LNSLNS

We thank our colleagues for their valuable comments. Due to space limitations, we were unable to discuss all potentially relevant risk factors for development of a cognitive disorder and dementia in our review article, although of course numerous additional risk factors exist (such as mental illness, cognitive and social factors, etc.).

The important point made by Behrens and Brüning about the significance of work-associated risks of dementia is underscored by recent studies. For instance, a recent Swedish cohort study indicated that work-related stress (for example, low control over the job, high work requirements, and low social support) was associated with an increased risk for developing vascular dementia (1). With regard to traumatic dementia, martial artists are especially exposed, and we have pointed out so a year ago in this journal their inhuman working conditions (2). Cognitive reserve is desirable and undoubtedly associated with privileged working conditions (3). Neither can be produced at will, and therefore appropriate lifelong learning opportunities have to be provided.

Recent results from basic research as well as results from large prospective cohort studies and small randomized intervention studies support the hypothesis that physical activity plays protective role, as Dr Hofmeister points out. According to a recent meta-analysis, up to 50% of all dementias worldwide are due to seven potentially modifiable risk factors: physical inactivity, lack of education/training, depression, smoking, diabetes, high blood pressure, and obesity in middle age (4).

Due to the increase in both medical data about, and public interest for, modifiable risk factors, it can be anticipated that their practical importance in the coming decades will continue to rise. Similar to how knowledge about the risks of smoking, alcohol, and obesity influenced the lifestyle in Europe over the last 50 years, we believe that knowledge about cognitive, emotional, social, and physical factors will lead to reasonable changes in this era of longevity.

DOI: 10.3238/arztebl.2012.0284

PD Dr. med. Thorleif Etgen
Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München
Neurologische Klinik, Kliniken Südostbayern – Klinikum Traunstein
thorleif.etgen@klinikum-traunstein.de

Dr. phil. Horst Bickel
Prof. Dr. med. Hans Förstl

Klinik und Poliklinik für Psychiatrie und Psychotherapie, Technische Universität München

Prof. Dr. med. Dirk Sander
Abteilung für Neurologie, Benedictus Krankenhaus, Tutzing

Klinik und Poliklinik für Neurologie, Technische Universität München

Conflict of interest statement
Dr. Bickel has received honoraria from Willmar Schwabe.

Prof. Förstl has received funding from Eisai, General Electric Lundbeck, Pfizer, Merz Janssen, Novartis, AstraZeneca, BMS, GSK, Lilly, Nutricia, Sanofi-Aventis, Schwabe, Servier, and other companies.

The remaining authors declare that no conflict of interest exists.

1.
Andel R, Crowe M, Hahn EA, et al.: Work-Related Stress May Increase the Risk of Vascular Dementia. J Am Geriatr Soc 2012; 60: 60–7. CrossRef MEDLINE
2.
Förstl H, Haass C, Hemmer B, Meyer B, Halle M: Boxen – akute Komplikationen und Spätfolgen – von der Gehirnerschütterung bis zur Demenz. Deutsches Ärzteblatt 2010; 107: 835–9. VOLLTEXT
3.
Perneczky R, Alexopoulos P, Schmid G, et al.: Kognitive Reserve – ihre Bedeutung für die Prävention und Diagnose der Demenz. Nervenarzt 2011; 82: 325–30; 332–35. CrossRef MEDLINE
4.
Barnes DE, Yaffe K: The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 2011; 10: 819–28. CrossRef MEDLINE
5.
Etgen T, Sander D, Bickel H, Förstl H: Mild cognitive impairment and dementia: the importance of modifiable risk factors. Dtsch Arztebl Int 2011; 108(44): 743–50. VOLLTEXT
1.Andel R, Crowe M, Hahn EA, et al.: Work-Related Stress May Increase the Risk of Vascular Dementia. J Am Geriatr Soc 2012; 60: 60–7. CrossRef MEDLINE
2.Förstl H, Haass C, Hemmer B, Meyer B, Halle M: Boxen – akute Komplikationen und Spätfolgen – von der Gehirnerschütterung bis zur Demenz. Deutsches Ärzteblatt 2010; 107: 835–9. VOLLTEXT
3.Perneczky R, Alexopoulos P, Schmid G, et al.: Kognitive Reserve – ihre Bedeutung für die Prävention und Diagnose der Demenz. Nervenarzt 2011; 82: 325–30; 332–35. CrossRef MEDLINE
4.Barnes DE, Yaffe K: The projected effect of risk factor reduction on Alzheimer’s disease prevalence. Lancet Neurol 2011; 10: 819–28. CrossRef MEDLINE
5.Etgen T, Sander D, Bickel H, Förstl H: Mild cognitive impairment and dementia: the importance of modifiable risk factors. Dtsch Arztebl Int 2011; 108(44): 743–50. VOLLTEXT