Editing Dementia (section)

==Prevention==
{{Main|Prevention of dementia}}

===Risk factors{{anchor|Causes}}===
{{See also|Neuroplastic effects of pollution}}
Risk factors for dementia include [[high blood pressure]], high levels of [[LDL cholesterol]], [[vision loss]], [[hearing loss]], [[tobacco smoking|smoking]], [[obesity]], [[Depression (mood)|depression]], [[Physical inactivity|inactivity]], [[diabetes]], lower levels of education and low social contact. Over-indulgence in alcohol, lack of sleep, [[anemia]], traumatic brain injury, and air pollution can also increase the chance of developing dementia.<ref name="Lancet2020">{{cite journal |vauthors=Livingston G, Huntley J, Sommerlad A, et al |date=August 2020 |title=Dementia prevention, intervention, and care: 2020 report of the Lancet Commission |journal=Lancet |volume=396 |issue=10248 |pages=413–446 |doi=10.1016/S0140-6736(20)30367-6 |pmc=7392084 |pmid=32738937}}</ref><ref>{{cite journal |vauthors=Zhang YR, Xu W, Zhang W, et al |date=October 2022 |title=Modifiable risk factors for incident dementia and cognitive impairment: An umbrella review of evidence |journal=J Affect Disord |volume=314 |issue= |pages=160–167 |doi=10.1016/j.jad.2022.07.008 |pmid=35863541}}</ref><ref>{{Cite journal |last1=Livingston |first1=Gill |last2=Huntley |first2=Jonathan |last3=Liu |first3=Kathy Y |last4=Costafreda |first4=Sergi G |last5=Selbæk |first5=Geir |last6=Alladi |first6=Suvarna |last7=Ames |first7=David |last8=Banerjee |first8=Sube |last9=Burns |first9=Alistair |last10=Brayne |first10=Carol |last11=Fox |first11=Nick C |last12=Ferri |first12=Cleusa P |last13=Gitlin |first13=Laura N |last14=Howard |first14=Robert |last15=Kales |first15=Helen C |date=August 2024 |title=Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission |url=https://linkinghub.elsevier.com/retrieve/pii/S0140673624012960 |journal=The Lancet |language=en |volume=404 |issue=10452 |pages=572–628 |doi=10.1016/S0140-6736(24)01296-0|pmid=39096926 }}</ref><ref>{{Cite web |last1=Larson |first1=Eric B. |last2=Gitlin |first2=Laura |date=2024-08-12 |title=Dementia risk factors identified in new global report are all preventable – addressing them could reduce dementia rates by 45% |url=https://theconversation.com/dementia-risk-factors-identified-in-new-global-report-are-all-preventable-addressing-them-could-reduce-dementia-rates-by-45-236290 |access-date=2024-10-17 |website=The Conversation |language=en-US}}</ref> Many of these risk factors, including the lower level of education, smoking, physical inactivity and diabetes, are modifiable.<ref name="pmid28960500">{{cite journal | vauthors = Huntley J, Corbett A, Wesnes K, Brooker H, Stenton R, Hampshire A, Ballard C | title = Online assessment of risk factors for dementia and cognitive function in healthy adults | journal = International Journal of Geriatric Psychiatry | volume = 33 | issue = 2 | pages = e286–e293 | date = February 2018 | pmid = 28960500 | doi = 10.1002/gps.4790 | s2cid = 33822160 | url = https://discovery.ucl.ac.uk/id/eprint/10073477/}}</ref> Several of the group are known as ''vascular risk factors'' that may be possible to be reduced or eliminated.<ref name="IRNDP">{{cite web |title=vascular risk factors and brain health |url=https://coghealth.net.au/wp-content/uploads/2018/12/English-Vascular-Risk-Factors.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://coghealth.net.au/wp-content/uploads/2018/12/English-Vascular-Risk-Factors.pdf |archive-date=October 9, 2022 |url-status=live |access-date=January 1, 2021}}</ref> Managing these risk factors can reduce the risk of dementia in individuals in their late midlife or older age. A reduction in a number of these risk factors can give a positive outcome.<ref>{{cite journal | vauthors = Ding J, Davis-Plourde KL, Sedaghat S, Tully PJ, Wang W, Phillips C, Pase MP, Himali JJ, Gwen Windham B, Griswold M, Gottesman R, Mosley TH, White L, Guðnason V, Debette S, Beiser AS, Seshadri S, Ikram MA, Meirelles O, Tzourio C, Launer LJ | display-authors = 6 | title = Antihypertensive medications and risk for incident dementia and Alzheimer's disease: a meta-analysis of individual participant data from prospective cohort studies | journal = The Lancet. Neurology | volume = 19 | issue = 1 | pages = 61–70 | date = January 2020 | pmid = 31706889 | pmc = 7391421 | doi = 10.1016/S1474-4422(19)30393-X }}</ref> The decreased risk achieved by adopting a healthy lifestyle is seen even in those with a high genetic risk.<ref>{{cite journal | vauthors = Lourida I, Hannon E, Littlejohns TJ, Langa KM, Hyppönen E, Kuzma E, Llewellyn DJ | title = Association of Lifestyle and Genetic Risk With Incidence of Dementia | journal = JAMA | volume = 322 | issue = 5 | pages = 430–437 | date = July 2019 | pmid = 31302669 | pmc = 6628594 | doi = 10.1001/jama.2019.9879 }}</ref>

In addition to the above risk factors, other psychological features, including certain personality traits (high [[neuroticism]], and low [[conscientiousness]]), low [[purpose in life]], and high [[loneliness]], are risk factors for Alzheimer's disease and related dementias.<ref>{{cite journal | vauthors = Aschwanden D, Strickhouser JE, Luchetti M, Stephan Y, Sutin AR, Terracciano A | title = Is personality associated with dementia risk? A meta-analytic investigation | journal = Ageing Research Reviews | volume = 67 | page = 101269 | date = May 2021 | pmid = 33561581 | pmc = 8005464 | doi = 10.1016/j.arr.2021.101269 }}</ref><ref>{{cite journal | vauthors = Sutin AR, Aschwanden D, Luchetti M, Stephan Y, Terracciano A | title = Sense of Purpose in Life Is Associated with Lower Risk of Incident Dementia: A Meta-Analysis | journal = Journal of Alzheimer's Disease | volume = 83 | issue = 1 | pages = 249–258 | year = 2021 | pmid = 34275900 | pmc = 8887819 | doi = 10.3233/JAD-210364 }}</ref><ref>{{cite journal | vauthors = Luchetti M, Terracciano A, Aschwanden D, Lee JH, Stephan Y, Sutin AR | title = Loneliness is associated with risk of cognitive impairment in the Survey of Health, Ageing and Retirement in Europe | journal = International Journal of Geriatric Psychiatry | volume = 35 | issue = 7 | pages = 794–801 | date = July 2020 | pmid = 32250480 | pmc = 7755119 | doi = 10.1002/gps.5304 }}</ref> For example, based on the [[English Longitudinal Study of Ageing]] (ELSA), research found that loneliness in older people can increase the risk of dementia by one-third. Not having a partner (being single, divorced, or widowed) can double the risk of dementia. However, having two or three closer relationships might reduce the risk by three-fifths.<ref>{{Cite journal |date=May 27, 2020 |title=Loneliness, but not social isolation, predicts development of dementia in older people |url=https://evidence.nihr.ac.uk/alert/loneliness-but-not-social-isolation-predicts-development-of-dementia-in-older-people/ |journal=NIHR Evidence |type=Plain English summary |language=en |doi=10.3310/alert_40330|s2cid=241649845 }}</ref><ref>{{cite journal | vauthors = Rafnsson SB, Orrell M, d'Orsi E, Hogervorst E, Steptoe A | title = Loneliness, Social Integration, and Incident Dementia Over 6 Years: Prospective Findings From the English Longitudinal Study of Ageing | journal = The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences | volume = 75 | issue = 1 | pages = 114–124 | date = January 2020 | pmid = 28658937 | pmc = 6909434 | doi = 10.1093/geronb/gbx087 | veditors = Carr D }}</ref>

The two most modifiable risk factors for dementia are [[physical inactivity]] and lack of cognitive stimulation.<ref name="Cheng">{{cite journal | vauthors = Cheng ST | title = Cognitive Reserve and the Prevention of Dementia: the Role of Physical and Cognitive Activities | journal = Current Psychiatry Reports | volume = 18 | issue = 9 | page = 85 | date = September 2016 | pmid = 27481112 | pmc = 4969323 | doi = 10.1007/s11920-016-0721-2 }}</ref> Physical activity, in particular [[aerobic exercise]], is associated with a reduction in age-related brain tissue loss, and neurotoxic factors thereby preserving brain volume and neuronal integrity. Cognitive activity strengthens [[neural plasticity]] and together they help to support [[cognitive reserve]]. The neglect of these risk factors diminishes this reserve.<ref name="Cheng"/>

Sensory impairments of vision and hearing are modifiable risk factors for dementia.<ref name=Dawes>{{cite journal |vauthors=Dawes P |title=Hearing interventions to prevent dementia |journal=HNO |volume=67 |issue=3 |pages=165–171 |date=March 2019 |pmid=30767054 |pmc=6399173 |doi=10.1007/s00106-019-0617-7}}</ref><ref>{{Cite journal |last1=Yu |first1=Ruan-Ching |last2=Proctor |first2=Danielle |last3=Soni |first3=Janvi |last4=Pikett |first4=Liam |last5=Livingston |first5=Gill |last6=Lewis |first6=Glyn |last7=Schilder |first7=Anne |last8=Bamiou |first8=Doris |last9=Mandavia |first9=Rishi |last10=Omar |first10=Rumana |last11=Pavlou |first11=Menelaos |last12=Lin |first12=Frank |last13=Goman |first13=Adele M. |last14=Gonzalez |first14=Sergi Costafreda |date=2024-07-01 |title=Adult-onset hearing loss and incident cognitive impairment and dementia – A systematic review and meta-analysis of cohort studies |url=https://www.sciencedirect.com/science/article/pii/S1568163724001648 |journal=Ageing Research Reviews |volume=98 |pages=102346 |doi=10.1016/j.arr.2024.102346 |pmid=38788800 |issn=1568-1637}}</ref><ref>{{Cite journal |date=19 February 2025 |title=What impact does hearing loss have on dementia risk? |url=https://evidence.nihr.ac.uk/alert/what-impact-does-hearing-loss-have-on-dementia-risk/ |journal=NIHR Evidence}}</ref> These impairments may precede the cognitive symptoms of Alzheimer's disease for example, by many years.<ref name="Panza">{{cite journal | vauthors = Panza F, Lozupone M, Sardone R, Battista P, Piccininni M, Dibello V, La Montagna M, Stallone R, Venezia P, Liguori A, Giannelli G, Bellomo A, Greco A, Daniele A, Seripa D, Quaranta N, Logroscino G | display-authors = 6 | title = Sensorial frailty: age-related hearing loss and the risk of cognitive impairment and dementia in later life | journal = Therapeutic Advances in Chronic Disease | volume = 10 | page = 2040622318811000 | date = 2019 | pmid = 31452865 | pmc = 6700845 | doi = 10.1177/2040622318811000 | doi-access = free }}</ref> Hearing loss may lead to [[social isolation]] which negatively affects cognition.<ref name=Tho2017>{{cite journal | vauthors = Thomson RS, Auduong P, Miller AT, Gurgel RK | title = Hearing loss as a risk factor for dementia: A systematic review | journal = Laryngoscope Investigative Otolaryngology | volume = 2 | issue = 2 | pages = 69–79 | date = April 2017 | pmid = 28894825 | pmc = 5527366 | doi = 10.1002/lio2.65 }}</ref> Social isolation is also identified as a modifiable risk factor.<ref name="Panza"/> Age-related hearing loss in midlife is linked to cognitive impairment in late life, and is seen as a risk factor for the development of Alzheimer's disease and dementia. Such hearing loss may be caused by a [[central auditory processing disorder]] that makes the understanding of speech against background noise difficult. Age-related hearing loss is characterised by slowed central processing of auditory information.<ref name="Panza"/><ref name="Hubbard">{{cite journal | vauthors = Hubbard HI, Mamo SK, Hopper T | title = Dementia and Hearing Loss: Interrelationships and Treatment Considerations | journal = Seminars in Speech and Language | volume = 39 | issue = 3 | pages = 197–210 | date = July 2018 | pmid = 29933487 | doi = 10.1055/s-0038-1660779 | s2cid = 49383232 }}</ref> Worldwide, mid-life hearing loss may account for around 9% of dementia cases.<ref name="Ford">{{cite journal | vauthors = Ford AH, Hankey GJ, Yeap BB, Golledge J, Flicker L, Almeida OP | title = Hearing loss and the risk of dementia in later life | journal = Maturitas | volume = 112 | pages = 1–11 | date = June 2018 | pmid = 29704910 | doi = 10.1016/j.maturitas.2018.03.004 | s2cid = 13998812 }}</ref>

[[Frailty syndrome|Frailty]] may increase the risk of cognitive decline, and dementia, and the inverse also holds of cognitive impairment increasing the risk of frailty. Prevention of frailty may help to prevent cognitive decline.<ref name="Panza"/>

There are no medications that can prevent cognitive decline and dementia.<ref name="Pharmacologic Interventions to Prev">{{cite journal | vauthors = Fink HA, Jutkowitz E, McCarten JR, Hemmy LS, Butler M, Davila H, Ratner E, Calvert C, Barclay TR, Brasure M, Nelson VA, Kane RL | display-authors = 6 | title = Pharmacologic Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia: A Systematic Review | journal = Annals of Internal Medicine | volume = 168 | issue = 1 | pages = 39–51 | date = January 2018 | pmid = 29255847 | doi = 10.7326/M17-1529 | s2cid = 24193907 }}</ref> However blood pressure lowering medications might decrease the risk of dementia or cognitive problems by around 0.5%.<ref>{{cite journal | vauthors = Hughes D, Judge C, Murphy R, Loughlin E, Costello M, Whiteley W, Bosch J, O'Donnell MJ, Canavan M | display-authors = 6 | title = Association of Blood Pressure Lowering With Incident Dementia or Cognitive Impairment: A Systematic Review and Meta-analysis | journal = JAMA | volume = 323 | issue = 19 | pages = 1934–1944 | date = May 2020 | pmid = 32427305 | pmc = 7237983 | doi = 10.1001/jama.2020.4249 }}</ref>

Economic disadvantage has been shown to have a strong link to higher dementia prevalence,<ref>{{cite journal | vauthors = Arapakis K, Brunner E, French E, McCauley J | title = Dementia and disadvantage in the USA and England: population-based comparative study | journal = BMJ Open | volume = 11 | issue = 10 | page = e045186 | date = October 2021 | pmid = 34615672 | pmc = 8496387 | doi = 10.1136/bmjopen-2020-045186 }}</ref> which cannot yet be fully explained by other risk factors.

A modelling study suggested that population-level interventions that target risk factors for dementia (such as high blood pressure, smoking and obesity) in England could save money and give people extra years in good health. For example, reduced salt in food could give 39,433 quality-adjusted life-years and save £2.4 billion.<ref>{{Cite journal |last1=Mukadam |first1=Naaheed |last2=Anderson |first2=Robert |last3=Walsh |first3=Sebastian |last4=Wittenberg |first4=Raphael |last5=Knapp |first5=Martin |last6=Brayne |first6=Carol |last7=Livingston |first7=Gill |date=2024-09-01 |title=Benefits of population-level interventions for dementia risk factors: an economic modelling study for England |url=https://www.thelancet.com/journals/lanhl/article/PIIS2666-7568(24)00117-X/fulltext |journal=The Lancet Healthy Longevity |language=English |volume=5 |issue=9 |doi=10.1016/S2666-7568(24)00117-X |issn=2666-7568 |pmid=39096915}}</ref><ref>{{Cite journal |date=20 March 2025 |title=Population-level policies on risk factors for dementia could reduce costs |url=https://evidence.nihr.ac.uk/alert/population-level-policies-on-risk-factors-for-dementia-could-reduce-costs/ |journal=NIHR Evidence}}</ref> 

===Dental health===
Limited evidence links poor oral health to cognitive decline. However, failure to perform tooth brushing and gingival inflammation can be used as dementia risk predictors.<ref>{{cite journal | vauthors = Daly B, Thompsell A, Sharpling J, Rooney YM, Hillman L, Wanyonyi KL, White S, Gallagher JE | title = Evidence summary: the relationship between oral health and dementia | journal = British Dental Journal | volume = 223 | issue = 11 | pages = 846–853 | date = January 2018 | pmid = 29192686 | doi = 10.1038/sj.bdj.2017.992 | s2cid = 19633523 | url = https://researchportal.port.ac.uk/portal/files/8739213/Evidence_summary_the_relationship_between_oral_health_and_dementia_post_print.pdf }}</ref>

====Oral bacteria====
There is some evidence that oral bacteria in people with gum disease may be a link to declines in cognitive health.<ref name="Miklossy">{{cite journal | vauthors = Miklossy J | title = Historic evidence to support a causal relationship between spirochetal infections and Alzheimer's disease | journal = Frontiers in Aging Neuroscience | volume = 7 | page = 46 | date = 2015 | pmid = 25932012 | pmc = 4399390 | doi = 10.3389/fnagi.2015.00046 | doi-access = free }}</ref> The proposed mechanism is still being studied, but research has linked specific types of bacteria in the mouth to those found in some people's brain who have Alzheimer's disease. There is also some evidence that people with a high level of tooth plaque are also at a greater risk of cognitive decline.<ref name="BDJ_2017">{{cite journal | vauthors = | title = Can poor oral health lead to dementia? | journal = British Dental Journal | volume = 223 | issue = 11 | page = 840 | date = December 2017 | pmid = 29243693 | doi = 10.1038/sj.bdj.2017.1064 | s2cid = 25898592 }}</ref> Poor oral hygiene can have an adverse effect on speech and nutrition, causing general and cognitive health decline.{{Citation needed|date=April 2025}}

====Oral viruses====
[[Herpes simplex virus]] (HSV) has been found in more than 70% of those aged over 50. HSV persists in the peripheral nervous system and can be triggered by stress, illness or fatigue.<ref name = "Olsen_2015">{{cite journal | vauthors = Olsen I, Singhrao SK | title = Can oral infection be a risk factor for Alzheimer's disease? | journal = Journal of Oral Microbiology | volume = 7 | page = 29143 | date = September 17, 2015 | pmid = 26385886 | pmc = 4575419 | doi = 10.3402/jom.v7.29143 }}</ref> High proportions of viral-associated proteins in [[amyloid plaques]] or [[neurofibrillary tangle]]s (NFTs) confirm the involvement of HSV-1 in Alzheimer's disease pathology. NFTs are known as the primary marker of Alzheimer's disease. HSV-1 produces the main components of NFTs.<ref>{{cite journal | vauthors = Carter CJ | title = Alzheimer's disease plaques and tangles: cemeteries of a pyrrhic victory of the immune defence network against herpes simplex infection at the expense of complement and inflammation-mediated neuronal destruction | journal = Neurochemistry International | volume = 58 | issue = 3 | pages = 301–320 | date = February 2011 | pmid = 21167244 | doi = 10.1016/j.neuint.2010.12.003 | s2cid = 715832 }}</ref>

===Diet===
Diet is seen to be a modifiable risk factor for the development of dementia. Thiamine deficiency is identified to increase the risk of Alzheimer's disease in adults.<ref>Gibson, GE, Hirsch, JA, Fonzetti, P, et al. (2016) Vitamin B1 (thiamine) and dementia. Ann N Y Acad Sci 1367, 21–30</ref> The role of thiamine in brain physiology is unique and essential for the normal cognitive function of older people.<ref>Butterworth, RF (2003) Thiamin deficiency and brain disorders. Nutr Res Rev 16, 277–284.</ref> Many dietary choices of the elderly population, including the higher intake of gluten-free products, compromise the intake of thiamine as these products are not fortified with thiamine.<ref>Hoffman, R. (2016). Thiamine deficiency in the Western diet and dementia risk. British Journal Of Nutrition, 116(1), 188–189.</ref>

The [[Mediterranean diet|Mediterranean]] and [[DASH diet|DASH]] diets are both associated with less cognitive decline. A different approach has been to incorporate elements of both of these diets into one known as the [[MIND diet]].<ref name=Acta1>{{cite journal |vauthors=Dominguez LJ, Barbagallo M |title=Nutritional prevention of cognitive decline and dementia |journal=  Acta Bio Medica: Atenei Parmensis |volume=89 |issue=2 |pages=276–290 |date=June 2018 |pmid=29957766 |pmc=6179018 |doi=10.23750/abm.v89i2.7401}}</ref> These diets are generally low in saturated fats while providing a good source of carbohydrates, mainly those that help stabilize blood sugar and insulin levels.<ref>{{Cite web| vauthors = Goodman B |title=Diet Affects Markers of Alzheimer's Disease|url=https://www.webmd.com/alzheimers/news/20110613/diet-affects-markers-of-alzheimers-disease|access-date=December 13, 2020|website=WebMD|language=en}}</ref> Raised [[blood sugar level]]s over a long time, can damage nerves and cause memory problems if they are not managed.<ref>{{Cite web|date=January 15, 2019|title=Memory loss can be caused by a number of factors, from short term causes such as low blood sugar or medication side effects to long term health issues such as dementia |url=https://www.diabetes.co.uk/diabetes-complications/diabetes-and-memory-loss.html|access-date=December 13, 2020|website=Diabetes|language=en-GB}}</ref> Nutritional factors associated with the proposed diets for reducing dementia risk include [[unsaturated fatty acid]]s, [[vitamin E]], [[vitamin C]], [[flavonoid]]s, [[vitamin B]], and [[vitamin D]].<ref name = "Cao_2016">{{cite journal | vauthors = Cao L, Tan L, Wang HF, Jiang T, Zhu XC, Lu H, Tan MS, Yu JT | display-authors = 6 | title = Dietary Patterns and Risk of Dementia: a Systematic Review and Meta-Analysis of Cohort Studies | journal = Molecular Neurobiology | volume = 53 | issue = 9 | pages = 6144–6154 | date = November 2016 | pmid = 26553347 | doi = 10.1007/s12035-015-9516-4 | s2cid = 8188716 | oclc = 6947867710 }}</ref><ref>{{cite journal | vauthors = Canevelli M, Lucchini F, Quarata F, Bruno G, Cesari M | title = Nutrition and Dementia: Evidence for Preventive Approaches? | journal = Nutrients | volume = 8 | issue = 3 | page = 144 | date = March 2016 | pmid = 26959055 | pmc = 4808873 | doi = 10.3390/nu8030144 | publisher = [[MDPI]] | oclc = 8147564576 | doi-access = free }}</ref> A study conducted at the University of Exeter in the United Kingdom seems to have confirmed these findings with fruits, vegetables, whole grains, and healthy fats creating an optimum diet that can help reduce the risk of dementia by roughly 25%.<ref name="Shannon">{{cite journal |vauthors=Shannon OM, Ranson JM, Gregory S, Macpherson H, Milte C, Lentjes M, Mulligan A, McEvoy C, Griffiths A, Matu J, Hill TR, Adamson A, Siervo M, Minihane AM, Muniz-Tererra G, Ritchie C, Mathers JC, Llewellyn DJ, Stevenson E |title=Mediterranean diet adherence is associated with lower dementia risk, independent of genetic predisposition: findings from the UK Biobank prospective cohort study |journal=BMC Med |volume=21 |issue=1 |page=81 |date=March 2023 |pmid=36915130 |doi=10.1186/s12916-023-02772-3 |pmc=10012551 |s2cid=257499227 |doi-access=free}}</ref>

The MIND diet may be more protective but further studies are needed. The Mediterranean diet seems to be more protective against Alzheimer's than DASH but there are no consistent findings against dementia in general. The role of [[olive oil]] needs further study as it may be one of the most important components in reducing the risk of cognitive decline and dementia.<ref name=Acta1/><ref name=Omar>{{cite journal |vauthors=Omar SH |title=Mediterranean and MIND Diets Containing Olive Biophenols Reduces the Prevalence of Alzheimer's Disease |journal=Int J Mol Sci |volume=20 |issue=11 |date=June 2019 |page=2797 |pmid=31181669 |pmc=6600544 |doi=10.3390/ijms20112797 |doi-access=free }}</ref>

In those with [[celiac disease]] or [[non-celiac gluten sensitivity]], a strict [[gluten-free diet]] may relieve the symptoms given a mild cognitive impairment.<ref name="ZisHadjivassiliou2019" /><ref name="MakhloufMesselmani2018" /> Once dementia is advanced no evidence suggests that a gluten-free diet is useful.<ref name="ZisHadjivassiliou2019">{{cite journal| vauthors=Zis P, Hadjivassiliou M| title=Treatment of Neurological Manifestations of Gluten Sensitivity and Coeliac Disease. | journal=Curr Treat Options Neurol | date=February 26, 2019 | volume= 21 | issue= 3 | page= 10 | pmid=30806821 | doi=10.1007/s11940-019-0552-7 | type=Review | doi-access=free }}</ref>

[[Omega-3 fatty acid]] supplements do not appear to benefit or harm people with mild to moderate symptoms.<ref>{{cite journal | vauthors = Burckhardt M, Herke M, Wustmann T, Watzke S, Langer G, Fink A | title = Omega-3 fatty acids for the treatment of dementia | journal = The Cochrane Database of Systematic Reviews | volume = 2016 | page = CD009002 | date = April 2016 | issue = 4 | pmid = 27063583 | doi = 10.1002/14651858.CD009002.pub3 | pmc = 7117565 }}</ref> However, there is good evidence that omega-3 incorporation into the diet is of benefit in treating depression, a common symptom,<ref name="Firth">{{cite journal |vauthors=Firth J, Teasdale SB, Allott K, Siskind D, Marx W, Cotter J, Veronese N, Schuch F, Smith L, Solmi M, Carvalho AF, Vancampfort D, Berk M, Stubbs B, Sarris J |title=The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta-review of meta-analyses of randomized controlled trials |journal=World Psychiatry |volume=18 |issue=3 |pages=308–324 |date=October 2019 |pmid=31496103 |pmc=6732706 |doi=10.1002/wps.20672}}</ref> and potentially modifiable risk factor for dementia.<ref name="Lancet2020"/>