Supplementary Material for: Evidence on protective factors for dementia and cognitive impairment in older adults: an umbrella review

Introduction: Dementia represents a global public health challenge, and no conclusive evidence exists on how to prevent its onset or at least reduce the risk. This umbrella review aims to identify interventions or exposures that can reduce the incidence of dementia or cognitive impairment.
Methods: A search of meta-analyses and systematic reviews published from 2018 to 2025 (January) was conducted across four databases. Articles assessing associations between interventions or exposures to protective factors and incidence of dementia or cognitive decline in non-demented older adults were selected.
Results: Out of 6,324 articles, 177 underwent full-text screening, and 17 were included. They showed that psychosocial factors (social engagement, purpose in life, life satisfaction, and cognitive reserve) and influenza vaccination protect against dementia. Evidence on antihypertensives is promising, while evidence on low-dose aspirin is promising yet inconclusive. No clear results emerged for both single- and multi-domain lifestyle interventions.
Conclusions: These results offer new insight on potential targets for dementia prevention, a global public health priority. In particular, favorable psychosocial factors and influenza vaccination, undervalued in the scientific debate on dementia prevention, emerged as promising and feasible targets for preventive initiatives. Future research should focus on fine-tuning interventions to promote brain health, exploring their underlying mechanisms, and developing targeted and personalized strategies for specific population subgroups.

引言：痴呆症（Dementia）是一项全球性公共卫生挑战，目前尚无确凿证据表明如何预防其发病或至少降低发病风险。本伞状综述（umbrella review）旨在识别可降低痴呆症或认知损害发病率的干预措施或暴露因素。
研究方法：本研究检索了2018年至2025年1月期间发表于4个数据库的荟萃分析（meta-analysis）与系统综述。纳入的文献需评估非痴呆老年人群中，干预措施或保护性因素暴露与痴呆症或认知衰退发病率之间的关联。
研究结果：在6324篇文献中，177篇经过全文筛选，最终纳入17篇。结果显示，社会心理因素（社交参与、人生目标、生活满意度与认知储备（cognitive reserve））及流感疫苗接种可预防痴呆症。抗高血压药物（antihypertensives）的相关证据颇具前景，而低剂量阿司匹林（low-dose aspirin）的相关证据虽具潜力但尚无定论。单一领域与多领域生活方式干预均未得出明确结论。
研究结论：本研究结果为痴呆症预防的潜在靶点提供了新见解，而痴呆症预防是全球公共卫生的重点工作。尤其值得注意的是，在痴呆症预防的学术讨论中被低估的有利社会心理因素与流感疫苗接种，成为预防性举措中颇具潜力且可行的靶点。未来研究应聚焦于优化促进脑健康的干预措施、探索其潜在作用机制，以及开发针对特定人群亚组的靶向化与个性化策略。