[Is prevention of dementia possible?]

Dementia is a clinical syndrome with many causes. Dementia of the Alzheimer type and vascular dementia account alone or in combination for the vast majority of the dementia in the elderly population. Primary prevention depends on the knowledge of etiopathogenetic mechanisms and the possibility to change contributing factors. In the case of dementia of the Alzheimer type (DAT) contributing factors (risk factors) are emerging. However, they are not easily altered. The protective effect of certain micronutrients, such as antioxidants, remains speculative. The well-established cardiovascular risk factors such as hypertension, diabetes, and overweight are effective in the etiopathogenesis of vascular dementia. Their treatment by diet and drugs is therefore indicated. The protective role of antioxidants is better established in vascular dementia. Antioxidant micronutrients could be an important part of the primary preventive strategy. Whether mental training is effective in primary prevention or not remains controversial. Better training allows the individuals to optimize their resources. In secondary prevention, mental training was shown to be effective in mild dementia (MMS > or = 23), maintaining or even improving function (vascular dementia) and maintaining function for a given time in DAT. In the population with advanced age, mixed forms of dementia become increasingly common. Hence, patients with mild dementia should receive mental training as well as a vigorous treatment of established risk factors.