerung führt. Die Bedeutung des Hirnkreislaufs wird unterschätzt, weil die meisten mikrovaskulären zerebralen Läsionen vom Patienten nicht wahrgenommen werden. Sämtliche Risikofaktoren für die Alzheimer-Demenz nach dem 65. Lebensjahr sind vaskuläre Risikofaktoren vor allem für Mikroangiopathie: Apo-E4, Östrogenmangel, Insulinresistenz, Diabetes, arterielle Hypertonie, Hyperlipidämie, hohes Alter und erhöhtes Plasma-Homocystein, das oft Folge schon von mäßigem Alkoholkonsum ist. Ein gesunder Lebensstil mit täglicher Bewegung im Freien und eine Mittelmeerdiät reduzieren nicht nur das Risiko von Demenz, sondern auch von Herzinfarkt und Krebs. Noch stärker als körperliche schützt geistige Aktivität vor Demenz; der Grund dazu wird in der Jugend durch Bildung gelegt. Therapie mit Statinen ist ratsam, wenn der Atherosklerose nicht wirksam mit Diät und Bewegung begegnet werden kann.
Abstract
Prevention of dementia: Life expectancy still increases linearly, and the elderly part of the European population grows rapidly in relation to the young. Dementia, however, grows even more rapidly, because it increases exponentially after age 65; it will become a great burden if nothing is done. The discussion so far is concentrated on treatment, whereas prevention is neglected. The therapy of dementia, however, has limited effect. Contrary to a widespread opinion prevention is possible. Genetic factors alone dominate the fate of cognition only in about 3 % of the cases. Besides age, lifestyle and the vascular risk factors exercise a great influence. High blood pressure carries a fourfold risk, diabetes more than doubles the risk both of the vascular and of the Alzheimer type; combined even more. Especially cerebral microangiopathy is strongly associated with Alzheimer’s dementia, it triggers the vicious circle which leads to amyloid deposition. The importance of the circulation is underestimated, because most of the microvascular cerebral lesions are not perceived by the patient. All the risk factors for Alzheimer’s disease after age 65 are also vascular risk factors especially for microangiopathy: Apo-E4, oestrogen deficiency, insulin resistance, diabetes, arterial hypertension, high cholesterol, old age and increased plasma homocystein which is often caused by alcohol consumption even in moderate doses. A healthy life style with daily outdoor activity and a Mediterranean diet not only reduces the risk of dementia, but also of coronary death and cancer. Cognitively stimulating activity protects even more than physical activity against dementia; the basis for this is acquired in youth by education. Therapy with statines is advisable if atherosclerosis cannot be reasonably counteracted by physical activity and diet.
Schlüsselwörter
Demenz - Alzheimer-Krankheit - Prävention - Risikofaktoren - Aktivität
Key words
Dementia - Alzheimer’s disease - prevention - risk factors - activity
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