Elsevier

The Lancet Neurology

Volume 3, Issue 6, June 2004, Pages 343-353
The Lancet Neurology

Review
An active and socially integrated lifestyle in late life might protect against dementia

https://doi.org/10.1016/S1474-4422(04)00767-7Get rights and content

Summary

The recent availability of longitudinal data on the possible association of different lifestyles with dementia and Alzheimer's disease (AD) allow some preliminary conclusions on this topic. This review systematically analyses the published longitudinal studies exploring the effect of social network, physical leisure, and non-physical activity on cognition and dementia and then summarises the current evidence taking into account the limitations of the studies and the biological plausibility. For all three lifestyle components (social, mental, and physical), a beneficial effect on cognition and a protective effect against dementia are suggested. The three components seem to have common pathways, rather than specific mechanisms, which might converge within three major aetiological hypotheses for dementia and AD: the cognitive reserve hypothesis, the vascular hypothesis, and the stress hypothesis. Taking into account the accumulated evidence and the biological plausibility of these hypotheses, we conclude that an active and socially integrated lifestyle in late life protects against dementia and AD. Further research is necessary to better define the mechanisms of these associations and better delineate preventive and therapeutic strategies.

Section snippets

Lifestyle effects on survival and health

There is a large amount of epidemiological data on the health benefits of social integration and social support. And there is more evidence of the effects of leisure activities on health and survival, especially physical activities and physical exercise.

Lifestyle effects on cognition

Research on different lifestyles and cognition is important for understanding and better defining their possible effects on dementia. We present here a systematic review of the observational studies and a summary of the randomised clinical trials.

Effect of social network and leisure activity on dementia risk

13 studies of the possible association between social network, physical and cognitive activity, and dementia were found.54, 55, 56, 57, 58, 59, 60, 61, 62, 63, 64, 65, 66

Current evidence

Most of the evidence is from observational studies (figure 1). A higher risk of cognitive decline or lower cognitive performance was observed in five of seven studies of social networks and six of seven studies of non-physical activity (mostly cognitively stimulating activity). Physical activity, including both exercise and daily physical activity, was inversely related to cognition in seven of eight studies. It is difficult to estimate the extent of publication bias, but owing to the debate

Conclusions

In the past 30 years extensive research has increased our knowledge of the aetiology of AD and other dementing disorders. Several hypotheses have already emerged from the epidemiological research. This review provides enough evidence to support the hypothesis that and active and socially integrated lifestyle in late life seems to protect against AD and dementia. This hypothesis can be easily integrated in a general model of dementia occurrence that takes into account the effect of different

Search strategy and selection criteria

Studies were identified by searches of MEDLINE, MEDLINE plus, and PubMed with the terms ā€œcognitionā€, ā€œdementiaā€, and ā€œAlzheimer's diseaseā€ in combination with ā€œsocial networkā€, ā€œsocial relationsā€, ā€œleisure activityā€, ā€œphysical activityā€; or ā€œcognitive trainingā€, and ā€œphysical trainingā€. Studies were also identified from relevant articles. Only papers published in English were included; abstracts or congress proceedings were not taken into account.

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