Maintaining brain health is an advanced goal of healthy ageing. Eating a diet with appropriate nutrients has been identified as a promising approach to reducing the risk of dementia, but community-dwelling residents have inadequate or no health guidance from medical workers since there is no detailed and comprehensive clinical dietary nutrients management program for brain health promotion for community-dwelling people .
To search, evaluate and summarize the evidence on dietary nutrients management for brain health promotion in community-dwelling people, providing an evidence-based basis for clinical implementation of such management for this group of population.
In March 2022, we searched UpToDate, BMJ Best Practice, JBI Model of Evidence-based Healthcare, National Institute on Aging, Registered Nurses' Association of Ontario, the Cochrane Library, PubMed, CNKI, Medlive and other databases to collect literature (involving clinical decisions, recommended practices, guidelines, evidence summaries, expert consensuses and systematic reviews) regarding dietary nutrients management for brain health promotion in community-dwelling people. The retrieval period was from January 1, 2017 to March 29, 2022. Two researchers systematically trained in evidence-based medicine independently screened literature, extracted data, and evaluated the quality of the included literature. Then evidence was extracted from the included literature, and its quality was graded, then the best evidence was summarized.
A total of 28 studies with an overall high methodological quality were included, including three clinical guidelines, five expert consensuses, one clinical decision and 19 systematic reviews. Finally, 23 pieces of best evidence were summarized, involving seven aspects of intervention timing, dietary nutrients assessment and screening, dietary patterns and components, specific nutrients, coffee intake, body weight management, health education and guidance.
Eating a diet with appropriate nutrients can promote brain health of residents. Community medical workers should develop an individualized dietary nutrients management program for brain health for them in accordance with the practical clinical situation, residents' current dietary nutrients status and preferences, and insights from the best evidence.
Lifestyle factors are important modifiable influencing factors for cognitive decline and dementia. Understanding the status and influencing factors of community-dwelling middle-aged and elderly adults adhering to the lifestyles conducive to dementia risk reduction will be a basis for medical workers to formulate individualized interventions for primary prevention of dementia, yet there are still few related studies.
To understand the status and influencing factors of dementia risk reduction lifestyle in community-dwelling middle-aged and elderly adults.
Five hundred and six middle-aged and elderly adults (aged 45 years and older) who had received free health check-ups in a community health center were selected from five communities in Chongqing's Shapingba District by convenience sampling from January to October 2021. The self-designed general information questionnaire and the Dementia Risk Reduction Lifestyle Scale (DRRLS) were used to investigate. The level of DRRLS score in the participants was compare by sociodemographic characteristics. Ordinal and multinomial Logistic regression analysis was performed to identify the influencing factors of the levels of DRRLS scores.
The average score of DRRLS was (88.00±13.27). The median scores of items in mental activity and brain-benefiting exercise were at a low level (≤2.00). The level of DRRLS score in the participants varied significantly by gender, age, personal monthly income and experience of receiving dementia-related health education (P<0.05). Ordinal and multinomial Logistic regression revealed that gender, educational level, personal monthly income and experience of receiving dementia-related health education were important influencing factors of the level of DRRLS score (P<0.05) .
In general, the lifestyles for dementia risk reduction were assessed at a moderate level in the community-dwelling middle-aged and elderly adults. In the primary prevention of dementia, the effects of mental activity and brain-benefiting exercise should be emphasized. Moreover, priority in community health management should be given to men, those with a low educational level or no previous experience of receiving dementia-related health education, and relevant health education and preventive interventions should be strengthened for them. All these efforts will urge these adults to adopt a lifestyle for dementia risk reduction and brain health promotion.
The incidence of dementia is gradually increasing in China. Lifestyle is an important modifiable factor for dementia, and the health belief model can be widely used to explain and predict health-related behaviors.
To analyze the impact of dementia prevention beliefs on health promoting lifestyle in Chinese adults, providing a scientific basis for the development of targeted dementia prevention regimens based on the health belief model.
An online survey was used for collecting data including sociodemographics, dementia-related knowledge and prevention beliefs as well as health promoting lifestyle level of 1 202 Chinese adults using a self-developed electronic questionnaire〔consisting of general information questionnaire, dementia prevention knowledge questionnaire (DPKQ), Chinese version of the Motivation to Change Lifestyle and Health Behaviors for Dementia Risk Reduction (MCLHB-DRR) scale, and Chinese version of the revised Health Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ R) 〕from February to March 2020. Multiple linear regression was used to analyze the effect of dementia prevention beliefs on health-promoting lifestyle.
A total of 1 201 cases returned responsive questionnaires, with a response rate of 99.92%. The average score of DPKQ of the respondents was (7.46±2.85), and the rate of correctly answering the questions in DPKQ was 67.82%. The average total score and average item score of the MCLHB-DRR in the respondents were (92.67±12.68), and (3.43±0.47), respectively. The average total score of HPLP-Ⅱ R was (100.00±15.81). The HPLP-Ⅱ R scores were affected by five domain scores of the Chinese version of MCLHB-DRR (perceived susceptibility, perceived benefits, perceived barriers, self-efficacy and general health motivation), the total score of DPKQ, living area (rural or urban), education level and the history of contacting with dementia patients.
The health promoting lifestyle of adults is partially affected by partial dimensions of dementia prevention beliefs and some sociodemographic characteristics. Therefore, health care workers can provide preventive interventions for adults to prevent dementia based on the relationship between the health belief model and health-related behaviors.
Maintaining brain health is an advanced goal of healthy ageing. As an important intervention to promote brain health and reduce the risk of cognitive impairment, physical activity is highly recommended in the WHO Guidelines on Risk Reduction of Cognitive Decline and Dementia. However, due to the lack of specific guidance on the types of exercise, amount of exercise and intervention methods, it is difficult to carry out physical activity in the community.
To construct a community-based physical activity intervention program to promote brain health in community-dwelling Chinese residents.
A draft of Community-based Physical Activity Intervention Program Promoting Brain Health (CPAIPPBH) was developed in December 2021 based on the evidence extracted from studies searched systematically after being screened and assessed in terms of quality by two researchers independently, and review results of our research group. Then from February to March 2022, the draft was revised in accordance with the results of a two-round email-based Delphi survey with 13 experts, and response rate, authority coefficient, Kendall's W, weight of each indicator, and the logical consistency of indicators at all levels were calculated, and finally the formal version was developed.
Altogether, 26 out of the 8 943 searched studies were enrolled, from which 27 pieces of evidence were summarized, involving target group and principles of physical activity, type of physical activity, intensity and time of physical activity, effect and relevant evaluation of physical activity, and considerations for physical activity. The draft CPAIPPBH consisted of 6 primary indicators and 32 secondary indicators. The response rate, authority coefficient, and Kendall's W were 100.0%, 0.940, and 0.257 (χ2=123.386, P<0.001), respectively, for the first round of survey, and were 100.0%, 0.925, and 0.275 (χ2=139.548, P<0.001), respectively, for the second round of survey. The final program includes 7 primary indicators (including target group and principles of physical activity, pre-intervention assessment, form of intervention, type of physical activity, intensity and time of physical activity, effect and relevant evaluation of physical activity, and considerations for physical activity, with corresponding weights of 0.213, 0.213, 0.213, 0.066, 0.116, 0.116, 0.066, respectively) and 33 secondary indicators. The consistency ratios of primary and secondary indicators were all <0.100 0.
The CPAIPPBH developed by us has proven to be scientific and practical, which could be used to guide the management of community-based physical activity interventions for brain health by community medical workers.
