There is no clear demonstration of benefit of cognitive training, nor is there evidence to suggest that one cognitive training strategy is better than another. “If [patients] like doing sudoku or they like doing puzzles, Scrabble, or cards, that is what I am going to emphasize,” he said. “It is very reasonable to recommend that our patients remain cognitively and socially engaged, whatever that means for the individual patient.”
In addition, a Mediterranean-type diet high in olive oil, fresh vegetables, and fish may be worth recommending to patients and their caregivers, as it has been associated in studies with a lower risk of Alzheimer’s disease and mild cognitive impairment. Furthermore, neurologists should screen patients for sleep dysfunction, excessive alcohol intake, thyroid dysfunction, vitamin B12 deficiency, stroke risk factors, and medications that may impair cognition.
Other potential dementia therapies, including numerous interventions promoted online, have little or no evidence to support them. “We have a responsibility, in my opinion, to step in and provide some counseling regarding that to save our patients from committing to potentially expensive treatments with questionable efficacy,” said Dr. Day.
—Jake Remaly